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Prioritizing the repair of complex adnexal trauma is important. A logical rational systematic approach based on anatomic considerations has been presented. The use of these principles has resulted in maximizing functional and cosmetic return and, in addition, has decreased the extent and necessity for subsequent complex reconstructive procedures.
Both benign and malignant adnexal masses can present as an emergency. Differential diagnosis, as well as practical clinical maneuvers to differentiate the two, and initial treatment are discussed in this article.
Three years after a heart transplant, a woman presented with an adnexal mass that proved to be endometriosis. Her management and its results are presented.
A retrospective analysis has been carried out on 118 cases of gynaecological tumours of the adnexae. The reliability of ultrasound examination is about 90% for evaluating the existence, the size, the localisation and the structure of these masses. The principal mistakes occurred when the technique was poor, when the interpretation of the picture was faulty and when loops on intestine were in the way. It is possible to diagnose accurately simple ovarian cysts, dermoid cysts and adenocarcinomatous cysts. It is difficult to be specific as far as tubal pathology is concerned, and particularly in infections and ectopic pregnancies. Echotomography of the pelvis has become accepted among the battery of paraclinical gynaecological examinations. It has become of greatest importance in these examinations and particularly when exploring adnexal gynaecological masses. The purpose of this retrospective work has been to evaluate the reliability of ultrasound diagnosis of the nature and origin of masses.
The author evaluates the results of ultrasonographic examination of adnex tumours in 317 patients, in correlation with the histological postoperative findings. US evaluation was focused on the quality and quantity of tumour echogenity, tumour size, its boundaries, possible presence of free fluid (ascites) in the abdominal cavity. The author discusses also factors influencing the US finding. It was revealed that the different criteria of conventional vaginal sonography only indicate the "direction of the nature of the tumour". The value of US criteria increases if several positive criteria are present simultaneously.
Both common pathogens and unconventional, fastidious bacteria, viruses, parasites, and fungi are causative agents in male urethro-adnexitis and in female acute urethral syndrome. Uropathogens, Neisseria gonorrhoeae, Treponema pallidum, Mycobacterium tuberculosis, Chlamydia trachomatis, Mycoplasma spp., Haemophilus ducreyi, Calymmatobacterium granulomatis, Gardnerella vaginalis, anaerobic bacteria, Herpes simplex virus type II (HSV II), papillomaviruses (HPV), Trichomonas vaginalis and Candida spp. must be considered. The various diagnostic procedures and criteria applied for aetiological classification in cases of balanitis, urethritis, prostatitis, epididymitis, orchitis, and acute urethral syndrome are reviewed and evaluated.
A study of domestic ocular and adnexal injuries over an 18 month period at the Guiness Eye Centre Onitsha showed that they constitute 26.4% of all cases of ocular trauma. Women and children were at a greater risk of sustaining eye injuries from domestic activities. The activities leading to injuries in the 45 patients studied were fight, children's play, chopping firewood, plucking fruits/vegetables and corporal punishment; the injuries were inflicted by self; playmates, siblings, parents and husbands; the agents of injury were fist, missibles, sticks and other sharp objects, exploding bottles and human bite. Most patients presented more than one week after injury. Only 18 patients (40%) kept follow-up appointment. Among these visual acuity improved in 11 while 5 remained blind. The importance of these epidemiologic characteristics in relation to prevention of such injuries and reduction of ocular morbidity in established cases are discussed.
BACKGROUND: The incidence of major complications from laparoscopy is reported to be 0.6-2.5%. The literature reviewing laparoscopic adnexal surgery reports few cases of intraoperative or postoperative complications. CASES: We describe three cases of intraabdominal bleeding following laparoscopic oophorectomy and salpingo-oophorectomy and salpingo-oophorectomy. In two of the three cases, postoperative exploratory laparotomy failed to identify the source of bleeding. CONCLUSION: Possible causes of postoperative bleeding are loosening of clips from an automated stapling device and delayed bleeding from vessels tamponaded by the pneumoperitoneum. Many complications of operative laparoscopy probably are underreported and, when present, may occur outside a health care facility since many of these cases are performed on an ambulatory basis. Some patients will acquire medical and/or surgical intervention.
A review of consecutive biopsies of adnexal tumours from 112 patients, received by the Department of Pathology, University of Malaya, over a 13-year period was undertaken. The age range of the patients was from 1 to 84 years, with a mean of 29.8 years. Thirty-three (32%) patients were under 20 years of age. There were 68 females with a male to female ratio of 1.0:1.5. In 105 cases (93.7%), the neoplasm was solitary. The tumour measured less than 2 cm in the largest dimension in 103 cases (92%). The common sites of occurrence were the head and neck region (59%) and extremities (25%). Neoplasms of hair follicle origin accounted for 63.4% (71 cases) of all lesions. Intra-tumour deposition of amyloid was noted in one of the 14 cases of trichoepithelioma.
Besides mycoplasmas and ureaplasmas chlamydias are able to cause an urethro-adnexitis in men. Jeasts, trichomonas and herpes-viruses are in our patients of less importance. Therapy with erythromycine of chlamydial urethroadnexitis is successful.
The diagnosis and treatment of adnexal cancers continues to pose a challenge to a wide range of clinicians. The diseases are a diverse lot, owing to the wide range of skin structures and large surface area. Early recognition and treatment are key to improved outcomes. Education of the patients as to their role in their care, especially early detection, is also of crucial importance. Further study may yield information to improve diagnosis and treatment.
INTRODUCTION: Amineptine-induced acne is a classical side effect often encountered after prolonged and excessive use of the antidepressor. CASE REPORT: We report the case of a young female drug addict (benzodiazepines and alcohol) who denied overuse of amineptine. The initial inflammatory aspect of the lesion was unusual as was the histology report. The sebaceous glands were the site of cystic dilatation as would be expected, but in addition the sudoriparous glands showed keratinizing syringometaplasia with areas of neutrophilic eccrine hidradenitis. DISCUSSION: This is the second report of such a case similar to other due to chemotherapy, benaxoprofene or toxic agents for example, and corresponds to direct toxicity to the sudoriparous glands which accumulate amineptine. We therefore propose the term of adnexal toxic drug eruption.
PURPOSE: Cell surface complement regulatory proteins have been identified in high levels in ocular tissues, but no experimental model is available for examining their physiological roles. To develop such a model, the distribution of 5I2 antigen, a protein possessing the functions of the human decay-accelerating factor (DAF [CD55]) and membrane cofactor protein (MCP [CD46]), and rat inhibitory protein (CD59), the homologue of the human membrane inhibitor of reactive lysis (MIRL[CD59]) were characterized in the rat eye and ocular adnexal structures. METHODS: After euthanasia of female Wistar rats, followed by orbital exenteration, eyelids and orbital tissue including the lacrimal gland were separated from the globes and immediately snap-frozen in liquid nitrogen at -70 degrees C. Tissues then were sectioned at -20 degrees C and examined immunohistochemically for 5I2 antigen and rat CD59. RESULTS: Both molecules were found to be present in high levels in multiple sites. Corneal and conjunctival epithelia showed moderate to intense labeling for both regulators. Fibroblasts in the corneal stroma, conjunctiva, and sclera labeled similarly. Corneal endothelial cells showed intense labeling for rat CD59 but not for 5I2 antigen. The iris and ciliary body showed intense labeling for both proteins. The retina showed labeling at multiple levels, with that of rat CD59 being more intense than that of 5I2 antigen. The lacrimal gland labeled for both regulators. Vessels, muscle, and nerves in the orbit labeled intensely for both antigens. In the eyelid, conjunctiva, sebaceous glands, and muscle and nerve tissues labeled moderately to intensely for both molecules, whereas skin epithelium labeled less intensely. CONCLUSIONS: 5I2 antigen and rat CD59 are expressed in high levels and distributed similarly in the rat eye and lacrimal gland to DAF, MCP, and MIRL in the human eye and lacrimal gland. These findings establish the rat ocular surface as a model for studying the role of cell surface complement regulators in this site. This first identification of copious expression of these proteins in eyelid structures, which also participate in protection of the ocular surface, further suggests an important role for surface complement regulatory proteins in this location.
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A broad-ligament tumor, of probable wolffian origin, is presented. The ultrastructural features of this histologically benign tumor have not been previously described. The fine structure of this tumor is compared with normal structures and tumors derived from wolffian and müllerian anlage. The findings are consistent with derivation from wolffian duct.
Uterine adenomyosis usually manifests as diffuse disease involving the myometrium and the endometrial-myometrial junction, but it may also manifest as a focal lesion. It is usually only a few millimeters in diameter but may sometimes be larger. We report the case of a 32-year-old woman with a large isolated mass in the uterine wall. Transvaginal sonography demonstrated the cystic nature of the mass and its characteristic hemorrhagic pattern, whereas CT confirmed its uterine origin. The patient underwent laparoscopic resection of the mass, and pathologic examinations led to the diagnosis of adenomyosis.