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Although endometriosis is a benign process treatment 247 generic naltrexone 50 mg with amex, it shares many characteristics with malignancy. Itisalsocuriousthatcyclichormonestendtoinduce growth,whereascontinuoushormonalexposure,especially in high doses, generally induces significant regression. The common finding of blue-gray lesions (A) represents less active "tatooing" of old endometriosis. The association between mild to moderate endometriosis and infertility is not clear. When more advanced stages of endometriosis distort the pelvic structures, the role of endometriosis in infertility is more predictable. The characteristic sharp, firm, exquisitely tender "barb" (so called because it is reminiscent of barbed wire) felt in the uterosacral ligament is the diagnostic sine qua non of endometriosis, but this finding is generally present only in severe cases. The definitive diagnosis is generally made on the basis of the characteristic gross and histologic findings obtained at laparoscopy or laparotomy. Characteristically, a tender, fixed adnexal mass is appreciated on bimanual examination. Denote appearance of superficial implant types as red [(R), red, red-pink, flamelike, vesicular blobs, clear vesicles], white [(W), opacifications, peritoneal defects, yellow-brown], or black [(B), black, hemosiderin deposits, blue]. Treatment is indicated for endometriosisassociated pelvic pain, dysmenorrhea, dyspareunia, abnormal bleeding, ovarian cysts, and infertility caused by gross distortion of tubal and ovarian anatomy. Surgicalinterventionisrequiredforanendometrioma larger than 3cm, gross distortion of pelvic anatomy,involvementofbowelorbladder,andadhesivedisease. There is no convincing evidence that treatment significantly improves fertility in women with mild endometriosis. Asymptomatic women found incidentally to have endometriosis may not require any therapy. Some women who have minimal symptoms may choose to bemanagedexpectantlyiftheyaretryingtoconceive oriftheyareapproachingmenopause,whenendometriosisgenerallybecomeslesssymptomatic.
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Abe, 52 years: Lightening Two or more weeks before labor, the fetal head in most primigravid women settles into the brim of the pelvis.
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