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

This study investigated the psychological differences between gynecological clinic attenders with either pelvic pain or infertility, or with both pelvic pain and infertility both before and after laparoscopic investigation with concurrent treatment. Given the differing meaning attached to the procedure by these groups, it was hypothesized that infertility patients would be more anxious but with less evidence of psychopathology in comparison with the pain group prior to laparoscopic surgery. Postsurgery and in the short term, pain reduction was expected to be associated with decreased pathology for the pain group. Contrary to the hypotheses, pain patients obtained higher anxiety scores in comparison with the infertility group both pretreatment as well as post-treatment. The latter group's scores were comparable to normative data. Other results were generally in line with the hypotheses, pain reduction for both pain groups being associated with a reduction in psychopathology. Patients with pain plus infertility resembled pain patients at pretreatment, while at post-treatment, they bore a closer resemblance to infertility patients in their psychological profile. This was despite the fact that for both pain groups, pain relief was similar. This reinforces the notion that in the patient groups studied anxiety is associated with pain rather than with infertility.
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PMID:Patients with chronic pelvic pain and/or infertility: psychological differences pre- and post-treatment. 803 88

Five hundred and nine Laparoscopic examinations performed between 1987-91, (147 procedures for evaluation of gynaecologic pelvic pain and 313 for infertility) revealed ectopic pregnancy (27%), twisted ovarian cyst (18%) and acute pelvic inflammatory disease (14%) in cases of acute gynaecologic pain, and endometriosis (17%) and chronic pelvic inflammatory disease (16%) in chronic pelvic pain. Adhesions (20%), tubal block (15%), endometriosis (9%) and polycystic ovary (7%) were common findings in cases of infertility. These data support the usefulness of this minimally invasive procedure in accurate diagnosis of gynaecological disorders and provides insight into the spectra of diseases seen in Pakistani women with pelvic pain and infertility.
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PMID:Laparoscopic appraisal of infertility and pelvic pain in Pakistani women: a 5 years audit. 804 Sep 92

Serum CA-125 concentrations were investigated preoperatively in 91 consecutive women undergoing laparoscopy for infertility, pelvic pain and/or annexial cysts. The presence and extent of endometriosis were carefully assessed, including the American Fertility Society stage of disease, and implant and adhesion scores. Postoperative CA-125 measurements were obtained in 32 of 53 endometriosis patients and evaluated with respect to clinical evolution of the disease. Serum levels of CA-125 were significantly increased in patients with endometriosis (46.5 +/- 39.5 vs. 13.5 +/- 7.3 U/ml in controls, p < 0.001) and correlated with the severity of disease. A positive correlation (r = 0.7, p < 0.001) was observed between adhesion score and CA-125 levels, while the relationship with implant score was not significant (r = 0.3, p = 0.07). CA-125 level was also significantly increased in women with peritoneal endometriosis (70.7 +/- 47.3 vs. 33.5 +/- 25.6 U/ml for those with ovarian endometriosis), and in these patients the post-operative CA-125 level was significantly related to the clinical evolution of the disease, being higher in patients whose disease recurred compared to those with negative follow-up, irrespective of the adhesion score. We conclude that in endometriosis patients, serum CA-125 level is directly related to the adhesion score and peritoneal involvement, suggesting a central role of pelvic and peritoneal irritation in the increased level of this serum marker.
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PMID:Serum CA-125 concentration in endometriosis patients: role of pelvic and peritoneal irritation. 805 14

An important advantage of open laparoscopy over closed techniques is the avoidance of placing a sharp trocar blindly into the peritoneal cavity. Although an open technique theoretically minimizes the risk of major retroperitoneal vessel injury and bowel injury, most laparoscopies are performed using a closed technique. In an effort to simplify open laparoscopy, a technique was developed that can be done without special equipment or sutures and nearly as quickly as a closed technique. To compare the effectiveness of this open laparoscopic technique to a closed technique, a prospective, observational, cohort study was carried out on 66 women undergoing laparoscopy for either infertility or pelvic pain. The open technique was performed on 35 consecutive patients and compared to a closed technique performed on 31 patients on a different service during the same period. Evaluation included total duration of the procedure, length of the incision, incidence of CO2 leakage and complications. The open technique took slightly longer, and the incision was slightly longer. CO2 leakage occurred in 5 of 35 of the open cases but in none of the 31 closed cases. Leakage was controlled effectively in every case by application of a towel clip to the skin incision. No complications occurred with either technique. This study suggested that an open technique that requires no special equipment or sutures may be a useful alternative approach for laparoscopy when insertion of a sharp trocar is undesirable.
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PMID:Open laparoscopy without special instruments or sutures. Comparison with a closed technique. 806 7

Conservative surgery at laparoscopy or laparotomy is effective against stage I-IV endometriosis to relieve pelvic pain and treat infertility. The subsequent average conception rate is 45-65%. Recurrence of endometriosis may occur, although pregnancy may delay this. Hysterectomy is indicated in severe disease, but the ovaries may be preserved if there is no evidence of active disease or significant periovarian adhesion. Combined surgery and pre- or postoperative medical therapy using gonadotropin releasing hormone agonists or danazol is recommended in young non-infertile women and those with extensive or severe disease.
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PMID:Surgical treatment and adjunct therapy of endometriosis. 809 25

Recent comparative studies and developments in our understanding of the pathogenesis and pathophysiology of endometriosis have led to increasing doubts about whether it should always be considered a disease. Widespread use of laparoscopy for gynaecological investigation and treatment, recognition of non-pigmented lesions which are more active than classical implants, and the documentation of microscopic lesions in visually normal peritoneum, have all resulted in an increase in the frequency with which endometriosis is diagnosed. Recent studies suggest a prevalence of up to 80% in women complaining of infertility or pelvic pain, but also in up to 22% of fertile asymptomatic women undergoing sterilization. Perhaps it is a normal physiological variant, being present in such a high proportion of the population. Circumstantial evidence suggests this may be so, and the results with placebo treatment in controlled trials suggest that endometriosis is self-limiting and will regress or disappear spontaneously in 58% of women. The frequency and severity of symptoms which are often presumed to result from endometriosis do not correlate with the extent or site of lesions. Most women are pain-free. There is no dysmenorrhoea in up to 77%, no dyspareunia in up to 70%, and no pelvic pain at all in up to 61% of women with endometriosis. The pathophysiology of pain related to endometriosis is not understood. There is no medical or conservative surgical treatment that is wholly effective for symptom relief, and there is considerable placebo benefit. All treatments have risks or side-effects, and recurrent symptoms will develop in up to 45% of women within 5 years. For these reasons treatment should only be used where endometriosis fulfils the criteria of a disease, showing signs of progression with tissue damage or physiological disturbance. Asymptomatic endometriosis without tissue damage should not be considered a disease and should not be treated. Treatment of pain associated with minor endometriosis, or prophylactic treatment to prevent progression, must be regarded as empirical and not the specific requirement to control what is a questionable disease.
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PMID:Is endometriosis a disease? 813 9

Pelvic inflammatory disease continues to take its physical, psychological, and financial tolls. Prompt treatment of symptomatic disease and screening of asymptomatic or mildly symptomatic women for the major causative organism--Chlamydia trachomatis--are the keys to preventing serious sequelae, such as chronic pelvic pain, ectopic pregnancy, and infertility.
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PMID:PID prevention: clinical and societal stakes. 814 16

Combined histological and bacteriological investigations of 800 specimens of nonpregnant endometrial curettings of 15 to 60 years age group of hill women of Darjeeling District were carried out for detection of tuberculous endometritis. The principal complaints were infertility (47.5 per cent), abnormal uterine bleeding (30.75 per cent), amenorrhoea (11.25 per cent), leucorrhoea (6.25 per cent), and miscellaneous conditions (pelvic pain and pyometra) (4.25 per cent) cases. By histological examination alone, only 10.9 per cent cases could be diagnosed while by combined study the incidence rate was 11.8 percent, an increase in the diagnostic acumen by more than 10.3 per cent. Bacteriological study was of greater value in doubtful cases where there was absence of tuberculous granuloma or epithelioid cell but presence of nonspecific inflammatory cells along with variable degree of necrosis of glandular epithelia. The incidence of M.tuberculosis was 97.7 percent while that of atypical mycobacteria was 2.3 per cent. Thus simultaneous use of culture and biopsy yielded better results. Our prevalence is a little higher than other reports from India. In cold weather at a high altitude, the tubercle bacilli survive longer in fomites which serve as important sources of infection in Darjeeling. Women of third decade are more frequently affected (43.2 per cent).
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PMID:Tuberculous endometritis in hills of Darjeeling: a clinicopathological and bacteriological study. 815 2

A retrospective analysis is reported of the management of 117 cases of infertility associated with Stage III and IV endometriosis. Combined medico-microsurgical treatment was selected in 75.3% of Stage III cases and in 83.3% of those on Stage IV. Medication consisted of medroxyprogesterone acetate in 26 patients and danazol in the remaining 64. Microsurgery alone was utilized in 24.7% of Stage III patients and in 16.6% of those on Stage IV. Both surgery alone and the combined therapy had a profound positive effect on subjective symptoms: dysmenorrhea, dyspareunia and pelvic pain. Following combined therapy, pregnancy was achieved in 34.4% of all women. Respective figures are 30.7% for medroxyprogesterone acetate (29.4% Stage III and 33.3% Stage IV) and 35.9% for danazol (37.7% Stage III and 27.2% Stage IV). In the group of patients treated by surgery alone, pregnancy occurred in 25.9%. Of the pregnancies in women with Stage III endometriosis, 25 were carried to term and 6 ended with a spontaneous abortion; figures for Stage IV women are 5 and 2, respectively. Second-look laparoscopy was performed in 49 of the 79 patients who failed to conceive, at 12-36 months after treatment; persistent genital pathology, to which infertility could be attributed, was found in 77.5% of them.
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PMID:Management of stage III and IV endometriosis: a 10-year experience. 820 Apr 67

Endometriosis is a common disease that affects up to 5 million women in the United States. Specifically the prevalence of endometriosis is 1 in 15 (7%) women of reproductive age, and there is an associated incidence of infertility in as many as 30% to 40% of cases. The precise physiologic mechanism for the development of endometriosis lesions in the pelvis and abdominal cavity has not been elucidated. Substantial evidence exists, however, that endometriosis is dependent on estrogen for continued growth and proliferation. Therefore, suppression of the hypothalamic-pituitary-ovarian axis with analogues of a gonadotropin-releasing hormone is being increasingly undertaken. Since the most effective resolution of endometriosis occurs after oophorectomy or onset of menopause, the hypoestrogenic state induced by GnRH analogues is of major significance for patients with active disease. Medical therapy for endometriosis is often used as primary therapy for symptomatic disease or as an adjunct to surgical management of pelvic pain or infertility.
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PMID:Pathophysiology and management of endometriosis. 822 53


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