Actinomycosis and the IUD: infection underdiagnosed.
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Biomedical subjects
Publications and source records attributed to B Majmudar.
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Recent reports suggest a relationship between intrauterine contraceptive device (IUD) use and colonization or infection of the genital tract with Actinomyces species. This prospective, case-controlled study was designed to determine the incidence of colonization or infection with Actinomyces in IUD users. None of 50 control patients and four of 50 study patients (8%) had Actinomyces identified. None of the patients with positive results had symptomatic pelvic infection. Cervical cytology was effective in detecting each of the four study patients with positive results. It appears that the presence of any type of IUD is a major predisposing factor to colonization with Actinomyces.
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Several recent reports have indicated the possible association between pelvic infection caused by Actinomyces and the use of intrauterine contraceptive devices. Seven cases of infection or colonization of the female genital tract have been detected among women using intrauterine contraceptive devices (IUD's) at Grady Memorial Hospital, Atlanta, Georgia, from March, 1975, until May, 1977. No single IUD type has been incriminated. The shortest duration of consecutive IUD use before the diagnosis was two and a half years. Six of these cases were detected incidentally at the time of endometrial or endocervical biopsy. The diagnosis in each case was made histologically. One patient presented with severe pelvic inflammatory disease and had Actinomyces identified. This is the first reported death associated with pelvic actinomycosis in a woman using an IUD. This organism must be considered as a possible pathogen whenever a patient with an IUD develops pelvic inflammatory disease.
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Although invasive carcinoma of the esophagus should theoretically begin as an in situ process, the latter is rarely seen in clinical practice. Two cases of carcinoma in situ of the esophagus were diagnosed at our institution.
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A case of squamous cell carcinoma of the lower end of the esophagus colliding with adenocarcinoma of the cardiac end of the stomach is reported. The rarity of the lesion, its diagnostic criteria, and therapeutic implications are briefly discussed.
A case of primary ovarian myxoma is reported. The tumor is rare as there are only two previously reported cases in the literature.
Granular cell tumor (myoblastoma) is a relatively frequent neoplasm found in many different anatomic locations. This is a case of such a tumor arising in the abdominal wall musculature, an extremely unusual site of occurrence. Excision with generous margins is required to prevent recurrence.
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The first case of endometriosis of the femoral vein presenting as a femoral hernia is reported. Histogenesis and sites of extragenital endometriosis are briefly reviewed.
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A case of primary, widely disseminated prostatic carcinoma causing bilateral urinary tract obstruction, hydronephrosis, and papillary necrosis and metastasizing in the substance of an unusual histologic variant of renal cell carcinoma and tubular adenoma of the same kidney is presented. Unusual incidental findings include isolated cardiac amyloidosis and myocardial abscesses. A brief review of the literature is presented. The peculiar tendency for renal cell carcinoma to be the host tumor for other primary carcinomas and various theories to account for this phenomenon are commented upon briefly.
A case of sarcoma botryoides of the common bile duct is described. A review of the literature reveals 24 reported cases of this entity. The clinical features of the disease and the poor prognosis associated with it are illustrated by a detailed presentation of the case. Although rare, this condition must be included in the differential diagnosis of jaundice in infancy or early childhood. Pathologic findings of diagnostic value are re-emphasized.
A neurilemoma arising in breast tissue is reported. Neurilemomas are usually well circumscribed and non-invasive, but may be confused with cystosarcoma phylloides, particularly in frozen section. Pertinent pathologic findings are described, and the literature is reviewed. Only one case of neurilemoma in the breast has previously been reported.
The authors report a case of Letterer-Siwe syndrome presenting primarily as a mediastinal mass erroneously diagnosed as cystic thymoma. Although thymic involvement in Letterer-Siwe syndrome is common, only 2 previous cases have involved a mediastinal mass.
Two cases of infarcted fibroadenomas of the breast during pregnancy represent the total incidence of this entity from a total of 404 fibroadenomas diagnosed during the last five years in our department. Gross and microscopic pathologic findings of these breast tumors must be carefully evaluated, since the relative rarity of this lesion may lead to suspicion of carcinoma.