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

Gynecological laparoscopic experience in a large private practice is described. Of 979 patients thus treated there have been no pregnancies. Laparoscopy has also been used to diagnose pelvic pain and abnormalities in the uterus. It has had its place in evaluating the infertile female for tubal patency. Liver biopsies can be performed by this method. This series reports the use of a double-puncture approach. Anesthesia is by Sodium Pentathol, iv muscle relaxants, oxygen and nitrous oxide. The patient is insufflanted with carbon dioxide and the pelvic cavity visualized through the laparoscope placed in the abdomen in the infra umbilical fold area. A 2nd incision is made above the pubic hairline. The tubes may either be coagulated at the cornua of the uterus and again 1.5 cm lateral to this, or coagulated and divided. Laparoscopy is an invaluable technique. It is a complicated, potentially dangerous procedure that should only be used by experienced operators.
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PMID:Gynecological laparoscopy in a large private practice. 13 39

The importance of recognizing uterine penetration by an IUD is emphasized by the following case report. 4 weeks after a spontaneous delivery, a 23-year-old woman was inserted with a Saf-T-Coil; at time of insertion, she experienced marked abdominal and pelvic pain. Pain persisted, accompanied with irregular vaginal bleeding, but there were no positive somatic findings. On examination, the threads of the IUD were properly visible, but an attempt was made to remove the device on the patient's request; it was unsuccessful. A flat film of the abdomen reported that the device was within the uterine cavity, and another attempt at IUD removal under anesthesia was unsuccessful. Hysterogram revealed the device to be extrauterine and appeared to perforate the uterus, lodged in the layers of the broad ligament. By exploratory laparotomy, the coil was found protruding through the uterine wall at the junction of the internal os and corpus. The coil was removed, and the laceration of the uterus was repaired. Fortunately, only loops of the coil were adherent to the small intestine, and no injury had occurred.
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PMID:Perforation of uterus with Saf-T-Coil. 57 Oct 33

Based on experience with 3100 tubal sterilizations and other pelviscopic operations the following conclusions are drawn: 1. Most endoscopic gynecologic operations can be performed as outpatient procedures by experienced gynecological surgeons without increased risk for patients. But not in all cases these operations can be done on an outpatient level a priori as by many american health insurance companies expected. 2. Most short operations don't need to be performed in general anaesthesia. Risks and costs can be reduced using local analgesia or "volonelgesie". 3. Such short operations can mostly be done with a single puncture laparoscope, more punctures for additional instruments should only be made if it is necessary. 4. Patients with chronic pelvic pain are able to give support in searching and finding painful organs under "volonelgesia". The treatment of these organs can be performed by injection of a local anaesthetic or in general anaesthesia. That necessitates cooperation between gynecologists, anaesthesiologists, nurses and patients which should be part of educational and training programs.
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PMID:[Ambulatory laparoscopy]. 183 16

This study sought to determine the effect of the antiprogestogen mifepristone (RU 486) on cervical resistance prior to 1st trimester termination of pregnancy. The Department of Gynecology in a Sheffield university teaching hospital was the site of this prospective, double-blind, randomized, placebo controlled study. A single dose of 600 mg mifepristone or placebo given orally 30 hours before pregnancy termination under general anesthesia was administered to 80 primigravid women 18 years of age who were between 7-13 weeks gestation. Pretreatment with mifepristone significantly reduced the amount of force required to dilate the cervix to 10 mm. In comparison to the placebo, the mean sum of the peak forces obtained with dilators 4-10 mm was reduced from 84.3 N (SD 29.7) to 46.0 N (SD 26.7). 2 women in the treated group had a cervical resistance of 100 N compared with 9 women in the placebo group (RR 0.18, 95% CI 0.04-0.89). The 8 mm dilator could be passed with less than 5 N force in 16 women (43%) in the treated group compared with none in the placebo group. Women in the active treatment group experienced more preoperative pelvic pain and vaginal bleeding but less postoperative pain. Mifepristone significantly reduces cervical resistance in the 1st trimester of pregnancy and produces minimal side effects.
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PMID:Pretreatment of the primigravid uterine cervix with mifepristone 30 h prior to termination of pregnancy: a double blind study. 191 85

Women complaining of lower abdominal and pelvic pain were tested for the presence of an ilioinguinal nerve entrapment. Forty-six women were considered to fulfill the requirements for this syndrome, five of them bilaterally. In the 51 nerves tested common findings were hyperaesthesia (88%), dysaesthesia (53%) and pain pressure at the nerve exit (75%); hypoaesthesia was rare (6%). A prerequisite for an operation was a positive result of a block with local anaesthesia. Good to excellent results of an operative approach, usually transection of the nerve, were noted after 39 procedures (76%). Some improvement was reported after six procedures whereas the operation had no effect in six others. A probable cause of the neuralgia could be found in only six women. Ilioinguinal nerve entrapment should be considered early in the differential diagnosis of lower abdominal and pelvic pain.
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PMID:Clinical findings and results of operative treatment in ilioinguinal nerve entrapment syndrome. 280 11

810 men and 594 women, sterilized at a hospital in Denmark between 1978-1982, were sent a questionnaire to determine their motivation, postoperative effects, and satisfaction. The men were vasectomized under local anesthesia on an outpatient basis. The women were sterilized either by laparoscopy, using the Falope Ring technic, or by minilaparotomy, using Pomeroy's method under general anesthesia, and either stayed overnight in hospital or were discharged on the evening of the surgery. The women tended to belong to a lower social class, 15% were unemployed, and 16% were single parents. The men tended as a group to be older. More women gave health reasons, contraceptive failure, fear of the pill's side effects, and marital problems as their reason for wanting sterilization. After sterilization, 21% of the women experienced menstrual changes and/or pelvic pain, and 8 women became pregnant. 2 of the men developed hematomas, and 4 caused pregnancies. 3% of men and 2% of women experienced a deterioration of their sex lives; 40% of men and 36% of women said their sex lives improved; and 57% of men and 62% of women said it was unchanged. 3% of men and 5% of women regretted the decision, and all felt that they had received insufficient information before surgery. The cost of a male sterilization is estimated at $60 and the cost of a female sterilization is estimated at $240. In view of the cost difference and the difference in the invasiveness of the procedure, more men should be motivated to be the sterilized partner.
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PMID:Male or female sterilization: a comparative study. 292 Aug 44

The levels of 11-deoxy-13,14-dihydro-15-keto-11 beta, 16 xi-cyclo PGE2 (bicyclo PGEM), 13,14-dihydro-15-keto PGF 2 alpha (PGFM), cortisol and prolactin were measured by radioimmunoassays in five serial plasma samples collected from fourteen patients undergoing falope ring application and three patients undergoing tubal electrocautery. Bicyclo PGEM, PGFM and cortisol levels were unchanged regardless of the type of tubal occlusion procedure or the type of anesthesia administered (7 received general and 10 local anesthesia). Prolactin levels, on the other hand, markedly increased. The increase was greatest in women that received general anesthesia. The lack of change in bicyclo PGEM and PGFM in peripheral plasma would suggest a local transfer of PGs produced by injured tubal tissue to other parts of the tube and the uterus resulting in increased contractions and pelvic pain.
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PMID:Peripheral plasma levels of prostaglandin metabolites, cortisol and prolactin in women undergoing falope ring application and tubal cautery. 346 83

In most developed countries in which therapeutic abortions are legal, termination of pregnancy is performed at between 8 and 12 weeks of gestation. Because the complication rate after this procedure rises with increasing gestation, there would be many advantages in inducing abortion before the eighth week ('menstrual induction'). With the increasing availability of highly sensitive methods of detecting human chorionic gonadotropin, pregnancy can now be diagnosed as early as 10-14 days after conception. The uterus can be surgically evacuated safely and simply by suction aspiration under local anaesthesia. However, a safe and effective method of inducing abortion by medical means would be a useful and cheaper alternative. Of the potentially useful compounds, only derivatives of prostaglandins E and F administered by vaginal pessary have so far been shown to be effective. Although the rate of haemorrhage and infection is low, 10-30% of women experience moderate side-effects of pelvic pain, diarrhoea and/or vomiting. The possibilities are discussed of reducing the incidence of side-effects by different methods of release or using prostaglandins in combination with other compounds such as antigestogens which might lower the therapeutic threshold.
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PMID:Menstrual induction: surgery versus prostaglandins. 386 9

100 patients aged 21-49 underwent endoscopic salpingectomy by monopolar electrocoagulation to obtain relief from chronic pelvic pain previously treated unsuccessfully. The new laparoscopic procedure was developed and performed at the Dept., of Obstetrics and Gynecology of the University of Passo Fundo, Brazil. General anesthesia was used in each case; endoscopic salpingectomy was performed in cases of enlarged and/or hyperemic tubes; in cases of very enlarged and/or adnexal adhesions laparotomy was done. The article describes all preoperative, operative, and postoperative procedures. Surgical time was 40-50 minutes; patients who underwent other surgery procedures at the same time had a longer hospital stay; total average hospitalization was 2.87 days. Patients were seen after 1 week, and only 67 returned for a 30-day evaluation. Main complications from the procedure included pain in 9 cases from residual CO2 used in pneumoperitoneum, and bleeding of the mesosalpinx in 1 case. The procedure failed to relieve chronic pelvic pain in 22 patients; 17 of these patients were subsequently clinically treated, 5 had an additional laparoscopic procedure, and 2 cases are still unsolved. The main advantages of this type of laparoscopic salpingectomy are reduction of length of hospital stay, and of surgery time and surgical trauma; the fact that the patient can return more rapidly to normal activities is very important.
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PMID:Endoscopic salpingectomy. 645

Uterine carcinosarcoma is a rare and rapidly fatal malignancy. The records of 49 patients with carcinosarcoma were studied; from these studies emerged a symptom complex of vaginal bleeding and abdominal or pelvic pain. Eleven patients had been previously irradiated at an average of 16.4 years before they developed uterine carcinosarcoma. Celiotomies revealed more extensive tumor than could be determined by pelvic examination under anesthesia. The majority of the patients died from local recurrence in the pelvis rather than from distant metastases. The overall 5-year survival was 6%. Celiotomies are recommended to stage carcinosarcomas and guide treatment decisions.
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PMID:Carcinosarcoma of the uterus: a 40-year experience from the state of Missouri. 671 6


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