1/4. A systematic history for the patient with chronic pelvic pain.Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/4. Trustworthiness as a clinical variable: the problem of trust in the management of chronic, nonmalignant pain.The subjective nature of pain leads to many treatment difficulties. These problems can often be resolved if we know that the patient is trustworthy. Trustworthiness should be assessed as a distinct clinical variable. This is more easily achieved if we examine the three components of trustworthiness: the patient's subjective reports, which we call testimony; the reason that the patient seeks treatment, which we call motive; and the patient's adherence with efforts to get well, which we call responsibility. Because of difficulties with assessing testimony and motive, we propose that establishing the patient's responsibility is the key to assessing trustworthiness.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/4. Ovarian actinomycosis mimicking malignancy.OBJECTIVE: To emphasize the importance of frozen section diagnosis in the treatment of ovarian carcinoma and to remind physicians that it may mimic ovarian carcinoma and occur in women without intrauterine contraceptive devices (IUDs). methods: Three cases operated on in Adana University Hospital between the year 2001-2003 with the diagnosis of ovarian actinomycosis were reported. CASE REPORT: Three female patients who had never used IUDs, aged 37, 45 and 47, who presented with pelvic pain and tumoral masses in the pelvis were operated on with the initial diagnosis of ovarian carcinoma between the years 2001 and 2003. Intraoperative frozen-section diagnoses of the pelvic masses were actinomycosis. In the postoperative period the patients received long-term antibiotic therapy initially intravenously (15 days), and later orally with 4 g/day for three months. They were healthy without evidence of actinomycosis infection for two years after the treatment. DISCUSSION: Pelvic actinomycosis is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. The behavior of the disease, which mimics malignancy and urogenital manifestation, poses difficulties in diagnosis and management. Preoperative examinations could not establish the nature of the tumour. An initial diagnosis of ovarian carcinoma is usually considered in all cases. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/4. Occult infection as a cause of hip pain in a patient with metastatic breast cancer.A 39-year-old woman with breast cancer metastatic to bone presented with acute hip pain marginally responsive to escalating doses of opioid analgesics. Pathologic pelvic fractures were present and there were minimal clinical indicators of infection, but the severity and intractable nature of the pain prompted further investigation. Computed tomography revealed a pelvic abscess. Antibiotic therapy and drainage of the abscess resulted in markedly improved pain control, decreased analgesic requirements, and improved quality of life. We suggest that, in patients with malignancy, the diagnosis of occult infection should be aggressively pursued as a potentially reversible cause of intractable pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |