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Query: UMLS:C0085693 (acute appendicitis)
 3,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

At the University Hospital, Lund, Sweden, laparoscopy has been routinely used as a diagnostic aid in cases for acute pelvic inflammatory disease since 1960. No significant complications have been encountered. The material of the study comprises 905 cases covering an 8 year period, 1960-1967. The operation was always performed under general anesthesia. The laparoscope was inserted in the midline below the umbilicus and a cannula inserted 10 cm laterally to manipulate the pelvic organs. A previous clinical diagnosis was required. In 814 cases acute inflammatory disease was suspected on clinical grounds. In 532 of these cases (65%) acute salpingitis was visually confirmed. Observation through the instrument was seldom difficult or uncertain. In 98 cases (12%) laparoscopy revealed other pathologic conditions. In 184 cases (23%) no pathologic changes were found. In another 91 cases acute salpingitis was found unexpectedly at laparoscopy (or in some cases by exploratory laparotomy) undertaken on other provisional clinical diagnoses. Altogether 623 patients were visually diagnosed as having acute salpingitis. Acute appendicitis was found in 24 cases, ectopic pregnancy in 11 cases, pelvic endometriosis in 16 cases, and several other pelvic disorders occasionally. In the total series of 623 confirmed cases of acute salpingitis 223 (365) were of gonococcal origin. These were mostly in the younger, unmarried, and nulliparous patients. Previous curettage was responsible for most othe r cases. The authors conclude that the diagnosis of acute adnexal inflammation based on commonly accepted clinical criteria was found inaccurate to an unsatisfactory high degree as 12% proved to have other disorders, several of a serious nature. Also 23% had no inflammatory reaction of the tubes or other pelvic structures leaving 65% of cases correctly diagnosed on clinical grounds. The prognosis as to later tubal patency varied with the stage of development of the salpingitis. Later studies show that patency was more frequent in cases of salpingitis diagnosed and treated early before adnexal swelling or mass was diagnosed clinically. Gonococcal cases showed a lower subsequent bilateral occlusion than others. 5 of the salpingitis patients were later operated on for ectopic pregnancy.
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PMID:Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. 424 30

The symptom of lower abdominal pain in women is extremely common and does not always indicate the presence of serious illness. However, women with certain serious conditions such as pelvic inflammatory disease (PID), acute appendicitis, ectopic pregnancy and other complications of pregnancy may present initially with this symptom. Therefore, in managing women with lower abdominal pain care should be taken to exclude any serious condition before dismissing the patient. PID is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This usually occurs as a result of an ascending cervical infection caused by Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria. The immediate and long term effects of PID include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy. Women with lower abdominal pain should be assessed carefully and if PID is the cause they should be treated for gonococcal, chlamydial and anaerobic bacterial infection. Other gynaecological and surgical causes of lower abdominal pain and the immediate complications of PID require urgent referral to a specialist. PID is associated with significant morbidity and mortality.
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PMID:Syndromic management of sexually transmitted diseases. Part 4--The management of lower abdominal pain in women. 1018 53

The most significant complication of sexually transmitted diseases (STDs) in women is pelvic inflammatory disease (PID), which is responsible for considerable medical, social, and economic problems. Chlamydia trachomatis, Neisseria gonorrhoeae, or both cause PID in at least 50% of cases. Other microorganisms that are part of the abnormal vaginal flora also cause PID. Gonorrhea rates have quickly fallen in most developed countries, but chlamydia infection rates are still high in developed countries as well as in developing countries. The clinical signs and symptoms of PID have changed over time. More and more PID cases are classified as atypical or subclinical. Typical PID is rare. A strong association exists between chlamydia infection and tubal factor infertility or ectopic pregnancy in women with or without a history of PID. Health providers are concerned about the problem of unrecognized PID. Thus, recommendations for PID diagnosis have changed. A syndromic diagnosis of PID is advocated. The minimum criteria for syndromic diagnosis of PID include lower abdominal tenderness, bilateral adnexal tenderness, cervical motion tenderness, and no evidence of competing diagnosis (e.g., acute appendicitis). Application of this improved approach will provide appropriate treatment earlier in the course of PID. PID-related morbidity (i.e., infertility and ectopic pregnancy) is a considerable public health problem worldwide. In order to prevent PID, clinicians and public health specialists need to understand the interactions of PID-causing microorganisms with the host immune system. By the time PID symptoms are detected, considerable tubal damage already exists limiting the effect of tertiary prevention of PID. Secondary prevention keeps lower genital tract infection from moving up to the upper genital tract. Health providers play a key role in secondary prevention by screening for STDs and in primary prevention by counseling patients about safer sex practices.
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PMID:Immunopathogenesis of pelvic inflammatory disease and infertility -- what do we know and what shall we do? 1234 74