Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030794 (pelvic pain)
 4,056 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstetrician-gynecologists at St. James's University Hospital in Leeds, England, compared various cervical ripening agents in 64 18-39 year old women presenting for first trimester abortion. The women either received oral administration of a placebo or RU-486 or had a laminaria tent or gemeprost vaginal suppository inserted into the endocervical canal or the posterior fornix, respectively. All cervical ripening agents dilated the cervix better than the placebo (p .02). They also greatly diminished the force needed (50-65%) to dilate the cervix to 8 mm Hegar (p .001). The laminaria tent resulted in greater initial cervical dilatation than gemeprost or RU-486, regardless of parity (p .05), but the total force was not significantly different between the 3 groups. 71% of the women who received the gemeprost vaginal suppository had pelvic pain and regular painful uterine contractions. The pain was so intense in 33.3% of them (20% of all gemeprost patients) that health workers had to inject opiate analgesia intramuscularly. 81% of laminaria tent patients experienced menstrual type pains. A significantly lower percentage of RU-486 patients (33%) suffered mild pelvic discomfort than the gemeprost (p = .03) and laminaria tent groups (p = .001). None of the women in the placebo, laminaria tent, and RU-486 groups received analgesia. 40-41% of women in the 3 treatment groups experienced preoperative vaginal bleeding. Since RU-486 patients suffered minimal side effects and insertion of laminaria tents is inconvenient and potentially damaging (e.g. iatrogenic complications of fistulas, dumb belling, and tent fracture), the physicians concluded that RU-486 is the easiest cervical priming agent to administer and is as effective as the other agents.
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PMID:Should we use prostaglandins, tents or progesterone antagonists for cervical ripening before first trimester abortion? 145 95

A study of 153 women with persistent pelvic pain and pelvic joint instability (PPPJI) following parturition, revealed that the women differed from the controls by a significantly lower age at menarche. Precocious puberty is associated with a fibrous dysplasia which resembles that seen in some PPPJI women patients at operations. Precocious puberty is known to be associated with hypothalamic dysfunction. Following cessation of lactation, 70 of 153 women did suffer galactorrhea and breast discomfort, suggesting a possible affection of the hypothalamic-pituitary system. Age at menarche was higher in users of oral contraceptives (OC) than in non-users, but onset of PPPJI was significantly earlier by gestation, and galactorrhea, and breast discomfort more frequent (60% affected as compared to 30% of non-users), suggesting that use of OC affects the hypothalamus in a manner similar to that associated with very early puberty. The widespread use of contraceptives is important if it truly leads to an increased proportion of PPPJI among reproducing women. Onset of puberty, controlled by the hypothalamus, coincides with the final step in brain development--elimination of some 40% of neuronal synapses. Age at puberty has declined by some 4 years in 100 years, and it is still falling. It cannot be excluded that in some very early maturers, redundancy of neuronal synapses persists, and that this is associated with hypothalamic dysfunction.
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PMID:Is persistent pelvic pain and pelvic joint instability associated with early menarche and with oral contraceptives? 161 66

Thirty-one patients with primary dysmenorrhoea were treated in a double-blind, six-period, cross-over clinical trial with tiaprofenic acid, naproxen sodium and a placebo in randomized order, each for 2 consecutive cycles. Complete disappearance of the symptoms or pronounced therapeutic effects were obtained with tiaprofenic acid, naproxen sodium and the placebo in 74%, 65% and 35% of cases, respectively, while these treatments were ineffective in 3%, 6% and 38% of cases, respectively. Tiaprofenic acid was superior to the placebo for relieving pelvic pain and overall discomfort and for reducing the need for bed-rest. Naproxen sodium compared favourably with the placebo with respect to pelvic pain and overall discomfort. The effects of tiaprofenic acid and naproxen sodium were not significantly different. Tiaprofenic acid had no side-effects, whereas tiredness was experienced in 3 cases of naproxen sodium treatment. The results indicate that tiaprofenic acid is a useful alternative for the treatment of primary dysmenorrhoea.
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PMID:Tiaprofenic acid in the treatment of primary dysmenorrhoea. 353 72

A specially designed compression plate has been used in symphysiodesis for chronic symphysiolysis with pelvic pain and discomfort suspected to be due to pelvic instability. Eight patients have been operated with this technique, and stable symphysiodesis was achieved in all. No signs of plate loosening were observed in any case.
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PMID:Symphysiodesis with a new compression plate. 674 82

The aim of this study is to obtain an actual survey of diagnostic and therapeutic procedures of endometriosis (EMT) in gynaecological practice in West Germany. A questionnaire was sent to 6,700 gynaecologist; 1,364 responded. Approximately 5% of all the patients in daily practice have symptoms related to EMT. Most of the patients are in their twenties. The common clinical symptoms of EMT are dysmenorrhoea (91.8%), infertility (79.7%), pelvic pain (70.9%), menstrual irregularity (46.3%), dyspareunia (21.8%) and painful defaecation (12.8%). The diagnostic standard is laparoscopy, but there are many doctors diagnosing EMT also by means of gynaecological examination (23.8%) or ultrasound (21.3%) - especially in young patients. Hormones are the first choice of therapy. Progestins and danazol are preferred. GnRH-analogues are only used by a smaller proportion of gynaecologists - particularly in infertile patients. Surgical procedures with or without hormonal suppression are another line of therapy adapted by 70.9% of the gynaecologists, which are often preferred in infertile patients. Psychological problems in EMT are caused by the uncertainties between EMT and infertility and by the difficulties between physiological menstrual discomfort and pain caused by EMT. 68.5% of the gynaecologists suggest that more information beyond diagnosis and therapy should be given to the patients. Promotion of self-supporting groups should be encouraged by the doctors.
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PMID:[Endometriosis--diagnosis and therapy. Results of a current survey of 6,700 gynecologists]. 858 85

The aim was to prospectively study the relationship between pelvic pain of otherwise unknown origin and laxity in the posterior vaginal fornix. Twenty-eight patients with negative laparoscopy findings, lower abdominal pain and laxity in the posterior ligamentous supports of the uterus underwent surgical approximation of their uterosacral ligaments. At 3-month review, 85% of patients were cured, and at 12 months, 70%. Nonorganic pelvic pain has frequently been attributed to psychological factors. However, the results suggest that this may be a T12-L1 parasympathetic pain referred to the lower abdomen, perhaps due to the force of gravity stimulating pain nerves unable to be supported by the lax uterosacral ligaments in which they are contained. It was concluded that laxity in the posterior ligaments of the vagina should first be excluded before referring patients with pelvic floor discomfort or pain for psychiatric care.
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PMID:Severe chronic pelvic pain in women may be caused by ligamentous laxity in the posterior fornix of the vagina. 888 67

Current concepts and basic principles of neurogastroenterology in relation to functional gastrointestinal disorders are reviewed. Neurogastroenterology is emphasized as a new and advancing subspecialty of clinical gastroenterology and digestive science. As such, it embraces the investigative sciences dealing with functions, malfunctions, and malformations in the brain and spinal cord, and the sympathetic, parasympathetic and enteric divisions of the autonomic innervation of the digestive tract. Somatomotor systems are included insofar as pharyngeal phases of swallowing and pelvic floor involvement in defecation, continence, and pelvic pain are concerned. Inclusion of basic physiology of smooth muscle, mucosal epithelium, and the enteric immune system in the neurogastroenterologic domain relates to requirements for compatibility with neural control mechanisms. Psychologic and psychiatric relations to functional gastrointestinal disorders are included because they are significant components of neurogastroenterology, especially in relation to projections of discomfort and pain to the digestive tract.
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PMID:Fundamentals of neurogastroenterology. 1045 39

The purpose of this report is to evaluate the association between lower genital tract inflammation and objectively diagnosed endometritis. We analyzed the first 157 patients enrolled in the PEACH study, a multicenter randomized clinical trial designed to compare the effectiveness of outpatient and inpatient therapy for PID. Women less than 38 years of age, who presented with a history of pelvic discomfort for 30 days or less and who were found to have pelvic organ tenderness (uterine or adnexal tenderness) on bimanual examination, were initially invited to participate. After recruitment of the first 58 patients (group 1) we added the presence of leukorrhea, mucopurulent cervicitis, or untreated positive test for N. gonorrhoeae or C. trachomatis to the inclusion criteria (group 2, N = 99). We compared rates of endometritis in the two groups and calculated the sensitivity, specificity, and predicted values of the presence of white blood cells in the vaginal wet preparation. The rate of upper genital tract infection in group 1 was 46.5% (27/58) compared to 49.5% (49/99) in group 2. Microbiologic evidence of either N. gonorrhoeae or C. trachomatis increased from 22.4% in group 1 to 38.3% in group 2. The presence of vaginal white blood cells or mucopus has a high sensitivity (88.9%), but a low specificity (19.4%) for the diagnosis of upper genital-tract infection. Assessment of the lower genital tract for evidence of infection or inflammation is a valuable component of the diagnostic evaluation of pelvic inflammatory disease. The presence of either mucopus or vaginal white blood cells is a highly sensitive test for endometritis in patients with pelvic pain and tenderness.
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PMID:Association of lower genital tract inflammation with objective evidence of endometritis. 1080 62

Objective: Laparoscopy, while routinely performed in the outpatient setting, is associated with considerable postoperative discomfort. Continuing pain experienced after surgery is due to post-traumatic functional changes in both the peripheral nervous system (hyperalgesia) and the central nervous system (hyperexcitability). Local anesthetic infiltrated at time of incision closure has limited effect because hypersensitivity and hyperexcitability have already developed. Preemptive analgesia refers to the blockage of afferent nerve fibers, before painful stimulus, which prevents or reduces subsequent pain even beyond the effect of the block. We tested the hypothesis that local anesthetic administered before skin incision, an example of preemptive analgesia, reduces postoperative pain for women undergoing laparoscopy, as compared to postincisional local anesthetic or placebo.Materials and Methods: Seventy-five patients undergoing laparoscopy for pelvic pain, infertility, or sterilization were randomized to one of three treatment groups. Two 10 mL syringes, labeled "Pre" and "Post," were prepared at time of laparoscopy and contents blinded to anesthesiology, surgeons, and the patient. For treatment group A (preincisional), the presyringe contained 10 mL of 0.5% bupivacaine (50 mg) and the postsyringe contained 10 mL of 0.9% saline. For treatment group B (postincisional) patients, the presyringe contained 10 mL of 0.9% saline and the postsyringe contained 10 mL of 0.5% bupivacaine. For treatment group C (control) patients, both syringes contained 10 mL of 0.9% saline. All patients underwent a standardized general anesthetic induction and maintenance. After the patient was properly positioned and draped, 5 mL of the presyringe was infiltrated into the umbilical incision site. The remaining 5 mL was infiltrated in a similar fashion at the suprapubic trocar placement site. After laparoscopy and immediately prior to closure of the incisions, the postsyringe was infiltrated into both incisions above and below the fascia in a diamond-shaped pattern.For postoperative pain, oral ibuprofen was given, as needed, with 30 mg intramuscular ketorolac tromethamine given if the patient was unable to tolerate oral pain medication. All patients were discharged with 800 mg ibuprofen tablets and asked to take as needed for pain relief. The modified McGill Present Pain Intensity scale was evaluated by nurse interview at 30 minutes, 2 hours, 4 hours, and 24 hours after incision closure. Statistical analysis was accomplished using chi(2) tests for proportional data and ANOVA for pain scores and other parametric data.Results: Fifty-seven patients completed the study protocol. Age, weight, height, race, indication, and operating time did not vary significantly between the three groups. Patients in treatment group A (n = 20) could tolerate a significantly longer time delay to their first analgesic medication. (A: 486.7 +/- 435.3 minutes; B: 229.4 +/- 330.4; C: 143.1 +/- 156.7, P <.001). Their 24-hour pain scores were also significantly lower than either treatment group B (n = 19) or C (n = 18) (A: 0.50 +/- 0.9; B: 1.61 +/- 1.3; C: 1.2 +/- 1.2, P <.02). Although statistical significance was not reached, patients in treatment group A required less total doses of analgesic than either treatment group B or C (A: 2.4 +/- 1.6 doses; B: 3.1 +/- 1.5; C: 3.1 +/- 1.2, P =.07).Conclusions: Preemptive local anesthesia in patients undergoing laparoscopy results in a longer time before analgesic is required and significantly lower pain 24 hours after surgery.
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PMID:A randomized blinded trial of preemptive local anesthesia in laparoscopy. 1083 76

Perihepatic adhesions between the liver capsule and the diaphragm or the anterior peritoneal surface characterizes Fitz-Hugh-Curtis syndrome (FHCS). FHCS is an extrapelvic manifestation of pelvic inflammatory disease and usually refractory to medical treatment and surgical intervention. With the increased incidence of pelvic inflammatory disease, chronic pelvic pain and sequalae of the process are becoming more common. Herein, we report 3 patients with pelvic inflammatory disease in whom medical treatment failed initially and FHCS was diagnosed via laparoscopy. Laparoscopic lysis of pelvic and perihepatic adhesions, irrigation of the abdomino-pelvic cavity, and antibiotics treatment after surgery successfully relieved these patients' symptoms. FHCS is not a new syndrome but most gynecologists might neglect this condition. Laparoscopy is a less invasive procedure than exploratory laparotomy. We recommend laparoscopy in patients with lower abdominal and right upper quadrant discomfort when other organic disease has been ruled out and medical treatment has failed to relieve symptoms.
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PMID:Laparoscopic diagnosis and management of Fitz-Hugh-Curtis syndrome: report of three cases. 1151 71


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