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

Sclerozing stromal tumor of the ovary is an extremely rare neoplasm occurring predominantly in the second and third decades of life. Most patients have menstrual irregularities and pelvic pain. Infertility and endometrial pathology have also been described. A 34-year-old woman presented with hirsutism and oligomenorrhea of three months duration. Ultrasound examination showed a heterogeneous right ovarian tumor consisting of predominantly solid tissue with several loculated cysts. On T2-weighted pelvic MR images, signal intensities of the cystic components were high and those of the solid components were heterogeneous, ranging from intermediate-high to high. Dynamic MRI marked early enhancement of solid components in the right ovary. The specimen obtained from endometrial curettage showed proliferative endometrium. Preoperative serum levels of tumor markers were in normal range: preoperative serum levels of testosterone (T) (2.42 ng/ml; normal for adult females 0.1-0.8 ng/ml) and dehydroepiandrosterone-sulphate (DHEA-S) (232.4 microg/dL; normal for adult female, 35-430 microg/dL) were measured and the T value was found increased. At laparotomy, a left ovarian mass was found attached to the right infundibulopelvic ligament and a left oophorectomy was performed. The mass was described as benign by frozen analysis. Definitive histopathological diagnosis was sclerozing stromal tumor of the ovary (SST). The histologic features included a pseudolobular pattern with focal areas of sclerosis and a two-cell population of spindled and polygonal cells. Immunohistochemical studies showed positive smooth muscle actin and negative cytokeratin, keratin, S100 and desmin. The T value decreased postoperatively (0.57 ng/ml).
 ...
PMID:Sclerosing stromal tumor of the ovary: a case report. 1458 67

Our patient, who had no history of trauma, developed bilateral femoral neck fractures several years after pelvic irradiation. The well-documented sequelae of femoral neck fractures include avascular necrosis, nonunion, and malunion. Postirradiation pelvic pain, particularly in the absence of trauma, should be aggressively evaluated. With high clinical suspicion and normal plain radiographs, MRI can be used to exclude potentially serious fractures.
 ...
PMID:Bilateral femoral neck fractures after pelvic irradiation. 1550 11

Information is still being collected on the long-term clinical responses and appropriate patient selection for UAE. Prospective RCTs have not been performed to compare the clinical results from UAE with more conventional therapies for symptomatic uterine leiomyomata. At least three attempts at conducting such RCTs have been unsuccessful because of poor patient accrual that related to differing patient expectation and desires, clinical bias, insurance coverage, and the tendency that patients who have exhausted other treatment options may be disposed more favorably to less invasive treatments. Other comparative studies have serious limitations. For example, the retrospective study that compared outcomes after abdominal myomectomy with UAE suggested that patients who received UAE were more likely to require further invasive treatment by 3 years than were recipients of myomectomy. Lack of randomization introduced a selection bias because women in the group that underwent UAEwere older and were more likely to have had previous surgeries. A prospective study of "contemporaneous cohorts," which excluded patients who had sub-mucosal and pedunculated subserosal myomas, sought to compare quality of life measures and adverse events in patients who underwent UAE or hysterectomy. The investigators concluded that both treatments resulted in marked improvement in symptoms and quality of life scores, but complications were higher in the group that underwent hysterectomy over 1 year. In this study,however, a greater proportion of patients who underwent hysterectomy had improved pelvic pain scores. Furthermore, hysterectomy eliminates uterine bleeding and the risk for recurrence of myomas. Despite the lack of controlled studies that compared UAE with conventional surgery, and despite limited extended outcome data, UAE has gained rapid acceptance, primarily because the procedure preserves the uterus, is less invasive, and has less short-term morbidity than do most surgical options. The cost of UAE varies by region, but is comparable to the charges for hysterectomy and is less expensive than abdominal myomectomy. The evaluation before UAE may entail additional fees for diagnostic testing, such as MRI, to assess the uterine size and screen for adenomyosis. Other centers have recommended pretreatment ultrasonography, laparoscopy, hysteroscopy, endometrial biopsy, and biopsy of large fibroids to evaluate sarcoma. Generally,after UAE the recovery time and time lost from work are less; however, the potential need for subsequent surgery may be greater when compared with abdominal myomectomy. Any center that offers UAE should adhere to published clinical guidelines,maintain ongoing assessment of quality improvements measures, and observe strict criteria for obtaining procedural privileges. After McLucas advocated that gynecologists learn the skill to perform UAE for managing symptomatic myomas, the Society of Interventional Radiology responded with a precautionary commentary on the level of technical proficiency that is necessary to maintain optimum results from UAE. The complexity of pelvic arterial anatomy, the skill that is required to master modern coaxial microcatheters, and the hazards of significant patient radiation exposure were cited as reasons why sound training and demonstration of expertise be obtained before clinicians are credentialed to perform UAE.A collaboration between the gynecologist and the interventional radiologist is necessary to optimize the safety and efficacy of UAE. The primary candidates for this procedure include women who have symptomatic uterine fibroids who no longer desire fertility, but wish to avoid surgery or are poor surgical risks. The gynecologist is likely to be the primary initial consultant to patients who present with complaints of symptomatic myomas. Therefore, they must be familiar with the indications, exclusions, outcome expectations, and complications of UAE in their particular center. When hysterectomy is the only option, UAE should be considered. Appropriate diagnostic testing should aid in the exclusion of most, but not all, gynecologic cancers and pregnancy. Other contraindications include severe contrast medium allergy, renal insufficiency, and coagulopathy. MRI may be used to screen women before treatment in an attempt to detect those who have adenomyosis; patients should be aware that UAE is less effective in the presence of solitary or coexistent adenomyosis. Because some women may experience ovarian failure after UAE, additional studies to determine basal follicle-stimulating hormone and estradiol before and after the procedure may provide insight into UAE-induced follicle depletion.UAE is a unique new treatment for uterine myomas, and is no longer considered investigational for symptomatic uterine fibroids. There is international recognition that data are needed from RCTs that compare UAE with surgical alternatives. Current efforts to provide prospective objective assessment of treatment outcomes and complications after UAE will help to optimize patient selection and clinical guidelines. FIBROID should provide critical data for the assessment of safety and outcomes measures for women who receive UAE for symptomatic uterine myomas.
 ...
PMID:Uterine artery embolization as a treatment option for uterine myomas. 1650 11

We describe a sciatic schwannoma spanning the sciatic notch in a 39-year-old woman with persistent pelvic pain after caesarean delivery. The tumour was detected by pelvic CT scan and MRI. Anterior transabdominal surgery allowed the en bloc removal of both the pelvic and the buttock component of the tumour.
 ...
PMID:Sciatic schwannoma spanning the sciatic notch: removal by an anterior, transabdominal approach. 1669 10

Isolated torsion of the fallopian tube is a rare clinical entity, especially in adolescents and at menarche. The diagnosis is essentially made at laparoscopy or at laparotomy because of nonspecific clinical signs. We present a case of isolated tubal torsion in a 12-year-old girl a few days after menarche, highlighting the sonographic and MR findings. Both techniques demonstrated the enlarged and tortuous fallopian tube with normal ovaries and uterus, but MR was also able to characterize contained blood and absent vascular supply. Although this condition is uncommon it should be considered as a cause of acute pelvic pain in adolescents because of the possibility of salvage surgery with early diagnosis. Sonography and MRI have a complementary role in this diagnosis.
 ...
PMID:Isolated tubal torsion: a rare cause of pelvic pain at menarche. Sonographic and MR findings. 1702 18

We describe imaging findings and interventional therapy of a 37-year old female patient suffering from chronic pelvic pain with associated vulvar varicosis. MR-angiography showed multiple varices in the left hemi-pelvis, a dilated draining vein from the left ovary as well as a left-sided vulvar varicosis, which was clinically evident. In addition, the MRI suggested insufficiency of the great saphenous vein with varicosis of its tributaries. After crossectomy and infragenual stripping of the great saphenous vein, we proceeded with a left phlebectomy and ligation of the supplying veins. Due to post-operative persistence of the vulvar varicosis the patient underwent coil-embolisation and liquid sclerotherapy (Aethoxysklerol) of the varicose pelvic veins and the left ovarian vein with good results.
 ...
PMID:[Pelvic congestion syndrom]. 1708 Jul 60

Pelvic floor weakness is characterized by abnormal symptomatic displacement of pelvic organs. It represents a complex clinical problem most commonly seen in middle-aged and elderly parous women. Its diagnosis remains difficult in many cases, since these disorders typically present with nonspecific symptoms, such as pelvic pain, incontinence and constipation. Fluoroscopic colpocystodefecography has been proven to surpass physical examination in the detection and characterization of functional abnormalities of the anorectum and surrounding pelvic structures. Similarly, MR defecography, performed either with an open- or closed-configuration unit, appears to be an accurate imaging technique to assess clinically relevant pelvic floor abnormalities. Moreover, MR defecography negates the need to expose the patient to harmful ionizing radiation and allows excellent depiction of the surrounding soft tissues of the pelvis. In this manuscript, we review the techniques and indications of MR defecography, and illustrate the MRI features of a vast array of morphologic and functional pelvic floor disorders, with emphasis on the posterior pelvic compartment (anorectum).
 ...
PMID:Dynamic MR defecography of the posterior compartment: Indications, techniques and MRI features. 1714 52

We report the MRI appearances in a patient with parametrial malakoplakia. The patient complained of pelvic pain and vaginal discharge. Physical examination revealed a "frozen" pelvis suggestive of malignancy. MRI showed bilateral parametrial "infiltration", but no overt primary pelvic tumour. The combination of these findings together with the inflammatory symptoms suggested an inflammatory condition. Malakoplakia was confirmed at resective biopsy.
 ...
PMID:MRI appearances of pelvic malakoplakia. 1721

We present a 33-year-old woman with a history of radical hysterectomy and pelvic radiation who developed a nonreducible high anterior vaginal wall bulge, postoperative pelvic pain, and dyspareunia. Dynamic MRI revealed herniation of the omentum into the vesico-vaginal space. The incarcerated hernia was repaired transvaginally, and the patient's symptoms improved.
 ...
PMID:Incarcerated vaginal herniation of the omentum mimicking vaginal prolapse. 1734 17

Intestinal endometriosis accounts for 8-12% of all endometriosis and rectal involvement is most often encountered in the context of deep pelvic infiltration. Intestinal symptoms, often nonspecific, are most typically seen as painful defecation or constipation worsening in the premenstrual period associated with pelvic pain, dysmenorrheal, dyspareunia, and infertility. Physical examination should include a pelvic exam under anesthesia. Endorectal ultrasound best evaluates rectal muscle invasion, while pelvic MRI and CT will evaluate the full extent of pelvic involvement and other GI sites of implantation. Only radical extirpative surgery of all intestinal, urologic, deep pelvic, and adnexal sites of endometriosis will permit relief of pain, prevent recurrence, and hopefully preserve fertility. In view of the frequency of extra-intestinal sites of involvement and technical difficulties augmented by previous surgical interventions, open laparotomy remains the preferred approach. A laparascopic approach would be reserved only for well-selected patients presenting with isolated colorectal involvement.
 ...
PMID:[Surgical treatment of rectal endometriosis]. 1736 54


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>