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

Fifty-one women with pelvic endometriosis were treated with the gonadotropin-releasing hormone agonist (GnRHa) Buserelin (Hoechst Holland N.V., Amsterdam, The Netherlands) 300 micrograms three times a day intranasally for 6 months. Forty-nine women completed treatment; 42 were available for 6 months of follow-up following treatment. Symptoms showed prompt and significant improvement. Follow-up after treatment revealed persistent relief from dysmenorrhea and dyspareunia in, respectively, 58.6% and 88.2% of the women, whereas pelvic pain returned to pretreatment scores. Serum estradiol (E2) was suppressed to predominantly early follicular phase concentrations. Laparoscopy at the end of therapy showed significant reduction of scores for implants only. There was no relation between the degree of E2 suppression during therapy and the improvement of symptoms or the reduction of endometriosis. Statistical analysis in 22 infertile patients, of whom 7 conceived during follow-up, revealed no differences in E2 levels during therapy, improvement of symptoms, or reduction of endometriosis. Buserelin appears to be safe, well tolerated, and effective in the management of endometriosis and associated complaints.
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PMID:Endometriosis: treatment with gonadotropin-releasing hormone agonist Buserelin. 252 63

Twenty-three patients with laparoscopically diagnosed endometriosis and pelvic pain were allocated randomly to treatment with cyproterone acetate 27 mg plus ethinyl estradiol 0.035 mg/day (11 patients) or danazol 600 mg/day (12 patients). All women received treatment for 6 months, except for one in the cyproterone group who suspended treatment for nonmedical reasons and was excluded from analysis of the results. The clinical condition and pain symptoms were monitored in all patients for 1 year after treatment suspension. The intensity of pelvic pain at diagnosis, during treatment, and at follow-up was evaluated by a multidimensional verbal score and an analogue scale. At the end of treatment, a repeat laparoscopy was performed in those patients who agreed (four in the cyproterone group, five in the danazol group); the results showed a partial regression of endometriotic lesions in both groups, with no significant differences between them. Dysmenorrhea disappeared in all patients during treatment. At 6 months after suspension, dysmenorrhea recurred in 66% of the cyproterone group and 58% of the danazol group, and at 1 year in 89 and 92%, respectively. Intermenstrual pelvic pain improved markedly during treatment in both groups; 6 months after treatment withdrawal it was present in four cyproterone subjects and four danazol group patients, whereas after 1 year, only one woman in the danazol group did not have this symptom. Deep dyspareunia was less affected by treatment, and 6 months later had recurred in all the women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of cyproterone acetate and danazol in the treatment of pelvic pain associated with endometriosis. 252 84

Chronic pelvic pain (CPP) in adolescent women is a frequent complaint. We assessed the value of laparoscopy in the differential diagnosis of CPP in 47 adolescents 11-19 years old after six months or more of cyclic or acyclic pelvic pain. No pelvic abnormalities were detected in 19 patients (40.4%), endometriosis was detected in 18 (38.3%) (frequently with nonpigmented or "nonclassic" lesions), partially obstructive genital tract malformations were found in 4 (8.4%), and other types of pathology were discovered in 6 (12.8%). Nearly 60% of the patients had a treatable pelvic disease. Laparoscopy is an invaluable tool in the diagnosis of CPP in adolescents and should be performed before starting a psychiatric evaluation or prescribing long-term medical treatment.
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PMID:Laparoscopy in the diagnosis of chronic pelvic pain in adolescent women. 252 73

Used endoscopically, the CO2 laser offers some advantages over other operative techniques for endometriosis and adhesions but, in spite of the continuing development of new instrumentation there are still problems with the system. The technique needs specialized equipment requiring ongoing biomedical maintenance and specialized technical care in the operating room. Some problems such as the intraperitoneal accumulation of smoke, gas leakage, and difficulty with maintenance of proper beam alignment still occur. In spite of these problems the advantages are numerous: the system allows precise bloodless destruction of diseased tissue and eliminates the risks of cautery. In the hands of an experienced laparoscopist, it appears safe and effective in vaporization of endometriotic lesions, utero-sacral neurectomy, adhesiolysis and salpingostomy. The judicious use of these techniques, combined with carefully planned further investigations by well-trained and experienced laparoscopists and continuing improvements in the delivery systems, will soon reveal the true efficacy of the CO2 laser laparoscope. If studies continue to show pregnancy rates and pain relief to be equivalent to those patients treated by laparotomy, CO2 laser laparoscopy will become the preferred procedure for the management of pelvic endometriosis and its associated adhesions, distal tubal occlusion, pelvic pain and tubal pregnancy. With the exception of using the argon laser to treat endometriosis, the selective absorption characteristic of lasers has not been greatly utilized. While the CO2 laser is heavily absorbed by water and hence vaporizes most cells in a rather indiscriminate fashion, this is not true for other wavelengths, such as argon, Nd-YAG, KTP, krypton, xenon, copper and gold vapour lasers. The energy form of each of these lasers has different properties of penetration, absorption, reflection and heat dissipation. Many of these lasers have not yet been evaluated in human subjects. An exciting, although not new, area of possible laser application involves the use of photosensitizers and fluorescing agents (Dougherty et al, 1978). Some recent experimental studies (Schellhas and Schneider, 1986; Schneider et al, 1988) may lead to new therapeutic possibilities. The surgical laser is not, however, a panacea. Only controlled trials carried out carefully over the next few years will clearly define its potential. In the meantime it is incumbent upon all of us to investigate the clinical, gynaecological and surgical applications in a careful, methodical and scientific manner.
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PMID:CO2 laser laparoscopic surgery. Adhesiolysis, salpingostomy, laser uterine nerve ablation and tubal pregnancy. 253 9

Serum Ca-125 levels were measured in 154 patients undergoing laparoscopy or laparotomy for infertility and/or pelvic pain. Pelvic endometriosis at various stages was observed in 102 of the patients, and 52 had a visually normal pelvis and served as a control group. We found a significantly higher mean serum Ca-125 concentration in the patients with stages III and IV endometriosis compared with the controls (P less than 0.001) whereas in the patients with stages I and II disease the mean antigen level was comparable to that of the control group. Considering its low sensitivity (14.7%) the usefulness of serum Ca-125 measurements as an initial diagnostic test for endometriosis is scanty. On the contrary, because of its elevated specificity (100%), this test may be useful in indicating early surgical exploration of the pelvis in cases of infertility and/or dysmenorrhea which are associated with high values of Ca-125.
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PMID:Serum Ca-125 concentrations in endometriosis. 253 79

Products of the cyclooxygenase and lipoxygenase pathways of arachidonic acid metabolism were estimated in the cul-de-sac fluid from patients with endometriosis, pelvic adhesions and normal laparoscopic examinations, with and without chronic pelvic pain. No correlation between the symptoms, underlying diagnoses, and the concentrations of eicosanoids were observed.
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PMID:Peritoneal fluid eicosanoids in chronic pelvic pain. 255 65

Two patients diagnosed at the University of Missouri Hospital underwent reconstructive surgery utilizing the atretic cervix as a conduit for the formation of an endometrial-vaginal fistula. A total of three surgeries was performed with both patients experiencing the onset of cyclic menses. One patient, followed for 22 years, never attempted to conceive and eventually succumbed to hysterectomy for pelvic pain and endometriosis. The other has been followed for 44 months and continues to have regular menses with mild dysmenorrhea. Less than 50 cases of congenital cervical atresia have been reported in the literature. The operative procedures and literature experience are provided.
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PMID:Surgical reconstruction of the congenitally atretic cervix: two cases. 266 83

Endometriosis is one of the most common conditions encountered in gynecology and the field of infertility. The clinical presentation depends on the location and the extent of disease, but the severity of symptoms does not correlate directly with the extent of disease. Symptoms of genital endometriosis may be categorized as menstrual dysfunction, ovulatory dysfunction, and reproductive dysfunction. With menstrual dysfunction, the frequent clinical symptoms are cyclic pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis is commonly found to be the cause in younger patients with pain and dysmenorrhea, particularly when the clinician is aware of the appearance of atypical lesions. Types of ovulatory dysfunction reported to be associated with endometriosis include anovulation, premenstrual spotting, luteal phase defects, and LUF syndrome. The data are not sufficient to determine the prevalence of endometriosis, luteal phase defects, and hyperprolactinemia. With LUF syndrome, there are data to support an association, but more data on the frequency of LUF in consecutive normal cycles compared to consecutive cycles in women with endometriosis would be beneficial. A higher rate of infertility is reported in couples with endometriosis. Two approaches are used to evaluate spontaneous abortions and endometriosis. In retrospective studies, the abortion rates are higher in couples with endometriosis; however, when the pregnancy outcomes in untreated couples are studied, there is less evidence to support the association of a higher spontaneous abortion rate. Formerly, the diagnosis of endometriosis depended on the appearance of typical lesions. With the recognition of early or atypical lesions the histologic confirmation of glands and stroma is assuming a more prominent role. Noninvasive techniques such as assays of endometrial antibodies or CA-125 have certain limitations in terms of producing false-positive results and lacking predictability in early stages of disease. Ultrasonography and MRI give additional and confirmatory information. Most noninvasive techniques are ancillary in diagnosis and management. It still needs to be determined whether their routine use will give enough added information to justify their cost. Currently, the diagnosis of endometriosis is best made by histologic evidence of glands and stroma.
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PMID:Clinical presentation and diagnosis of endometriosis. 266 21

Dysmenorrhea is a common complaint of women during their reproductive years. Primary dysmenorrhea and endometriosis are the most common forms of pelvic pain. Through a comprehensive health history and physical examination, a clinical diagnosis can be made to facilitate optimum management of symptoms. The incidence, etiology, symptomatology and treatment modalities for these entities are discussed. Particular attention is devoted to the differentiation between primary dysmenorrhea and endometriosis.
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PMID:Primary dysmenorrhea or endometriosis? 272 18

The results of second-look laparoscopy were compared with subjective symptomatology and findings at pelvic exploration in 36 patients who had received conservative treatment for endometriosis. In the 14 patients given pharmacologic treatment, second-look laparoscopy demonstrated active endometriosis in 57.1%, whereas pelvic pain was present in 64.3% and gynecologic examination was positive in 28.6%. In the 22 patients who underwent surgery, active endometriosis was detected by second-look laparoscopy in 31.8%, whereas 40.9% reported pelvic pain and pelvic examination was positive in 31.8%. Thus clinical signs and symptoms were unreliable in the diagnosis of endometriosis recurrence, whereas laparoscopy was indispensable. It should be programmed for 6 months from the end of medical treatment and 12 months after surgery; however, if the pain symptomatology recurs, then laparoscopy is performed immediately.
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PMID:Second-look laparoscopy in the treatment of endometriosis. 290 36


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