1/33. A patient with multiple sclerosis and Down's syndrome with a rare paroxysmal symptom at onset.Down's syndrome (DS) is often associated with autoimmune diseases, although an association with multiple sclerosis (MS) has not been previously reported. A 49-year-old male with DS experienced progressively worsening gait and bladder dysfunction. Following Poser criteria, the patient was diagnosed with laboratory-supported definite MS. Ten days following diagnosis the patient experienced dysestetic paroxysmal pain at the pelvic level (an uncommon complaint in MS) which was initially addressed with carbamazepine, resulting in mild relief and adverse effects consisting of increased motor deficit and decreased daytime alertness. A titration combination of lamotrigine and gabapentin, two relatively new antiepileptic drugs which have been utilized individually for a number of neurological symptoms, resulted in significant reduction in pain frequency and intensity, with no adverse effects. This case study presents details of the first reported association of DS and MS, between which the pathogenetic relationship remains unclear. The presence of a rare symptom complaint in MS, as well as the effective combination of lamotrigine and gabapentin for treating this symptom, without adverse effects is an additional interesting aspect of this case.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
2/33. Punctate midline myelotomy. A new approach in the management of visceral pain.Nauta et al. reported on a successful punctate midline myelotomy (PMM) for the treatment of intractable pelvic pain. The authors describe an other case history of a patient with multiple anaplastic carcinomas of the small intestine, peritoneal carcinosis and retroperitoneal lymphomas, suffering from severe visceral pain in the hypo-, meso-, and epigastrium. Nauta's PMM was successfully performed at the Th4 level. Narcotic medication was tapered from 30 mg i.v. morphine per hour pre-operatively to 5 mg per hour within 5 days postoperatively. Intensity of pain decreased from 10 to 2-3 on the visual analog scale. Only minor transient side effects appeared and the patient was discharged 5 days postoperatively. The pain reduction was maintained until the patient died from the extended disease five weeks later. We conclude that punctate midline myelotomy sufficiently controls not only pelvic visceral pain, but also visceral pain generated in the meso- and epigastrium. The findings support the concept of a midline dorsal column visceral pain pathway.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
3/33. Neurologic disease presenting as chronic pelvic pain.Neurologic disease as a cause of chronic pelvic pain may be more common than previously reported. We report three cases wherein patients with complaints of pelvic pain were subsequently found to have neurologic disease involving the lumbosacral spine. In all three cases, the presenting features were complaints of cyclic or noncyclic lower abdominal pain attributed to endometriosis, pelvic inflammatory disease, or uterine fibroids. When conventional therapies failed to resolve the pain, magnetic resonance imaging (MRI) of the lumbosacral spine showed a neoplasm in one patient and disk herniation in two patients. Evolving lumbar disk disease or intradural neoplasms in the upper lumbar area can produce symptoms interpreted as pelvic pain. Symptoms consistent with radiculopathy occurred late in the course of each of the three cases reported.- - - - - - - - - - ranking = 8keywords = disease (Clic here for more details about this article) |
4/33. Primary non Hodgkin's lymphoma of the vagina.The genital tract as a primary site of malignant lymphoma in women is extremely rare. This report concerns a 64 year old patient with a primary vaginal non-Hodgkin lymphoma (large cell B lineage according to the REAL classification--centroblastic type according to the Kiel classification--"G" according Working Formulation) with an unusual clinical presentation--pelvic discomfort accompanied by frequent ureteral-like colic. Due to gynecological onset symptoms and the rarity of this extranodal primary site misinterpretation of a primary vaginal lymphoma as a benign inflammatory disease or endometriosis may occur. We emphasize the importance of their recognition and also the differential diagnosis of cervical lymphoma from other neoplastic and non-neoplastic lesions.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
5/33. celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia.BACKGROUND:celiac disease may be subclinical and difficult to diagnose in adults. It has been associated with infertility and miscarriage but rarely with other gynecologic symptoms.CASE:A 43-year-old woman complaining of chronic abdominal and pelvic pain, deep dyspareunia, dysmenorrhea, diarrhea, and a 5-kg weight loss during the last 6 months was referred to our institution. Laboratory and clinical examinations were negative. At laparoscopy, numerous small leiomyomata were seen. A few filmy adhesions between the small bowel and the abdominal wall were lysed. With the exception of deep dyspareunia, all symptoms remitted after surgery, only to recur at 6 months of follow-up. A diagnostic work-up for celiac disease revealed the presence of antigliadin and antiendomysial antibodies. The diagnosis was confirmed at gastroduodenoscopy including biopsy. A gluten-free diet was prescribed, and the patient is now free of symptoms.CONCLUSION:celiac disease should be considered in women presenting with unexplained chronic pelvic pain, dysmenorrhea, and deep dyspareunia.- - - - - - - - - - ranking = 7keywords = disease (Clic here for more details about this article) |
6/33. Microlaparoscopic conscious pain mapping in the evaluation of chronic pelvic pain: a case report.Chronic pelvic pain is a debilitating, life-altering syndrome that negatively affects a woman's quality of life and personal relationships. Many women continue to suffer with pelvic pain despite having undergone multiple medical and surgical treatments. Unfortunately, some women are incorrectly labeled as having psychological illness when organic disease may be present. I report a case of a woman who underwent multiple pelvic and abdominal surgeries before the cause of her pain was identified through microlaparoscopic conscious pain mapping.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
7/33. Endosalpingiosis-an underestimated cause of chronic pelvic pain or an accidental finding? A retrospective study of 16 cases.OBJECTIVE: The relevance of endosalpingiosis as a cause of chronic pelvic pain is controversial. To examine the clinical presentation of endosalpingiosis, the files of the Institute of pathology at the University of Munster for the years 1994-1999 were screened by keyword search for the diagnosis of endosalpingiosis and the patient files were reviewed. patients: Thirteen patients with the diagnosis endosalpingiosis treated at our institution were identified within the past 6 years. Five patients (38%) presented with pelvic pain, five (38%) with hyper- or dysmenorrhea, five (38%) patients had no complaints at all, one of these had primary and one had secondary infertility, three had persistent ovarian cysts. The diagnosis of endosalpingiosis was confirmed by a second pathologist for all patients included in this study. RESULTS: Mean age at diagnosis was 43 (range 24-82), of the five patients presenting with pelvic pain, the localization of endosalpingiosis was consistent with the localization of pain in only four (30%) patients. Localization and macroscopic appearance of endosalpingiosis and endometriosis seems to be the same in our cases. Five (38%) patients suffered from myomatous uterus, five (38%) had additional endometriosis, five (15%) patients had hydrosalpinx (postinflammatory tubal disease), and seven (53%) had pelvic adhesions. Nine patients had previously been admitted for surgery, only two (15%) patients had tubal surgery, two (15%) had cesarian section and five (38%) had a history of more than two abdominal operations. Eleven (85%) cases of endosalpingiosis were diagnosed by the same pathologist. CONCLUSIONS: Endosalpingiosis seems to be an accidental finding, associated with additional pelvic pathology, rather than being a frequent cause of pelvic pain.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
8/33. phenol saddle blocks for intractable pain at end of life: report of four cases and literature review.Four cancer patients with prior bladder diversions had phenol neurolytic saddle blocks performed for intractable pelvi-sacral pain. All patients had advanced disease, the focus of their treatment being palliative. Treatment limiting side effects precluded further upward titration of systemic analgesic therapies. Pain control improved after intrathecal neurolysis and allowed a greater than 60 percent reduction in systemic opiate dosage. No significant block-related adverse effects were encountered. The value and technical aspects of intrathecal saddle blocks in end-of-life pain management is discussed.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
9/33. Primary extrarenal rhabdoid tumor of the ovary. A case report.BACKGROUND: Malignant rhabdoid tumors are rare, aggressive neoplasms that consist of both renal and extrarenal subtypes. Although extrarenal rhabdoid tumors have been documented at multiple extrarenal sites, to our knowledge no primary ovarian cases have been reported. CASE: An 18-year-old, Caucasian woman was diagnosed with a pure primary extrarenal rhabdoid tumor of the ovary following diagnostic laparoscopy for pelvic pain. The tumor exhibited rapid growth, failed to respond to chemotherapy and led rapidly to death. CONCLUSION: Although no other reports on primary ovarian extrarenal rhabdoid tumor have been published, the aggressive behavior of the tumor in this patient was similar to that seen in patients with metastatic disease.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
10/33. Sacral neuromodulation for chronic pain conditions.Some of the pelvic pain syndromes seem to have features of neurogenic inflammation and neuropathic pain in common. As opposed to being separate disease entities, they may represent a spectrum of clinical presentations of CRPS I of the pelvis. Sacral nerve root stimulation provides good symptomatic relief of pain and voiding dysfunction. The techniques of retrograde root stimulation may offer superior results with fewer complications and lead migrations when compared with other methods. Perhaps neuromodulation should be used earlier in the treatment paradigm for these disorders, before the potentially injurious procedures of hydrodistention, bladder installations, and cystectomies.- - - - - - - - - - ranking = 1keywords = disease (Clic here for more details about this article) |
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