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

A 42-year-old woman with recurrent bilateral endometrial ovarian cystoma presented with fever and pelvic pain caused by a tubo-ovarian abscess (TOA), which was resistant to several varieties of intravenous and oral antibiotics for 2 weeks (Case 1). Computed tomography (CT)-guided diagnostic aspiration for a rapid enlarged right ovarian cystoma through a transabdominal route confirmed that it had developed into a TOA. Subsequent percutaneous abscess drainage (PAD) and irrigation for 3 days were successful. One-year follow-up revealed no recurrence of TOA. A 58-year-old woman with recurrent cervical cancer after external radiation therapy (RT) presented with fever, confusion and tremor caused by pyometra (Case 2). Since transvaginal drainage was impossible due to cervical os obstruction, the patient had undergone CT-guided transabdominal PAD and irrigation for a month. Thereafter, the clinical findings improved and a tracheloplasty was performed to prevent recurrence. CT-guided PAD may be a useful treatment option for gynecologic abscess as a diagnostic aspiration, a temporizing procedure until surgery, or an alternative surgery.
Hiroshima J Med Sci 2006 Sep
PMID:Gynecologic abscess: CT-guided percutaneous drainage. 1699 96

Inflammatory disease of the prostate and distal genital tract is emerging as a major health problem because it is estimated that up to 15% of adult men may be affected at some point in their lives. Clinically, the diagnosis of "prostatitis" refers to multiple disorders that cause pelvic pain and discomfort, ranging from acute bacterial infection to complex conditions that may not necessarily be caused by prostatic inflammation. Because the traditional etiology-based classification system did not always correlate with symptoms and therapeutic efficacy, a new classification of prostatitis has been suggested by the National Institutes of Health. New imaging techniques such as high-resolution transrectal ultrasonography (TRUS) and MR imaging provide exquisite anatomic detail and often play a crucial role in the evaluation of these patients.
Radiol Clin North Am 2006 Sep
PMID:Inflammatory disorders of the prostate and the distal genital tract. 1703 Feb 19

The intrauterine devices (IUD) is a contraceptive method largely used as an effective, safe and economic method of contraception; IUD efficacy is demonstrated to be about 97%, and copper IUD contraceptive failure frequency is about 0.8% for the first year of use, and this is about 0.1-0.2% for the progestin IUD. IUD benefits are different; it produces a well-defined contraceptive efficacy for long time, is useful for sexual activity and is rather free from common problems. However, IUD utilization is associated with an increasing risk of pelvic infection (0.5%) in the 8 years from initial use, and the common risk of pelvic inflammatory infection (PID) is about one to two cases per year; this risk, for copper IUD users, is 0.2-0.5% per year. The possible side effects of IUD use are: pelvic pain, irregular meshes, infections, bleeding and uterine perforation; we report a uterine perforation due to IUD migration in the Retzius space, diagnosed on transvaginal ultrasonography, confirmed on CT and removed by laparoscopy. In any case, the IUD remains the mainstay of family planning measures in developing countries but, unfortunately, its association with possible serious complications, change the cost-benefit link and restrict its utilization by a large part of the general population.
Eur J Contracept Reprod Health Care 2006 Sep
PMID:The intrauterine device in modern contraception: Still an actuality? 1705 50

Interstitial cystitis (IC) is a chronic bladder inflammatory disease of unknown etiology that is often regarded as a neurogenic cystitis. IC is associated with urothelial lesions, voiding dysfunction, and pain in the pelvic/perineal area, and diet can exacerbate IC symptoms. In this study, we used a murine neurogenic cystitis model to investigate the development of pelvic pain behavior. Neurogenic cystitis was induced by the injection of Bartha's strain of pseudorabies virus (PRV) into the abductor caudalis dorsalis tail base muscle of female C57BL/6J mice. Infectious PRV virions were isolated only from the spinal cord, confirming the centrally mediated nature of this neurogenic cystitis model. Pelvic pain was assessed using von Frey filament stimulation to the pelvic region, and mice infected with PRV developed progressive pelvic pain. Pelvic pain was alleviated by 2% lidocaine instillation into either the bladder or the colon but not following lidocaine instillation into the uterus. The bladders of PRV-infected mice showed markers of inflammation and increased vascular permeability compared with controls. In contrast, colon histology was normal and vascular permeability was unchanged, suggesting that development of pelvic pain was due only to bladder inflammation. Bladder-induced pelvic pain was also exacerbated by colonic administration of a subthreshold dose of capsaicin. These data indicate organ cross talk in pelvic pain and modulation of pain responses by visceral inputs distinct from the inflamed site. Furthermore, these data suggest a mechanism by which dietary modification benefits pelvic pain symptoms.
Am J Physiol Regul Integr Comp Physiol 2007 Sep
PMID:Organ cross talk modulates pelvic pain. 1762 30

Endometriosis, defined by the development of endometrial tissue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are estrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis.
Gynecol Obstet Fertil 2007 Sep
PMID:[Pathogenesis of endometriosis]. 1771 73

Depression may relapse during pregnancy in women with a history of depression. Treatments which may be effective for mothers may be harmful to the fetus. Electroconvulsive therapy (ECT) has been widely used in patients with different medical illnesses. It is safe, and its efficacy is well established. In our example, the patient was a 34-year-old white woman who was at 13 weeks' gestation at the time of admission to our hospital. Over a 1-month period, the patient underwent a total of 13 ECTs (3 times a week) and 3 more ECTs monthly until the birth of her child. After 10th ECT, the Hamilton Depression Rating Scale score was reduced from 33 before ECT to 7. After 3 more weekly ECTs, the patient was discharged from the hospital with a Hamilton Depression Rating Scale score of 3. The patient was instructed to continue maintenance treatment with ECT sessions monthly. Except for pelvic pain and transient fetal arrhythmias, no complications were reported. Thus, acute and maintenance ECT may be the choice of treatment in severely depressed or psychotic pregnant patients.
J ECT 2007 Sep
PMID:Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient. 1780 97

Advances in technology and improved availability have led to increased use of computed tomography (CT) and magnetic resonance imaging (MRI) to evaluate women presenting to the emergency department or to their primary care provider with abdominal and/or pelvic pain. Computed tomographic examinations are often performed to evaluate the presence of appendicitis or renal stone disease. However, gynecologic abnormalities are frequently identified on these examinations. Although ultrasound remains the primary modality by which complaints specific to the pelvis are evaluated, in many instances, CT and MRI imaging occurs before sonographic evaluation.Historically, because of cost, radiation exposure, and relative ease of use, ultrasound examinations have preceded all other imaging modalities when evaluating pelvic disorders. However, as CT and MRI technology have improved, their use in diagnosing causes of pelvic pain has become equal to that of ultrasound. In some cases, primarily because of historic comfort with sonographic evaluation, gynecologic abnormalities originally diagnosed on CT or MRI may be immediately and unnecessarily reevaluated by ultrasound. For a woman in her reproductive years, the most common adnexal masses are physiological cysts, endometriomas, and cystic teratomas. Although lesions are often asymptomatic and incidentally detected, they can present with pain, and they increase the risk of ovarian torsion. Common causes of chronic pelvic pain in this population include leiomyomata and adenomyosis. In postmenopausal women, ovarian carcinoma, which often does not present clinically until a late stage, has to be included in the differential diagnosis of adnexal masses. If a gynecologic pathology is discovered on CT or MRI, an immediate follow-up ultrasound need not be pursued if the lesion can be characterized as benign, needing immediate surgical intervention, or a variant of normal anatomy. If, on the other hand, findings demonstrate a mass that either is uncharacteristic of a benign lesion, has an indeterminate risk for malignancy, or demonstrates suspicious characteristics for malignancy (such as enhancing mural nodules), further evaluation by serial ultrasound, biochemical marker, and/or CT or MRI is warranted. The purpose of this review is to present a series of commonly encountered gynecologic abnormalities with either CT or MR to make radiologists more familiar with gynecologic pathology on CT and MRI.
Ultrasound Q 2007 Sep
PMID:Computed tomographic and magnetic resonance features of gynecologic abnormalities in women presenting with acute or chronic abdominal pain. 1780 65

Botulinum toxin type A (BTX-A) has been used to treat urethral and prostatic diseases (off-label uses). Injection of BTX-A into the external sphincter of patients with detrusor external sphincter dyssynergia has been shown to successfully lower postvoid residual volumes and detrusor pressures. Average efficacy is 3 to 4 months, but long-term effects on detrusor leak point pressures or renal function are unknown. Injection of BTX-A into the prostate has shown promising short-term results (< or = 12 months) in improving the symptoms, postvoid residual volumes, maximal urinary flow rates, and prostate sizes in patients with benign prostatic hyperplasia. The mechanisms of action and long-term durability of this treatment modality are unknown. Evidence supporting the use of BTX-A in treating detrusor hypocontractility, pelvic floor dysfunction, postpubovaginal sling retention, urethral stricture, prostatitis, and chronic pelvic pain syndrome in men is preliminary and deserves further evaluation.
Curr Urol Rep 2007 Sep
PMID:Hitting below the belt (bladder): botulinum treatment of urethral and prostate disorders. 1788 Aug 32

In women, clinical studies suggest that pain syndromes such as irritable bowel syndrome and interstitial cystitis, which are associated with visceral hyperalgesia, are often comorbid with endometriosis and chronic pelvic pain. One of the possible explanations for this phenomenon is viscerovisceral cross-sensitization, in which increased nociceptive input from an inflamed pelvic organ sensitizes neurons that receive convergent input to the same dorsal root ganglion (DRG) from an unaffected visceral organ. Nociception induces up-regulation of cellular mechanisms such as phosphorylated extracellular signal-regulated kinase (pERK) and substance P (SP), neurotransmitters associated with induced pain sensation. The purpose of this study was to determine, in a rodent model, whether uterine inflammation increased the number of pERK- and SP-positive neurons that received input from both the uterus and the colon. Cell bodies of colonic and uterine DRG were retrogradely labeled with fluorescent tracer dyes microinjected into the colon/rectum and into the uterus. Ganglia were harvested for fluorescent microscopy to identify positively stained neurons. Approximately 6% of neurons were colon specific and 10% uterus specific. Among these uterus- or colon-specific neurons, up to 3-5% of DRG neurons in the lumbosacral neurons (L1-S3 levels) received input from both visceral organs. Uterine inflammation increased the number of pERK- and SP-immunoreactive DRG neurons innervating specifically colon, or innervating specifically uterus, and those innervating both organs. These results suggest that a localized inflammation activates primary visceral afferents, regardless of whether they innervate the affected organ. This visceral sensory integration in the DRG may underlie the observed comorbidity of female pelvic pain syndromes.
J Neurosci Res 2008 Sep
PMID:Inflammation in the uterus induces phosphorylated extracellular signal-regulated kinase and substance P immunoreactivity in dorsal root ganglia neurons innervating both uterus and colon in rats. 1847 47

Cross-organ sensitization between the uterus and the lower urinary tract (LUT) underlies the high concurrence of pelvic pain syndrome and LUT dysfunctions, and yet the role of gonadal steroids is still unknown. We tested the hypothesis that cross-organ sensitization on pelvic-urethra reflex activity caused by uterine capsaicin instillation is estrous cycle dependent. When compared with the baseline reflex activity (1.00 +/- 0.00 spikes/stimulation), uterine capsaicin instillation significantly increased reflex activity (45.42 +/- 9.13 spikes/stimulation, P < 0.01, n = 7) that was corroborated by an increase in phosphorylated NMDA NR2B (P < 0.05, n = 4) but not NR2A subunit (P > 0.05, n = 4) expression. Both intrauterine pretreatment with capsazepine (5.02 +/- 2.11 spikes/stimulation, P < 0.01, n = 7) and an intrathecal injection of AP5 (3.21 +/- 0.83 spikes/stimulation, P < 0.01, n = 7) abolished the capsaicin-induced cross-organ sensitization and the increment in the phosphorylated NR2B level (P < 0.05, n = 4). The degrees of the cross-organ sensitization increased in a dose-dependent manner with the concentration of instilled capsaicin from 100 to 300 microM in both the proestrus and metestrus stages, whereas they weakened when the concentrations were higher than 1,000 microM. Moreover, the cross-organ sensitization caused by the uterine capsaicin instillation increased significantly in the rats during the proestrus stage when compared with the metestrus stage (P < 0.01, n = 7). These results suggest that estrogen levels might modulate the cross-organ sensitization between the uterus and the urethra and underlie the high concurrence of pelvic pain syndrome and LUT dysfunctions.
Am J Physiol Endocrinol Metab 2008 Sep
PMID:Estrous cycle variation of TRPV1-mediated cross-organ sensitization between uterus and NMDA-dependent pelvic-urethra reflex activity. 1857 91


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