Gynecologic Etiologies Research Articles

Osteopathic Approach to a Patient with Recurring Low Back Pain following OMT results in Diagnosis of Underlying Gynecological Etiology: A Case Report

Abstract This case report describes the occurrence of acute low back pain, and the application of Osteopathic Manipulative Treatment techniques (OMT) initially resulting in resolution of the patient's presenting symptoms. When OMT is successful in resolving the patient's symptoms, this usually supports a musculoskeletal etiology; however, when confronted with recurrence of symptoms despite repeated successful resolution of these symptoms with OMT, the physician should suspect an organic etiology. This case demonstrates the importance of the osteopathic physician understanding viscerosomatic dysfunctions and the efficacy of the osteopathic approach to arriving at correct diagnoses. Of note, the osteopathic approach to a patient with recurring low back pain following OMT resulted in diagnosis of the underlying gynecological organic etiology for this patient's symptoms.

Hemoperitoneum due to deep endometriosis in a patient on peritoneal dialysis with a good response to progestin

Hemoperitoneum is common in patients undergoing peritoneal dialysis. Its varied causes include catheter-related complications, obstetric and gynecological etiologies, coagulopathies, and vascular, infectious, and intra-abdominal pathologies. A gynecological etiology, whether pathological or physiological, is the most common cause of hemoperitoneum in adult women undergoing peritoneal dialysis, with more than one-third of cases related to the menstrual cycle. Endometriosis can also cause hemoperitoneum, and the bleeding may originate from endometrial tissue implanted in the peritoneal cavity or that detaches from the intrauterine endometrium during the menstrual period. We report a case of hemoperitoneum in a patient with deep endometriosis and previous hysterectomy who had an excellent response to oral progestin.

PREVALENCE AND COPING STRATEGIES OF DYSMENORRHEA AMONG UNDERGRADUATE NON-MEDICAL STUDENTS

Although dysmenorrhea is not a life-threatening disorder, it can have a significant negative impact on both individuals and society. Dysmenorrhea is a chronic condition that causes significant pain, cramping, and constriction in the lower abdomen. Additional symptoms like sweating, headaches, nausea, vomiting, and diarrhea frequently accompany it. Primary dysmenorrhea is another pain term with no obvious medically identifiable gynecological etiology. This study conducted a cross-sectional investigation on a sample of 377 people gathered from various women's colleges in Karachi. Version 24 of SPSS was utilized for the analysis. The results show that the participants knew about the risk factors of dysmenorrhea, but knowledge regarding dietary recommendations and physical activity was low. This study provides insight into the incidence of dysmenorrhea among undergraduate non-medical females and the coping strategies used by these students. This information will benefit medical care providers to recommend the most effective strategies according to medical literature to those not using the effective method. A program of awareness development is required to promote young females' health.

Sonographic Findings of a Gynecological Cause of Acute Pelvic Pain - A Systematic Review.

The purpose of this study was to use ultrasonographic data to rule out and distinguish diseases that cause acute pelvic pain. The literature was reviewed using a systematic search of the databases Google Scholars and PubMed, as well as through hand searching. We looked through a total of 35 articles, but only 26 were selected after preliminary screening. Furthermore, 14 articles were left out because they required a membership, copyright clearance, or featured non-English references. There were a total of 12 articles included in the final revuew. Among all the study-related articles, only original research studies and one systematic review that sonographically explored the gynecological etiology of acute pelvic pain were selected. Acute pelvic pain in women might be difficult to identify between gynecologic and non-gynecologic causes based solely on patient history and examination. Advanced imaging, like ultrasound, aids in determining the reason. Pelvic inflammatory disease can be difficult to diagnose, and clinicians should use a low threshold for starting presumptive treatment in order to avoid significant long-term effects such as infertility. Pelvic pain can be acute, chronic or functional. Imaging investigations such as CT, ultrasonography, and MRI can assist in establishing a diagnosis. Particularly ultrasound scanning makes it possible to arrive at a diagnosis with a high degree of precision.

A Giant Ovarian Cystadenoma in A 20-Year-Old Nulliparous Woman: A Case Report

Giant ovarian cyst itself is defined as a cyst >10 cm in diameter from radiological- examination or the size of the cyst exceeds the umbilicus. Extra-large benign and malignant cysts of the ovary are uncommon and involve diagnostic and management challenges. We present the case of a 20-year-old nulliparous woman who was referred to our center with complaints of abdominal pain and heavy breathing. She benefited from a salphingo-oophorectomy laparotomy procedure. Benign and malignant gynecologic and non-gynecologic etiologies are included in the differential diagnosis of an abdominal mass. Because of the infrequent occurrence or absence of distinctive clinical presentation of the giant ovarian cyst, accurate preoperative diagnosis is challenging.

A Case-series on Clinical and Surgical Findings of Ovarian Torsion

Background: Ovarian Torsion (OT) is a common gynecological emergency. Clinical presentation is nonspecific, and diagnosis is based on a high index of suspicion. Current recommendations strongly are based on ovarian support. Objectives: To assess clinical findings and therapeutic approach of patients diagnosed with OT. Materials & Methods: In this retrospective study 104 patients with confirmed OT in surgery were investigated. Clinical symptoms, laboratory indices, ultrasonography finding, and therapeutic approach were collected from hospital records of patients from 2001 to 2021. Results: The Mean±SD age of patients was 34.7±14.1 years old. The Mean±SD duration from hospitalization to surgery was 6.4±3 hours. The most common symptom in patients was abdominal pain (100%) followed by nausea and vomiting (76.9%). Ovarian cyst (71.2%) was the most gynecologic etiology of OT. Local tenderness (92.3%) and rebound tenderness (46.2%) were the most prevalent sign in physical examination. Necrotic ovary was found in 60 patients (57.7%) at surgery. Detorsion was possible in only 26 patients (25%). Conclusion: This study revealed that most objective findings in patients were nondifferential. The majority of patients with OT were in the reproductive ages, but just one fourth of them treated with conservative management.

S2044 A Rare Case of Lymphocytic Esophagitis in a Patient With Recurrent and Severe Oral Ulcers

Introduction: We describe a unique case of lymphocytic esophagitis with non-necrotizing granulomas in a patient with a three-year history of recurrent oral ulcers that did not resolve with standard medical therapy. Case Description/Methods: A 37-year-old female with a history of iron deficiency anemia presents with recurring intermittent episodes of severe oral ulcers that began after a 6-month course of antibiotics for hiradenitis suppurativa. She reported weight loss due to odynophagia and oral pain. An oral ulcer biopsy revealed dense lymphocytic and plasmocytic infiltrate with collections of histiocytic granulomas and multinucleated giant cells. Ulcer outbreaks coincided with stress and menstruation, but a gynecological etiology was unremarkable. Colonoscopy locally was non diagnostic for Crohn’s disease (CD). An obvious rheumatological etiology was not found. The patient was placed on fexofenadine once daily and a second biopsy of the oral ulcers revealed connective tissue focally surfaced by fragments of squamous epithelium, erosive lichen planus and a robust influx of mixed chronic inflammation including non-necrotizing granulomas. Further rheumatologic and dermatologic evaluation suggested an oral manifestation of Behcet’s disease. Given persistent odynophagia, esophagogastroduodenoscopy was performed. Small non-bleeding erosions in the lower third of the esophagus was found on endoscopy. Biopsies were significant for lymphocytic esophagitis with non-necrotizing granulomas and mycobacteria and fungus stains were negative. Differential diagnosis by pathology included sarcoidosis, Behcet’s disease and inflammatory bowel disease. Acid-fast and fungal stains were negative. Repeat colonoscopy including ileoscopy was negative. Management considerations by rheumatology included genetic testing for HLA-B51, steroids and colchicine. Discussion: Granulomatous esophagitis is a rare manifestation of systemic autoimmune disease including Behcet’s, Crohn’s Disease and sarcoidosis. Although only seen in 5% of CD cases, esophageal manifestations can present as granulomatous esophagitis. Pyogenic granulomatous esophagitis is typically managed with systemic corticosteroids or endoscopic resection. In our case, evaluation for Crohn’s disease was unremarkable and the presence of pathergy and involvement of non-keratinized squamous mucosa is suggestive of an oral manifestation of Behcet’s disease despite absent genital ulcers and join pain.

Emergency Department Evaluation of Abdominal Pain in Female Adolescents.

Evaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department. A retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented. A total of 1082 girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. Sexually transmitted infection (STI) testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic examination performed. In multivariable modeling, Black patients were significantly more likely than White patients to have STI testing performed (adjusted risk ratio [aRR]=1.39; confidence interval [CI]=1.13-1.70) and to undergo a pelvic examination (aRR=2.45; CI=1.34-4.50), and less likely to undergo imaging (aRR=0.69; CI=0.59-0.81). The assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities, and evidence of potential racial disparities.

Chronic Pelvic Pain: ACOG Practice Bulletin Summary, Number 218.

Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists (1-4).

Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218.

Chronic pelvic pain is a common, burdensome, and costly condition that disproportionately affects women. Diagnosis and initial management of chronic pelvic pain in women are within the scope of practice of specialists in obstetrics and gynecology. The challenging complexity of chronic pelvic pain care can be addressed by increased visit time using appropriate coding modifiers, as well as identification of multidisciplinary team members within the practice or by facilitated referral. This Practice Bulletin addresses the diagnosis and management of chronic pelvic pain that is not completely explained by identifiable pathology of the gynecologic, urologic, or gastrointestinal organ systems. When evidence on chronic pelvic pain treatment is limited, recommendations are extrapolated from treatment of other chronic pain conditions to help guide management. The evaluation and management of potential gynecologic etiologies of pelvic pain (ie, endometriosis, adenomyosis, leiomyomas, adnexal pathology, vulvar disorders) are discussed in other publications of the American College of Obstetricians and Gynecologists ().

Litiasis uretral como causa de retención aguda de orina en un paciente pediátrico

Antecedentes. Si bien la retención aguda de orina es una emergencia urológica común, rara vez se encuentra en niños; en cuyos casos generalmente se ha asociado con una amplia variedad de causas: obstrucción mecánica (piedras o estenosis), estreñimiento, infección e inflamación, impactación fecal, enfermedades neurológicas y ginecológicas, malignidad o etiología conductual e idiopática, entre otros.
 Caso Clínico. Un niño de dos años, sin antecedentes familiares de cálculos renales, que comienza con dolor abdominal repentino acompañado de llanto durante la micción. Se realizó una cistostomía en urgencias y fue enviado para valoración por el especialista a nuestro centro. El examen físico reveló un cuerpo extraño en la uretra, por lo que se realizó una uretrocistoscopia de forma inmediata, con un uretrocistoscopio pediátrico, encontrando un cálculo en uretra anterior.
 Discusión. Los cálculos urinarios en niños son una patología poco común y es rara como la causa de la retención aguda de orina (2%). Es más común en niños y en la uretra anterior. Aquellos con cálculos uretrales posteriores tienen goteo urinario continuo, y los pacientes con cálculos uretrales anteriores tienen retención urinaria aguda. El uso de equipos endoscópicos es seguro en la resolución de los cálculos uretrales y, si está disponible, debe considerarse como la primera opción de tratamiento.

Profile of Obstetric and Iatrogenic Fistula Surgeries at Kathmandu Model Hospital

Aims: Vesico-vaginal fistula (VVF) is an abnormal fistulous communication between the bladder and/or urethra and the vagina that allows continuous involuntary discharge of urine into the vaginal vault affecting patients’ medical, physical, mental, social and sexual life. The aim of this study was to review and deliver a profile, their demography and outcome in the early phase of fistula surgery performed in our institute.
 Methods: This was a retrospective study of 222 patients who underwent fistula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The fistula were classified according to Goh`s system. Patients’ demography, obstetric characteristics and fistula repair outcomes were reviewed. The primary outcome was in terms of urinary continence.
 Results: A total of 222 women aged between 10 to 65 years with a mean age of 31.4 were included. Majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and in 42 % (n=95) of patients had fistula of gynecological etiology. Most of the patients had fistula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classification. Among 127 fistulas repaired of obstetric etiology100 (78.7%) patients and 85 (89.4%) out of 95 fistula patients of gynecological cause were continent and dry.
 Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, however iatrogenic fistula was also becoming common. Majority of our cases had successful outcome with some degree of stress in some patients.

Characterization of Bladder and Pelvic Floor Dysfunction in Women With Chronic Pelvic Pain

Objective: The purpose of this study was to elucidate the link between voiding dysfunction and lower urinary tract symptoms (LUTSs) associated with chronic pelvic pain (CPP). Study Design: Retrospective cohort study. Background: Although a gynecologic etiology is the most common cause of pelvic pain, there exists a population of patients for which these diagnoses have been ruled out, which extremely limits their diagnostic and therapeutic options. Methods and Measures: A total of 105 consecutive female patients who underwent video urodynamics for evaluation of CPP between January 2010 and December 2015 participated in the study. Following urodynamics, patients with LUTSs and associated CPP were divided into 3 urodynamic diagnostic categories post hoc and compared with standard questionnaires and urodynamic findings across each group. Results: Mean age of the cohort was 53 ± 16.60 years, and mean body mass index was 26.05 ± 5.45 kg/m2. Of the 105 patients, 50 patients were found to have detrusor overactivity, 41 patients had detrusor underactivity, and 14 patients were found to have dysfunctional voiding. The patients with detrusor overactivity had lower bladder capacity, as well as earlier desires to void, compared with the other groups. A total of 79% of patients with dysfunctional voiding and 7.4% of patients with detrusor underactivity had discordant electromyogram activity. Conclusions: In addition, preliminary data show that many of the patients may have underlying pelvic floor muscle dysfunction leading to their LUTS. Given the discordant therapy for LUTS versus CPP, this study presents the preliminary work to demonstrate muscular skeletal dysfunction associated with LUTS.

Clinical examination in gynecology consult X laboratory findings: evidence of the main infections of the reproductive tract

Sexually transmitted infections (STIs) are among the most common public health problems worldwide. The study aimed to identify gynecological infectious etiology, based on the clinical complaint of the patient and later compare with the results released by the clinical laboratory, clinically analyzing external gynecological changes and clinical complaints of patients seen in primary care. This is a documentary, descriptive, and quantitative research, conducted in a primary care unit of the Sinop municipality in 2015. Women assisted by the Extension Project Team “Nursing care: A health promotion tool sexual and reproductive” participated in this work. The clinical examination data were collected in gynecological care and preventive examinations and recorded in a structured form. The number of preventive examinations in 2015 was 100 samples. The age of the women participating in the survey that stood out was 20 to 29 years old. Analyzing aspects of the cervix of patients who performed the Pap smear: 82 (82%) were complete, 5 (5%) showed some change, 6 (6%) were friable, 5 (5%) were not displayed having been surgically removed and 2 (2%) were not displayed. According to this survey, of the 20 amendments in the laboratory results, 14 (70%) examinations portrayed resemblance to the clinical description of the gynecological examination. The infectious agent of higher prevalence compared with the clinical description of abundant leucorrhea was Gardinerella vaginalis represented in 09 reports of cervical cytology. There was 68 (68%) negative Schiller test and 8 (8%) positive Schiller test and 24 (24%) women, unfortunately, did not perform the test for lack of material during collection at the unit. It is concluded that investment in health education is necessary, with groups that address women's health, emphasizing the importance of prevention as well as the return of the woman to take the laboratory results and/or post-therapeutic assessment; promoting the realization of more joint efforts for preventive collection for more flexible hours to give opportunity to the patient who has dual working day and offer minimum conditions for carrying out the Papanicolaou and Schiller test.

ACR Appropriateness Criteria® Acute Pelvic Pain in the Reproductive Age Group.

Acute pelvic pain in premenopausal women frequently poses a diagnostic dilemma. These patients may exhibit nonspecific signs and symptoms such as nausea, vomiting and leukocytosis. The cause of pelvic pain includes a myriad of diagnostic possibilities such as obstetric, gynecologic, urologic, gastrointestinal, and vascular etiologies. The choice of the imaging modality is usually determined by a suspected clinical differential diagnosis. Thus the patient should undergo careful evaluation and the suspected differential diagnosis should be narrowed before an optimal imaging modality is chosen. Transvaginal and transabdominal pelvic sonography is the modality of choice, to assess for pelvic pain, when an obstetric or gynecologic etiology is suspected and computed tomography is often more useful when gastrointestinal or genitourinary pathology is thought to be more likely. Magnetic resonance imaging, when available in the acute setting, is favored over computed tomography for assessing pregnant patients for nongynecologic etiologies owing to its lack of ionizing radiation.The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Acute Kidney Injury Associated with Disseminated Intravascular Coagulation that Developed after a Hysterectomy in a Patient with Probable Catastrophic Antiphospholipid Syndrome

Acute kidney injury associated with disseminated intravascular coagulation (DIC) and a coagulation factor defect may develop with infection, malignancy, severe trauma, or obstetric complications. However, a gynecological etiology, such as hysterectomy, in a patient with adenomyosis has rarely been reported. We describe a case of a 42-year-old women who presented with DIC and acute kidney injury after a total hysterectomy. We thought that the cause for the acute kidney injury might be small vascular thrombosis and acute tubulointerstital nephritis due to probable catastrophic antiphospholipid syndrome with DIC. The patient was successfully treated with steroid therapy. (Korean J Med 2012;82:739-743)

Emergency Medicine Simulation Scenario: First-Trimester “Septic” Abortion

OPEN ACCESSNovember 16, 2011Emergency Medicine Simulation Scenario: First-Trimester “Septic” Abortion Jonathan Davis, MD, Lauren Weinberger, MD Jonathan Davis, MD Georgetown University School of Medicine Google Scholar More articles by this author , Lauren Weinberger, MD Hospital of the University of Pennsylvania Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9027 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis case scenario is used to demonstrate effective communication skills with an underage patient and her parents when evaluating a pregnancy-related complication, identify a gynecologic etiology of undifferentiated low abdominal pain in a reproductive-age female patient, and effectively and appropriately manage a first-trimester pregnancy complication (septic abortion). The case scenario is suitable for simulation training in a wide range of acute care medical specialties, as well as preparation for the oral board examination in emergency medicine. The target audience is medical students, medical residents, or attending physicians in the emergency department setting. In addition, it can be utilized for other medical specialties, including obstetrics and gynecology, family medicine, and adolescent medicine. It is optimal to have a standardized patient for this scenario. If this is not feasible, a low-fidelity or high-fidelity manikin can be utilized as an alternative. Necessary additional roles include a treating physician being evaluated and one nurse, as well as the instructor who controls the scenario and acts as both the historian and any consulting physicians. Other participants may serve as additional staff to be directed by the treating physician and/or family. This case has been utilized as a mock oral board training case for emergency medicine residents and faculty members preparing for the oral board examination, which, along with a written examination, is required for board certification in emergency medicine. Approximately 30 learners have used this case over the course of several years. The case materials have been continuously refined and revised based on feedback from both faculty examiners and learners. Educational Objectives By the end of this case, learners will be able to: Identify a gynecologic etiology of undifferentiated low abdominal pain in a reproductive-age female patient.Demonstrate effective communication skills with an underage patient and her parents when evaluating a pregnancy-related complication.Effectively and appropriately manage a first-trimester pregnancy complication (septic abortion).Consult obstetric/ gynecologic specialists in a timely fashion.Administer appropriate antibiotics for a patient with septic abortion.Determine maternal Rh status and treat with RHO immune globulin when indicated for an Rh negative mother.Differentiate appropriate diagnostic imaging (abdominal and/or pelvic ultrasound) to identify retained products of conception. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Septic Abortion Debriefing Materials.doc Septic Abortion Simulation Case.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationDavis J, Weinberger L. Emergency Medicine Simulation Scenario: First-Trimester “Septic” Abortion. MedEdPORTAL. 2011;7:9027. https://doi.org/10.15766/mep_2374-8265.9027 Copyright & Permissions© 2011 Davis and Weinberger. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsFeverInfectionEndometritisSpontaneous AbortionMiscarriageFirst Pregnancy Trimester Disclosures None to report. Funding/Support None to report. Loading ...

Robotic single-site surgery: from research to clinical practice?

With the introduction of laparoscopic cholecystectomy in the late 1980’s, the endoscopic revolution was launched and the world of surgery changed forever. Over the years, minimally invasive surgery, namely operative laparoscopy, has emerged as the standard treatment for many gynecologic benign and malignant etiologies. Laparoscopic surgery has answered the patient’s right to better cosmesis, less blood loss, faster recovery, shorter hospital stay, and less pain. A novel development in minimally invasive surgery that is even less invasive than traditional laparoscopy or robotic surgery is laparoendoscopic single-site (LESS) surgery. It is also known as single-incision laparoscopic surgery (SILS) or single-port access (SPA) surgery. Benefits of LESS include better cosmesis, improved postoperative pain scores, and less post-operative narcotic use. A recent randomized trial by Chen et al. compared the immediate results of patients undergoing either two-channel single-port laparoscopic-assisted vaginal hysterectomy or conventional multiport laparoscopic-assisted

Venous Reflux From the Pelvis and Vulvoperineal Region as a Possible Cause of Lower Extremity Varicose Veins

The aim of this study was to demonstrate with the use of computed tomography and ultrasonography that isolated venous reflux from the pelvis and vulvoperineal region is a possible cause of lower extremity varicose veins. From a consecutive series of patients who were referred to the vascular imaging laboratory, we retrospectively selected patients who had unusual lower extremity varicose veins that arose from the pelvis and vulvoperineal region. Computed tomographic venography and ultrasonograhy were used to exclude other causes of varicose veins. We reviewed medical records to evaluate the presence of pelvic congestion syndrome. Computed tomographic findings were reviewed to locate ovarian vein dilatation. Twenty limbs of 15 female patients (age range, 33-72 years; mean age, 53.2 years) were diagnosed with varicose veins that arose from the pelvis and vulvoperineal region without any saphenofemoral insufficiency. Eleven patients (73.3%) had no history of chronic pelvic pain. Four patients (26.7%) presented with chronic pelvic pain without any other evident gynecological etiology. Dilatation of the left ovarian vein was seen in 10 patients (67%; mean dilatation, 8.6 mm; range, 7.5-9.6 mm). Five patients (33%; mean dilatation, 4.9 mm; range, 3.8-6.6 mm) showed no ovarian vein dilatation. The combined use of computed tomographic venography and ultrasonography may be a possible noninvasive method for the diagnosis of unusual lower extremity varicose veins. Venous reflux from the pelvis and vulvoperineal region as a cause of lower extremity varicose veins can manifest without evidence of pelvic congestion syndrome or ovarian vein dilatation.

Research on the Methods of Treating Gynecological Inflammatory Diseases with Traditional Chinese Medicine

Objective To research the methods of treating gynecological inflammatory diseases with TCM. Methods By analyzing gynecological etiology and pathogenesis of inflammatory diseases, we explored the functions of pathogenic dampness, heat, blood stasis, and deficiency of genuine Qi on the onset, development and changes of gynecological inflammatory diseases. Results Gynecological inflammatory diseases is mainly caused by external invasion of pathogenic dampness, heat and insect poison and internal disorder of viscera, leading to the generation of internal dampness, heat, blood stasis and turbid fluid. Besides, the deficiency of genuine Qi is also a major reason for this disease. The therapeutic methods should be eliminating dampness, clearing heat, removing blood stasis, and strengthening genuine Qi. Conclusion TCM is effective in treating gynecological inflammatory diseases. Key words: Gynecological inflammatory diseases; Traditional Chinese medicine