Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study, based on data compiled by Family Health International, examined IUD performance in terms of problems related to insertion. The subjects included 2415 women from 6 centers in 5 countries who had had a Lippes Loop D, Copper T-200, Copper T-380 Ag, or Multiload 375 IUD inserted in 1976-84. Of these women, 165 (6.8%) had at least 1 insertion-related problem, including moderate or severe pain in 115, cervical laceration in 30, and syncope or other vasovagal reactions in 20. 150 of these cases were able to be matched with controls of similar age and parity with no insertion-related problems with the same device. Cases and controls were then compared in terms of rates of accidental pregnancy, expulsions, and medical removal in the 6 months postinsertion. The pregnancy rate at 6 months was 2.5% in cases vs. 1.6% in controls. The expulsion rate was 4.4% in cases vs. 1.5% in controls, and the medical removal rate was 2.3% in cases vs. 6.1% in controls. None of these differences was statistically significant. This lack of difference may be due to the experienced personnel at the study centers. In addition, since virtually all subjects had had at least 1 child, the study population was a low-risk one in terms of insertion-related problems. Moreover, there may not have been real differences between cases and controls, i.e., cases may have exaggerated the degree of insertion pain as moderate or severe when it was in fact mild. Although these results suggest that insertion-related problems are not associated with an increased risk of IUD termination, further studies with larger samples are needed to confirm this finding.
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PMID:Do insertion-related problems affect subsequent IUD performance? 381 33

A retrospective study of patients admitted for ectopic pregnancy over the 1979-84 period was undertaken at the Kilpauk Medical College and Hospital, Madras to analyze the cases of ectopic pregnancies among women who had attempted to restrict their families. There were 41,785 deliveries and 125 ectopic pregnancies during the study period, giving a ratio of 1 ectopic pregnancy to 334 deliveries. In this study, in 123 cases the age was between 20-38 years, and in 2 cases 40 years. The incidence of nullipara was about 22 cases (17.6%); para 1, 30 cases (24%); para 2, 38 cases (30.4); para 3, 21 cases (16.8%); and para 4 and above, 14 cases (11.2). Among 125 cases, 120 cases (96%) tubal pregnancies, 2 were ovarian pregnancies and 1 was a secondary abdonominal pregnancy. As for the clinical features, 40% (50) cases came with a history of amenorrhea and other associated symptoms and in 60% (75 cases) pain was the most consistent feature. On analyzing the incidence of tubal pregnancy following fertility control measures, the modes of conception also seem to have some influence on the incidence of etopic pregnancy. In 125 cases with dagnosis of ectopic pregnancy, 20 (16%) were found to have tubal pregnancies following temporary or premanent family planning methods. Those women ranged in age from 24 to 35 years, and all were multiparous except 1 nulliparous who had hormones for hypoplastic uterus for 15 days. 8 women with 2-3 children had puerperal sterilization, 6 women with 2-8 children had induced abortion with minilap, 1 woman with 2 children had transvaginal tubectomy, 3 with 0-3 children used oral contraceptives, and 2 with 5 and 8 children had a copper-T IUD. With increasing parity the fertility control measures were associated with increasing numbers of ectopic pregnancy. The mean time interval between last pregnancy and the occurrence of ectopic pregnancy varied greatly in the various fertility control measures.
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PMID:Ectopic pregnancy and fertility control measures. 383 56

The case of a 32-year old woman (gravida 3 para 2) in whom a Copper-7 IUD perforated the uterus, lodging both within the myometrium and the lumen of the small intestine is described. The patient presented in the emergency room 18 months after IUD insertion with heavy vaginal bleeding and passage of tissue. A diagnosis of spontaneous abortion was made. In this case, the small bowel had to be resected and side-to-side anastomosis was performed. This patient was asymptomatic until 3 weeks prior to admission. Other cases demonstrate acute symptoms of peritonitis and intestinal obstruction or more chronic complaints of vague abdominal pain and diarrhea. An IUD string that is not visible at the external os of the cervix generally reflects upward retraction of the string or unnoted spontaneous expulsion of the IUD. However, on occasion it can be associated with uterine or even intestinal perforation, as occurred in this case. Pain on insertion, also noted in this case, can serve as a warning sign of perforation. In this patient, the device was inserted 5 weeks after delivery, lending support to the recommendation that puerperal insertion be avoided. It is important to know the exact location of an ectopic IUD to prevent dangerous attempts at removal through the vagina. Laparoscopy and ultrasound are generally helpful in localizing the IUD and preparing the patient for laparotomy and possible bowel resection.
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PMID:Asymptomatic perforation of the small intestine by a copper-7 intrauterine device. 386 28

The possible biological significance of low concentrations of Cu2+ on the guinea-pig ileum has been investigated. Responses to nerve stimulation by single electrical shocks, acetylcholine (ACh), and histamine and the response to ACh of depolarized muscle were examined. In summary, Cu2+ has diverse and dose-dependent effects on the ileum. A stimulant effect dominates in intestine accommodated in physiological saline solution. The excitatory effect of the ion, in the concentration range 10 nM-1 microM, is probably due to stimulation of a depolarization-coupled initiation of the contraction. The inhibitory effect of Cu2+ (10 nm-1 microM) is presumably due to a decreased Ca2+ availability for the contractile process. In a higher concentration range (10 microM-100 microM) the stimulant action could also, in part, be related to a copper-induced release of Ca2+ from a storage site. No effect that certainly could be ascribed to a neuronal site of action could be observed. The possible effect of Cu2+, released during corrosion of dental alloys, on oral excitable tissue such as taste and pain receptors is discussed.
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PMID:Effects of cupric ions on isolated guinea-pig ileum. 386 41

An evaluation of the Cu ML 375 IUD, which has the same structure as the Cu ML 250 but increased copper content, indicates that the greater amount of the copper provides greater protection against accidental pregnancy with no change in the rate of expulsions. The cumulative rates for 1969 insertions of the Cu ML 375 after 12, 24, 36, 48, and 60 months of use respectively were .4, 1.6 2.1, 2.8, and 3.2 for pregnancy; 1.8, 2.3, 2.7, 3.6, and 4.0 for expulsion, 5.9, 10.8, 14.7, 18.5, and 21.2 for removal because of pain and bleeding; .9, 2.3, 3.2, 4.1, and 5.2 for removal because of other medical factors; 5.2, 11.6, 16.0, 19.3, and 22.0 for removal to become pregnant; and 2.7, 5.8, 10.2, 14.0, and 10.4 for removal for other personal reasons. The continuation rates were 85.0, 70.3, 59.5, 51.3, and 44.3 for each of the 5 years. The numbers of cycles covered were 21,762, 39,223, 53,173, 64,567, and 71,818. A simple study of the Cu ML 250 inserted in 877 women gave cumulative rates after 12 and 24 months of 1.2 and 2.0 for accidental pregnancy, 1.3, and 2.1 for expulsion, 5.7 and 10.7 for removal because of pain and bleeding; 3.4 and 3.8 for removal because of other medical factors; 3.0 and 8.5 for removal to become pregnant, and 4.8 and 10.9 for removal for other personal reasons. The continuation rates were 82.7 and 32.3 and the numbers of cycles covered were 9440 and 16,761. The devices were inserted intramenstrually, postpartum, or postabortum in women with no contraindications to IUD use. Another study of the Cu ML 375 2 years later involving 1650 insertions gave cumulative rates of .3 and 1.5 for accidental pregnancy and 1.5 and 2.0 for expulsions. The continuation rates were 85.9 and 71.9. 10,333 and 33,322 cycles were covered respectively. The better contraception offered by the Cu ML 375 appears to result more from the effect of the increased mass of copper than from the increased surface area.
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PMID:[Larger amounts of copper correspond to greater contraceptive effectiveness. Experiments with the ML Cu 375, the IUD with the highest copper content]. 403 97

In cooperation with the Population Council, New York, 463 women had a copper-T intrauterine device inserted between August 1970 and March 1973. Maximum period of use was 32 months, but IUDs were normally replaced after 2 years of use. Results were calculated using the Life Table Method, comparing the whole collective with nulliparae, miltiparae, women with regular or irregular menstrual cycles, and single or married women. The pregnancy rate in all women was 2.5/100 women/17 months (Pearl Index 1.6), or .9/100 women/12 months. 6 women became pregnant with the IUD in place; of these, 4 had therapeutic abortions because of the presence of the IUD, 1 had a normal pregnancy and gave birth to a healthy baby, and 1 was lost to follwo-up. Expulsion rate was 4.2/100 women/17 months, and the removal rate for all reasons (bleeding, pain, inflammation, childbearing, personal reasons) was .4/100 women/17 months. 60% of patients continued with this method after 1 year. Frequency of spotting, dysmenorrhea, and menstrual cycle changes are evaluated, and results of bacteriological, cytological, and histological studies are reported.
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PMID:[Clinical experiences with the copper-T-intrauterine device (author's transl)]. 460

A study of the effectiveness and complications associated with the Model 200 copper T intrauterine device in 471 nulliparous women ranging in age from 14-33 years is reported, including 6044 woman-months of device use. 128 of the patients had had 1 or more previous abortions. This T-shaped device is made of polyethylene impregnated with barium sulfate, wound with .2 mm diameter copper wire providing a copper surface area of 200 square mm, and is inserted easily without anesthesia and with minimal pain. Continuation and failure rates were calculated for the first 12 months of use by life-table analysis. The overall continuation rate of device use was 74.2 per 100 women, the expulsion rate was 5.4, removal rate for bleeding or pain was 10.7, and pregnancy failure occurred at a rate of 1.7 per 100 women per year. These discontinuation event rates are lower than those reported for other IUDs in nulliparous women and comparable to IUD rates in multiparas. In the past, other IUD designs have been very unsatisfactory in nulliparas because of high expulsion and removal rates, but this study indicates that the TCu 200 IUD model is well accepted by nulliparas with good safety and effectiveness, and provides a promising and highly desired contraceptive alternative to oral contraception for young women.
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PMID:A study of the copper T intrauterine contraceptive device (TCu 200) in nulliparous women. 472 Nov 38

A review of the history of contraception with intrauterine devices, characteristics of present devices, and directions of current research is presented. The serious need for population control is not yet being met by today's inconvenient, ineffective, or unsafe methods. Intrauterine devices have been best for international family planning programs because they are cheap, easily installed, and provide continuous protection. There are many different models that have been and are being used, with different effectiveness and complication rates. The most commonly used today is the Lippes Loop, with a pregnancy rate of 2.8/100 years of woman use and an expulsion rate of 10.4. Most of these failures occur in the first few months of use, after which these rates are greatly reduced. The removal rate because of bleeding or pain for the Lippes device is 14.0. Other devices commonly used have pregnancy rates ranging 1.3-4.7, expulsion rates of 2.6-25.8, and removal rates of 13.5-22.1. Expulsion is directly related to the size and design of the IUD and the age and parity of t,e recipient. It is important to match the size of the device used to the individual characteristics of the patient. Research is seeking a design that will implant itself in the endometrium to resist expulsion, but not too deeply so that it is covered. Removal for bleeding and pain remains the most frequent complication of the IUD, and it partly depends on the skill of the inserting physician and how well the patient is psychologically prepared for side effects in the first months of use. Pregnancy is the most significant IUD complication. The key to an effective IUD is an understanding of its antifertility mechanism, which has thus far eluded researchers. The IUD prevents implantation of the blastocyst in the uterine wall, which may be due to a foreign-body reaction in the endometrium. IUDs with copper cause a greater reaction than plastic devices and provide hope for a very effective device; particularly the T-shaped design, which resists expulsion. The most promising new IUD is the Dalkon Shield. It has small projections that imbed in the endometrium and a broad surface for contact with the uterine wall. In preliminary experiments the pregnancy rate with this device was 1.1, the expulsion rate 2.3, and the removal rate 2.0, much lower than that with any other device yet developed. It is concluded that IUDs such as the Dalkon Shield can provide safe contraception with high effectiveness.
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PMID:Contraception with intrauterine devices. 480 54

The plastic intrauterine device is now being used as a carrier to hold the contraceptive agent (copper in this case) in the uterus. The action of copper as a contraceptive agent is thought to be due to an alteration in intrauterine environment thus preventing implantation and causing rapid loss or destruction of the fertilized ova. Studies show that such local use of copper appears to be safe over long-term use, and no changes in cervical cytology or endometrial histology and no evidence of tumor production due to copper have been seen. Presented here is a study of 127 women using a Gravigard (Copper 7) IUD. The patients ranged from 18 to 42 years old, and 33 (26%) were nulliparous. Insertion was easy in 111 (87%), there were minor problems in 10 (8%), and difficulties in 6 (4.7%). The majority of patients had no immediate postinsertion pain or problems, but 11 (9%) did complain of uterine cramps or symptoms of faintness or nausea. 3 patients were lost to follow-up, and the remaining 124 women were followed over a total of 1089 woman-months. 7 patients (5.5%) expelled the Gravigard, 3 (2.4%) became pregnant, and 10 (7.9%) had their IUDs removed for medical reasons.
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PMID:Evaluation of the Gravigard intrauterine copper contraceptive device. 485 32

605 women were inserted with plain T-IUDs, 508 patients were inserted with TCu-A devices, and 279 women were inserted with TCu-B devices. In the TCu-A, a 2 cm length of copper wire of .5 mm diameter was wound around the upper aspect of the vertical arm of the T-IUD. In the TCu-B, a 6 cm length of wire of .15 mm diameter was coiled downward over a 1 cm distance. The surface area of copper was 30 mm in both prototypes. The data derived from the 3 series of patients were tabulated and analyzed utilizing the Life Table method of Tietze. Endometrial biopsies were obtained from randomly selected patients. Results showed that after 2 years of use, the plain T device had a significantly lower rate of metrorrhagia than had been reported for any other contraceptive device. The rate was approximately 6 times less than that observed with the Lippes loop D. Pain was a negligible cause for closure during the 2 year period. The T device had a rate of pregnancy of 24.3 which is 6 times the pregnancy rate of the Lippes loop D. The first expulsion rate was 4.5, but the rate for later expulsions was .4. When a small qlantity of copper was added to the T there was a dramatic and highly significant reduction in the rate of pregnancy. At the end of 2 years of use the rate was 9.8 for the TCu-A. Other clinical parameters also were apparently modified by the metallic copper. The expulsion rate was reduced, the rate of metrorrhagia was slightly increased, and the rate of pain may have been increased. During the same lenght of time the rate of removal for loop D because of bleeding and/or pain is approximately 3 times greater than for the T with copper. Reductions in both expulsion and removal rates of TCu because of medical reasons constituted the principal factors accounting for the continuation rate of 77.6 as compared with 65.6 for loop D at the end of 2 years of use.
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PMID:Metallic copper as an intrauterine contraceptice adjunct to the "T" device. 536 Feb 57


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