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

Adenomyosis was present in 161 of 1619 consecutive hysterectomy specimens. Adenomyosis coexisted with other pelvic pathology in 97 women and was the only histologic finding in 64 women. Most patients were 35 to 50 years of age, parous, white, had not taken steroid hormones, had not had uterine surgery, and complained of abnormal uterine bleeding and/or pelvic pain. Adenomyosis was most associated with leiomyomata, endometrial hyperplasia and carcinoma, and endometriosis. The clinical signs of uterine enlargement and tenderness were rarely observed. The diagnosis was suspected preoperatively in 10% of women. At surgery, adenomyosis was not recognized in 65% of patients. Adenomyosis is a disease of unknown etiology whose uncharacteristic clinical profile and frequent association with more obvious pelvic pathology make it a neglected diagnosis.
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PMID:Adenomyosis: a neglected diagnosis. 90 5

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

Cyclic pelvic pain is a common gynecologic problem caused by relatively few diseases, which usually can be diagnosed and remedied quickly. Some complaints reflect normal physiologic aspects of the menstrual cycle (mittelschmerz, menstrual awareness). Premenstrual syndrome can be diagnosed, but an effective and convenient treatment is lacking. Dysmenorrhea is the commonest source of cyclic pain, diagnosed by its characteristic history and rapid relief on administration of antiprostaglandin agents. Endometriosis is diagnosed surgically and best treated either surgically then, or medically by danazol or GnRH agonists. In contrast, adenomyosis is a problem commonly encountered in later life, and hysterectomy is usually needed for both definitive diagnosis and treatment.
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PMID:Cyclic pelvic pain. 223 52

This study evaluates the long-term outcome of 99 women who underwent hysterectomy for pelvic pain of at least 6 months' duration. All had symptoms and physical examination findings suggestive of disease confined to the uterus. Patients were excluded if there was previously documented extrauterine pelvic disease, extrauterine pelvic disease at the time of surgery, or uterine weight exceeding 200 g. Histopathologic analysis revealed leiomyomata in 12 (12.1%), adenomyosis in 20 (20.2%), and both leiomyomata and adenomyosis in two (2.02%). The average uterine weight was 91.1 g (range 24-198). Patients were followed after hysterectomy for an average of 21.6 months (range 15-64), with 77 of 99 (77.8%) showing significant improvement and 22 (22.2%) having persistent pelvic pain. Despite preoperative history and physical findings suggesting and histologic findings confirming uterine disease, nearly a quarter of the patients had persistent pelvic pain after hysterectomy for chronic pelvic pain. These findings should have a significant impact on the therapeutic choices recommended by gynecologists and may alter the informed consent that patients give in such cases.
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PMID:Hysterectomy for chronic pelvic pain of presumed uterine etiology. 238 29

A criteria-based quality assurance process for hysterectomy was instituted at a large teaching hospital. After this process was initiated, the overall frequency of hysterectomy decreased by 24%, p less than 0.001. Significant reductions were seen in hysterectomy rates for the following indications: chronic pelvic pain (77%, p less than 0.0001), recurrent uterine bleeding (46%, p less than 0.001), preinvasive disease of the uterus (55%, p less than 0.005), and severe infection (70%, p less than 0.025). Adenomyosis was the single indication for which an increase in hysterectomy rate was observed. This increase, however, was completely reversed during the last 2 years of the study. This quality assurance process also resulted in a significant increase in the histologic verification rate (i.e., 82% vs 93%, p less than 0.001). These observations suggest that using such a criteria-based process can reduce the number of hysterectomies performed and improve the accuracy of the preoperative diagnosis.
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PMID:The impact of a quality assurance process on the frequency and confirmation rate of hysterectomy. 238 42

Microbiological and histopathological specimens were obtained from three levels (fundal, middle and cervical) of the endometrium immediately after removing the uterus. Hysterectomy indication was menometrorrhagia and uterine fibroids in eight cases and chronic pelvic pain in two cases. All cultures for C. trachomatis, N. gonorrhoeae, M. hominis, U. urealyticum, herpes simplex virus, anaerobic and facultative bacteria were negative. Histopathological examination showed few plasma cells in the endometrium in four cases with the presence of uterine fibroids and in one case with adenomyosis. These results suggest that the endometrial cavity of a nonpregnant uterus is sterile.
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PMID:Endometrial microbial flora of hysterectomy specimens. 366 72

Few previous studies have examined the relationship between the preoperative and pathologic diagnoses for hysterectomy. To determine the percentage of preoperative diagnoses that were confirmed by pathologic examination, we analyzed data from the Collaborative Review of Sterilization, a multicenter study of hysterectomies and tubal sterilizations in women aged 15 to 44 years. Data were collected from patient interviews and chart reviews. Of the 1851 women included in this study, 1283 (69%) had abdominal hysterectomies and 568 (31%) had vaginal hysterectomies. Overall, 52% of the hysterectomies were performed for a preoperative diagnosis that could potentially be confirmed by pathologic examination. Pathologic examination actually confirmed the preoperative diagnosis of endometrial hyperplasia in 95% of the cases, cervical intraepithelial neoplasia in 89%, leiomyomas in 84%, pelvic inflammatory disease in 75%, adenomyosis in 48%, and endometriosis in 47%. Among all of the potentially confirmable diagnoses, 80% were confirmed. The remaining 48% of the women who had hysterectomies had preoperative diagnoses that were not amenable to confirmation by pathology. Most of these were for one of three diagnoses: menstrual bleeding disorders, pelvic pain, or pelvic relaxation. In 47% of these cases, pathologic examination showed leiomyoma or adenomyosis; no abnormalities were found in 38% of these cases.
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PMID:Confirmation of the preoperative diagnoses for hysterectomy. 648 93

The authors report a case of endometrial stromal sarcoma which was detected by endometrial cytology. The tumour originates either in the stroma of the endometrium or in foci of myometrial adenomyosis. It occurs most frequently in patients who are more than 60 years of age. It appears as an intra-uterine polypoid mass and causes bleeding and pelvic pain. Its incidence is difficult to establish. Endometrial cytology is highly suggestive of stromal sarcoma when smears harbour numerous atypical sarcomatous cells mixed with regular endometrial cells. Biopsies of the endometrium show decidua-like arrangements of malignant cells. Stromal sarcoma constitutes the homologous form of mesenchymal tumours of the uterus. The prognosis depends on whether local recurrences occur and on the sites of metastases in which the sarcomatous component seems to be latent with lesions that resemble adenocarcinomata . The five years salvage rate is approximately 26 to 28%. Treatment is surgical with or without irradiation.
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PMID:[Detection of endometrial stromal sarcoma using endometrial cytology. Apropos of a case]. 672 76

A 42-year-old woman presented with intermittent low back and left lower extremity pain. The blood flow and blood pool images of bone scintigraphy showed a large focus of increased activity in the right lower abdomen. Computed tomography showed an enlarged uterus displaced to the right side of the pelvis. At surgery, the uterus was found to be involved with adenomyosis. Three-phase bone scintigraphy consisting of blood flow and blood pool images over the anterior pelvis may be a valuable diagnostic aid in the evaluation of lower back or pelvic pain of a woman.
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PMID:Adenomyosis as seen on blood flow and blood pool imaging during bone scintigraphy. 803 68

This report presents an attempt to assess quantitatively the extent of adenomyotic lesions in hysterectomy specimens from women with symptoms suggesting adenomyosis (n = 14) and from women operated on for other reasons (n = 12). The specimens were cut into 5 mm-thick slices in which adenomyotic lesions were localized and counted microscopically. Nineteen uteri contained from 1 to 890 lesions. The distribution of lesions was mostly focal and patchy. More than half of the cases with adenomyotic lesions would have remained unrecognized if only the slice from the axial plane had been examined. Seventy-two per cent of the lesions were found in the posterior wall. Leiomyomas were found in 68% of the uteri with adenomyotic lesions. As adenomyotic lesions were observed with equal frequency in patients with and without pelvic pain, and as the degree of adenomyotic involvement did not correlate with complaints of pain, the significance of adenomyotic lesions as a cause of gynecological symptoms may be questioned.
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PMID:The extent and clinical significance of adenomyotic lesions in the uterine wall. A quantitative assessment. 811 Apr 46


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