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

An open-label randomized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m. depot injection for the relief of chronic pelvic pain in women with endometriosis. A total of 30 women aged 18-38 years were allocated to the 3-monthly depot arm (n = 15) or to the monthly depot arm (n = 15) after laparoscopic diagnosis of pelvic endometriosis. Mean (SD) deep dyspareunia scores according to a 0-3 point verbal rating scale decreased from 1.8 (0.9) at baseline to 1.3 (0.7) at the end of treatment in the 3-monthly depot group and from 2.1 (1.2) to 1.3 (0.7) in the monthly depot group. Corresponding values in non-menstrual pain scores fell from 2.1 (0.6) to 1.1 (0.3), and from 2.1 (0.8) to 1.2 (0.4) respectively, without statistically significant differences between the groups. Serum luteinizing hormone (LH) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values, without differences between the groups. The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone (FSH) levels with respect to the 3-monthly preparation. Mean (SD) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 (25.1) and 12.2 (9.3) in the 3-monthly depot group and 29.0 (22.7) and 13.1 (15.3) in the monthly depot group (paired t-test, P < 0.05). Mean percentage decrease in lumbar spine bone mineral density was 5.2% in the former and 4.9% in the latter subjects. In the 3-monthly depot group, 13 women graded the tolerability of their treatment schedule as "good' compared with seven in the monthly depot group (chi 2 = 5.40, P = 0.02).
Hum Reprod 1996 Dec
PMID:Leuprolide in a 3-monthly versus a monthly depot formulation for the treatment of symptomatic endometriosis: a pilot study. 902 80

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.
Hum Reprod 1996 Dec
PMID:Spontaneous resolution of ectopic pregnancy in a surrogate after oocyte donation and frozen embryo transfer. 902 91

The performance of the presacral neurectomy with a standard laparoscopic approach utilizing a Contact-tip Nd: YAG Laser with the GRP6 sapphire scalpel tip is feasible, effective, and safe. Patients suffering from severe disabling dysmenorrhea have had complete relief of their symptoms with up to an eighteen-month follow up. The resection of the presacral nerve plexus is associated with significant relief of symptoms. The pain impulses from the uterus which travel through the inferior hypogastric plexus into the intermediate hypogastric plexus and the superior hypogastric plexus can be interrupted by the performance of this procedure in a laparoscopic manner. The intermediate hypogastric plexus which is composed of two or three trunks lying on the vertebral body of L5 is the most appropriate place for the resection. The presacral neurectomy is not appropriate treatment for relief of lateral or back pain. Patients with midline pain will experience significant relief by the use of this procedure. In conclusion, the performance of the presacral neurectomy utilizing the Contact-tip Nd: YAG Laser with GRP6 sapphire tip combined with other conservative surgery for resection of endometriosis does offer relief of dysmenorrhea and other pelvic pain and is an alternative for women wishing further childbearing and those who do not wish a hysterectomy. Twenty women in whom this procedure has been performed have reported a decrease in pain level from 9.4 (scale of 0 = no pain to 10 = disabling pain) to 2.0 with follow up to 18 months. There have been no complications with this procedure.
Keio J Med 1996 Dec
PMID:Laparoscopic presacral neurectomy utilizing contact-tip Nd: YAG laser. 902 52

In order to evaluate the contribution of tubal spasm to pelvic pain following laparoscopic sterilisation, we have studied the effect of glycopyrrolate, an anticholinergic agent with antispasmodic properties, on 60 ASA 1 and 2 patients presenting as day-cases for laparoscopic sterilisation using Filshie clips. In a randomised, double-blind, controlled trial, patients received either glycopyrrolate 0.3 mg or saline intravenously prior to induction of anaesthesia. Compared with the control group, patients receiving glycopyrrolate had significantly reduced immediate postoperative pain scores (p < 0.02) and required significantly less postoperative morphine (p < 0.01). Nausea, vomiting and anti-emetic requirements were also reduced though not significantly. We conclude that glycopyrrolate 0.3 mg at induction of anaesthesia is an effective method of improving the quality of recovery after day-case laparoscopic sterilisation using clips.
Anaesthesia 1996 Dec
PMID:The effect of glycopyrrolate on postoperative pain and analgesic requirements following laparoscopic sterilisation. 903 63

Endometriosis is relatively frequent in females of menstrual age and consists in the appearance of active endometrial tissue at site other than uterine cavity. Endometrial tissue has been described to colonise the urinary system, particularly the urinary bladder. The most common clinical features of vesical endometriosis are urgency and frequency, hypogastric pain and hematuria. We report on a case of vesical endometriosis whose presenting features were dysmenorrhea, stranguria and pelvic pain. MRI and CT did not provide different or more precise information than ultrasound scan: these findings were indistinguishable from an intrauterine lesion. On the contrary endovaginal sonography was more sensitivity than MRI and CT. Cystoscopy was negative. Nondiagnostic laparoscopy was performed. Patient underwent laparotomy and partial cystectomy. Histopatological findings demonstrated an endometriosis of the muscle layer of the bladder. The rarity of this condition prompted us to report on the problems encountered in making the differential diagnosis.
Arch Ital Urol Androl 1996 Dec
PMID:[Echographic, MRI and CT features in a case of bladder endometriosis]. 916 60

Over the last 10 years, the most significant advancement in imaging of the acute abdomen has been the development of helical CT imaging. Rapid breath-hold imaging and improved intravascular opacification have enabled radiologists to obtain volumetric data that can be viewed in smaller slice increments. Helical data can also be analyzed utilizing multiplanar and three-dimensional techniques. With its proven ability to diagnose a wide variety of conditions, CT remains the diagnostic modality of choice for imaging the surgical abdomen. There have been considerable improvements in image resolution in US with improvements in transducer technology. Ultrasonography often serves as the first study in evaluating the pediatric or female patient with right lower quadrant or pelvic pain. Computed tomography may be necessary if US is not diagnostic. Despite these technical advances, plain film radiography should be the first imaging study for suspected cases of bowel perforation or obstruction. Magnetic resonance imaging continues to evolve, with improvements in hardware and software design that allow for faster imaging, but current levels of availability in the acute setting preclude its wider use. Whereas further imaging is not necessary for patients presenting with classic signs and symptoms of various acute abdominal diseases, the atypical patient often requires careful diagnostic imaging. Close consultation between the radiologist and surgeon leads to studies appropriately tailored to meet the diagnostic challenge at hand.
Surg Clin North Am 1997 Dec
PMID:Advances in imaging of the acute abdomen. 943 38

Subtotal hysterectomy has been advocated in recent years as an alternative to total abdominal hysterectomy. In leaving behind the uterine cervix, this remnant can be at risk for dysplastic and neoplastic changes. The development of cancer of the cervix after subtotal hysterectomy is considered low and is usually of an epithelial origin. Carcinosarcomas of the uterine corpus are infrequent aggressive tumors with a very poor prognosis. This malignancy of the cervix has been rarely reported. We present a case of cervical carcinosarcoma occurring in the remaining lower uterine segment and cervix following subtotal hysterectomy for pelvic pain.
Gynecol Oncol 1997 Dec
PMID:Cervical carcinosarcoma occurring after subtotal hysterectomy, a case report. 944 82

This open multicenter study was performed in 20 hospital gynecological units in the UK. The effects of 600 mg oral mifepristone as pretreatment to vaginal prostaglandin induction of second trimester abortion was studied in 267 women. The primary efficacy variable was the abortion induction interval, defined as the time taken to expel the fetus from the time of administration of the first prostaglandin pessary. Induction was commenced 36 to 48 hours following mifepristone intake. The mean abortion induction interval was 7 h. A total of 81.9% of women aborted within 12 h. There was a significant relationship between abortion induction interval and age of gestation, and a significant inverse relationship between abortion induction interval and parity. Vomiting, pelvic pain, and nausea were the most frequently reported adverse events. Two patients required transfusion and one patient with a uterine scar from a previous cesarean section suffered a ruptured uterus and hysterotomy.
Contraception 1997 Dec
PMID:Oral mifepristone 600 mg and vaginal gemeprost for mid-trimester induction of abortion. An open multicenter study. UK Multicenter Study Group. 949 69

A correct classification of female pelvic pain originating from gynaecological disorders is essential if the most appropriate therapy is to be chosen. Certain types of non-steroidal anti-inflammatory drugs and oral contraceptives reduce the production of prostaglandins, which are responsible in large part for primary dysmenorrhoea. Oestroprogestin formulations become the drugs of choice if the patient also requests contraception. Secondary dysmenorrhoea and chronic pelvic pain may require combined medical and surgical treatment. Oral contraceptives can also be used as post-treatment agents in endometriosis, one of the most common causes of pelvic pain, whereas more specific compounds (GnRH-analogues and Danazol) are used to produce anatomical regression of endometriosis.
Cephalalgia 1997 Dec
PMID:Chronic pelvic pain: oral contraceptives and non-steroidal anti-inflammatory compounds. 949 75

Chronic pelvic pain and endometriosis remain two of the most perplexing problems in gynecology. In some women with both conditions, endometriosis might not be the cause of their pain. The problem is determining when the pain is caused by endometriosis. On the basis of clinical studies, I suggest three criteria that should be met before attributing chronic pelvic pain to endometriosis. First, the pelvic pain should be cyclic because endometriosis is a hormonally responsive disease. Second, endometriosis should be diagnosed surgically to avoid overdiagnosing this condition. Finally, medical or surgical treatment of endometriosis should result in prolonged pain relief. Application of these evidence-based criteria reminds us that endometriosis often can be asymptomatic, even in some women with chronic pelvic pain. These criteria might help gynecologists determine the women for whom surgical therapy will resolve the pain; however, only prospective evaluation can determine their ultimate usefulness.
Obstet Gynecol 1998 Dec
PMID:Criteria that indicate endometriosis is the cause of chronic pelvic pain. 1007 3


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