Gynecological Causes Research Articles

Pelvic pain — pelvic congestion or the irritable bowel syndrome?

Chronic unexplained pelvic pain in women may arise from either gynaecological or colonic causes. 35 women with pelvic congestion were interviewed with regard to their bowel habits and compared with a population with the irritable bowel syndrome. The results suggest that pelvic congestion and the irritable bowel syndrome are two distinctly different conditions, both of which may cause chronic lower abdominal pain in women.

Drugs for menorrhagia: often disappointing

Excessive menstrual bleeding is a common presenting symptom and is the commonest cause of iron deficiency anaemia in women in Britain. Before medical treatment is given, it is important to exclude the many specific gynaecological, endocrine and haematological causes of menorrhagia.1 If any post-coital or intermenstrual bleeding has occurred, examination by a gynaecologist and histological study of the endometrium is necessary.

Staging and treatment of ovarian carcinoma.

The staging and treatment of ovarian cancer is reviewed with special attention to developments during the last decade. Pathways of spread, presurgical and surgical staging are described and discussed, as are the biologic characters of the different histologic subtypes. Principles of surgery, endoperitoneal and external radiotherapy, single-drug and multiple-drug systemic chemotherapy (therapeutic and adjuvant), intraperitoneal chemotherapy, second-line chemotherapy, hormone therapy and the use of biologic response modifiers are reported and discussed with background of recent clinical trials. It is concluded that considerable progress has been made concerning diagnosis, staging and treatment of ovarian cancer. The proportion of cases in advanced stages has thus decreased and the survival rate increased. However, it is also obvious that the long-term prognosis for patients with advanced disease has not significantly improved over the last 10 years, despite introduction of multiple-drug regimens with high initial response rates. Ovarian cancer remains the most important gynecologic cause of death in the Western countries.

An unusual translocation 46,XX,t(14;17)(q33.2;p11.2) in a woman with recurrent spontaneous abortions.

An unusual translocation 46,XX,t(14;17)(q33.2;pll.2) was detected in a 28-year-old woman referred to our cytogenetic department because of recurrent spontaneous abortions. Obvious gynecological causes had been ruled out for the miscarriages. The parents were not available for examination, so it was not possible to establish if the translocation was de novo or inherited. Chromosomal preparations from peripheral blood lymphocytes were analyzed by conventional Gand Cbanding techniques. The karyotype of the patient was 46,XX, t(14;17)(q33.2;pll.2). The husband had a normal karyotype. We ask our colleagues who have observed similar cases for information.

Vaginal Cuff Dehiscence Presenting as an Acute Abdomen

To the Editor .—This communication presents an uncommon gynecologic cause of pneumoperitoneum: dehiscence of the vaginal cuff after transvaginal hysterectomy. Report of a Case .—A 41-year-old woman, gravida O, with a two-year history of biliary colic, complained of a feeling of upper abdominal fullness and bloating with right upper abdominal quadrant pain that lasted for seven hours and was not relieved by glycopyrrolate. She attempted to relieve the pain by sitting in her whirlpool bath and, while there, felt a sudden pop in her left lower abdominal quadrant and groin followed by generalized abdominal pain with radiation to the right shoulder. Coughing and abdominal motion significantly exacerbated the pain. The patient had no other gastrointestinal tract or gynecologic symptoms and specifically denied recent coitus or unusual sexual activity. Her medical history was pertinent for an appendectomy performed 20 years previously and a transvaginal hysterectomy performed for contraception four months prior

Chromosome anomalies in 136 couples with a history of recurrent abortions.

Cytogenetic studies were performed on 136 couples with a history of two or more abortions referred to us after gynaecological causes of the abortions had been excluded. Fifteen (11%) of the couples were found to have a chromosome anomaly, and when the couples were subdivided according to number of abortions, surprisingly 6 (10%) of the 59 couples with a history of only two abortions had a chromosome anomaly. An increased frequency of mosaicism for X-chromosome aneuploidy (2.2%) in the women from the 136 couples was also found. A review of the literature shows that translocations of some chromosomes (e.g. nos. 1, 7 or 22) preferentially lead to fetal wastage, while those involving, for example, chromosome nos. 5, 9, 14 or 21 are more likely to result in the birth of a handicapped child. Couples with a history of two abortions should be investigated cytogenetically. Other causes of miscarriages must, however, be excluded first.

Pain in gynecologic practice.

This paper has given a general discussion of the spectrum of pain complaints presented to the gynecologist. Specific information about pain sensation and localization has been reviewed together with the gynecologic causes of acute abdominal pain. Chronic pain has been classified as episodic or continuous, and the causes, mechanisms, diagnosis and treatment of episodic and chronic pelvic pain have been presented. The concluding remarks have outlined some diagnostic considerations for the patient with chronic pain. (The interested reader will find more extensive information on these subjects in the articles listed in the bibliography.).

New concepts in dysmenorrhea

The etiology of primary dysmenorrhea, which is the most common gynecologic complaint and cause of lost working hours, remains obscure but merits careful scientific investigation. Recent studies suggest that increased endometrial prostaglandin production and release may be responsible for dysmenorrhea. Prostaglandins cause myometrial contractility that, if excessive, leads to uterine ischemia and pain. This hypothesis has led to clinical trials of antiprostaglandin agents such as indomethacin and fenamates, which inhibit the synthesis of prostaglandin through the prostaglandin synthetase system as well as antagonize their action at the cell receptor level. The good response of dysmenorrhea to other conventional forms of therapy such as oral contraceptives and dilatation of the cervix can be partly explained on the basis of a reduced level of prostaglandins in the menstrual fluid with such therapy. There is a definite need for further evaluation of the antiprostaglandin compounds in the treatment of dysmenorrhea so that sound formulations can be evolved for the elimination of this incapacitating disorder.

Fosfomycin in the treatment of gynecological infections.

Here we present the results obtained in the treatment with fosfomycin of 58 patients of diverse obstetric-gynecological infections manifested by clinical symptomology and by the initial isolation of 70 strains of different germs, all of them sensitive to this antibiotic. The types of infections were urinary, abdominal wall, perennial septicemias, and endometritis; 45 of them motivated by or resulting from pregnancy, and the remaining 13 from gynecological causes. The most frequent treatment was 1 g/6h during 10 days, using sodium salt intramuscularly in 33 cases, and calcium salt taken orally in 26. The clinical results were good in 50 cases (86.2%) with improvement in 3 (5.1%) and persistency of the infection in 5. The bacteriological evolution was good on 34 occasions (58.6%), partial in 4 (6.8%), and poor in 6 (10.3%). In 14 cases no control could be made since the wound healed. The tolerance to the antibiotic was good and no manifestations of toxicity were observed.

Vesical Dysfunction Due to Prolapsed Disc

Neural disturbance of micturition may occur as a result of a prolapsed intervertebral disc. Single nerve root lesions are unlikely to cause bladder dysfunction; a massive central protrusion producing total blockage of the vertebral canal or multiple disc lesions are more likely to cause disturbance of voiding. High lesions are more prone to cause severe bladder dysfunction. Vesical dysfunction may sometimes be present without the typical back and leg pain.Provided a gynaecological cause is excluded, any young or middle-aged woman developing incontinence and retention with a sterile urine must be fully investigated to exclude a disc lesion. Once the disc has been removed, bladder function will improve, but in some cases recovery will be slow. Rarely some patients have permanent bladder dysfunction following a disc operation.

Early glucose metabolic disorder and sterility

From 42 patients, selected at random who had primary or secondary sterility without any apparent gynecologic cause, 76.3 per cent were shown to have an early derangement of carbohydrate metabolism, as evidenced by an abnormal triamcinolon. test. In contrast, a control group showed only 4.7 per cent abnormal results with this test (p < 0.001) . The incidence 01 abnormal standard glucose tolerance was also higher in the sterile group than the control group (p = 0.01). These findings suggest a relationship between sterility and a disorder in glucose metabolism.

The meaning of backache in gynecology

Gynecologic affections have been variously estimated to be the cause of lumbo-sacral backache in women in from 30 to 85 per cent of cases. Recently, however, more exact knowledge has greatly reduced the relative importance of the so-called gynecologic backache. In my own experience, the gynecologic causes of backache have been greatly overestimated. There are three great groups of backaches occurring in women; namely, I the pelvic type, which may result from a physiologic congestion at the menstrual epoch or uterine malpositions and pelvic inflammation; 2 the orthopedic type, arising from such conditions as sacroiliac relaxation, faulty posture, flat feet, spondylitis, and involvement of the lumbar muscles or fascia; and 3 the focal infective type, due to distant infection in the teeth, tonsils, accessory nasal sinuses, or elsewhere. Every case of obscure backache requires a study of the entire patient. Only when the investigation is conducted carefully from all angles may we hope to discover the particular cause in an individual case and thus be in a position to direct effective treatment.

RETINAL HEMORRHAGE.

With the passing of the ophthalmoscope from the exclusive use of the oculist, the cases and causes of hemorrhage into the retina have greatly multiplied. The underlying etiologic factors have become of interest to all, regardless of specialism; for the affection may occur in the practice of the surgeon and gynecologist as well as in that of the oculist and the devotee to internal medicine. It may come without warning and indeed without apparent sufficient justification, or cautions in the way of constitutional disease may have existed for years. It is no respector of age, nor are either of the sexes favored to any extent; for an increase on the one hand due to obstetric and gynecologic causes is equalized on the other by the greater prevalence of arteriosclerosis and injuries among males. In size it may be barely discernible or may involve the retina in its entirety. There may