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

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

Compared with transabdominal pelvic ultrasonography, transvaginal ultrasonography provides improved resolution for visualization of female pelvic organs, with less artifact. Transvaginal ultrasonography has superseded the transabdominal approach in many situations. Identification of uterine and adnexal masses can be facilitated with use of transvaginal ultrasonography. Transvaginal ultrasonography is also useful in the evaluation of pelvic pain and suspected pelvic inflammatory disease. Postmenopausal patients with vaginal bleeding or a palpable ovary can be triaged on the basis of transvaginal ultrasonographic findings, avoiding invasive diagnostic procedures in selected patients. Screening average-risk patients for ovarian cancer is not an accepted indication for transvaginal ultrasonography at this time.
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PMID:Transvaginal ultrasonography in nonpregnant and postmenopausal women. 862 19

Echography was prospectively performed in 345 black African female patients with pelvic masses which had been clinically detected in some cases. The women were between 11 and 65 years old. The aims of this study were to list the pelvic masses observed in black. African women, to record any potentially distinguishing features and to evaluate the sensitivity and the specificity of echography as applied here. A total of 477 masses were listed. Ovarian masses were the most frequent (56.66%) followed by uterine masses (31.45%). Most masses were benign. We observed only two cases of ovarian cancer. The sensitivity was 100% and the specificity was 97.69%. Eleven cases (2.3%) of the ultrasound diagnoses did not correspond with the final diagnoses. As for distinguishing aspects, these patients were younger than European patients-this was particularly true for patients with fibroid masses (a range of 31 to 40 years compared to 40 to 50 years). Genetic factors in these patients could explain the high rate and early appearance of fibroids. Because the diagnosis of vaginal masses is well established by clinical examination rather than by echography, this lesion was rarely observed. The most frequent clinical complaint was pelvic pain (36.94%), followed by pelvic mass impression (28.65%). We found high rates of both past histories of miscarriage and abortion (60.7%) and postabortion pelvic hematoma. The hematomas comprised 45.4% of the non-genital pelvic masses. Misdiagnosis of pyosalpinx was often a source of diagnostic error. Thus, to avoid false diagnoses of pyosalpinx in evaluating pelvic masses with a void in ultrasound, the possibility of an infectious episode should be evaluated by definitive questioning. Ultrasound examination is of value in evaluating the pelvic masses of women; however, this should be considered within the appropriate disease context.
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PMID:[The application of ultrasonography: uterovaginal and pelvic masses in black African women]. 876 47

A case of tubal pregnancy in a young and healthy woman participating in a programme of in-vitro fertilization (IVF) gestational surrogacy is reported. The gestational surrogate was the 30 year old fertile sister of a 25 year old patient affected by stage 1 ovarian cancer. After mandatory oncological consultation, the donor was recommended to prospectively undergo controlled ovarian hyperstimulation cycles for embryo banking before being treated by total hysterectomy. Available embryos were cryopreserved and after adequate endometrial preparation using artificial cycles of hormone replacement therapy, three thawed frozen embryos were transferred to the surrogate. At 17 days following embryo transfer the surrogate was noted to have a negative beta-human chorionic gonadotrophin (HCG) serum concentration. All medication was suspended and a few days later normal menstrual bleeding occurred. After 2 weeks, the beta-HCG concentrations, performed as part of routine follow-up evaluation, were showing signs of trophoblast activity (236 mIU/ml). Taking into account the stable condition of the patient, a decision was made to undertake expectant management. At 43 days after embryo transfer, a complete tubal abortion was apparently seen in the posterior cul-de-sac by ultrasound associated with a subtle and short lasting pelvic pain. We stress that this ectopic gestation was able to maintain prolonged viability in conditions of absent corpus luteum and exogenous steroid supplementation.
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PMID:Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer. 902 91

Ifosfamide has been shown to possess modest activity in patients with platinum/cyclophosphamide refractory ovarian cancer. Current standard initial chemotherapy for ovarian cancer does not include an alkylating agent (paclitaxel substituting for cyclophosphamide). To evaluate the activity of ifosfamide in patients with refractory ovarian cancer who had not previously received an alkylating agent, 21 patients with platinum/paclitaxel refractory disease were treated with the drug as a single agent (1.8 g/m2/day x 3 days, with treatment repeated every 28 days). Treatment was reasonably well tolerated in most patients, although 1 individual was removed from study secondary to neurotoxicity. One patient exhibited an objective response of measurable disease, while a second individual had a major decrease in CA-125 levels (no measurable disease present) following therapy. An additional patient experienced disappearance of severe pelvic pain following treatment but failed to meet the criteria for a partial response. We conclude that ifosfamide has modest activity in platinum/paclitaxel refractory ovarian cancer. However, the level of effectiveness does not appear to be increased in individuals who are alkylating-agent naive, compared to previously reported experience in patients with prior exposure to this class of cytotoxic drugs (10-15% response rate).
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PMID:Phase 2 trial of single agent ifosfamide/mesna in patients with platinum/paclitaxel refractory ovarian cancer who have not previously been treated with an alkylating agent. 974 Jul 4

Many US women remain unaware of the noncontraceptive health benefits associated with oral contraceptive (OC) use. An extensive body of research has established that OCs protect women against dysmenorrhea and menorrhagia, menstrual cycle irregularities, iron deficiency anemia, ectopic pregnancy, pelvic inflammatory disease, ovarian cysts, benign breast disease, and endometrial and ovarian cancer. More recent studies have suggested that OCs can be used for the treatment of acne vulgaris and the prevention of osteopenia in hypoestrogenic women. In addition to these classic and emerging noncontraceptive health benefits, many clinicians prescribe OCs for the treatment of common gynecologic conditions such as dysfunctional uterine bleeding, polycystic ovarian syndrome, premature ovarian failure, pelvic pain, mittelschmertz, endometriosis, and control of bleeding in women with blood dyscrasias. If OC acceptors are educated about these benefits, contraceptive compliance and continuation are likely to improve.
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PMID:Oral contraceptive health benefits: perception versus reality. 1034 94

A sizeable literature corroborates the multiple health benefits of oral contraceptive use. The first estrogen/progestin combination pills were marketed to treat a variety of menstrual disorders. Although currently used oral contraceptives no longer carry FDA-approved labeling for these indications, they remain important therapeutic options for a variety of gynecologic conditions. Well-established gynecologic benefits include a reduction in dysmenorrhea and menorrhagia, iron-deficiency anemia, ectopic pregnancy, and PID. Although older, higher-dose pills reduced the incidence of ovarian cysts, low-dose pills suppress follicular activity less consistently. Nevertheless, cycle-related symptoms, including functional cysts, dysmenorrhea, chronic pelvic pain, and ovulation pain (mittelschmerz), generally improve. Women with polycystic ovary syndrome note improvement in bleeding patterns and a reduction in acne and hirsutism. Symptoms from endometriosis also improve with oral contraceptive therapy. Current data suggest that oral contraceptive therapy increases bone density and that past use decreases fracture risk. Oral contraceptives also improve acne, a major health concern of young women. Oral contraceptives provide lasting reduction in the risk of two serious gynecologic malignancies--ovarian and endometrial cancer. The data with respect to ovarian cancer are compelling enough to recommend the use of oral contraceptives to women at high risk by virtue of family history, positive carrier status of the BRCA mutations, or nulliparity, even if contraception is not required. Health care providers must counsel women regarding these benefits to counteract deeply held public attitudes and misconceptions regarding oral contraceptive use. Messages should focus on topics of interest to particular groups of women. The fact that oral contraceptives increase bone mineral density and reduce ovarian cancer is of great interest to women in their forties and helps influence use and compliance in this group. In contrast, the beneficial effects of oral contraceptives on acne resonates with younger women. Getting the good news out about the benefits of oral contraceptives will enable more women to take advantage of their positive health effects.
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PMID:Health benefits of oral contraceptives. 1109 85

Around 28% of US women using contraception have accepted female sterilization. Female sterilization is a permanent contraceptive method. A surgeon usually uses a laparoscope to locate the fallopian tubes to either cut or obstruct them with clips, rings, or an electrical current under general or local anesthesia. Female sterilization is usually performed on an outpatient basis. The obstructed tubes keep sperm from fertilizing the egg. Female sterilization is very safe. The rare major complications tend to arise from general anesthesia use. The physician will discuss the risks and benefits of female sterilization before the surgery. The failure rate is 0.2-0.4%. Female sterilization might protect against ovarian cancer. Some sterilized women experience post-sterilization syndrome. Its symptoms include pelvic pain, change in sexual behavior, changes in mental health, changes in the menstrual cycle, increased blood loss, and increase in premenstrual symptoms. Most women do not suffer from this syndrome, however. It is not known whether sterilization is responsible for these changes or the changes are part of normal aging or gynecological problems. Terminating the previous contraceptive method (e.g., oral contraceptives) may contribute to the changes. Sterilization is for persons who do not want any more children. They should discuss sterilization first with their physician. They should ask the physician to explain the procedure and possible risks. Vasectomy should also be considered for couples who want no more children. Generally, due to less inhibition and more spontaneity without fear of pregnancy, sterilization improves sexual activity.
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PMID:Female sterilization. Patient update. 1228 83

Endometriosis is a common clinical disorder in women and usually presents with pelvic pain, infertility, or adnexal masses secondary to intracystic hemorrhage with the formation of an endometrioma. Endometriosis shares certain characteristics with malignant neoplasms, and malignant ovarian tumours have been documented in women with endometriosis. Endometriosis-associated ovarian cancer (EAOC) usually occurs in younger women, has favourable outcomes, and appears as either a low-grade tumour of endometrioid cell type or as a clear cell tumour. As it has been suggested that the pathologic features of "atypical endometriosis" may constitute a precancerous state, women with atypical endometriosis may be at an increased risk of developing EAOC. There are no prospective randomized trials assessing treatment regimens for EAOC. Most women receive treatment similar to other epithelial ovarian cancers. However, women with EAOC represent a subgroup of patients that may require different therapeutic options. English-language journals indexed in MEDLINE and PubMed were searched for relevant articles that evaluated the association between endometriosis and ovarian cancer, theories of pathogenesis and transformation, the clinical presentation and pathologic features of EAOC, as well as the treatment options available.
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PMID:Endometriosis-associated ovarian cancer: a clinicopathologic review. 1530 75

Endometriosis is an oestrogen-dependent disorder that can result in substantial morbidity, including pelvic pain, multiple operations, and infertility. New findings on the genetics, the possible roles of the environment and the immune system, and intrinsic abnormalities in the endometrium of affected women and secreted products of endometriotic lesions have given insight into the pathogenesis of this disorder and serve as the background for new treatments for disease-associated pain and infertility. Affected women are at higher risk than the general female population of developing ovarian cancer, and they also may be at increased risk of breast and other cancers as well as autoimmune and atopic disorders. Clinicians should assess and follow up affected women for these and other associated disorders. There will probably be a new repertoire of approaches for treatment and perhaps cure of this enigmatic disorder in the near future.
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PMID:Endometriosis. 1554 53


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