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

A retrospective review of 625 consecutive laparoscopies performed in Southland Hospital from 2/74 to 10/78 revealed that 41.7% (262) were carried out for diagnostic purposes (pelvic pain and infertility), 57.3% (357) for sterilization, and 1% (6) for a combination of both. Complications rate for each were observed in 2.2% and 5.6% respectively; 1.1% had serious complications and required laparotomy. Complication rate for each year decreased since the beginning of the study (from 6.7% in 1974 to 2.2% in 1978). The introduction of laparoscopic sterilization in 1975 resulted in an increase in number of sterilizations (from 142 in 1974 to 310 in 1975). 1/3 of the total sterilizations each year consisted of laparoscopic sterilization; abdominal tubal ligation, and postpartum tubal ligation. Of the sterilizations 97.2% (353) were interval procedures, 2.2% (8) were done at the time of termination of pregnancy, and .6% (2) were after spontaneous abortion. Because of lower complication rates associated with laparoscopy; shorter hospital stay; and rapid recovery, it was concluded that laparoscopic sterilization is a valuable diagnostic technique and a safe method of sterilization.
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PMID:Laparoscopy in Southland. 644 35

1 out of 4-5 women develop uterine leiomyomata, the most common solid pelvic tumors in women. This paper assesses the reports of 4714 myomectomies and records of 59 personal cases. Townsend et al. suggested that leiomyomata are unicellular in origin. Estrogen, growth hormone, and progesterone may influence the growth of the tumors. In the performance of myomectomy, the 2 major technical concerns are the minimization of blood loss and the prevention of postoperative adhesions. Although most leiomyomata are asymptomatic and grow slowly, 20-50% of the tumors are estimated to produce symptoms, the severity of which depends upon the number, size, and location of the tumors. The symptoms include menorrhagia, infertility, fetal wastage, pelvic pain/pressure, polycythemia, ascites, impingement, and related complications (e.g., ulceration and infection, fever, pain, uterine inversion, sarcomatous change). Asymptomatic patients with uteri of less than 10-12 weeks' gestational size require no more than observation at 6-month intervals regardless of fertility status. For women with uteri of 10-12 weeks gestational size or longer, management will depend on the patient's desire for fertility. Women desirous of fertility should have a 6-12 month trial for conception. If tumor growth is rapid, myometomy may be performed earlier. Women not desirous of fertility (e.g., pre- and post-menopausal) should have total abdominal hysterectomy and bilateral salpingo-oophorectomy. For symptomatic patients desirous of fertility, myomectomy using the transabdominal approach or hysteroscopy should be performed. For symptomatic patients not desiring fertility, dilatation and curettage and hysterectomy should be performed. With regard to oral contraceptive use, no studies have yet demonstrated that women on oral pills are at increased risk for growth of these tumors. Low-dose contraceptives should not be contraindicated in patients with leiomyomata if they desire to use this form of contraceptive. With IUD users, the device should be discontinued if bleeding occurs.
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PMID:Uterine leiomyomata: etiology, symptomatology, and management. 702 95

The pathophysiology of endometriosis and its treatment are discussed. Endometriosis is a gynecological disorder characterized by the growth of the ectopic endometrium. The usual plaque looks like a small blood-filled cyst that is surrounded by a puckering scar. This tissue responds to fluctuating levels of hormones just as the normal endometrium does, and monthly bleeding of the cysts occurs followed by inflammation and scarring. Endometriosis may cause infertility, dyspareunia, dysmenorrhea, pelvic pain, and other menstrual problems. Therapy is chosen based on extent of disease, tolerance of side effects, and desire for pregnancy. Surgery is usually reserved for more extensive cases of the disease or if fertility is no longer desired. Induction of "pseudopregnancy" with estrogen-progesterone combinations has been used frequently; however, weight gain, initial exacerbation of pain, and the possibility of thromboembolism are limiting factors. Pseudomenopause, induced by danazol therapy, is an alternate method of treatment that causes a static endometrium. It offers rapid relief of symptoms to the majority of patients, and its most common side effects of weight gain and edema are reversible. Fertility rates after treatment are difficult to compare, but they appear to be similar for both hormonal therapies. Danazol has emerged as an effective alternative to the estrogen-progesterone combination treatment of endometriosis. Danazol may be prescribed before surgery to reduce lesions, following surgery to ablate any remaining lesions, or as the sole therapy for endometriosis.
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PMID:Pathophysiology and treatment of endometriosis. 703 70

Physicians can play an important role in the prevention of infertility through aggressive treatment of pelvic infections and improved surgical techniques. The cause of infertility can be diagnosed 90 percent of the time. Ovulation, tubal, peritoneal, uterine, and cervical factors should be evaluated. Sperm-cervical mucus interaction should be assessed. Basal body temperature charts are simple and reliable. An endometrical biopsy should be timed for 8 to 10 days after ovulation, histologically dated, and compared with basal body temperatures. Tubal factors are best assessed by hysterosalpingogram and treated by microsurgery. The incidence of pelvic factors increases with age, prior infection, previous surgery, and pelvic pain. Cervical mucus can be studied and changes quantitated by using a simple scoring system. Uterine anomalies increase pregnancy risk but do not usually cause infertility. Clomiphene therapy should be limited to women who ovulate infrequently or not at all. Estrogen improves cervical mucus production; progesterone treats luteal phase defects. Infertile patients are often angry, anxious, and depressed, and additional time should be set aside during an office visit for optimum communication.
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PMID:Female infertility. 710 67

Coincident with the epidemic of sexually transmitted diseases, the incidence of pelvic inflammatory disease has risen sharply in recent years. Pelvic inflammatory disease is a major direct cause of infertility; in addition, it leads to ectopic pregnancies and chronic inflammatory residua requiring surgical intervention. This threat to the future fertility of women is rendered more serious by the difficulty of making a correct diagnosis and the likelihood that faulty diagnosis will result in inadequate treatment. Pelvic inflammatory disease is caused not only by Neisseria gonorrhoeae but also by Chlamydia trachomatis, genital tract mycoplasmas, and mixed bacteria from the endogenous vaginal and cervical flora, especially anaerobes. Diagnostic criteria include (1) lower abdominal and pelvic pain, (2) lower abdominal tenderness, (3) elevation of erythrocyte sedimentation rate, (4) adnexal inflammatory mass, and (5) presence of leukocytes and bacteria in the peritoneal fluid. Early diagnosis and prompt treatment appear to be crucial in preventing infertility. No studies have evaluated prospectively the relative advantages of inpatient vs. outpatient management of acute pelvic inflammatory disease. The recommendations of the Centers for Disease Control (CDC; Atlanta, Ga.) for outpatient treatment and the results of a multi-hospital collaborative study using the CDC regimens are discussed. Criteria for hospitalization and parenteral antibiotic therapy are presented.
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PMID:Pelvic inflammatory disease: etiology, diagnosis, and treatment. 733 Jul 55

The use of endoscopy in gynecological and obstetrical cases, both for diagnosis and management, are outlined. A short historical perspective is presented followed by short descriptions of various endoscopic methods, including culdoscopy, laparoscopy, and hysteroscopy. The instrumentation is described, and patient preparation is briefly outlined for each scope and procedure. Various applications of endoscopy in fertility control are discussed. Infertility can be examined by endoscopy to determine tubal patency, for example. Culdoscopic sterilization and laparoscopy is compared. Laparoscopy is indicated for patients in acute pelvic pain. The laparoscope offers better pelvic visualization. Laparoscopy can be performed in the presence of vaginal deformity. And laparoscopy is more easily learned than culdoscopy. Indications for culdoscopy include obese patients and patients with previous midline abdominal scars. Culdoscopy is cheaper to perform and takes less time than laparoscopy.
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PMID:Gynaecological endoscopy in fertility control. 740 95

Twenty patients have undergone presacral neurectomy at Yale-New Haven hospital over the past 7 years. The patients were separated into three subdivisions according to abnormal findings at the time of surgery: group I, endometriosis; group II, pelvic inflammatory disease (PID); and group III, those patients with neither endometriosis nor pelvic inflammatory disease but with pelvic pain and infertility. At the time of surgery, an attempt was made to correct and repair coexistent pelvic abnormalities. The groups were evaluated for relief of pain and subsequent viable intrauterine pregnancy. A control group of infertility patients complaining of pain who underwent infertility laparotomy without presacral neurectomy was used for comparison. Presacral neurectomy has traditionally been performed for pain associated with endometriosis and has resulted in subsequent pain relief and pregnancy rates of 30% to 60%. Pregnancy rates of 46% to 47% were found in the PID group, the endometriosis group, and the control group. In addition, 75% of the patients with either PID or endometriosis had significant relief of pain following presacral neurectomy as compared with only 26% of the control group undergoing only infertility laparotomy. It is concluded from these findings that presacral neurectomy plus reconstructive pelvic surgery is more effective than infertility laparotomy alone for the treatment of pelvic pain but that presacral neurectomy does not increase the subsequent incidence of pregnancy.
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PMID:Presacral neurectomy for pelvic pain in infertility. 745 74

Ascites is a rare but important complication of endometriosis because it mimics ovarian cancer. Most cases occur in nulliparous young black women and present with massive ascites. Treatment is effected by ablation of ovarian function by surgery, radiotherapy, or suppression of endometriosis by endocrine therapy. The pathogenesis is unknown. In this paper, we present a case report and review of the other 19 cases in the literature. Because of the age of most of these women, endocrine therapy is preferred rather than castration. The majority of symptoms and signs of endometriosis are well known, including pelvic pain, dysmenorrhea, dyspareunia, infertility, and pelvic tenderness with or without masses. However, it is seldom appreciated that the disease can be a cause of, and can present with ascites, often massive and recurrent. It is important for gynecologists and oncologists to be aware of this entity because the presence of ascites with abdominal and/or pelvic masses and weight loss immediately suggests the diagnosis of malignancy, and the possibility of endometriosis is rarely considered. We are reporting a case of endometriosis causing massive and recurrent ascites, along with a review of the literature and a discussion of the epidemiology, pathogenesis, and management of this disorder.
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PMID:Ascites due to endometriosis. 747 17

The authors evaluated 100 women scheduled for diagnostic laparoscopy (50 for chronic pain, 50 for tubal ligation or infertility evaluation) using structured psychiatric, family history, and sexual trauma interviews. Laparoscopy reports were blindly rated by a gynecologist. Compared with the nonpain group, the women with chronic pelvic pain had significantly higher current and lifetime rates of psychiatric disorders, as well as childhood and adult sexual victimization. They reported significantly higher mean numbers of somatization symptoms, but no significant differences in objective laparoscopic findings. Psychiatric disorders and sexual victimization are common in women with chronic pelvic pain and should be considered in the evaluation and treatment of these patients.
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PMID:Psychiatric diagnoses and sexual victimization in women with chronic pelvic pain. 899 21

Our objective was to investigate the role of estrogens in the development and progression of endometriosis, and evaluate the in vitro boosting effect of lymphokines on the activity of natural killer cells from endometriosis patients, with respect to the estradiol concentrations. Natural killer activity of peripheral blood was evaluated in 42 endometriosis patients who underwent laparoscopy for pelvic pain, infertility and benign adnexal masses, and it was correlated with serum estradiol levels. Twenty-five women with moderate and severe disease were re-evaluated for immune and endocrine parameters 4-8 weeks after surgery, before any specific adjuvant medical treatment, and analyzed for in vitro responsiveness of cytotoxic cells to interferon (IFN) alpha 2 beta and interleukin-2 (IL-2) incubation. Patients with moderate and severe endometriosis showed a significant decrease of natural cytotoxicity when compared with patients with mild and minimal disease (p = 0.01). The decrease of immune reactivity was independent of a reduced representation of natural killer cells, and persisted after surgical removal of all macroscopic endometriosis foci. A significant inverse relationship was observed between natural killer activity and serum estradiol levels, which resulted in moderate and severe disease (r = -0.4, p = 0.009) but not in stages I and II. The in vitro responsiveness of cytotoxic cells to lymphokine incubation was preserved; both IFN alpha 2 beta and IL-2 were able to increase the cytotoxicity of natural killer cells significantly from advanced-stage patients (p = 0.014 and p = 0.006 for IFN alpha 2 beta and IL-2 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Natural killer activity in stage III and IV endometriosis: impaired cytotoxicity and retained lymphokine responsiveness of natural killer cells. 750 88


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