1/10. 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 = physician (Clic here for more details about this article) |
2/10. Clinical utility of pelvic pain mapping.STUDY OBJECTIVE: To survey physicians' opinions concerning the impact of pelvic pain mapping on clinical management and surgical decisions. DESIGN: Opinions of physicians based on clinical experience (Canadian Task Force classification III). SETTING: Evening meetings appended to two national meetings. MEASUREMENTS AND MAIN RESULTS: After viewing videotaped interviews, physical examinations, standard laparoscopy, and pelvic pain mapping at laparoscopy in two patients, practicing gynecologists completed questionnaires recording their opinions about the utility of pelvic pain mapping. A second group of gynecologists viewed only one tape. The first group considered pain mapping to be moderately or extremely useful (patient 1, 57.9%; patient 2, 73.7%). Mapping data either made surgeons change the surgical procedure they would have chosen or further clarified the diagnosis (patient 1, 68.4%; patient 2, 84.2%). Of the second group of 67 surgeons, 73% thought that mapping results would have made them change their surgical approach. CONCLUSION: In appropriate cases, pelvic pain mapping during microlaparoscopy under conscious sedation can provide information that may influence surgical decisions as well as general clinical management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients.Treatment of chronic pelvic pain (CPP), interstitial cystitis (IC), prostatodynia, and irritative voiding symptoms can be frustrating for both patients and physicians. The usual approaches do not always produce the desired results. We found that when we treated myofascial trigger points (TrP) in pelvic floor muscles as well as the gluteus, piriform, infraspinatus, and supraspinatus muscles, symptoms improved or resolved. Various palpation techniques were used to isolate active myofascial TrPs in these muscles of four patients with severe CPP, IC, and irritative voiding symptoms. Injection and stretch techniques for these muscles were performed. Visual twitch responses at the skin surface and in the muscles were used to verify successful needle piercing of a TrP. The patients were asked to verbally describe exactly where the flash of distant pain was felt, a process that permitted an accurate recording of the precise pattern of pain referred by that TrP. The findings involved with the four patients substantiate the need for myofascial evaluation prior to considering more invasive treatments for IC, CPP, and irritative voiding symptoms. Referred pain and motor activity to the pelvic floor muscles (sphincters), as well as to the pelvic organs, can be the sole cause of IC, CPP, and irritative voiding dysfunction and certainly needs further investigation.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/10. Pelvic congestion syndrome--findings on multi-detector row computerized tomography: a case report.Chronic pelvic pain is a common gynecologic complaint, sometimes without any obvious etiology. We report a case of pelvic congestion syndrome with chronic pelvic pain. The diagnosis can be overlooked by clinical physicians but diagnosed using multi-detector row computerized tomography. This method seems to be an effective and non-invasive imaging modality.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/10. Chronic pelvic pain following prostate brachytherapy: a case report.PURPOSE: To alert physicians and potential patients that chronic postimplant pelvic pain syndromes can occur, and that dosimetric parameters (i.e., implant technique) may predispose patients to it. methods AND MATERIALS: The authors are currently following 3 prostate brachytherapy patients with what appear to be chronic radiation-related pelvic pain, variously exacerbated by urination or perineal pressure. The 3 patients were identified in the course of routine follow-up, and do not represent a concerted attempt to identify such patients from a larger group of patients being followed by the authors. Three control groups of 10 patients each treated with (125)I, (103)Pd, or (103)Pd external beam radiation and with no reported dysuria at 6 months postimplant were taken from two ongoing prospective trials. The 3 patients reported here were each administered a brief questionnaire regarding the effect of their urinary pain on daily activities. RESULTS: patients with chronic pain tended to have high central prostatic doses, at least on some planes. Maximal, mean, and median urethral doses were higher for patients with chronic pain, but there was some overlap with control patients. The prostate V100s were similar between patients with chronic pain and controls, but there was a trend toward higher V200s and V300s in pain syndrome patients. CONCLUSION: Recalcitrant brachytherapy-related pelvic pain is an uncommon occurrence that may be partly related to higher central prostatic doses.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/10. An ovary with a twist: a case of interesting sonographic findings of ovarian torsion.An otherwise healthy young woman presented to the Emergency Department with abdominal pain. Multiple diagnoses were considered, as must be in cases of women with lower quadrant abdominal pain. Rapid identification of an abnormally enlarged ovary in close proximity to the opposite ovary on pelvic ultrasonography suggested the diagnosis of ovarian torsion. This was verified on laparoscopy. Of note is the fact that normal Doppler flow to both ovaries was demonstrated on pelvic ultrasound. We present this case, and its associated images, with the intent to highlight a readily identifiable sign of ovarian torsion for emergency physicians and to briefly review ovarian torsion's salient clinico-pathologic features.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/10. 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 = 0.5keywords = physician (Clic here for more details about this article) |
8/10. hematuria and clot retention after transvaginal oocyte aspiration: a case report.OBJECTIVE: To report a case of bladder injury with hematuria and urinary retention after transvaginal oocyte aspiration. DESIGN: Case report. SETTING: Emergency room in a university medical center. PATIENT(S): A 28-year-old woman presented with urinary retention and suprapubic pain 8 hours after oocyte aspiration. INTERVENTION(S): Foley catheter, intravenous fluid bolus, bladder irrigation, and computed tomography with postvoid films that showed a blood clot in the bladder. Patient was discharged home with antibiotics and catheter in place. MAIN OUTCOME MEASURE(S): Clinical follow-up. RESULT(S): Patient passed voiding trial 4 days later and was artificially inseminated. No further hematuria or voiding problems were reported, and she had a successful pregnancy. CONCLUSION(S): patients who elect to undergo oocyte aspiration should be warned about the possibility of bladder injury because of the close proximity of the ovaries to the bladder, and physicians should have an appropriate treatment plan.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/10. Musculoskeletal origins of chronic pelvic pain. diagnosis and treatment.Musculoskeletal dysfunctions often contribute to the signs and symptoms of chronic pelvic pain and in many cases may be the primary cause. The traditional team approach to chronic pelvic pain has not, however, routinely included a practitioner skilled in musculoskeletal examination and treatment. Characteristics of musculoskeletal pain are reviewed as are specific dysfunctions commonly found to produce lower abdominal and pelvic floor pain. A screening examination is presented to assist the gynecologic physician in identifying patients who may benefit from physical therapy.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/10. osteitis pubis: a diagnosis for the family physician.BACKGROUND: osteitis pubis was first described in 1924 in patients who had had suprapubic surgery. Since that time many theories concerning the cause of the disease have been developed. Published case reports and retrospective record reviews of specific, isolated patient populations have been used to postulate an infectious, inflammatory, or traumatic cause of this condition. Such confusion reduces the likelihood of an accurate diagnosis of osteitis pubis, particularly in the primary care setting, where it is becoming increasingly likely that patients afflicted with this frustrating illness will initially seek treatment. methods: This article describes a case report and provides a review of the literature. The medical literature was searched using the following key words: "abdominal pain," "pelvic pain," "inflammation," "symphysis pubis," and "enthesopathy." RESULTS AND CONCLUSIONS: osteitis pubis, considered to be the most common inflammatory disease of the pubic symphysis, is a self-limiting inflammation secondary to trauma, pelvic surgery, childbirth, or overuse, and it can be found in almost any patient population. Occurring more commonly in men during their 30s and 40s, osteitis pubis causes pain in the pubic area, one or both groins, and in the lower rectus abdominis muscle. The pain can be exacerbated by exercise or specific movements, such as running, kicking, or pivoting on one leg, and is relieved with rest. Pain can occur with walking and can be in one or several of many distributions: perineal, testicular, suprapubic, inguinal, and postejaculatory in the scrotum and perineum. Symptoms are described as "groin burning," with discomfort while climbing stairs, coughing, or sneezing. A greater understanding and awareness of osteitis pubis will reduce patient and physician frustration while improving overall outcomes.- - - - - - - - - - ranking = 2.5keywords = physician (Clic here for more details about this article) |
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