Cases reported "Pain"

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1/10. Insertion of a slim fit tampon into the urethra. A case report.

    BACKGROUND: A 14-year-old accidentally inserted a slim fit tampon into her urethra. Such a case could occur again in young teenagers who otherwise have never inserted a tampon and especially have yet to see a gynecologist for their first gynecologic examination. CASE: Accidental insertion of a slim fit tampon into the urethra by a 14-year-old necessitated cystoscopic resection of the engorged tampon. CONCLUSION: Although this is the only case reported of urethral tampon placement, one must include it as part of the differential diagnosis in assessing acute onset of pain or hematuria after the placement of a slim fit tampon.
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ranking = 1
keywords = gynecologic
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2/10. Chronic perineal pain related to sacral meningeal cysts.

    Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.
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ranking = 1
keywords = gynecologic
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3/10. Vasospasm of the nipple presenting as painful lactation.

    BACKGROUND: breast pain is a common complaint among lactating women. Vasospasm of the nipple should be considered in the differential diagnosis of breast pain, particularly when no other signs of infection or trauma are encountered. This report demonstrates a case of vasospasm successfully treated with nifedipine. CASE: A 26-year-old breastfeeding multipara presented with intermittent episodes of extreme pain associated with blanching of the nipple. The pain subsided upon return of normal color to the nipple. She was able to continue breastfeeding after successful treatment with nifedipine. CONCLUSION: Vasospasm of the nipple causes severe episodic breast pain and may lead to discontinuation of breastfeeding if not appropriately treated. This phenomenon is not well reported in the obstetric and gynecologic literature, although the obstetrician may be the first physician to evaluate a patient with symptoms. patients with episodic nipple pain and pallor can be successfully treated with nifedipine.
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ranking = 1
keywords = gynecologic
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4/10. Three-cycle fentanyl patch system significantly improves pain control in gynecologic cancer.

    Pain affects many cancer patients, and in advanced stages of the disease it can significantly affect the quality of their lives. morphine has long been the 'gold standard' for the treatment of cancer pain. However, its side-effects, particularly sedation and cognitive impairment at high doses, have encouraged the use of 'opioid rotation'. The transdermal fentanyl patch has advantages over oral morphine, with reduced side-effects and increased convenience in practical usage. The side-effects were reduced in patients who changed to the fentanyl patch, but rescue analgesia was often needed because of the decrease of fentanyl release from the patch, especially on the patch replacement day. We have developed a three-cycle fentanyl patch system that provided an appropriate pain control, and this system should be considered for pain relief in cancer patients.
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ranking = 4
keywords = gynecologic
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5/10. Benign metastasizing leiomyomatosis with massive brachial plexus involvement mimicking neurofibromatosis type 1.

    We report the case of a patient who presented with right arm and shoulder pain due to compression of the infraclavicular brachial plexus due to benign metastasizing leiomyomatosis (BML). She was initially and had been repeatedly misdiagnosed as having neurofibromatosis type 1 (NF 1). The diagnosis of BML was not obvious due to its rare nature, the patient's not detailing the specifics of her gynecologic history of having undergone resection of a large uterine leiomyoma and followed by disseminated pelvic leiomyomatous nodules, histologic misinterpretation of an extrauterine lesion of the spine and the brachial plexus as a neurofibroma and the radiologic diagnosis of lung nodules as being "non-specific" in nature. In addition and importantly, no clinical, radiographic or histologic features of NF 1 were present. Although a rare condition, BML should be considered in the differential diagnosis of NF and in patients having a history of uterine leiomyoma. The remarkable, selective involvement of the brachial plexus in this case is unexplained.
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ranking = 1
keywords = gynecologic
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6/10. An abused psychotic preadolescent at risk for Huntington's disease.

    An abused 10-year-old girl with a family history of Huntington's disease developed incapacitating abdominal pain with concomitant behavioral symptomatology suggestive of dementia. The pseudoneurologic nature of her symptoms was clarified through exhaustive evaluation and did not appear to be that of early-onset Huntington's disease. Assessment included pediatric, psychiatric, neurologic, and gynecologic examination; extensive radiologic and laboratory tests; and chronobiology studies. Successful treatment necessitated the integration of numerous therapeutic modalities including dynamically oriented psychotherapy, psychopharmacologic intervention, physical therapy, behavior modification, and electroconvulsive therapy.
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ranking = 1
keywords = gynecologic
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7/10. Continuous thoracic epidural analgesia for the control of pain associated with pleural sclerosis.

    Successful use of nonnarcotic, thoracic epidural analgesia for the control of pain associated with pleural sclerosis was accomplished in three gynecologic oncology patients with severe respiratory compromise due to malignant pleural effusions. Excellent analgesia was obtained with no observed anesthetic complications.
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ranking = 1
keywords = gynecologic
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8/10. A technique for surgical correction of fallopian tube prolapse.

    prolapse of the fallopian tube is a rare complication of gynecologic surgery. Five cases were operated upon in the authors' hospital within the past year. A summary of these cases is given. One of the cases, which required a second operative procedure, is discussed. The surgical technique for complete excision of the prolapsed fallopian tube via the vagina is described.
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ranking = 1
keywords = gynecologic
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9/10. Ovarian arteriovenous fistula. An unusual cause of abdominal pain.

    Arteriovenous fistulae of the ovarian artery may develop after gynecologic surgery. A case that occurred 9 years after hysterectomy with bilateral oophorectomy is presented and discussed. It illustrates an unusual cause of left lower quadrant abdominal pain. Surgical removal of the ovarian arteriovenous fistula resulted in complete relief of the patient's symptoms. This uncommon entity must be considered when dealing with lower quadrant pain and a past history of hysterectomy.
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ranking = 1
keywords = gynecologic
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10/10. Fistula formation after implanting an ePTFE membrane. A case report.

    BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) membranes have been used successfully as permanent implants to prevent adhesions after gynecologic surgery. Fistulization involving such an implant has not been reported previously. CASE: A 27-year-old woman had micturition problems and pain four years after a myomectomy and implantation of an ePTFE membrane. laparotomy revealed that the membrane was partly inserted into a hole in the anterior bladder wall, close to the vesicouterine pouch. The membrane was removed and the fistula repaired. Pathologic studies of the specimen showed multispecies bacterial contamination. CONCLUSION: The fistula may have originated with ischemia at the vesicouterine fold caused by the suture in the corner of the ePTFE membrane. This led to intussusception of the prosthesis. The hole that was created expanded, and pelvic inflammatory disease probably produced the local sepsis. In patients with posterior or fundal uterine incisions for myomectomy, the ePTFE membrane is a useful permanent adhesion barrier in an area at substantial risk of adhesion formation. In cases using anterior incisions, however, in which the membrane may be fixed close to the vesicouterine fold, surgeons should consider removing the prosthesis after peritoneal healing has occurred.
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ranking = 1
keywords = gynecologic
(Clic here for more details about this article)
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