SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A xanthogranulomatous salpingitis, occurring in a fifty-two year old patient and appearing itself as a hydrosalpinx, is reported. The histological picture was characterized by the presence of several foamy histiocytes admixed with other inflammatory cells. Considerations about epidemiology, etiopathogenetic mechanisms and problems of differential diagnosis with other diseases are discussed.
The combination of sulbactam-ampicillin was compared to cefoxitin for the treatment of acute salpingitis in 40 women divided into two groups of 20 women each. There were 11 patients in each group who were given doxycycline because of evidence of chlamydial infection. All patients were diagnosed by laparoscopic examination and evaluated by the same procedure 7-12 weeks later: At the second laparoscopy, only 1 of the 20 patients (5%) treated with sulbactam/ampicillin had severe adhesions, while 6 of the 20 patients (40%) treated with cefoxitin had severe adhesions. Tubal patency was without obstruction in 14 patients (70%) given the combination treatment and in 12 patients (60%) given cefoxitin. Side effects were essentially absent in both groups.
The current epidemic of pelvic inflammatory disease and recent advances in gynecologic techniques have resulted in a marked increase in the incidence of combined pregnancy. In the case reported on here the coexistence of an intrauterine pregnancy with acute salpingitis and an ectopic gestation in the same fallopian tube led to early diagnostic errors.
The sera from 12 consecutive symptomatic women with laparoscopy-confirmed salpingitis were screened for the presence of specific IgG and IgA antibodies to Chlamydia trachomatis by a single antigen (L-2) immunoperoxidase assay. All women were found to have IgG and IgA antibodies to C trachomatis. Six women had positive endocervical cultures for C trachomatis, and one of these had positive cultures from the conjunctiva and fallopian tubes. Serum chlamydial IgA antibodies may serve as markers for active infection with C trachomatis regardless of whether organisms can be identified by culture or direct fluorescent antibody techniques from endocervical or fallopian tube samples.
Laparoscopy is a valuable diagnostic tool in salpingitis, which enables to recognize the severity of their evolution and their bacteriological etiology. However, it should not be advocated in all circumstances and it is necessary to specifically select the time when it will be the most useful.
The authors presented the results of microbiological study of internal genitalia of 22 females operated on for tubal infertility caused by chronic salpingitis (all of them were subjected to laparoscopic or laparotomic intervention with subsequent salpingoovariolysis and fimbriostomatoplasty). Cervical discharge, endometrial biopsy specimens, tissue and contents of sactosalpinx as well as abdominal exudates were subjected to bacteriological study. Quantitative and qualitative assessment of aerobic and anaerobic microflora composition was made. The findings stated the variety of inflammation activity levels disregarding the degree of anatomical changes in the genitalia. However, microorganisms were detected in the focus of inflammation only in the acute stage of the inflammation in the true pelvis.
We examined two groups of infertile women who underwent microsurgical repair of their fallopian tube(s) for distal tubal obstruction, one with a history of salpingitis (overt pelvic inflammatory disease) (N = 34) and one without (silent pelvic inflammatory disease) (N = 25). Nine women with normal tubes undergoing hysterectomy and salpingectomy served as controls. Tubal biopsy specimens were studied by light, scanning, and transmission electron microscopy to assess tubal damage. Morphologic damage was scored 0-9, with 0 representing normal tubal architecture and 9 assigned to severe tubal damage. The mean score (+/- SEM) in women with overt pelvic inflammatory disease was 4.2 +/- 0.4; in women with silent pelvic inflammatory disease, 4.3 +/- 0.4; and in the control group, 0.76 +/- 0.2 (P less than .001). Fallopian tube abnormalities seen in women with overt and silent pelvic inflammatory disease included flattened mucosal folds, extensive deciliation, and degeneration of secretory epithelial cells, morphologic changes that are similar to the cellular changes observed in our experimental Chlamydia trachomatis infections in monkeys. Laser light-scattering spectroscopy was used to measure the ciliary activity of the epithelial cells. Ciliary beat frequency was significantly reduced in women with overt pelvic inflammatory disease (N = 13; f = 6.4 +/- 1.2 Hz) and in women with silent pelvic inflammatory disease (N = 11; f = 7.2 +/- 1.2 Hz) as compared with the controls (N = 5; f = 23.4 +/- 1.5 Hz) (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
A patient who had endometritis confirmed by endometrial biopsy and acute salpingitis confirmed by laparoscopy is reported. Chlamydia trachomatis and herpes simplex virus type two were isolated from the endometrial cavity and the fallopian tube. The histopathologic findings of the endometritis were similar to those frequently seen in chronic chlamydial eye disease or chlamydial cervicitis.
Numbers of women discharged from hospital after being treated for acute salpingitis decreased by 40% in Sweden between 1974 and 1984. Several factors argue that this decrease was real, rather than a shift from inpatient to outpatient treatment. (Outpatients here include those treated by general practitioners as well as at hospital outpatient clinics). The decrease was nation wide and included all age groups. Repeat episodes of the disease decreased more than first episodes. The main reason for the decrease seems to be more strict attitudes to sexual relationships, especially in young people. Public and professional awareness of genital chlamydial infections was probably a contributing factor.
Five in a series of ten patients with laparoscopically demonstrated salpingitis had cultures positive for Chlamydia trachomatis obtained from tubal and peritoneal surfaces. Spermatozoa were observed in the peritoneal fluid of three of these patients, and two had cultures positive for C trachomatis. C trachomatis was attached to spermatozoa recovered from the peritoneal cavity in both patients. This observation suggests that spermatozoa may serve as vectors for C trachomatis and spread this pathogen to the peritoneal surfaces of the uterus and fallopian tubes.
A retrospective study was undertaken to evaluate the radiologic appearance of salpingitis isthmica nodosa (SIN) in the fallopian tubes of 150 consecutive patients having hysterosalpingograms performed almost exclusively for primary and secondary infertility. SIN was observed in 13 of these 150 patients. The characteristic radiologic features of this condition are minute loculations of contrast medium adjacent to the tubal lumen which range in size up to 2 mm in diameter and are clustered together over a tubal length of 1 to 2 cm. Although the most frequent site of occurrence is in the proximal isthmic portion of the tube, there is occasional involvement of the distal isthmus and even the interstitial portion of the adjacent uterine cornu. Associated tubal abnormalities in this condition such as hydrosalpinx and tubal occlusion help explain the increased incidence of tubal pregnancy and infertility in patients with SIN.
Cultures of specimens from the abdominal cavity (14) or the lower genital tract (11) were positive for Chlamydia trachomatis in 25 (22.7%) of 110 patients with a laparoscopic diagnosis of acute salpingitis. Microimmunofluorescence serodiagnosis showed positive IgG levels (greater than or equal to 1/64) in 35 patients (32%). Of the 34 patients in whom a second serodiagnosis was performed after 6 weeks, 20 (58%) had positive IgG levels (greater than or equal to 1/64) and 12 (35%) had a fourfold or more change in dilution. Thus, culture and serodiagnosis provided evidence of Chlamydia infection in 46% of the patient population. Forty-six patients were followed up for several months to evaluate the response to antibiotic therapy. Among tetracyclines, lymecycline was effective in 19/25 cases, doxycycline in 15/19 cases and minocycline in 2/4 cases. Switching to another tetracycline after failure of the first one usually gave satisfactory results.
Eighty-six women with suspected acute salpingitis were treated with parenteral cefamandole. From 53 (62%) of these Neisseria gonorrhoeae was recovered from an anogenital site(s) at admission. These women were younger, of lower parity, had pain for a shorter period of time, responded more rapidly to therapy, and required less antimicrobial agent for clinical cure than those from whom N gonorrhoeae was not recovered. The clinical success observed in these women was 94%, and only 2% of 122 gonococcal isolates were resistant to cefamandole in vitro.
Out of a series of 50 salpingitis, we have made bacteriological swabs of tubes and peritoneum in 37 cases (25 cases by laparoscopy and 2 cases by laparotomy). 27 women had received no antibiotic treatment before swabbing: bacteriological culture was positive in 14 cases and gram Stain positive in 15 cases: thus we had either a complete study, either a "good idea" of pathological flora in 20 cases out of 27. 10 women received some antibiotic treatment before swabbing: bacteriological culture was positive in 2 cases, gram stain positive in 3 cases. We had idea of pathological flora in 4 cases out of 10. Tubal cultures show either a one-agent infection (gonococcus, E. Coli or anaerobic agent) either a various aero-anaerobic flora. In 18 cases we could compare abdominal flora and low genital tract flora: results were identical in half of cases only (7 cases on 18). Gonococcus was cultured either in women with P.I.D. either in their partner's genital tract, in 11 cases on 37. Both cultures and gram stain were negatives in 13 cases: in these cases, we could perhaps incriminate either a supplement requiring bacterie, either other micro-organisms (chlamydia trachomatis or Mycoplasma) which will be studied in a further series (to be published).
Acute salpingitis is occurring with increasing frequency among sexually active young women and is associated with a significant risk of long term morbidity, especially infertility. Clinical diagnosis is difficult because symptoms and signs are nonspecific and their severity is not always commensurate with the tubal pathology. No antibiotic is ideal; the choice should depend on the most likely pathogen in each patient and the severity of her disease.
Chlamydia trachomatis was isolated from 17 (24%) of 71 patients with acute salpingitis (AS) hospitalized for parenteral treatment. For patients with AS, antimicrobial therapy was started immediately on admission and before the availability of culture results. Notable clinical response was seen in 16 of 17 chlamydial-positive cases. Despite apparent clinical cure, posttreatment cultures from the endometrial cavity yielded C trachomatis from 12 of 13 patients treated solely with second- or third-generation cephalosporins as single-agent therapy. The finding of persistent chlamydial infection of the endometrium suggests that some patients treated for AS, despite apparent clinical response, maintain chlamydial infection of the endometrium that might cause relapse or chronic fallopian tube infection with tubal obstruction and infertility, or perhaps reflect a similar tubal persistence of Chlamydia. Treatment of AS should routinely include coverage for C trachomatis, as clinical response and findings may not reflect its presence or persistence.
The diagnosis of acute salpingitis no longer requires the patient to have fever, bilateral adnexal tenderness and/or swelling, leukocytosis and an elevated sedimentation rate. New criteria have been formulated. There is increasing awareness of the potential role of Chlamydia and increasing use of antibiotics effective against that organism.
The Gainesville staging of acute salpingitis subdivides the complexity of clinical disease into four major stages. Each stage is predicated upon distinct therapeutic goals and different therapeutic regimens for achieving the principal goal of each stage.