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

Endometriosis is a common cause of pelvic pain and infertility in young women. Transvaginal sonography is major means for diagnosing ovarian In our study, we scanned 60 patients with endometriomata who underwent laparotomy or laparoscopy. We compared preoperative ultrasonographic diagnosis with histological reports. The sonographic criteria for the diagnosis of endometriomata were (1) cystic structure with low, homogeneous echogenicity and (2) thick cystic wall with regular margins. In 50 patients, sonography suggested an endometrioma. In 47 cases, the diagnosis was correct. The false-positive cases were all caused by cystic teratomas with a homogeneous sonographic pattern. Ten false-negative cases were diagnosed by ultra-sonography as functional ovarian cysts (5), teratomas (3), and benign ovarian cystoma (1). Only 1 case of a 5-mm endometrioma was demonstrated by laparoscopy but not by TVS. The sensitivity of TVS for diagnosing endometriomata was 82.4% and specificity 97.7%; the positive and negative predictive values were 94% and 92.8%, respectively. The diagnostic accuracy of TVS was 93%. In our experience, TVS is a very specific means for diagnosing endometriomata when the typical pattern is detected; however, the sensitivity of the technique needs to be improved.
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PMID:Role of transvaginal sonography in the detection of endometriomata. 872 24

Endometriosis is a disease of the female pelvic mesenchyme in which tissue with epithelial and stromal characteristics of the endometrium develops in a situation other than in the uterus. The aim of this study was to evaluate the prevalence of endometriosis in premenopausal women submitted to laparoscopy and/or laparotomy for infertility, chronic pelvic pain, benign ovarian cysts and uterine myomas. The prevalence of the disease was higher in patients with infertility (30.5%), chronic pelvic (45%) and benign ovarian cysts (43%) than in patients with uterine mvomas (8.5%).
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PMID:The prevalence of endometriosis in premenopausal women undergoing gynecological surgery. 792 3

The objective of this study was to determine if color flow Doppler ultrasonography based on patterns of perfusion can aid in providing a specific diagnosis of ovarian masses associated with pelvic pain. Color flow Doppler images of 42 ovarian lesions in 42 adolescent girls (age range, 10 to 17 years) were analyzed prospectively. The color flow patterns were classified into three main categories: lesions with no vascularity; lesions with peripheral vascularity; and lesions with internal vascularity. The diagnoses included 22 hemorrhagic ovarian cysts, seven simple cysts, three cystadenomas, seven inflamed ovaries (five with microabscesses and two with dominant cystic abscesses), and three ovarian torsions. A peripheral pattern of flow was observed in 29 of 34 (85%) cystic lesions, including 18 hemorrhagic and six simple cysts, three cystadenomas and two abscesses. Peripheral flow was also identified in four enlarged ovaries, two with inflammatory disease and two with torsion. Internal flow was noted in five patients with enlarged ovaries due to inflammatory disease. Intraovarian flow was absent in three patients with torsion and in five of 34 cystic lesions. Internal ovarian flow was identified in 90% of normal ovaries. Resistive indices, obtained in 33 abnormal ovaries, were higher in cystic lesions than in inflammatory lesions, although the values overlapped. Our findings showed that internal ovarian flow can be found in inflammatory processes and normal ovaries, but the absence of flow also is nonspecific and can be found in a variety of ovarian cystic lesions as well as in torsion. This overlap limits the usefulness of color Doppler ultrasonography for differentiating cystic ovarian lesions associated with pain in adolescent girls.
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PMID:Transabdominal color Doppler ultrasonography of the painful adolescent ovary. 793 18

We have evaluated the prevalence of endometriosis in selected gynaecological conditions requiring surgery. Eligible for the study were women with primary or secondary sterility, chronic pelvic pain, fibroids or benign ovarian cysts requiring laparoscopy or laparotomy consecutively observed during the study period in 23 obstetrics and gynaecology departments in Italy between May 1991 and July 1992. Women with a previous diagnosis of endometriosis were specifically excluded. A total of 3684 subjects entered the study. Of these, 660 (mean age 31 years) were included for sterility, 409 (mean age 32) for chronic pelvic pain, 1880 (mean age 42) for fibroids and 735 (mean age 33) for benign ovarian cysts. During the surgical procedure surgeons were asked to examine the pelvis carefully to identify endometriosis. Out of the 660 women included for sterility, 195 [30%, 95% confidence interval (CI) 26-35] had endometriosis; the corresponding figures were 185 out of 409 (45%, 95% CI 39-52) for pelvic pain, 219 out of 1880 (12%, 95% CI 10-14) for fibroids and 257 out of 735 (35%, 95% CI 31-40) for ovarian cysts; these differences were significant (chi2(3) heterogeneity, absence versus presence = 323.9, P < 0.001). Among women with endometriosis who entered the study for sterility, 51% were at stage 1, 22% at stage 2, 20% at stage 3 and 7% at stage 4. The corresponding figures for pelvic pain and fibroids were largely similar: 37%, 24%, 30%, 10% for women with pelvic pain, 36%, 11%, 45% and 8% for those with fibroids, but among cases with ovarian cysts stage 3 was over-represented (62% of cases).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prevalence and anatomical distribution of endometriosis in women with selected gynaecological conditions: results from a multicentric Italian study. Gruppo italiano per lo studio dell'endometriosi. 796 93

The aim of the present study was to evaluate the role of laparoscopy not only in the diagnosis but also in the therapy of pelvic endometriosis. Ninety-four patients underwent laparoscopy between May 1991 and May 1993. The patients were divided into 2 groups, according to the indication for laparoscopy: group I (benign ovarian cysts n = 47); group II (chronic pelvic pain, n = 47). All laparoscopies were performed by 2 surgeons only. When present, endometriosis was scored according to the American Fertility Society revised classification 1985 (AFS 1985). Endometriosis was present in 37 (39.4%) of the 94 patients included in the study: 19 out of 47 (40.4%) in group I, 18 out of 47 (38.3%) in group II. In 29 patients with endometriosis (78.3%), the score was reduced surgically during the diagnostic procedure. In 24 cases (82.8%) by laparoscopy and in 5 cases (17.2%) only, by laparotomy. Therefore, the careful selection of cases, the use of appropriate instruments and the experience in endoscopic surgery, combined with a good knowledge of pelvic anatomy, may allow the treatment of endometriosis immediately after diagnosis by laparoscopy, resulting in shorter hospitalization, less physical trauma, and a lower number of post-operative adhesions.
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PMID:The role of laparoscopy in the treatment of endometriosis. 799 71

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

In Winston-Salem, North Carolina, researchers compared prospective data on 64 consecutive women (18-70 years old, only 2 of whom were postmenopausal) who experienced laparoscopic adnexectomy between January, 1991, and March, 1993, with retrospective data on 26 consecutive women (21-44 years old) who experienced adnexectomy by laparotomy between January, 1989, and December, 1991. The indication for adnexectomy for most women was pelvic pain (91% for laparoscopy patients and 92% for laparotomy patients). The reasons for the pelvic pain included chronic pelvic inflammatory disease, recurrent ovarian cyst, endometrioma, cyclic ovarian pain, and periovarian adhesions. Among women with no pelvic pain, 7 women had a chronic adnexal cyst, and 1 woman had an ovary secreting an androgen. The median operative time for laparoscopy was significantly shorter than for laparotomy (88 vs. 107 minutes; p = .04). Even though the estimated blood loss was significantly less among laparoscopy patients than laparotomy patients (72 vs. 222 ml; p = .01), the change in hematocrit in both groups was not significant (3.9 vs. 5.2), and no one needed a blood transfusion. Women in the laparoscopy group were in the hospital for a significantly shorter period (1 vs. 3 days; p = .0001) and recovered more rapidly (1 vs. 4 weeks; p = .001) than did those in the laparotomy group. The total cost was lower for laparoscopic adnexectomy than for adnexectomy by laparotomy ($4573 vs. $6044; p = .02). Women in both groups noted improvement in pelvic pain. Just 1 woman from each group had a major complication. These findings suggest that experienced laparoscopic surgeons can quickly, safely, and effectively perform adnexectomy using laparoscopy.
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PMID:Laparoscopic adnexectomy: a comparison with laparotomy. 805 16

Patients with chronic pelvic pain are challenging, from both diagnostic and therapeutic viewpoints. At the pain clinic at the Medical College of Georgia School of Medicine, Augusta, we have discovered over the past 3 years that psychiatric disease is probably underrecognized in these patients and that physicians are often reluctant to discuss intimate details of a patient's sex life even though they may provide important information. In addition, sleep disorders are very prevalent. Use of vaginal-probe ultrasound may decrease the need for diagnostic laparoscopy, especially in patients without pelvic disease. In most cases, ovarian cysts in ovulating patients do not represent an abnormality. Laparoscopy and major pelvic surgery should be limited to patients with a high probability of anatomic abnormalities or persistent symptoms.
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PMID:Chronic pelvic pain. Differentiating anatomic from functional causes. 817 Aug 72

Published studies relating to the usefulness of diagnostic and operative laparoscopy in women with chronic pelvic pain (CPP) were reviewed. This revealed that approximately 40 per cent of all laparoscopies were done for CPP. However, the definition of CPP was found to be nebulous and inconsistent, and that muddled definitive conclusions about patient diagnoses and treatments. The following definition of CPP was proposed: nonmenstrual pain of 3 or more months duration that localizes to the anatomic pelvis and is severe enough to cause functional disability and require medical or surgical treatment. A survey of published reports showed laparoscopically diagnosable abnormalities in 61 per cent of patients, compared with abnormalities in 28 per cent of women without CPP. Studies in adolescents were also reviewed and showed that adolescents with CPP also had significant laparoscopically diagnosed abnormalities, with 78 per cent showing some pathology, especially endometriosis (40 per cent). Endometriosis, pelvic adhesions, chronic pelvic inflammatory disease, and ovarian cysts were the diagnoses most commonly made via laparoscopy in CPP patients. The potential roles of each of these abnormalities in CPP were discussed, as well as the results of laparoscopic treatment of each disease. Laparoscopy was also found to have a limited role in women with CPP after hysterectomy or bilateral salpingo-oophorectomy, with usefulness in diagnosing and treating adhesions and residual ovary syndrome, although its role in ovarian remnant syndrome was uncertain. Overall, the data showed that less than 50 per cent of women with CPP were helped by diagnostic and operative laparoscopy, stressing the need for both physicians and patients to recognize that laparoscopy is neither the ultimate evaluation nor the panacea for CPP.
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PMID:The role of laparoscopy in chronic pelvic pain: promise and pitfalls. 832 35

Physicians are beginning more and more to understand pelvic pain syndrome (PPS). Transuterine pelvic venography shows that some women who suffer from chronic pelvic pain have moderate or severe congestion. On the other hand, laparoscopy indicates that some cases have no physical abnormalities. A psychological component is frequently involved, but automatically referring a woman with PPS to a psychiatrist is unproductive. Instead, physicians should involve a psychologist based at a gynecologic clinic, especially in the case of women with a history of sex abuse with a high somatization score. In the case of women who suffer from PPS but clearly show no apparent physical causes, physicians should not investigate any further, but instead reassure them. Reassurance usually results in alleviation of pain within 6 months. PPS only strikes premenopausal women, suggesting that ovarian activity may also be involved. Thus, treating women with hormones to suppress ovulation benefits some women. The medical community still does not know whether longterm treatment with gonadotropin-releasing hormone analogues and hormone replacement effectively eliminates pelvic pain. If the above treatments do not successfully treat PPS, physicians can perform a hysterectomy and bilateral oophorectomy and prescribe sufficient hormone replacement therapy to remove heretofore undetected disease (e.g., ovarian cysts, adenomyosis, and fibroids) in 33% of cases of idiopathic PPS and alleviate pelvic pain in 66% of such cases.
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PMID:The pelvic pain syndrome. 833 82


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