[Pyosalpingitis after interadnexal laparoscopic hysterectomy. Two cases. Gynecol Obstet Fertil 2005;33:768-71].
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Biomedical subjects
Publications and source records attributed to P Judlin.
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Infections due to bacteria, virus or parasites are frequent during pregnancy and can have severe consequences. Moreover, the vaginal carriage of commensal bacteria or dramatic changes in the equilibrium of the vaginal flora can induce complications and cause fetal contaminations. With the help of the guidelines set up by the French Agency of Accreditation and Evaluation in Health (Anaes), the authors detail the microbiological exams and screening which take part in the management of different situations at risk.
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The mycoplasmas frequently isolated in genital tract, and potentially pathogenic, are M. hominis, U. urealyticum and M. genitalium. M. hominis and U. urealyticum are very frequent in the vaginal tract and they can be, according to circumstances, either commensal or pathogenic. M. hominis and/or U. urealyticum, have been considered as responsible for many types of genital infectious diseases (such as cervicitis, pelvis inflammatory disease), for infertility, obstetrical pathologies (premature delivery, premature rupture of membranes, chorio-amniotitis) and neonatal infections. Yet, most of the time, their actual responsibility has not been conclusively proven. Published data lack indisputable conclusions and in many fields, doubts still exist whether these mycoplasmas are pathogens or mere co-factors associated with genital infections. On the other hand, M. genitalium has been much less studied but it seems to be an unquestionable pathogen of genital tract; new studies will be necessary so that one has a better understanding of the pathologies it can induce.
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In the 300,000 inhabitant city-area of Nancy (France), admission of women victims of sexual violence follows a special procedure. That has been jointly set by the Justice Department, Police and Emergency Rooms of both the Maternite Régionale and the University General Hospital. Nevertheless, we have recently conclude the management and follow-up of victims were generally not good enough. Early management of the psychological shock and formation of all intervening parties have to be improved. As both a gynecologist attached to the Maternite regionale and the Commission for the Fight of violence against women to take initiatives aimed at increasing public awareness (congresses ...). These initiatives have driven to the creation of a meeting place where a multidisciplinary team takes care of victims and leads talking groups including both victims and authors of violence. The organization of such a multidisciplinary management team is slow and difficult. Strong political will and compassion are needed to achieve that task. In the process, power and knowledge of every member of the team have continuously to be called into question.
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OBJECTIVE: To evaluate the efficacy and safety of ofloxacin+coamoxiclav versus doxycycline-coamoxiclav in the treatment of chlamydial pelvic infections. DESIGN: An open, comparative, randomised, monocentric study. SUBJECTS: A hundred and eighteen patients (85 endometritis and 33 salpingitis) were included. Clinical, laparoscopic and bacteriological assessments were performed before treatment. 30.4% of salpingitis were considered as severe (COGIT score > 6). 25.4% of acute pelvic infections were only caused by Chlamydia trachomatis. TREATMENT: A hundred and eighteen patients were treated orally with 3 week combination ofloxacin (200 mg b.i.d.) + coamoxiclav (1 g b.i.d.) (n = 60) or with a 6 week coamoxiclav (1 g b.i.d.) + doxycycline (100 mg b.i.d.) (n = 58). RESULTS: Oral combination ofloxacin-coamoxiclav is as effective as oral combination doxycycline+coamoxyclav with respectively 96.7% versus 96.6% and 100% versus 98.4% satisfactory clinical et bacteriological results.
A 56-year-old woman with long-lasting fever of unknown origin was diagnosed as having a giant-cell arteritis of the genital tract with no evidence of temporal arteritis. Diagnosis relied on pathological examination, which showed a segmental panarteritis of ovaries, myometrium, endometrium and uterus cervix. Corticosteroid therapy led to clinical cure within a few weeks. Twenty-five cases of giant-cell arteritis of the female genital tract have been published of which only four were associated with temporal arteritis. We recommend that such a diagnosis should be considered in women presenting with long-lasting fever of unknown origin, even in the absence of temporal arteritis and the clinical evidence of genital abnormalities.
Acute pelvic pain is a common syndrome in women and is an emergency. Management requires rapid diagnostic evaluation to enable immediate treatment. Blood tests (beta-HCG assay, etc.), bacteriological studies and pelvic ultrasonography may be required. Gynecological problems are the commonest etiology: ectopic pregnancy, miscarriage, PID. The possibility nevertheless remains of appendicitis, sigmoid diverticulitis, UTI or renal colic, all of which are medical or surgical emergencies.
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There is an increased risk of cancer (mainly breast cancer) in patients with Cowden disease. Little is known of the etiopathogenic mechanisms of this condition, but immunologic abnormalities may be evoked. A young patient with Cowden disease was submitted for gynecologic examination and immunologic investigations. Although no neoplastic disorder had appeared, laboratory investigations disclosed abnormalities of the humoral and cellular immune compartments in the peripheral blood. This rare observation of gynecologic involvement in a very young girl with family antecedents of Cowden disease prompted a review of the gynecologic features and etiopathogenic bases of Cowden disease. The possible role of neoplasia such as breast cancer in this syndrome makes early diagnosis a criterion for good prognosis.
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