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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The advent of MRI has improved the ability of the diagnostic radiologist to provide useful clinical information to the practicing gynecologist. Although US remains the screening procedure of choice for evaluation of the uterus and adnexa because of its relative safety and low cost, MRI is now considered the next imaging step. In a woman with pelvic pain, MRI can accurately identify adenomyosis, enumerate and localize uterine fibroids, and provide more accurate identification of endometriosis and cystic teratomas of the ovary than US. Although MRI should not be used as a screening procedure for diagnosing endometrial or cervical carcinoma, it can aid in patient management by determining the extent of myometrial or cervical invasion by endometrial carcinoma and can be used to calculate tumor volume in patients with cervical carcinoma. Early studies suggest that MRI may be helpful in distinguishing between long-term radiation fibrosis and tumor recurrence in such patients. MRI findings may be highly indicative of the presence of ovarian malignancy, but the procedure adds little to CT or US findings. Nevertheless, MRI is superior in the localization of pelvic masses and is often indicated in clarifying the origin of a mass as uterine or ovarian.
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PMID:Applications of magnetic resonance imaging to gynecology. 218 59

Blockade of the superior hypogastric nerve plexus was performed for relief of chronic cancer related pelvic pain. The targeted sympathetic nerves lie anterior to the sacral promontory. Twenty-eight patients with neoplastic involvement of pelvic viscera secondary to cervical, prostate, and testicular cancer or radiation injury were treated with neurolytic superior hypogastric plexus block. Sympathetically mediated pain was significantly reduced or eliminated in all cases and no serious complications occurred. Superior hypogastric plexus block is recommended for diagnostic/prognostic and therapeutic purposes in patients with chronic pelvic pain, particularly when pain is of neoplastic origin.
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PMID:Superior hypogastric plexus block for pelvic cancer pain. 238 49

A retrospective review of an entire clinical series of 152 women over 50 years of age, in whom cystic lesions without solid parts had been diagnosed by ultrasound, found there were no malignancies in 58 completely anechoic lesions less than 5 cm in diameter. Of 10 small lesions (less than 5 cm in diameter) with some echogenicity or septa, one was a borderline tumour. In contrast, in patients with lesions greater than 5 cm in diameter there were three malignancies in the group of 33 totally anechoic cysts, five in the group of 32 cysts with some echogenicity, and as many as eight malignancies in the 18 lesions where several septa were present. Two borderline and one malignant tumour had been missed at previous clinical examination. We conclude that small anechoic lesions are seldom, if ever, malignant in elderly women. Sonography is helpful in patients with a negative clinical examination when pelvic pain or signs of malignancy are present.
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PMID:Cystic lesions in elderly women, diagnosed by ultrasound. 267 73

The authors describe 4 cases of tubal cancer reported in the gynaecology department of the University Hospital in Caen and review the international literature. If all authors are in agreement on the early symptoms (leukorrhea, haemorrhages, pelvic pain), the lack of diagnosis before the procedure, the lack of information regarding the staging and the grading, as well as the surgical and radiation treatment, there is, above all, controversy regarding the use of chemotherapy, since the low number of patients in the different series does not permit reaching a conclusion.
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PMID:[Tubal adenocarcinoma. Apropos of 4 cases and review of the literature]. 269 Mar 4

Twenty-one patients with inoperable colon cancer in the pelvis were treated with intra-arterial 5-fluorouracil (5-FU) and mitomycin C, given bilaterally into the internal iliac arteries. Seventeen of the 21 patients had failed previous radiation therapy and 15 had also failed systemic intravenous chemotherapy. Eighteen of the 21 patients received intra-arterial treatments because of pelvic pain. Effect of this treatment on the pain could be evaluated in 16 patients. A measurable decrease in pain medication occurred in 8 of 16, whereas a subjective feeling of pain relief was observed in 12 of 16 patients for a mean period of 3.5 months. However, objective tumor response was considered definite only if associated with a greater than 50% decline of an elevated plasma carcinoembryonic antigen level; this was observed in 5 of 11 patients (45%). Reduction in tumor mass as measured by imaging techniques was observed in two of ten patients in whom it was evaluable. Improvement in hydronephrosis was observed in five of seven evaluable patients. Hematuria was present in 12 patients and improved in 10 of those patients. The most significant side effect of chemotherapy was perineal and gluteal skin erythema, which was observed in 36% of the patients after the first course and in 24% during the second course. This frequently escalated to cutaneous vesiculation and desquamation. This side effect was prevented by concurrent administration of steroids. Pelvic arterial infusion of 5-FU and mitomycin C can offer temporary pain relief to patients who have failed other means of therapy. Objective antitumor effects may have also resulted but were much harder to assess in this group of patients.
Cancer 1985 Nov 01
PMID:Palliation of pelvic recurrence of colorectal cancer with intra-arterial 5-fluorouracil and mitomycin. 299 49

Gynecologic malignancies are the third most common cancer among women in the United States. Because of often subtle early findings, the diagnosis may not be made before the widespread dissemination of the disease. The Emergency Department physician will commonly encounter a woman with vaginal bleeding, pelvic pain, or a symptomatic abdominal mass. In this article, we have described the epidemiology, recognized patterns of spread, and associated findings of gynecologic tumors. The proper Emergency Department evaluation and management of these problems is emphasized with guidelines for the timing of referrals and consultation with the gynecologic oncologist. The treatment of gynecologic malignancies is often complicated and responsible for Emergency Department visits. The various modalities are addressed according to the organ systems affected and include sections on postoperative problems, gastrointestinal complaints, urologic complications of therapy, radiation therapy and its complications, with an emphasis on the most serious complications necessitating either careful outpatient management or hospital admission. As cost-containment pressure grows, we have included sections on chemotherapy and total parenteral nutrition, both of which are becoming common outpatient events for the cancer patient.
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PMID:Management of gynecologic oncology emergencies. 311 60

Five cases of intestinal endometriosis presented with infertility and pelvic pain. Rectal bleeding occurred in two patients and diarrhea in one. A diagnosis was achieved with a barium enema study and colonoscopy. All the patients had pelvic endometriosis as documented by laparoscopy. Endometriosis was present in the sigmoid colon in three patients and in the cecum in one; it was pericecal in the fifth. Bowel resection and pathologic study are necessary to relieve the symptoms and avoid neglecting a malignant tumor or other lesions.
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PMID:Diagnosis and management of intestinal endometriosis. A report of five cases. 319 19

One hundred and eight patients with cancer of the ovaries were studied retrospectively for a period of seventeen years. All the patients were managed in the Second Department of Obstetrics and Gynecology of the University of Athens. The symptoms of the patients were: pelvic pain in 43, ascites in 27, metrorrhagia in 23 and weight loss in 12. Fifty six per cent of the patients were between 40 to 60 years old and 63% were menopause. The PAP-smear in 40% was class I or II, in 50% was class III and in 10% was class IV-V. The stage of the disease was: 3 patients stage I, stage II 38, stage III 42 and 25 stage IV. No patient had stage 0. Laparotomy was done in all the patients. Thirty eight patients had Co-treatment and 42 patients chemotherapy. The pathology report was: serous cystadeno-Ca in 40, mucinous cystadeno-Ca in 38 of the cases, adenocarcinoma 18 and 12 other types of malignant tumors. The follow up of the patients showed a five years survival rate in 10% for stage I, 25% for stage II, 5% for stage III and none for stage IV.
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PMID:Review of ovarian cancer of the University of Athens. 334 79

The clinical and pathological features of 25 serous papillary cystadenomas of borderline malignancy of the broad ligament were analyzed. The ages of the patients ranged from 19 to 67 (average, 32) years. The clinical presentation was lower abdominal pain, pelvic pain or both in five cases, accompanied by menometrorrhagia or amenorrhea in three cases. One patient was thought to have an acute abdominal disorder. The tumors of the remaining 19 patients were discovered either on routine gynecological examination or during an evaluation of the pregnancy status of the patient. In 14 cases the tumor was located in the left broad ligament and in 11 cases it was on the right side; all the tumors were entirely separated from the ipsilateral ovary. On gross examination the tumors were 1-13 cm in greatest dimension, had smooth outer surfaces, and contained straw-colored, watery fluid. The inner lining bore single or multiple 0.3-2.5 cm excrescences. Microscopic examination revealed that the cyst walls and their excrescences were lined by simple to pseudostratified, cuboidal to columnar, focally ciliated epithelium. Slight nuclear atypism, very rare mitotic activity, and focal psammoma body formation were also found. The stroma resembled ovarian stroma but no primary follicles or follicular derivatives were identified. Twenty-three of the patients were alive and well from 0.5 to 11 years after excision of the tumor, one patient was disease-free for 8.5 years but died of an open-heart surgical procedure; and two patients were lost to follow-up examination.
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PMID:Serous papillary cystadenoma of borderline malignancy of broad ligament. A report of 25 cases. 339 8

Twenty cancer patients with severe chronic pain have been treated with intraventricular morphine sulfate. Adequate pain relief until death was achieved in 10 patients; 1 patient has been treated for 9 months and is still being treated. In 2 patients, the effects of the morphine sulfate on their unilateral pelvic pain wore off after 4 and 6 months because of tumor progression. At that time, they underwent chordotomy procedures elsewhere. The treatment was discontinued in 4 patients for reasons other than inadequate pain relief, such as medical complications or resolution of pain. In 3 patients, the procedure was abandoned when emotional and psychological factors interfered with pain control. Dose requirements of intraventricular morphine sulfate varied greatly, depending on the total daily dose of systemic narcotic intake at the onset of the study. Intraventricular morphine sulfate is a feasible and reliable method to achieve pain relief in selected cancer patients with severe chronic pain when the maximum tolerated dose of systemic narcotic analgesics has become insufficient to control their pain.
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PMID:Intraventricular morphine administration for control of chronic cancer pain. 382 95


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