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Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Correlation among clinical, laboratory, and hepatobiliary scanning findings in patients with suspected acute cholecystitis. Diagnostic tests for Helicobacter pylori—can they help select patients for endoscopy? Risk of osteoarthritis associated with long-term weight bearing sport: a radiographic survey of the hips and knees in female ex-athletes and population controls.
The relationship of running to osteoarthritis of the knee and hip and bone mineral density of the lumbar spine: A 9-year longitudinal study. Osteoarthritis of the hip in women and its relationship to physical load from sports activities. The vagina is the canal leading from the cervix (the opening of uterus) to the outside of the body.
Age and being exposed to the drug DES (diethylstilbestrol) before birth affect a woman’s risk of vaginal cancer. Tests that examine the vagina and other organs in the pelvis are used to detect (find) and diagnose vaginal cancer.
After vaginal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the vagina or to other parts of the body.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. In vaginal intraepithelial neoplasia (VAIN), abnormal cells are found in tissue lining the inside of the vagina.
VAIN 1: Abnormal cells are found in the outermost one third of the tissue lining the vagina.
VAIN 2: Abnormal cells are found in the outermost two-thirds of the tissue lining the vagina.
In stage II, cancer has spread through the wall of the vagina to the tissue around the vagina. Stage IVB: Cancer has spread to parts of the body that are not near the vagina, such as the lung or bone. Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor. Wide local excision: A surgical procedure that takes out the cancer and some of the healthy tissue around it.
Lymph node dissection: A surgical procedure in which lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. Pelvic exenteration: Surgery to remove the lower colon, rectum, bladder, cervix, vagina, and ovaries. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Topical chemotherapy for squamous cell vaginal cancer may be applied to the vagina in a cream or lotion. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated.
A combination of therapies that may include wide local excision with or without lymph node dissection and internal radiation therapy.
Treatment of stage II vaginal cancer is the same for squamous cell cancer and adenocarcinoma.
Treatment of stage III vaginal cancer is the same for squamous cell cancer and adenocarcinoma.
Treatment of stage IVA vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Treatment of stage IVB vaginal cancer is the same for squamous cell cancer and adenocarcinoma. Radiation therapy as palliative therapy, to relieve symptoms and improve the quality of life. Although no anticancer drugs have been shown to help patients with stage IVB vaginal cancer live longer, they are often treated with regimens used for cervical cancer.
Although no anticancer drugs have been shown to help patients with recurrent vaginal cancer live longer, they are often treated with regimens used for cervical cancer.
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database.
This PDQ cancer information summary has current information about the treatment of vaginal cancer.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Evaluating abdominal pain requires an approach that relies on the likelihood of disease, patient history, physical examination, laboratory tests, and imaging studies.
After the location is identified, the physician should obtain general information about onset, duration, severity, and quality of pain and about exacerbating and remitting factors.Associated symptoms often allow the physician to further focus the differential diagnosis. Adolescents and young adults are at particular risk for various apophyseal and epiphyseal injuries due to lack of ossification of these cartilaginous growth plates. The authors recommend obtaining anteroposterior and frog leg lateral hip radiographs of all acutely injured patients with painful gaits, inability to bear weight, point tenderness at a site of muscular insertion, or a markedly reduced range of motion.For patients with chronic symptoms, the decision to perform radiographs and other special tests depends on the severity of the symptoms and the differential diagnosis. Descriptions of each diagnosis, history, physical findings, differential diagnosis, radiographic testing, treatment options are outlined in Table 1.
A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the lungs, liver, or bone.
Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and lymph nodes. A history of the patient’s health habits and past illnesses and treatments will also be taken. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand.
If a Pap test shows abnormal cells in the vagina, a biopsy may be done during a colposcopy. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder.
A ureteroscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the ureter.
Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. For example, if vaginal cancer spreads to the lung, the cancer cells in the lung are actually vaginal cancer cells. When abnormal cells are found throughout the tissue lining, it is called carcinoma in situ. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.


Skin grafting is a surgical procedure in which skin is moved from one part of the body to another.
Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. See the Treatment Options section that follows for links to current treatment clinical trials.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. These Boards are made up of experts in cancer treatment and other specialties related to cancer.
If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. For bowel obstruction, constipation is the symptom with the highest positive predictive value. One study of patients 15 to 83 years of age with suspected appendicitis found that a white blood cell count greater than 10,000 per mm3. Ovarian cysts, uterine fibroids, tuboovarian abscesses, and endometriosis are common causes of lower abdominal pain in women.
Several areas of the abdomen deserve special attention because the clearest evidence for a consistent work-up is in these areas.For right upper quadrant pain, the history focuses on differentiating pulmonary, urinary, and hepatobiliary pain (Figure 2). Older athletes are more likely to present with tendinitis in these areas because their growth plates have closed. For the large majority of patients with suspected musculotendinous injury, an initial trial of conservative therapy is reasonable, with radiographs reserved for those who do not respond to treatment. Pediatric x-ray diagnosis: textbook for students and practitioners of pediatrics, surgery and radiology.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.
A rare type of adenocarcinoma is linked to being exposed to diethylstilbestrol (DES) before birth.
A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A piece of healthy skin is taken from a part of the body that is usually hidden, such as the buttock or thigh, and used to repair or rebuild the area treated with surgery. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. For appendicitis, right lower quadrant pain has the highest positive predictive value, although migration from periumbilical to right lower quadrant pain and fever also suggest appendicitis.
In women of reproductive age, special attention to pregnancy, including ectopic pregnancy, and loss of pregnancy is critical in forming an appropriate differential diagnosis. In younger patients, nonossified bone present at growth plates such as the femoral head epiphysis and the anterior superior iliac spine apophysis is susceptible to injury until the skeleton matures (Figure 1). Bursitis and muscle strains are more likely to be seen in skeletally mature active young adults.
Many children will have a history of recent minor trauma, although this is obviously nonspecific in this age group. Adenocarcinomas that are not linked with being exposed to DES are most common in women after menopause. A cone biopsy (removal of a larger, cone-shaped piece of tissue from the cervix and cervical canal) is usually done in the hospital. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed.
When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). During treatment clinical trials, information is collected about the effects of a new treatment and how well it works.
The trochanteric bursa is the most commonly injured, and the lesion is easily identified by palpation of the area. Degenerative arthritis becomes more common with advancing age and is seen primarily in older adults.For all age groups, an accurate diagnosis depends on a careful history. Transient synovitis typically affects young children who present with a limp of acute onset. Some of these women develop a rare form of vaginal cancer called clear cell adenocarcinoma.
It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed.
The way the chemotherapy is given depends on the type and stage of the cancer being treated. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. The American College of Radiology has recommended different imaging studies for assessing abdominal pain based on pain location. A urine pregnancy test should be performed in women of childbearing age who have abdominal pain to narrow the differential diagnosis and to determine whether certain imaging studies are appropriate.
Iliotibial band syndrome presents with similar lateral hip pain and may be identified by provocative testing (Ober's test). These muscles can be divided into groups according to the motion that they are most involved with. Patients whose hip pain is caused by pathology in other organs may have other associated symptoms.
On examination, the child will often refuse to use the affected leg and will have pain with any motion.
The way the radiation therapy is given depends on the type and stage of the cancer being treated. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish. Ultrasonography is recommended to assess right upper quadrant pain, and computed tomography is recommended for right and left lower quadrant pain.
Although colic is associated with several diseases, the location of colic may help diagnose the cause.
Presentation may differ in older patients, and poor patient recall or a reduction in symptom severity may cause misdiagnosis.
A methodical physical examination that specifically tests the various muscle groups that move the hip joint can help determine a more specific diagnosis for the often vague complaint of hip pain.
Hip flexion is performed by the iliopsoas and a group of muscles commonly referred to as the quadriceps, while hip extension is primarily the function of the hamstring group. Unexplained weight loss, fever and night sweats indicate the possibility of a systemic inflammatory process.
It is also important to consider special populations such as women, who are at risk of genitourinary disease, which may cause abdominal pain; and the elderly, who may present with atypical symptoms of a disease. There are several diseases that should be considered in all older patients with abdominal pain because of the increased incidence and high risk of morbidity and mortality in these patients.
Other muscles serve to perform hip adduction, abduction, and internal and external rotation.


Genitourinary and abdominal symptoms likewise may indicate that the pathology is located in one of these areas instead of the hip.
Abdominal pain is a common presentation in the outpatient setting and is challenging to diagnose. If the patient's history and physical examination suggest esophageal or gastric pathology, endoscopy (or an upper gastrointestinal series) is recommended. It is helpful to have a clinical anatomy reference handy when evaluating sport injuries in order to more readily identify specific muscle or tendon injuries. A careful search for these symptoms is indicated for patients with a history of disease in these systems, as well as for patients who do not have findings consistent with musculoskeletal disease.PHYSICAL EXAMINATIONThe physical examination of the hip is similar for athletes of all ages.
Abnormalities in these parameters should increase suspicion of a septic joint or other inflammatory process. In other patients with left upper quadrant pain, CT is useful because it provides imaging of the pancreas, spleen, kidneys, intestines, and vasculature.
Femoral neck stress fractures are seen in adult athletes, especially those involved in endurance sports, and can progress to necrosis of the femoral head if not found early. Pain on passive stretching or active motion in a particular direction will often help to identify an injury.NERVESThe two nerves most likely to cause pain or numbness around the hip are the sciatic and lateral femoral cutaneous nerves. Using a stepwise approach, including observation, palpation, and testing for range of motion and strength, will help ensure that important findings are not missed. Radiographic studies will show bony disruption or sclerosis of the femoral head in classic cases, but films can appear normal. A normal evaluation should prompt further consideration of urinary or gynecologic pathology. Older athletes may be limited by degenerative joint disease but nonetheless should be encouraged to stay active. The sciatic nerve includes motor and sensory components that originate from the L4, L5, S1, S2 and S3 nerve roots. Bone scans or MRI may be useful if plain films are unremarkable.ADOLESCENCEAnother age-specific condition that affects the femoral head is slipped capital femoral epiphysis. An upright radiograph of the chest or abdomen can detect free air under the diaphragm, which indicates a perforation of the gastrointestinal tract. It passes through the sciatic notch, where it is susceptible to compression by the piriformis muscle (Figure 2a).5 Patients typically complain of a dull ache in the buttock that may radiate down the posterior thigh.
Covering the patient's genitals during the examination and using a sheet, especially while testing range of motion, will also help the patient feel more comfortable.Observation. Failure of the cartilaginous growth plates allows the epiphysis to slip on the femoral neck.
Patients with peritonitis tend to lie very still, whereas those with renal colic seem unable to stay still. This pain may be difficult to distinguish from radicular pain caused by nerve root compression in the lumbosacral spine. A limited functional evaluation includes determining whether the affected leg can bear weight. There may be a history of a recent sport injury, but again this is nonspecific and common for this age group.
Fever suggests infection; however, its absence does not rule it out, especially in patients who are older or immunocompromised.
Gynecologic causes of abdominal pain are more common in these women, and radiation exposure should be avoided if pregnancy is likely. If it can, important points to observe include the patient's posture, gait and ability to transfer independently from standing to sitting to lying down, and then back to standing.If the patient is able to stand erect, the examiner can estimate the height symmetry of the iliac crests by resting his or her hands on the iliac wings.
Therefore, abdominal or transvaginal ultrasonography is generally recommended for evaluating left lower quadrant pain in women of childbearing age16 and in pregnant patients with right lower quadrant abdominal pain.15If ectopic pregnancy is suspected, transvaginal ultrasonography should be performed.
If the crests are asymmetric or the patient is unable to stand, the next step is to compare leg lengths: the distance between the anterior superior iliac spine and the medial malleolus of each leg (Figure 3). Leg length discrepancies have been implicated in a number of musculoskeletal hip and leg injuries.
However, obesity and male sex increase the risk.12A  Slipped capital femoral epiphysis may be acute or chronic (Table 1). Physicians should pay close attention to the cardiac and lung examinations in patients with upper abdominal pain because they could suggest pneumonia or cardiac ischemia.There are several specialized maneuvers that evaluate for signs associated with causes of abdominal pain.
It can be compressed as it passes under the inguinal ligament, especially in obese patients and those with tight-fitting clothing or belts. Missing this diagnosis increases the risk for progression of the slip and increases the likelihood of later development of avascular necrosis of the femoral head and early degenerative arthritis.Patients with confirmed or suspected slips should not be permitted to bear weight, and referral to an orthopedic surgeon should be considered.
Careful palpation of each muscle group in the area of the symptoms may help to localize vague complaints to a specific structure. A rectal examination may reveal fecal impaction, a palpable mass, or occult blood in the stool. The trochanteric bursa is located lateral to the greater trochanter and is the most commonly injured bursa in the hip. In particular, palpation can identify tenderness over the sites of muscle attachment to bone and the bursae.Range of Motion. This group is more likely to be involved in high-intensity sports that may involve risk of substantial trauma.
The iliotibial band and gluteus muscles pass over this area (Figure 1).Falls onto the lateral hip and overuse injuries (especially common in runners and dancers) are the most common causes of trochanteric bursitis. Normal ranges of motion are dependent on the patient's stage of skeletal development, with the range tending to decrease as age increases. Avulsion fractures, muscle contusions, femoral neck stress fractures, osteoid osteoma, iliotibial band syndrome and a host of other conditions are possible (Table 1).The most critical diagnosis to make early in this group is the femoral neck stress fracture.
After passing over the greater trochanter, the iliotibial band inserts at the knee on the lateral aspect of the tibia, so patients with iliotibial band syndrome may also complain of lateral knee pain. Decreased range of motion on the side of the affected hip should heighten the suspicion of an underlying injury.
Steroid injection into the trochanteric bursa may be helpful in addition to icing, anti-inflammatory medication and avoidance of excessive training or overuse.Another commonly injured bursa is one overlying the ischial tuberosity (Figure 1). Another group at increased risk is women with the female athlete triad (amenorrhea, eating disorder and osteoporosis).14 The typical history in these cases is progressively increasing pain with exercise that eventually becomes pain at rest. Muscle strength should be tested for the affected hip and the unaffected one to enable the physician to compare strength and detect subtle deficits. Femoral neck stress fractures can progress to unstable fractures and are at increased risk for avascular necrosis of the femoral head. The differential diagnosis includes a hamstring strain, an apophysitis or even an avulsion fracture in a skeletally immature athlete.Less commonly injured is the iliopsoas (iliopectineal) bursa, which cushions the iliopsoas hip flexor muscle as it sweeps over the femoral head and inserts on the lesser trochanter. Hip flexion strength is best tested with the patient in a sitting position, lifting against the examiner's hand (Figure 4). Patients with an inflamed iliopsoas bursa usually complain of anterior groin pain, which is worse with resisted hip flexion.NONMUSCULOSKELETAL STRUCTURESPathology associated with male and female sexual organs, the intestinal tract, the urinary tract and vascular structures can occasionally lead to symptoms referred to the hip. External and internal rotation also can be evaluated in this position, with the examiner providing resistance against the patient's lower leg (Figures 5 and 6). Positive scans are nonspecific and may require MRI or other imaging to be certain of a diagnosis.Osteoid osteoma is a benign bone tumor of adolescents and young adults often discovered incidentally on a hip film.
Abduction and adduction are best tested with the patient supine and the examiner providing resistance against the medial and lateral side of the knee (Figures 7 and 8). Extension strength is best tested with the patient prone and the examiner applying resistance against the lower leg (Figure 9). While the piriformis is an external rotator of the hip, it is best tested with the patient supine. For severe, refractory cases, surgical excision may be used.OLDER ADULTOlder athletes are at much greater risk of developing degenerative arthritis in the hip joint, which is a major cause of disability in the elderly. Symptomatic patients complain of pain over the lateral aspect of the hip and may feel snapping at the iliotibial band over the greater trochanter with flexion and extension. Lack of activity places older adults at increased risk of obesity, with a resultant elevated risk of degenerative arthritis. The patient should be able to drop the affected leg to the table without discomfort while lying on the unaffected side.
The affected hip is passively extended (long arrow) and allowed to drop to the examination table (short arrow).




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