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1.
Rev. colomb. cir ; 37(3): 455-468, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378744

ABSTRACT

Introducción. Debido a la rareza de la hernia obturatriz y la imposibilidad para desarrollar estudios controlados de alto grado de evidencia, la mayoría de la literatura al respecto proviene de reportes de casos. Lo anterior, aunado al poco conocimiento del área anatómica de presentación y el cuadro clínico, la convierte en la hernia con mayor mortalidad. Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos, ilustrado con pacientes manejados en el Servicio de Cirugía general de la Clínica Santa María de Sincelejo, Colombia. Discusión. La hernia obturatriz se puede descubrir en mujeres ancianas con antecedentes de cirugía abdominal o multiparidad. El signo de Howship­Romberg, que se presenta en la mitad de los pacientes, puede acompañarse de dolor abdominal en hipogastrio, vómitos y distensión progresiva. La radiografía de abdomen simple muestra tardíamente niveles hidroaéreos con ausencia de gas en ampolla rectal, pero como es poco específica para demostrar el sitio de obstrucción, es preferible la Tomografía computarizada. Conclusión. La hernia obturatriz requiere alto índice de sospecha, que ayude a la detección temprana e intervención quirúrgica inmediata, para evitar las complicaciones.


Introduction. Due to the rarity of the obturator hernia and the impossibility to develop controlled studies with a high degree of evidence, most of the reference in the literature comes from case reports. This, coupled with little knowledge of the anatomical area of presentation and clinical picture, makes it the hernia with the highest mortality. Methods. A literature search was carried out in the main databases, illustrated with patients managed in the General Surgery Service of the Clínica Santa María de Sincelejo. Discussion. Obturator hernia can be discovered in elderly women with a history of abdominal surgery or multiparity. The Howship ­ Romberg sign occurs in half of the patients, it can be associated with lower abdominal pain, vomiting, and progressive distension. Plain abdominal X-ray shows delayed air-fluid levels with absence of gas in the rectal ampulla, but since it is not very specific to demonstrate the site of obstruction, computed axial tomography is preferable. Conclusion. Obturator hernia requires a high index of suspicion, which helps early detection and immediate surgical intervention, to avoid complications.


Subject(s)
Humans , Hernia, Obturator , Intestinal Obstruction , Tomography, X-Ray Computed , Abdominal Pain , Pelvic Pain , Diagnosis
2.
Rev. bras. ginecol. obstet ; 44(3): 295-303, Mar. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1387872

ABSTRACT

Abstract Introduction Endometriosis is an inflammatory disease that affects women of reproductive age, causing pain and the possibility of infertility. Endometriosis was associated to low life quality and research shows the impact of endometriosis in several areas of life, justifying how these patients are more likely to develop depression, anxiety, and stress. Objective The aim of the present systematic review was to explore the field of psychology in endometriosis, identifying studies that used the cognitive behavioral therapy technique as a treatment for endometriosis and chronic pelvic pain. Methods The keywords used were Endometriosis and Behavioral Therapy; Behavioral Disciplines and Activities; Cognitive Behavioral Therapy; Mental Health; Psychological Techniques; Psychology; Psychotherapy; Mental Health Services; and the search was performed in the following databases: PubMed/Medline, Scielo, Lilacs, and Capes. The study followed the PRISMA guidelines and all studies whose intervention strategy used was related to cognitive-behavioral therapy were considered. Results Of the 129 articles found, only 5 were selected, and it was possible to identify that the psychological intervention whose approach brought cognitive-behavioral therapy techniques promoted a decrease in the sensation of pain, improvements in the scores of depression and stress, and significant changes in aspects of quality of life such as vitality, physical and social functioning, emotional well-being, control, and autonomy. Conclusion Cognitive-behavioral therapy can be very promising to take care of the emotional side of those who have endometriosis However, the present systematic review highlights the need to develop more structured studies with consistent, clear and replicablemethods to reach a psychological intervention protocol for patients who live with this gynecological-physical-emotional condition.


Resumo Introdução A endometriose é uma doença inflamatória que afeta mulheres em idade reprodutiva, causando dor e possibilidade de infertilidade. A endometriose foi associada a baixa qualidade de vida e pesquisas mostram o impacto da endometriose emdiversas áreas da vida, justificando como tais pacientes têmmaior probabilidade de desenvolver depressão, ansiedade e estresse. Objetivo O objetivo da presente revisão sistemática foi explorar o campo da psicologia na endometriose, identificando estudos que usaram a técnica da terapia cognitiva comportamental como tratamento da endometriose e da dor pélvica crônica. Métodos As palavras chaves utilizadas foram Endometriose AND Terapia comportamental; Disciplinas e atividades comportamentais; Terapia cognitiva comportamental; Saúde mental; Técnicas psicológicas; Psicologia; Psicoterapia; Serviços de saúde mental, e a busca foi realizada nos bancos de dados PubMed / Medline, SCIELO, LILACS e CAPES. O estudo seguiu as diretrizes dos Principais Itens para Relatar Revisões Sistemáticas e Metanálises (PRISMA, na sigla em inglês) e foram considerados todos os estudos cuja estratégia de intervenção utilizada estava relacionada à terapia cognitivocomportamental. Resultados Dos 129 artigos encontrados, somente 5 foram selecionados, e foi possível identificar que a intervenção psicológica cuja abordagem trouxe técnicas da terapia cognitivo-comportamental promoveu diminuição na sensação de dor, melhora nos escores de depressão e estresse e mudanças significativas em aspectos da qualidade de vida como vitalidade, funcionalidade física e social, bem-estar emocional, controle e autonomia. Conclusão A terapia cognitivo-comportamental pode ser muito promissora para o tratamento psicológico/emocional de quem tem endometriose. No entanto, a presente revisão sistemática destaca a necessidade de desenvolver estudos mais estruturados com métodos consistentes, claros e replicáveis para se chegar a um protocolo de intervenção psicológica para pacientes que convivem com esse quadro ginecológico-físico-emocional.

3.
Fisioter. Mov. (Online) ; 35: e35124, 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1384942

ABSTRACT

Abstract Introduction: Endometriosis is a disorder that can significantly affect quality of life (QOL) and interfere in biological, psychological, social, marital and family aspects. Objective: To analyze the influence of endometriosis on the QOL of women diagnosed with the disease. Methods: The study was carried out from March to April 2018, with 10 volunteers from the Santa Casa de Misericórdia do Pará Foundation, with a clinical diagnosis of endometriosis. The Portuguese version of the endometriosis health profile questionnaire (EHP-30) was applied in order to assess QOL in women with this pathology. Results: The sociodemographic results revealed a predominance of women aged between 29 and 55 years, most of whom were married (6) and high school graduates (5). Seven of the ten volunteers had previous pregnancies. Of the aspects evaluated in the EHP-30, 79% of the items associated with pelvic pain in the core questionnaire were present in the participants. In other questionnaires, sexual life (82%) was the most affected index, followed by professional life (70%) and infertility (58.82%). Conclusion: The aspects of QOL most impacted by pelvic pain associated with endometriosis in the women evaluated were sexuality and professional life, leading to biopsychosocial trauma.


Resumo Introdução: A endometriose é um distúrbio que pode atingir amplamente a qualidade de vida (QV) e interferir no âmbito biológico, psicológico, social, marital e familiar. Objetivo: Analisar a influência da endometriose na QV de mulheres portadoras dessa patologia. Métodos: O estudo foi realizado no período de março a abril de 2018, com dez voluntárias da Fundação Santa Casa de Misericórdia do Pará, que apresentavam diagnóstico clínico de endometriose. Aplicou-se o Questionário de Qualidade de vida em Endometriose (EHP-30), versão em português, a fim de avaliar a QV em mulheres com endometriose. Resultados: Os resultados sociodemográficos mostra-ram uma predominância de mulheres com idade entre 29 e 55 anos, sendo a maioria casada (6) e com colegial completo (5). Sete das dez voluntárias tiveram gestações. Dentre os âmbitos avaliados pelo EHP-30, o questionário central de QV relacionado à dor pélvica teve 79% dos itens comprometendo as participantes. Nos demais questionários, a vida sexual (82%) foi o índice mais afetado, seguido da vida profissional (70%) e infertilidade (58,82%). Conclusão: Nas mulheres avaliadas, os aspectos da QV mais influenciados pela dor pélvica relacionada à endometriose foram a sexualidade e a vida profissional, acarretando prejuízos biopsicossociais.

4.
Ginecol. obstet. Méx ; 90(4): 331-341, ene. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1385030

ABSTRACT

Resumen OBJETIVO: Evaluar la asociación entre los hallazgos quirúrgicos y la intensidad del dolor posoperatorio y su reacción a los analgésicos en pacientes intervenidas para esterilización quirúrgica. MATERIALES Y MÉTODOS: Estudio observacional, analítico, de tipo cohorte retrospectiva efectuado en una institución del Oriente colombiano en mujeres mayores de 18 años que optaron por la esterilización quirúrgica por vía laparoscópica como método de planificación familiar. Las variables cuantitativas se analizaron en medidas de tendencia central y las nominales en porcentajes. Se comparó el antecedente de dolor pélvico con la severidad del dolor posquirúrgico, con ajuste de las variables de confusión. RESULTADOS: Se estudiaron 141 pacientes con límites de edad de 25 y 34 años. El antecedente de dolor pélvico se evidenció en el 26.2%. Durante la cirugía el 29.7% resultaron con síndrome adherencial moderado de la pared abdominal hacia el útero, circunstancia que se asoció con el antecedente de dolor pélvico en un 29.7%. En la evaluación del dolor posquirúrgico, el 48.2% sufrió dolor moderado. En 95% de las pacientes el dolor se logró controlar con 500 mg de paracetamol cada 6 horas, sin requerir opioides. CONCLUSIONES: El síndrome adherencial moderado se asoció con el antecedente de dolor pélvico crónico y cesárea previa. No hubo relación significativa entre el dolor posoperatorio y los hallazgos quirúrgicos. El dolor a las 72 horas fue leve y moderado en 46.1 y 48.2%, respectivamente. En este estudio el procedimiento laparoscópico no se asoció con aumento del dolor, que se controló con analgesia convencional, lo que ratifica una ventaja importante de este tipo de procedimiento.


Abstract OBJECTIVE: To evaluate the association between surgical findings and postoperative pain intensity and its reaction to analgesics in women who underwent surgical sterilization. MATERIALS AND METHODS: Observational, analytical, retrospective cohort study carried out in an institution in eastern Colombia in women over 18 years of age who opted for laparoscopic surgical sterilization as a method of family planning. Quantitative variables were analyzed as measures of central tendency and nominal variables as percentages. The history of pelvic pain was compared with the severity of postoperative pain, with adjustment for confounding variables. RESULTS: We studied 141 patients with age limits of 25 and 34 years. A history of pelvic pain was evident in 26.2%. During surgery 29.7% had moderate adhesive syndrome of the abdominal wall towards the uterus, which was associated with a history of pelvic pain in 29.7%. In the evaluation of postoperative pain, 48.2% suffered moderate pain. In 95% of the patient's pain was controlled with 500 mg of paracetamol every 6 hours, without requiring opioids. CONCLUSIONS: Moderate adhesive syndrome was associated with a history of chronic pelvic pain and previous cesarean section. There was no significant relationship between postoperative pain and surgical findings. Pain at 72 hours was mild and moderate in 46.1 and 48.2% respectively. In this study the laparoscopic procedure was not associated with increased pain, which was controlled with conventional analgesia, which confirms an important advantage of this type of procedure.

5.
Asian Journal of Andrology ; (6): 323-331, 2022.
Article in English | WPRIM | ID: wpr-928541

ABSTRACT

We investigated the therapeutic effects of superoxide dismutase (SOD) from thermophilic bacterium HB27 on chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its underlying mechanisms. A Sprague-Dawley rat model of CP/CPPS was prepared and then administered saline or Thermus thermophilic (Tt)-SOD intragastrically for 4 weeks. Prostate inflammation and fibrosis were analyzed by hematoxylin and eosin staining, and Masson staining. Alanine transaminase (ALT), aspartate transaminase (AST), serum creatinine (CR), and blood urea nitrogen (BUN) levels were assayed for all animals. Enzyme-linked immunosorbent assays (ELISA) were performed to analyze serum cytokine concentrations and tissue levels of malondialdehyde, nitric oxide, SOD, catalase, and glutathione peroxidase. Reactive oxygen species levels were detected using dichlorofluorescein diacetate. The messenger ribonucleic acid (mRNA) expression of tissue cytokines was analyzed by reverse transcription polymerase chain reaction (RT-PCR), and infiltrating inflammatory cells were examined using immunohistochemistry. Nuclear factor-κB (NF-κB) P65, P38, and inhibitor of nuclear factor-κBα (I-κBα) protein levels were determined using western blot. Tt-SOD significantly improved histopathological changes in CP/CPPS, reduced inflammatory cell infiltration and fibrosis, increased pain threshold, and reduced the prostate index. Tt-SOD treatment showed no significant effect on ALT, AST, CR, or BUN levels. Furthermore, Tt-SOD reduced inflammatory cytokine expression in prostate tissue and increased antioxidant capacity. This anti-inflammatory activity correlated with decreases in the abundance of cluster of differentiation 3 (CD3), cluster of differentiation 45 (CD45), and macrophage inflammatory protein 1α (MIP1α) cells. Tt-SOD alleviated inflammation and oxidative stress by reducing NF-κB P65 and P38 protein levels and increasing I-κBα protein levels. These findings support Tt-SOD as a potential drug for CP/CPPS.


Subject(s)
Animals , Chronic Pain , Cytokines/metabolism , Fibrosis , Humans , Inflammation/metabolism , Male , NF-kappa B/metabolism , Pelvic Pain/pathology , Prostatitis/metabolism , Rats , Rats, Sprague-Dawley , Superoxide Dismutase , Syndrome
6.
Article in Chinese | WPRIM | ID: wpr-927395

ABSTRACT

OBJECTIVE@#To observe the clinical therapeutic effect of CO2 laser moxibustion on endometriosis related pelvic pain of cold coagulation and blood stasis.@*METHODS@#A total of 76 patients with endometriosis related pelvic pain of cold coagulation and blood stasis were randomized into a laser moxibustion group and a sham laser moxibustion group, 38 cases in each group. In the laser moxibustion group, moxibustion was applied at bilateral Zigong (EX-CA 1) using CO2 laser moxibustion instrument. In the sham laser moxibustion group, the manipulation of moxibustion was same as the laser moxibustion group, without laser output. The treatment was given once every other day, 30 min each time, 3 times a week for 4 weeks in both groups. Before and after treatment and follow-up of 3 months after treatment, the scores of Gracely box scale (GBS) and visual analogue scale (VAS) were observed, the usage of non-steroidal anti-inflammatory drug for the duration of the treatment and the average days of taking drugs were recorded in both groups.@*RESULTS@#Compared before treatment, the GBS and VAS scores were decreased after treatment and during follow-up in the laser moxibustion group (P<0.05), while those in the sham moxibustion group had no significant differences (P>0.05). Compared with the sham moxibustion group, the GBS and VAS scores were decreased after treatment and during follow-up (P<0.05), the cases and average days of taking drugs were less in the laser moxibustion group (P<0.05).@*CONCLUSION@#CO2 laser moxibustion can improve the pain symptom in patients with endometriosis related pelvic pain of cold coagulation and blood stasis, and reduce the use of analgesic drugs.


Subject(s)
Acupuncture Points , Carbon Dioxide , Endometriosis/complications , Female , Humans , Moxibustion , Pelvic Pain/therapy , Treatment Outcome
7.
Rev. cuba. med. mil ; 50(3): e1295, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1357311

ABSTRACT

Introducción: La factibilidad y seguridad del empleo de la ozonoterapia se evidencia en los resultados expuestos por varios autores, en enfermedades cuyo síntoma fundamental es el dolor crónico. Objetivo: Determinar la evolución clínica de las pacientes con dolor pélvico crónico, tratadas con ozono asociado al tratamiento médico convencional. Métodos: Estudio descriptivo, observacional, retrospectivo, en el que se determinó la evolución clínica de las pacientes con dolor pélvico crónico tratadas con ozono, asociada al tratamiento médico convencional. La muestra fue de 54 mujeres. Las variables utilizadas fueron: edad, causa del dolor pélvico, tiempo de evolución, puntuación de la escala de dolor antes y después de la aplicación de la ozonoterapia y evaluación del tratamiento. Resultados: Prevalecieron las pacientes con edad de 26-35 años. El 57,4 por ciento tenían entre 2 y 2 años de evolución del dolor. La enfermedad inflamatoria pélvica crónica fue la causa de mayor frecuencia con 42,5 por ciento. Antes de la aplicación de la ozonoterapia la media de puntuación en la escala de dolor fue de 6,31, y disminuyó a 3 después del tratamiento, con una evaluación de bien en el 81,1 por ciento de los casos. Conclusiones: Después de la aplicación de la ozonoterapia asociada al tratamiento médico convencional, se produce mejoría clínica, por lo que puede ser una alternativa de tratamiento(AU)


Introduction: The feasibility and safety of the use of ozone therapy is evidenced in the results presented by several authors, in diseases whose main symptom is chronic pain. Objective: To determine the clinical evolution of patients with chronic pelvic pain treated with ozone associated with conventional medical treatment. Methods: Descriptive, observational, retrospective study, in which the clinical evolution of patients with chronic pelvic pain treated from January 2018 to January 2020, with ozone therapy, associated with conventional medical treatment. The sample was 54 women. The variables used were: age, cause of pelvic pain, time of evolution, score on the pain scale before and after the application of ozone therapy, and evaluation of the treatment. Results: Patients aged 26-35 years prevailed. 57,4 percent had between two and four years of pain evolution. Chronic pelvic inflammatory disease was the most frequent cause with 42,5 percent. Before the application of ozone therapy, the mean score on the pain scale was 6.31, and it decreased to 3 after treatment, with an evaluation of good in 81,1percent of the cases. Conclusions: After the application of ozone therapy associated with conventional medical treatment, there is evident clinical improvement, which is why it constitutes an alternative of treatment(AU)


Subject(s)
Humans , Female , Ozone/therapeutic use , Pelvic Pain/therapy , Epidemiology, Descriptive , Cross-Sectional Studies
8.
BrJP ; 4(3): 239-244, July-Sept. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1339284

ABSTRACT

ABSTRACT BACKGROUND AND OBJECTIVES: Sexual dysfunctions associated with pain symptoms can affect female genito-pelvic functionality. The objective of this study was to identify non-pharmacological analgesic therapies used in painful sexual dysfunctions to guide clinical and therapeutic practice in comprehensive care of women's sexual health. CONTENTS: An integrative review, carried out in the Pubmed, LILACS, Scielo, PEDro and Biblioteca Virtual de Saúde databases. The searches were performed using the combinations: "dysfunction" AND "pain" AND "sexual" AND "treatment". The inclusion criteria allowed the analysis of six articles published between January 2009 and August 2019. It was observed that dysfunctions in the muscles of the pelvic floor may be associated with pain and sexual dysfunctions, thus, non-pharmacological analgesic interventions can provide greater muscle relaxation and perineal self-perception, reducing painful symptoms in the sexual response cycle. CONCLUSION: The treatment of painful sexual dysfunctions with the use of non-pharmacological resources, using techniques such as perineal massage, myofascial release, muscle training, biofeedback, vaginal dilators, electrostimulation, and radiofrequency aim to improve sexual performance and quality of life for women.


RESUMO JUSTIFICATIVA E OBJETIVOS: Disfunções sexuais associadas a sintomas dolorosos podem repercutir sobre a funcionalidade gênito-pélvica feminina. O objetivo deste estudo foi identificar terapêuticas não farmacológicas analgésicas utilizadas em disfunções sexuais dolorosas a fim de contribuir com a prática clínica e terapêutica no cuidado integral à saúde sexual feminina. CONTEÚDO: Trata-se de revisão integrativa realizada nas bases de dados Pubmed, LILACS, Scielo, PEDro e Biblioteca Virtual da Saúde. As buscas foram realizadas utilizando as combinações: "dysfunction" AND "pain" AND ''sexual'' AND ''treatment''. Os critérios de inclusão permitiram a análise de seis artigos publicados no período de janeiro de 2009 a agosto de 2019. Observou-se que as disfunções na musculatura do assoalho pélvico podem estar associadas a quadros álgicos e disfunções sexuais, de modo que intervenções não farmacológicas analgésicas podem proporcionar maior relaxamento muscular e autopercepção perineal, reduzindo, assim, sintomas dolorosos no ciclo de resposta sexual. CONCLUSÃO: O tratamento de disfunções sexuais dolorosas com utilização de recursos não farmacológicos, através de técnicas como a massagem perineal, liberação miofascial, treinamento muscular, biofeedback, dilatadores vaginais, eletroestimulação e radiofrequência visam proporcionar melhora no desempenho sexual e na qualidade de vida feminina.

9.
Arch. méd. Camaguey ; 25(4): e7803, 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339121

ABSTRACT

RESUMEN Fundamento: el dolor pélvico crónico es un problema ginecológico frecuente en las mujeres de edad fértil. Se define como el dolor no cíclico que persiste durante seis meses o más, localizado en la pelvis, en la porción infra umbilical de la pared abdominal anterior, en la región lumbosacra o en la región glútea lo que provoca discapacidad funcional. Las mujeres en edad fértil, son sin lugar a duda el grupo etario fundamental para la salud global y de las futuras generaciones. Muchas mujeres acuden a consulta de Ginecología por presentar dolor pelviano crónico y al realizarles la historia clínica, se observan problemas de fertilidad. Objetivo: caracterizar el comportamiento del dolor pélvico crónico de causa ginecológica en pacientes en edad fértil. Métodos: se realizó un estudio observacional, descriptivo, transversal. La población de estudio estuvo constituida por 123 mujeres con diagnóstico de dolor pélvico crónico de causa ginecológica y en edad fértil, que fueron atendidas en consulta de Ginecología en el Hospital Docente Clínico Quirúrgico Comandante Manuel Fajardo Rivero de Villa Clara durante el período comprendido entre el 1ro de septiembre de 2017 al 30 de septiembre de 2019. Resultados: las mujeres en el estudio eran adultas. La principal causa del dolor fue la endometriosis. La mayoría eran multíparas y presentaron infertilidad. Conclusiones: la mayoría de las pacientes con dolor pélvico crónico en edad fértil eran adultas. La principal causa del dolor pélvico crónico fue la endometriosis, seguido de las adherencias. La mayoría de las mujeres eran multíparas y presentaron infertilidad.


ABSTRACT Background: chronic pelvic pain is a frequent gynecological problem in women of childbearing age. It is defined as non-cyclical pain that persists for six months or more, located in the pelvis, in the infra-umbilical portion of the anterior abdominal wall, in the lumbosacral region or in the gluteal region, causing functional disability. Women of childbearing age are without a doubt the fundamental age group for global health and for future generations. Many women come to the gynecology clinic for having chronic pelvic pain and when the medical history is done, a high incidence of fertility problems is observed. Objective: to characterize the behavior of chronic pelvic pain of gynecological cause in patients of childbearing age. Methods: an observational, descriptive, cross-sectional study was carried out. The study population consisted of 123 patients with a diagnosis of chronic pelvic pain of gynecological cause and of childbearing age, which weretreated in a gynecology consultation at the Comandante Manuel Fajardo Rivero Teaching Clinical Hospital of Villa Clara during the period from September 1st, 2017 to September 30th, 2019. Results: the women in the study were adults. The main cause of pain was endometriosis. Most of the women were multiparous and had infertility. Conclusions: most of the patients with chronic pelvic pain in childbearing age were adults. The main cause of chronic pelvic pain was endometriosis, followed by adhesions. Most of the women were multiparous and had infertility.

10.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388634

ABSTRACT

RESUMEN Introducción: La endometriosis afecta hasta un 10-15% de las mujeres jóvenes. Se define como tejido endometrial funcional fuera de la cavidad uterina y su presentación clásica es la dismenorrea. La variedad profunda afecta a un 1-2% y las localizaciones más frecuentes son el peritoneo pélvico, ovarios, ligamentos útero-sacros y septum recto-vaginal; sin embargo, puede presentarse de forma muy infrecuente como implantes aislados localizados en relación al nervio ciático. El diagnóstico habitualmente es complejo y tardío, dado que los síntomas son inespecíficos y el examen físico puede ser indistinguible de otras etiologías. El estudio imagenológico de elección para la endometriosis profunda es la resonancia magnética (RM) de pelvis ya que una adecuada localización pre-quirúrgica de las lesiones es fundamental. Caso Clínico: Paciente de sexo femenino de 46 años, con tres años de dolor pélvico, dismenorrea y dispareunia. El síntoma cardinal fue dolor ciático progresivo, con déficit motor y alteraciones sensitivas, los cuales se exacerbaban durante la menstruación y no presentaban respuesta al tratamiento farmacológico. En la RM se identifica nódulo sólido sospechoso de endometriosis en relación al nervio ciático derecho. El caso es evaluado por un comité multidisciplinario y se realiza cirugía laparoscópica. El diagnóstico de sospecha es confirmado histológicamente. La paciente presenta buena recuperación post-quirúrgica y cese completo de los síntomas descritos. Discusión: La endometriosis profunda presenta un reto diagnóstico y habitualmente es tardío. Este caso presenta el resultado exitoso de una buena sospecha clínica, un estudio imagenológico completo y la resolución con una técnica quirúrgica compleja.


ABSTRACT Introduction: Endometriosis is a disease that affects 10-15% of young women. It is characterized as functional endometrial tissue outside the uterine cavity. The most common form of presentation is dysmenorrhea. Deep endometriosis affects 1-2% of the patients, and is frequently located in the pelvic peritoneum, ovaries, utero-sacral ligaments and recto-vaginal septum. The isolated endometriosis of the sciatic nerve is a very uncommon presentation of this disease. Late diagnosis is frequent, mainly because the symptoms are non-specific, and the physical examination may be indistinguishable from other etiologies. The imaging study of choice is the pelvic magnetic resonance imaging (MRI) and an accurate pre-surgical location of the lesions is critical for a successful surgical outcome. Clinical case: 46-year-old female patient with 3 years of pelvic pain, dysmenorrhea and dyspareunia. The cardinal symptom was progressive sciatic pain, with motor deficit and sensory alterations. The pain was persistent despite pharmacological treatment and exacerbated during menstruation. MRI identifies a nodule located in the pelvic portion of the right sciatic nerve, suggestive of an endometriosis implant. The case was discussed by a multidisciplinary committee and laparoscopic surgery was performed. The diagnosis was confirmed with histology. The patient recovered well from surgery with significant improvement of the previously described symptoms. Discussion: The diagnosis of deep endometriosis is challenging and usually delayed. This rare disease had a successful outcome, due to an early clinical suspicion, a thorough imaging study and an effective resolution with a complex surgical technique.

11.
Femina ; 49(2): 115-120, 20210228. ilus
Article in Portuguese | LILACS | ID: biblio-1224068

ABSTRACT

Este trabalho buscou reunir dados essenciais sobre as etiologias de dor pélvica aguda, uma queixa constante nos serviços de emergências e ambulatórios de ginecologia, responsável por grande desconforto e impacto na qualidade de vida de pacientes mulheres. É uma condição laboriosa por causa de seu amplo espectro de causas, devendo ser abordada com cuidado e atenção pelo profissional médico, o qual deve considerar os diversos diagnósticos diferenciais, sendo a ultrassonografia o exame de maior importância para auxiliar em seu diagnóstico. As principais etiologias não obstétricas podem ser não ginecológicas e ginecológicas; essas últimas são divididas em anexiais e uterinas. Entre as causas ginecológicas, devem- -se investigar cistos ovarianos, torções anexiais, leiomiomas, doença inflamatória pélvica, abscesso tubo-ovariano, dismenorreia e complicações de dispositivos intrauterinos. A maioria das causas tem tratamento eficaz, com retorno da função do órgão e melhora da qualidade de vida, sem complicações, especialmente se diagnosticada precocemente.(AU)


The aim of this study was to gather important data on acute pelvic pain etiologies, a usual complaint in the emergency services and gynecology outpatient clinics, responsible for great discomfort and impact on quality of life in female patients. It is a laborious condition due to its wide spectrum of causes, which needs to be approached with attention by the physician, who must consider all the possible diagnoses, being the ultrasonography the most important exam to detect it. The main non-obstetric etiologies can be non-gynecological and gynecological, which are separated in adnexal and uterine causes. Among the gynecological causes, ovarian cysts, adnexal torsions, leiomyomas, pelvic inflammatory disease, ovarian tube abscess, dysmenorrhea and complications of intrauterine devices should be investigated. Most causes can be effectively treated, with return of organ function and improved quality of life, without complications, especially if diagnosed early.(AU)


Subject(s)
Humans , Female , Pelvic Pain/etiology , Acute Pain/etiology , Ovarian Cysts/complications , Databases, Bibliographic , Pelvic Inflammatory Disease/complications , Pelvic Pain/diagnosis , Pelvic Pain/diagnostic imaging , Abscess/complications , Dysmenorrhea/complications , Ovarian Torsion/complications , Intrauterine Devices/adverse effects , Leiomyoma/complications
12.
Asian Journal of Andrology ; (6): 319-324, 2021.
Article in English | WPRIM | ID: wpr-879754

ABSTRACT

This study aimed to assess the association between psychological disorders and erectile dysfunction (ED) in patients with different degrees of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). This was a retrospective study conducted from June 2017 to October 2019 and included 182 outpatients. Patients were interviewed using the Structured Interview on Erectile Dysfunction (SIEDY) for pathogenic quantification. The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and the International Index of Erectile Function-5 (IIEF-5) were used for the evaluation of CP/CPPS and ED. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety symptoms and depressive symptoms. The number of patients with mild CP/CPPS and mild ED, mild CP/CPPS and moderate-to-severe ED, moderate-to-severe CP/CPPS and mild ED, and moderate-to-severe CP/CPPS and moderate-to-severe ED was 69 (37.9%), 36 (19.8%), 35 (19.2%), and 42 (23.1%), respectively. The corresponding PHQ-9 scores of the four groups were 6.22, 7.19, 10.69, and 7.71, respectively. The corresponding GAD-7 scores of the four groups were 5.26, 6.31, 8.77, and 6.36, respectively. Among patients with moderate-to-severe CP/CPPS, the PHQ-9 and GAD-7 scores of the moderate-to-severe ED group were significantly lower than those of the mild ED group (P = 0.007 and P = 0.010, respectively). The prevalence of ED and premature ejaculation (PE) in patients with moderate-to-severe CP/CPPS was significantly higher than that in patients with mild CP/CPPS (P = 0.001 and P = 0.024, respectively). Our findings proved that the severity of ED was negatively associated with psychological symptoms in outpatients with moderate-to-severe CP/CPPS.

13.
Article in Chinese | WPRIM | ID: wpr-877628

ABSTRACT

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on chronic pelvic pain in patients with sequelae of pelvic inflammatory disease.@*METHODS@#A total of 144 patients with chronic pelvic pain were randomly divided into an observation group (72 cases, 10 cases dropped off) and a control group (72 cases, 9 cases dropped off). The patients in the control group were treated with ibuprofen sustained-release capsules 10 days before menstruation, 0.3 g each time, once a day. On the basis of the treatment of the control group, the patients in the observation group were treated with EA at Guanyuan (CV 4), Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32), disperse-dense wave, 2 Hz/15 Hz of frequency, once a day. The patients in both groups were treated for 10 days per menstrual cycle for 3 menstrual cycles. The visual analogue scale (VAS) scores of lower abdomen and lumbosacral area, local sign score, quality of life scale score and pain disappearance rate were compared between the two groups before and after treatment.@*RESULTS@#The VAS scores of lower abdomen and lumbosacral area as well as each item score and total score of local signs in the observation group after treatment were significantly lower than those before treatment and those in the control group (@*CONCLUSION@#EA can relieve the pain symptoms in patients with chronic pelvic pain and improve their quality of life.


Subject(s)
Acupuncture Points , Analgesics , Electroacupuncture , Female , Humans , Pelvic Inflammatory Disease/therapy , Pelvic Pain/therapy , Quality of Life
14.
Article in Chinese | WPRIM | ID: wpr-877545

ABSTRACT

OBJECTIVE@#To compare the therapeutic effect between acupuncture combined with ibuprofen sustained-release capsule and simple ibuprofen sustained-release capsule on chronic pelvic pain (CPP) after pelvic inflammatory disease (PID).@*METHODS@#A total of 144 patients were randomized into an observation group (72 cases, 10 cases dropped off) and a control group (72 cases, 9 cases dropped off). Ibuprofen sustained-release capsule was given orally in the control group, one capsule a time. On the basis of the treatment in the control group, acupuncture was applied at Guanyuan (CV 4), Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32), and Shuidao (ST 28), Guilai (ST 29), Shenshu (BL 23) and Ciliao (BL 32) were connected to electroacupuncture in the observation group. The treatment was given 10 days before menstruation, once a day for 3 menstrual cycles in both groups, and the follow-up was adopted 3 menstrual cycles after treatment. The visual analogue scale (VAS) scores of hypogastrium and lumbosacral region before treatment, after treatment, and at the follow-up, the score of local signs and the score of World Health Organization quality of life questionnaire-brief version (WHOQOL-BREF) before and after treatment were observed in the both groups.@*RESULTS@#After treatment and at the follow-up, the VAS scores of hypogastrium and lumbosacral region were decreased compared before treatment in both groups (@*CONCLUSION@#Acupuncture combined with ibuprofen sustained-release capsule can effectively improve the symptoms, signs and quality of life in patients with CPP after PID, the therapeutic effect is superior to simple ibuprofen sustained-release capsule.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Female , Humans , Pelvic Inflammatory Disease/etiology , Pelvic Pain/etiology , Quality of Life , Treatment Outcome
15.
Article in English | WPRIM | ID: wpr-922122

ABSTRACT

OBJECTIVE@#To evaluate the effect and safety of Kangfuyan Capsules () for treating pelvic inflammatory disease (PID) in patients with chronic pelvic pain (CPP) in a multicenter, randomized, controlled, double-blind, parallel-group clinical trial.@*METHODS@#Totally, 240 PID patients with CPP were randomized into 2 groups using a computer generated random number at a 1:1 ratio from 10 hospitals in China between September 2014 and November 2015. Patients received either oral Kangfuyan Capsules or Gongyanping Capsules (, control); the regimen for both groups comprised 4 capsules (3 times daily) for 12 weeks, with follow-up visit 4 weeks after treatment. The visual analogue scale (VAS) scores, clinical responses, remarkable cure rates for each symptom, and quality of life scores were assessed at baseline, and after 1, 2, and 3 months. Adverse events were also recorded.@*RESULTS@#The VAS scores were significantly lower (P<0.05), whereas the clinical responses, remarkable cure rates for lower abdominal pain, uterine tenderness, adnexal mass, and adnexal tenderness, and Health-related quality of life (EQ-5D) scores were higher in the Kangfuyan group than in the control group at 3 months (P<0.05). Common treatment-related adverse events included high hepatic enzyme levels, reduced hemoglobin levels, and elevated platelet counts, although all the adverse events were either mild or moderate in severity.@*CONCLUSION@#Compared with Gongyanping therapy, Kangfuyan therapy yielded markedly better analgesia effects for CPP caused by PID, with obvious long-term efficacy and good safety. (Registration No. ChiCTR190022732).


Subject(s)
Capsules , Chronic Pain/drug therapy , Double-Blind Method , Humans , Pelvic Pain/drug therapy , Quality of Life , Treatment Outcome
16.
Chinese Journal of Urology ; (12): 797-800, 2021.
Article in Chinese | WPRIM | ID: wpr-911121

ABSTRACT

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disease in men. In recent years, it has become younger, which seriously affects the patients'quality of life. A deep understanding of the pathogenesis of CP/CPPS will help the choice of treatment. Its pathogenesis is not only related to immune factors, but also related to local microcirculation disorders of the prostate, endocrine hormone imbalance, adjacent gut microbes and compression of lumbar intervertebral disc, but it has not been fully elucidated. Therefore, this article aims to review the pathogenesis of CP/CPPS and provide directions for its diagnosis and treatment.

17.
Epidemiol. serv. saúde ; 30(spe1): e2020602, 2021. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1154179

ABSTRACT

Resumo O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.


Abstract Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.


Resumen El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.

18.
Epidemiol. serv. saúde ; 30(spe1): e2020602, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1154160

ABSTRACT

O tema doença inflamatória pélvica está contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. A doença inflamatória pélvica é a infecção aguda do trato genital superior feminino decorrente da ascensão canalicular de microrganismos cervicovaginais endógenos e, principalmente, os de transmissão sexual. Entre os agentes etiológicos envolvidos, destacam-se Chlamydia trachomatis e Neisseria gonorrhoeae. As sequelas mais importantes são dor pélvica crônica, infertilidade e gravidez ectópica. O diagnóstico clínico apresenta-se como a abordagem prática mais importante. O tratamento com antibióticos deve ser iniciado imediatamente diante da suspeição clínica. Descrevem-se orientações para gestores e profissionais de saúde sobre testes diagnósticos, tratamento preconizado, seguimento, aconselhamento, notificação, manejo de parcerias sexuais e de populações especiais. Com a maior disponibilidade da técnica de biologia molecular no Brasil, recomenda-se o rastreio de C. trachomatis e N. gonorrhoeae como estratégia preventiva da doença.


Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.


El tema de la enfermedad inflamatoria pélvica está incluido en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral para Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. La enfermedad inflamatoria pélvica es una infección aguda del tracto genital superior femenino resultante del ascenso canalicular de microorganismos cervicovaginales endógenos y, principalmente, los de transmisión sexual. Entre los agentes etiológicos involucrados, se destacan Chlamydia trachomatis y Neisseria gonorrhoeae. Las secuelas más importantes son: dolor pélvico crónico, infertilidad y embarazo ectópico. El diagnóstico clínico es el enfoque práctico más importante. El tratamiento con antibiótico debe iniciarse inmediatamente ante la sospecha clínica. Se describen pautas para gestores y profesionales de la salud sobre pruebas de diagnóstico, tratamiento, seguimiento, asesoramiento, notificación, manejo de parejas sexuales y poblaciones especiales. Con la mayor disponibilidad de la técnica de biología molecular, se recomienda el cribado de C. trachomatis y N. gonorrhoeae como estrategia preventiva para la enfermedad.


Subject(s)
Humans , Female , Pregnancy , Sexually Transmitted Diseases/epidemiology , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/therapy , Pelvic Inflammatory Disease/epidemiology , Sexual Behavior , Brazil/epidemiology , Chlamydia trachomatis/pathogenicity , Clinical Protocols , Neisseria gonorrhoeae/pathogenicity
19.
Clinics ; 76: e2981, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286092

ABSTRACT

OBJECTIVE: To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms. METHODS: This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group. RESULTS: The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis. CONCLUSION: The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.


Subject(s)
Humans , Female , Adult , Aged , Uterine Diseases/epidemiology , Uterine Diseases/diagnostic imaging , Endometriosis , Adenomyosis/diagnostic imaging , Prospective Studies , Ultrasonography
20.
Adv Rheumatol ; 61: 23, 2021. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1248672

ABSTRACT

Abstract Background: Chronic prostatitis has been a common disease reported with high frequency in ankylosing spondylitis (AS) even from decades ago. Infectious (Chlamydia trachomatis) or non-infectious (uric acid) prostatitis can hypothetically trigger vertebral inflammation in AS. This study aimed to assess the features of chronic prostatitis in patients with AS compared to healthy controls. Methods: A cross-sectional study including male patients with AS and healthy controls who agreed to undergo a prostate examination was conducted. Structured clinical interviews, prostate physical examinations, and cytological, biochemical, and microbiological tests on urinary samples collected before and after standardized prostatic massage (pre- and post-massage test) were performed. Results: Ninety participants (45 AS patients, mean age: 52.5 ± 10.0 years, with longstanding disease, 12.4 ± 6.9years, and 45 controls, mean age: 52.8 ± 12.1 years) were included. National Institutes of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) scores were similar in the AS and control groups (4.0 [1.0-12.0] vs. 5.0 [1.0—8.5], p = 0.994). The frequencies of symptoms of chronic prostatitis (NIH-CPSI Pain Domain ≥4) were also similar in both groups (23.3% vs. 22.7%, p = 0.953). Results of polymerase chain reaction tests for Chlamydia trachomatis were negative in all tested urinary samples, and uric acid concentrations and leukocyte counts were similar in all pre- and post-massage urinary samples. Conclusions: In this study, chronic prostatitis occurred in male patients with AS, but its frequency and characteristics did not differ from those found in the healthy male population of similar age.

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