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)

Vaginal suppositories containing 15(S)15-methyl-PGF2alpha-methyl ester (prostaglandin, PG) were tested for legal abortion of pregnancies (36-60 days after last menstrual period) in 42 women; 4 suppositories each containing 1 or 1.5 mg of PG were given every 3 hours. Serum levels of human chorionic gonadotropin (HCG), estradiol-17 beta, and progesterone were measured before and up to 3 weeks after the abortion. Blood loss during, after, and during a menstrual period 2-4 months after the abortion (in 30 women) was determined. Abortion without retention of major products of conception occurred in 93% of the cases. However, 18% of these successful cases had a slow decline in HCG, indicating incomplete expulsion of viable chorionic tissue. Average blood loss was 37 ml during the 1st 24 hours after insertion, with an additional loss of 94 ml in the next 11 days (range, 5-25 days). Heavy blood loss after abortion was significantly related to slow decline in serum HCG. Later menstrual flow was strikingly heavy overall (mean, 74 ml). There was no difference in efficacy or incidence of slow HCG decline between the PG dose of 1 mg and 1.5 mg, but side effects of uterine pain, vomiting, and diarrhea (50% overall, in no case severe) were more marked with the 1.5-mg dose.
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PMID:Early abortion by vaginal prostaglandin suppositories. Blood loss in relation to elimination of serum chorionic gonadotrophin, progesterone and estradiol-17 beta. 63 Aug 88

General practitioners and obstetrician-gynecologists referred 301 women who were or= 56 days pregnant and asked for an abortion to the Royal Infirmary of Edinburgh in Scotland. Physicians administered 1 mg of gemeprost alone every 6 hours up to 3 mg to the 151 women and 200-600 mg mifepristone (RU-486) followed by 1 mg gemeprost 2 days later to 150 women. Women who received RU-486 and gemeprost were more likely to experience a complete abortion than those who received only gemeprost (98% vs. 87.4%; p = .0004). There were no significant differences in the efficacy of 200, 400, or 600 mg of RU-486 followed by gemeprost. Women who received gemeprost alone suffered more pain than those who received RU-486 and gemeprost so they were more likely to need analgesics (p = .0001). Women who received gemeprost alone experienced considerable more abdominal and pelvic pain as time passed (p .001 and .0002, respectively). In addition, women treated with gemeprost alone had a significantly lower median concentration of serum human chorionic gonadotropin on day 8 than those treated with RU-486 and gemeprost (median 1.78% VS. 3.57%; P .00101), even though more of them still were pregnant. On the other hand, both groups of women experienced the same duration of bleeding, interval from abortion induction to menstruation, and change in hemoglobin concentration between days 1 and 8. In the gemeprost alone group, most abortions occurred on day 1 and most abortions occurred on day 3 in the RU-486 and gemeprost group. Women treated with gemeprost alone were required to spend 1 night in the hospital while none of the women in the other group did. The RU-486 and gemeprost regimen had considerable advantages over the gemeprost-alone regimen for inducing an early medical abortion. Yet when RU-486 is not available or contraindicated, physicians can use gemeprost alone.
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PMID:Medical abortion in women of less than or equal to 56 days amenorrhoea: a comparison between gemeprost (a PGE1 analogue) alone and mifepristone and gemeprost. 152 4

In Ohio, a 33-year old woman who had never had an ectopic pregnancy presented at an emergency facility not physically attached to a hospital with abdominal pain over 24 hours which had become more intense during the preceding 4 hours. She did not have vaginal bleeding, diarrhea, vomiting, or pain while urinating. 2 weeks earlier she had a voluntary intrauterine abortion at 8 weeks' gestation. She had intercourse 1 week before coming to the emergency facility. She had widespread tenderness in her abdomen, especially in the lower areas. Blood cell studies suggested an infection. The attending physician presumed her to have pelvic inflammatory disease (PID) as a result of either sexual intercourse or the elective abortion. The physician called for a urinary beta human chorionic gonadotropin test to determine whether placental tissue remained in the uterus. It was positive. 60 minutes after admission, the supine patient's pain increased and her blood pressure dropped to 80/50 mm Hg from 100/60 mm Hg at admission. After administering Ringer's solution, the health team sat her up and she fainted. A repeat cell count indicated sepsis. Her blood pressure decreased to 60 by Doppler and the physician continued to give her fluids and began dopamine. After the team stabilized her, they transferred her to a hospital. Her private physician examined her and then began surgery. The physician found a tubal pregnancy and removed the affected tube and ovary. She recuperated completely. Combined intrauterine and extrauterine pregnancy occurs once in every 30,000 cases. Previous PID, use of ovulation inducing medication, and in vitro fertilization with embryo transfer increases the likelihood of this type of pregnancy occurring. Physicians should consider this possibility if a woman has any of these histories and a combination of abdominal pain, adnexal mass with pain and tenderness, peritoneal irritation, and an enlarged uterus.
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PMID:Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion. 157 Sep 21

A previously healthy 33-year-old woman presented with decreased vision and pain in her left eye. Funduscopic examination revealed a mass in the posterior pole of the eye, and chest radiography showed a lesion in the lower lobe of her left lung. The eye became painful and blind over 12 days and was enucleated. The tumour had the typical histopathological and immunohistochemical features of choriocarcinoma: sheets of cytotrophoblasts with pleomorphic nuclei and lacy cytoplasm intermingled with multinucleated syncytiotrophoblasts. The neoplastic cells stained positively for cytokeratin and the beta subunit of human chorionic gonadotropin (beta-HCG). The serum beta-HCG level was markedly elevated, at 82,000 (normally less than 5) IU/L. The patient was treated with combination chemotherapy, and normal serum beta-HCG levels were obtained. Thirty months after presentation the serum beta-HCG level was normal and there had been no clinical evidence of recurrence. To our knowledge this is the second case of metastatic choriocarcinoma in the eye in which the ocular tumour caused the presenting symptom.
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PMID:Metastatic choroidal choriocarcinoma: a clinicopathological study. 175 15

The International Planned Parenthood Federation (IPPF) new statement on the diagnosis of pregnancy was drawn up in April 1990. A pregnancy diagnosis includes clinical evaluation of the woman's history, symptoms, physical examination, and pregnancy tests. Pregnancy symptoms may include amenorrhea, nausea, vomiting, enlargement and tenderness of the breasts, frequent urination, and changes in appetite and food and drink habits. If biochemical testing is not possible, a reliable clinical diagnosis of pregnancy cannot take place before 6-8 weeks. At this time, the clinician can observe cervical softening and uterine softening and enlargement if a woman is pregnant. If the uterine size does not match the length of amenorrhea, clinicians should suspect the following: earlier or later conception than indicated, ectopic pregnancy, incomplete or missed spontaneous abortion, twin gestation, hydatidiform mole, or other uterine anomaly. They should suspect ectopic pregnancy in women with smaller than expected uterine size when they have been sterilized or are using an IUD or are using low-dose progestogen-only pills or Norplant. They should refer women with smaller than expected uterine size who are experiencing bleeding and/or pain to a more sophisticated clinical facility, where an accurate diagnosis of and adequate treatment for ectopic pregnancy can be done. Biochemical pregnancy tests consist of antibodies that mark human chorionic gonadotropin (hCG) from a urine or serum sample. hCG levels increase beginning about 10 days after fertilization. The most convenient and inexpensive pregnancy test for clinics is the immunoassay test (slide test), which requires a urine or serum sample. It can provide reliable results a few days after the missed menstrual period. Clinicians should provide appropriate counseling regardless of whether the client wishes to continue or terminate the pregnancy.
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PMID:New IPPF statement on the diagnosis of pregnancy. 192 37

Ectopic pregnancy (EP) is a common, life-threatening complication of pregnancy. Modern technology (ultrasonography and improved pregnancy tests) should facilitate the diagnosis of EP. However, in a retrospective review of 65 cases of confirmed EP managed over 18 months at an urban teaching hospital, only 37 of 65 patients (57%, Cl95 = 44%, 69%) received prompt diagnosis and treatment; delays occurred in 28 patients (43%). In 10 of the 27 delayed cases, the diagnosis of EP was not even considered at the time of the first visit. In patients with a delayed diagnosis, morbidity (transfusions, cardiovascular instability, progression of illness) did occur. Diagnostic pitfalls that resulted in delayed care were reviewed, delays most commonly occurred in patients with a benign examination or "atypical" pain. Risk factors for EP were missed (7 patients, 25%), subtle clues to blood loss were often ignored (10 patients, 36%), and passage of tissue was thought to exclude EP (2 patients). Ultrasound was only helpful for half of the diagnoses and was misinterpreted in 27%. A dry or serous culdocentesis occurred frequently. In five patients, a falling or low quantitative human chorionic gonadotropin level was believed to indicate a completed abortion. The authors conclude that almost half of EPs are still missed on the first physician visit; errors and pitfalls in diagnosis are still common in the 1980s.
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PMID:Ectopic pregnancy: ten common pitfalls in diagnosis. 222 96

The recent availability of mifepristone (RU 486), a competitive progesterone antagonist capable of interrupting pregnancy in the 1st month, offers a new method for the medical termination of pregnancy. This study evaluated the efficacy and safety of RU 486 as a contragestive agent in 100 healthy pregnant women who applied for abortion within 10 days of the expected onset of the missed menstrual period. The women were randomly assigned to 1 of 3 different regimens of oral RU 486: 50 mg twice/day for 4 days (group 1), 50 mg 3 times/day for 4 days (group 2), and 400 mg once/day for 2 days (group 3). Uterine bleeding occurred in all study subjects and began within 4 days of the 1st dose of RU 486. 85 of the 100 subjects were considered to have had a complete abortion. This included 28/34 patients in group 1, 23/26 patients in group 2, and 34/40 patients in group 3. The mean duration of uterine bleeding was 11.6 + or - 5.8 days in the women with complete abortion. 18% of these women experienced heavy bleeding for 2-6 days and 26% reported painful uterine contractions exceeding normal menstrual pain. Plasma beta human chorionic gonadotropin (hCG) levels were relatively constant during RU 486 treatment, but dropped dramatically 2-4 days later. Plasma P and E2 levels paralleled plasma beta hCG levels, suggesting that the luteolysis was 2ndary to the decrease of beta hCG after trophoblast separation. The high frequency of complete abortion in this study (85%) compared to other studies suggests that the efficacy of RU 486 increases with shorter length of gestation.
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PMID:Emergency contragestion. 244 24

A Phase I clinical trial of the immunogenicity and safety of a vaccine against the C-terminal region of the beta subunit of human chorionic gonadotropin (hCG-B) demonstrated a dose-related immune response. The antigen was a synthetic peptide of the C 109-145 region of hCG-B, conjugated to diphtheria toxoid, and administered in a water-soluble synthetic adjuvant in a saline-oil emulsion. This vaccine had been previously tested for toxicity in laboratory animals and for immunogenicity, safety and contraceptive effectiveness in baboons. 30 previously sterilized women were given 2 injections 6 weeks apart, ranging from 50 to 1000 mcg of the antigen. Each woman tested free of HLA B27 antigen and reacted negative to the diphtheria toxoid skin test. Based on calculated contraceptive antibody binding level of 0.52 nmol/l, all subjects mounted an effective antibody response for at least 6 months. 2 subjects in the group given 1000 mcg who were followed for 9 and 10 months maintained this level of antibody. 12 women showed an anamnestic response to diphtheria toxoid, while 8 did not. The only adverse reactions were mild, transient pain at the injection site. Several women who received unstable adjuvant experienced more severe myalgia. Menstrual changes appeared in 5 subjects: early menopause in 1, spotting in 3 and menorrhagia in 1 woman. Only transient positive findings were seen in some sera screened for autoantibodies. This preliminary trial indicates that anti-hCG vaccine is a hopeful reversible contraceptive.
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PMID:Phase I clinical trial of a World Health Organisation birth control vaccine. 245 66

Persistent ectopic syndrome is a complication of conservative surgery for tubal pregnancy. This study is directed toward the escalating conservatism in the treatment of tubal ectopic pregnancy and its possible sequelae. Residual trophoblast propagation after initial surgery is becoming more frequent. Two cases are reported. The first woman was admitted with an acute abdomen; salpingectomy was performed to control hemorrhage from tubal rupture at the site of the previous salpingostomy. The second woman was treated by fimbrial expression. Because of the recurrence of pain, the beta human chorionic gonadotropin (BHCG) levels were measured; they indicated fresh trophoblastic activity. She was treated with methotrexate orally, 10 mg/d for 5 days. The need for BHCG surveillance of conservatively managed tubal ectopic pregnancy is stressed. The value of using methotrexate when tubal integrity persists is discussed in the light of its traditional role against trophoblastic tumours.
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PMID:Persistent ectopic syndrome. 247 38

A 23-year-old male with a suprasellar germinoma was initially treated with local irradiation, and the tumor completely disappeared. Three months later, he complained of pain in the left thigh. Myelography revealed multiple spinal metastases at the Th5 to Th8 and Th11 to L5 levels. The tumors were removed through a laminectomy, and the histopathological diagnosis was typical germinoma. Whole spinal irradiation was administered postoperatively. Neurological examination on discharge revealed no abnormality other than hypalgesia over the left L5 segment. Six years later, tumor was found in the lateral ventricles. The human chorionic gonadotropin (HCG) and HCG beta subunit levels were markedly elevated in both serum and cerebrospinal fluid (CSF). Irradiation considerably decreased the size of the tumor but did not completely eradicate it. Subsequent chemotherapy with cisplatin resulted in complete disappearance of the intraventricular tumor, as evidenced by computed tomography (CT). The serum and CSF levels of HCG and HCG beta subunit were well correlated with the tumor size, as shown by CT. The authors emphasize the curative potential of cisplatin in the treatment of recurrent germinoma.
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PMID:[Recurrent germinoma successfully treated with cisplatin. Case report]. 247 54


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