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PubMed1988

Treatment of penetrating abdominal trauma and gynecologic infections.

Both penetrating abdominal trauma and gynecologic infections are polymicrobial and require antibiotics with broad-spectrum activity against both aerobic and anaerobic pathogens. In an open study, ticarcillin disodium/clavulanate potassium was used to treat patients with penetrating abdominal trauma, intraabdominal infection or gynecologic infection. Ticarcillin disodium/clavulanate potassium was administered at a dose of 3.1 g every four or every six hours, and therapy lasted for a minimum of three days. Among 20 patients with intraabdominal infections that involved abdominal organ perforation, ticarcillin disodium/clavulanate potassium was effective in 16. Eighteen of 19 aerobic isolates were susceptible to ticarcillin disodium/clavulanate potassium, as were all of 21 anaerobic isolates. Fifteen of 21 evaluable patients with gynecologic infections were cured. Among the infections were pelvic inflammatory disease, salpingitis, salpingitis with tuboovarian abscess, pelvic inflammatory disease with tuboovarian abscess, salpingitis/pelvic inflammatory disease and peritonitis, endomyometritis, cervicitis and pelvic inflammatory disease with peritonitis. A total of 32 aerobic and 15 anaerobic organisms were isolated, and 14 of the patients had more than one organism isolated.

Abdominal Injuries↗

PubMed1987

The contralateral corpus luteum and tubal pregnancy.

One hundred fourteen cases of tubal pregnancy were examined for evidence of active or chronic salpingitis, other anatomic and functional etiologies, and the side of the corpus luteum relative to the pregnancy. A corpus luteum was found ipsilateral to the tubal pregnancy in 80 cases (70%) and contralateral in 18 (16%). In 16 cases (14%), the position of the corpus luteum could not be identified by inspection. No differences were noted among the groups in days from last normal menstrual period or the incidence of irregular bleeding. Of the 98 cases in which a corpus luteum was identified, 53 women (54%) had at least one condition that could be considered etiologic for tubal pregnancy, including 38 (39%) who had microscopic evidence of chronic salpingitis. No association was found between the laterality of the corpus luteum and the presence of risk factors, including mechanical factors. Possible explanations for absent corpora lutea in association with tubal pregnancies are discussed.

Adult↗

PubMed1986

[Epidemiology of tubal lesions. Apropos of 588 microsurgical plastic procedures and 69 in vitro fertilisations].

Genital infections and in particular sexually transmitted diseases are mainly responsible for tubal sterility. We have studied five factors each of which could carry responsibility for this sterility. All were in some degree associated with infection in the 588 patients who were operated on for tuboplasty and 69 patients who had in vitro fertilisation. There results have been compared with 50 sterile women who had healthy tubes and with 8,356 women who were delivered during the same period of time. The previous histories of women who had extra-uterine pregnancies were significantly more frequent for these infections in the tubes leading to chronic salpingitis. Acute salpingitis was given in the history in about 35% of women who had to have tubal surgery or in vitro fertilisation. This was significantly higher than those sterile women who had healthy tubes and those who were delivered of babies. There was a significantly raised number of those where the serology was positive for chlamydia trachomatis in sterile women with tubal lesions. We have also been able to note that there was correlation between the frequency with which positive serology was found and the degree of severity of the tubal lesions. So, the serology was often positive in cases of hydrosalpinx (77.3%) and in double lesions (91.5%). These figures were significantly higher than those who had proximal blocks (61%) and who had adhesions (54.8%). The frequency of therapeutic terminations of pregnancy in patients with tubal lesions was significantly higher than those in the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Chlamydia Infections↗

PubMed1986

[Tubal histology in extra-uterine pregnancies].

141 patients affected by tubal pregnancy have been treated by total salpingectomy at the Port-Royal university clinic between the 1st January 1977 and the 31st January 1984. Tubal pregnancy occurred in the majority of cases in a pathological Fallopian tube, of which the histological state was unrelated to the clinical observations made at laparotomy. Ampullary pregnancy (88% of cases) is secondary to a pathological ampulla in 94 p. cent of cases. The latter was chronic salpingitis in 92 p. cent of cases. Isthmic pregnancy (12% of cases) appears to us to be secondary to isthmic pathology in all cases, and is generally associated with ampullary lesions. There also chronic salpingitis preponderates, whilst endometriosis is very rare. The great frequency of pre-existing lesions which we have noted explains perfectly the high level of recurrences in situ observed after conservative surgery of the gravid tube.

Fallopian Tubes↗

PubMed1985

The pathologic spectrum of uterotubal junction obstruction.

Excised tubal segments from 42 women with uterotubal junction obstruction were studied histologically to evaluate the pathologic spectrum of disease and correlate this with clinical data. The most frequent lesion encountered was obliterative fibrosis (38.1%), confirmed by connective tissue stains, which was not associated with cornual nodularity. Other pathologic entities included salpingitis isthmica nodosa (23.8%), intramucosal endometriosis (14.3%), and chronic tubal inflammation (21.4%). Intramucosal endometriosis was distinguishable from salpingitis isthmica nodosa by virtue of its unique stroma confirmed by connective tissue staining. Women with previous pregnancies were included in all the groups. In all instances, the obstruction was present in the transmural portion of the tube and extended a variable distance into the isthmic segment. These observations on uterotubal junction obstruction demonstrate that: 1) There are multiple distinct histologic patterns, 2) Intraabdominal findings do not predict the histology of the uterotubal junction pathology, 3) Any histologic pattern can be associated with a previous intrauterine or ectopic pregnancy, and 4) The obstruction begins within the transmural portion of the oviduct, extends a variable distance into the isthmic segment, but does not obstruct the ampullary segment. These data suggest that the initiating process originates within the uterus and that fibrosis may represent a nonspecific response to chronic injury of the transmural and isthmic segments of the oviduct.

Chronic Disease↗

PubMed1984

Circulating immune complexes in sera of patients with gynecologic disorders.

Sera from 211 women seen in the Department of Obstetrics and Gynecology at the New York Hospital were assayed for CIC by the Raji cell enzyme linked immunosorbent assay. Only 9 per cent of healthy women (two of 21), 6 per cent of pregnant women (two of 34), 2 per cent of women with benign tumors (one of 39) and 5 per cent of women with vaginal and cervical infection (two of 37) had detectable CIC. CIC was present in low concentrations when it was found. In marked contrast, 80 per cent of the patients with Condylomata acuminatum infection (eight of ten), 46 per cent with acute salpingitis (11 of 24) and 39 per cent with gynecologic malignant diseases (13 of 33) had CIC, usually at high levels. In a patient with salpingitis, CIC was shown to be 19S and 14S, dissociable at acid pH and capable of activating complement.

Antigen-Antibody Complex↗

PubMed1984

[Prevention of Chlamydia trachomatis infections in women].

Over the past several years, the incidence of chronic salpingitis has increased relentlessly, with its accompanying pelvic pain, ectopic pregnancies, and tubal sterility. Chlamydia are a frequent etiologic agent. Preventing these infections is difficult, nevertheless proper care will be given by recalling four key words: avoidance, diagnosis, education, and treatment. It is important to discourage early sexual activity and multiple sexual partners, to encourage the use of condoms, and avoid the use of an intrauterine device in adolescents. Atypical presentations of salpingitis must be recognized and treated effectively, thus preventing the spread of infection. Education on venereal diseases should be presented in secondary schools, during military service, and other similar groups, but especially during physician visits for contraception.

Adolescent↗

PubMed1983

Host response to primary Chlamydia trachomatis infection of the fallopian tube in pig-tailed monkeys.

Experimental acute salpingitis was produced in four pig-tailed monkeys, Macaca nemestrina, by intratubal inoculation with Chlamydia trachomatis (serotypes E or F). The organisms were reisolated from both the endosalpinx and endocervix as early as 1 week after the original inoculation. Endosalpinx cellular responses to the infection were examined by light, transmission, and scanning electron microscopy. A moderate lymphocyte infiltration was detected in the submucosa on day 7. By days 14 and 21 the lymphocytic infiltration was heavy and extended into both the submucosa and the mucosa; the infiltration subsided by day 35. Epithelial cell degeneration occurred in close approximation to lymphocytes, suggesting the immunologic basis of tissue destruction. Scanning electron microscopy revealed extensive deciliation and increased plasmalemmal alterations of nonciliated cells. The presence of C. trachomatis in frozen and deparaffinized tissues was demonstrated by immunofluorescence and immunoperoxidase staining with monoclonal antibody to C. trachomatis. Only secretory cells contained chlamydial inclusions. A humoral immune response to C. trachomatis was demonstrated by microimmunofluorescence. No histologic or immunologic evidence of infection was present in two control monkeys inoculated with HeLa cell material. The histopathologic and immunologic findings of this study establish the pig-tailed monkey as a useful model for further studies of the pathogenesis and pathophysiology of chlamydial salpingitis.

Acute Disease↗

PubMed1983

[Infections in gynecology].

After the author had reviewed present ideas about infections he outlined the specific character and the role of the normal flora to be found in the cervix and in the vagina, as well as the common characteristics of sexually transmitted diseases. The pathogenic role of bacteria that were previously considered to be "innocent" (type B streptococci, staphylococcus aureus, Gardnerella vaginalis) and Chlamydiae and mycoplasmas make it easier to understand the pathogenesis of basal gynaecological infections and of the urethral syndrome. The author then studies the aetiology of acute salpingitis that can be classified according to a number of responsible organisms: monomicrobial salpingitis (due to gonococci, Chlamydia, and microplasmas) or polymicrobacterial, the nature (endogenous or exogenous) of the infecting agents and the role of iatrogenic factors (such as intra-uterine contraceptive devices, terminations of pregnancies and so on). The diagnosis and the risks of gynaecological infections occurring are pointed out as well as the different problems associated with preventing these infections.

Adult↗

PubMedDate not supplied

Isthmic tubal occlusion: etiology and histology.

Twenty five patients were operated on for isthmic tubal occlusion. In 15 cases (60%) the etiology of this lesion was salpingitis isthmica nodosa. Of the other 10 cases, three showed tubal endometriosis and another three isthmic fibrosis. In two patients the histologic examination showed chronic inflammation. In one case etiology was tubal tuberculosis and in one case a cyst of calcified Gartner 's duct was seen. Inflammatory etiology seems to be important in isthmic tubal occlusion. In many cases chlamydial infection may be the chronic irritant which also cause the muscular hypertrophy leading to salpingitis isthmica nodosa.

Calcinosis↗

PubMed1995

A peptide of Chlamydia trachomatis shown to be a primary T-cell epitope in vitro induces cell-mediated immunity in vivo.

Chlamydiae are a major cause of infertility and preventable blindness and there is currently no effective vaccine in humans or rodents against these organisms. We have previously shown that a peptide of 12 amino acids (termed TINKP) from a conserved region of the major outer membrane protein (MOMP) of Chlamydia trachomatis (C. trachomatis) is a primary T-cell epitope in humans. Here we showed that when dendritic cells (DC) from C3H or BALB/c mice were pulsed in vitro with the peptide they stimulated proliferation of syngeneic T cells in vitro indicating that the peptide is also a primary T-cell epitope in mice. Since the skin is a rich source of DC, we immunized mice from each strain with an intradermal injection of the peptide. Humoral and cell-mediated immunity to peptide, MOMP or whole elementary bodies (EB) of C. trachomatis (F/NI1/GU) were assessed. No antibody response to TINKP was observed. However, immunized mice showed recall responses to all three chlamydial antigens. T-cell-mediated immunity in the absence of antibody was induced by a single injection of the peptide intradermally. C. trachomatis isolated from the human genital tract causes salpingitis in mice. Preliminary studies in susceptible C3H mice indicated that intradermal injection of peptide conferred some protection against the development of salpingitis. Thus, a primary T-cell epitope identified by in vitro stimulation using DC can also initiate cell-mediated immunity in vivo and this approach may be useful in the development of vaccines.

Animals↗

PubMed1995

[Comparative study of ofloxacin+amoxicillin-clavulanic acid versus doxycycline+amoxicillin-clavulanic acid combination in the treatment of pelvic Chlamydia trachomatis infections].

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.

Adolescent↗

PubMed1994

[Sexually transmitted diseases in women, mothers, under-age females. 7th Consensus Conference on Antiinfectious therapy. Paris, 3 November 1993].

This paper is a report of a consensus conference held by the "Société de pathologie infectieuse de langue française" on diagnosis and treatment of sexually transmitted diseases in females (HIV and hepatitis B being excluded). Three subjects are concerned. 1) Diagnosis and medical treatment of salpingitis, with particular attention to salpingitis in adolescent girls, the two most common infections being Chlamydia trachomatis and Neisseria gonorrhoeae. 2) Diagnosis and treatment of sexually transmitted diseases in girls younger than 15, with the underlying question of possible sexual abuse. 3) The neonatal consequences of maternal sexually transmitted diseases and their treatment (Neisseria gonorrhoeae, Treponema Pallidum, Mycoplasma, Chlamydia trachomatis, Herpes, Cytomegalovirus, Papillomavirus).

Adolescent↗

PubMed1994

[A new therapeutic strategy using a ofloxacin-amoxicillin-clavulanic acid combination in the treatment of upper gynecologic infections. Apropos of 123 cases].

OBJECTIVE: To evaluate a new antibiotic strategy with a combination of ofloxacin + co-amoxiclav in the treatment of pelvic infectious diseases. DESIGN: An open-non-comparative multicentre (10) study. SUBJECTS: 123 patients (118 salpingitis and 5 endometritis) were included clinical, laparoscopic and bacteriological assessments were performed before treatment and a laparoscopic control was done in 35% of cases. Among positive bacteriological samples before treatment 48.7% C. trachomatis were isolated; 56.1% of salpingitis were considered as severe (COGIT score > 6). TREATMENT: Patients received at entry oral ofloxacin 200 mg bid in combination with parenteral co-amoxiclav 2 to 4 g following by oral route. Total duration of treatment was 21 days. RESULTS: With respectively 97.2% and 91.6% satisfactory clinical and bacteriological results, this combination should take a major place in the treatment of pelvic infectious diseases.

Adolescent↗

PubMed1996

Ectopic pregnancy. A recent five-year study and review of the last 50 years' literature.

OBJECTIVE: To compare the past and current clinical and pathologic factors that are responsible for ectopic pregnancy (EP). STUDY DESIGN: We performed a retrospective chart and histopathologic specimen review of 740 cases of EP during a recent, five-year period. Products of conception, as well as 240 cases of concomitant endometrial biopsies, were examined. RESULTS: The mean age at presentation, proportion of patients with a history of pelvic inflammatory disease, voluntary interruption of pregnancy (VIP), previous surgery and laterality (right side) of the tubal EP were similar to rates reported in previous studies. Ninety-four percent of the EPs were tubal, and 90% of the tubes exhibited some pathologic changes, including chronic salpingitis (49.5%) and follicular salpingitis (10%), among others. Gestational endometrial patterns were seen in 44% of cases. The corpus luteum of pregnancy was contralateral in 30% of cases in which an ovarian biopsy was performed. CONCLUSION: The factors classically associated with EP remained similar over a period of about 50 years, although the association with VIP still appears to be controversial. Endometrial curettage alone cannot be used to exclude an EP. Ovum transmigration may play a role in the genesis of EP.

Adolescent↗

PubMed1984

The nature of urogenital involvements in female uro-arthritis, with special reference to chlamydial infection.

To study the nature of urogenital involvements in female uro-arthritis 73 consecutive patients with arthritis concomitant with any type of urogenital involvement were examined. The controls were 281 females interviewed only and an additional 83 also gynaecologically examined. A history of cervicitis, salpingitis, dysuria and pyelocystitis/-nephritis occurred significantly more often in patients than in controls. Clinical gynaecological examination revealed cervicitis in 26,8% (19/71) of the patients and 15.7% (13/83) of the controls (p less than 0.05). Aseptic pyuria was definitely more frequent in patients (19/73) than in controls (0/63). The isolation of Chlamydia trachomatis was positive in 14.7% (10/68) of the patients and 3.7% (3/81) of the controls (p less than 0.025). Serological evidence (titre greater than or equal to 64) for chlamydial infection was obtained in 53.4% (39/73) of the patients and 18.2% (14/77) of the controls (p less than 0.00025). The results indicate the importance of urogenital history and findings in females with rheumatic attacks. The most prominent and persistent urogenital involvements were cervicitis, salpingitis, pyuria and dysuria. Chlamydial infection appears in any case to be responsible for part of these involvements (42/73).

Adolescent↗

PubMed2002

Fecundity and morbidity following acute pelvic inflammatory disease treated with doxycycline and metronidazole.

We studied fecundity and late sequelae of 39 women who had laparoscopic and microbiological sampling-proven acute pelvic inflammatory disease (PID) treated with the same antimicrobial regimen. The grade and etiology of index PID were classified using laparoscopy, endometrial biopsy and microbiological cultures from the cervix, endometrium and tubes: 20 had mild and 19 severe PID. The mean (SD) follow-up period after the index PID was 125 (44) [range 8-204] months. The primary end-point was pregnancy. All other or recurrent infections or other diseases related to the infection, including infertility, were evaluated. Twenty (51%) women had laparotomy or second laparoscopy during follow-up and findings were evaluated. Chlamydia trachomatis was isolated in 38% of all cases. Eleven (28%) of 39 women avoided conception or it was no longer possible. Twenty-eight women had tried to conceive after the index PID and 25 (89%) of them had at least one pregnancy. Twenty-five women had 56 pregnancies, 33 (59%) of which ended in delivery, 9 (16%) miscarried, 13 (23%) were induced abortion and only one (1.8%) tubal pregnancy occurred. Etiologic factors or severity of PID made no difference to the conception rate. Patients with mild or moderate salpingitis had a high conception rate. Endometriosis was found in 6 (30%) out of 20 women with second laparoscopy or laparotomy. Hysterectomy had been performed in 4 cases. Precise diagnosis of acute PID is the cornerstone for the treatment of the condition. Combination regimens, including drugs against the most common factors underlying acute PID against both aerobic and anaerobic microbes, prevent late sequelae in cases with mild or moderate salpingitis but not in cases with tubal or pelvic abscess.

Abortion, Induced↗

PubMed1983

Comparative study of piperacillin versus cefoxitin in the treatment of obstetric and gynecologic infections.

Piperacillin sodium (Pipracil, Lederle Laboratories, Wayne, New Jersey), a new semisynthetic penicillin, demonstrated in vitro activity against a broad spectrum of clinical pathogens. It is active against most strains of the clinically important gram-negative aerobic or facultative bacteria and against virtually all the clinically important anaerobic organisms, including Bacteroides fragilis and Bacteroides bivius. This broad antibacterial spectrum suggested that piperacillin might be an effective single antimicrobial agent for the treatment of mixed aerobic/anaerobic infections in obstetric and gynecologic patients. In this study, the clinical efficacy and safety of piperacillin was compared with that of cefoxitin in the management of pelvic infections. There were 23 patients in the piperacillin group (acute salpingitis, 12; endomyometritis, 7; pelvic cellulitis, 2; tuboovarian abscess, 2) and 25 patients in the cefoxitin group (acute salpingitis, 13; endomyometritis, 10; tuboovarian abscess, 2). An average of six bacteria were isolated from each patient. Aerobic bacteria only were recovered from 12.5%, anaerobic bacteria only in 6.5%, and both aerobic and anaerobic bacteria were present in 82.5% of patients. Overall, 21 of 23 (91%) of the piperacillin treatment group and 23 of 25 (92%) of the cefoxitin group responded to therapy with antimicrobial agents alone. The major cause of failure was the presence of an abscess. Piperacillin was shown to be an effective single agent for the management of pelvic infections caused by mixed aerobic and anaerobic bacteria. In addition, piperacillin proved to be safe and well tolerated.

Adolescent↗