A Case of Disabling Urinary Frequency and Pelvic Pain Due to Postoperative Uterine Adhesions

INTRODUCTION

Dense lower abdominal adhesions are known to cause urinary frequency by restricting expansion of the bladder. However, since preoperative diagnosis of adhesions has been difficult and there are multiple other causes of urinary frequency, such patients may go undiagnosed. With the improving resolution of ultrasound, ever smaller pathologic structures may be visualized, particularly if they are considered in the differential diagnosis.

CASE PRESENTATION

To confirm the possibility that clinically significant lower abdominal adhesions may be visualized by ultrasound, we report on a patient who had developed disabling urinary frequency and pelvic pain after a cesarean section. Over a 5-year period, the patient underwent multiple diagnostic and therapeutic interventions at 2 large medical centers in multiple departments without success. Following this, a pelvic sonogram revealed a band of adhesions between the uterus and abdominal wall. Laparoscopic lysis of extensive pelvic adhesions was undertaken. Postoperatively, the patient was able to resume an active lifestyle, with good improvement in urinary frequency and pelvic pain.

CONCLUSION

Ultrasound diagnosis of uterine adhesions to the abdominal wall led to successful laparoscopiclysis of adhesions with significant improvement in a patient's urinary tract symptoms and pelvic pain.

Effects of methylmercury exposure on the behavior of captive-reared common loon (Gavia immer) chicks

Behavioral effects resulting from exposure to dietary methylmercury (MeHg) have been reported in studies of several wildlife species. However, quantifying the impact of contaminant exposure on wild populations is complicated by the confounding effects of other environmental stressors. We controlled confounding stressors in a laboratory study to quantify the level of dietary MeHg exposure associated with negative effects on the fitness of captive-reared common loon (Gavia immer) chicks. We evaluated the effect of MeHg on loon chick behavior by employing several assays, including measures of righting reflexes, responsiveness to taped parental calls, reaction to frightening stimuli, and estimates of time activity budgets. Evidence suggested that as chicks aged, those exposed to nominal dietary dose levels of 0.4 and 1.2 microg Hg/g wet-weight in food (average estimated delivered dietary level of 0.55 and 1.94 microg Hg/g, respectively) were less likely (p < 0.01) to right themselves after being positioned on their backs during outdoor trials (> or =37 days old) compared to chicks on the control diet. We detected differences (p < 0.05) in several response variables with respect to source of eggs. Chicks from nests on low-pH lakes tended to spend more time on resting platforms, spent less time in the shade, were more likely to walk across a platform upon release and do it quicker, were less responsive to a frightening stimulus, and exhibited less intense response to parental wail calls than did chicks from neutral pH-lakes. Rapid MeHg excretion during feather growth likely provides loon chicks protection from MeHg toxicity and may explain the lack of behavioral differences with dietary intake. Lake source effects suggest that in ovo exposure to MeHg or other factors related to lake pH have consequences on chick behavior.