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PubMed1988

Upper and lower reproductive tract bacteria in 126 women with acute pelvic inflammatory disease. Microbial susceptibility and clinical response to four therapeutic regimens.

To more clearly understand the microbiology of acute salpingitis in our patients and to evaluate the clinical efficacy and safety of recommended and new therapeutic regimens, 126 women who met clinical diagnostic criteria for acute community-acquired pelvic inflammatory disease underwent endocervical and endometrial cultures prior to random intravenous therapy with cefoxitin plus doxycycline, ceftizoxime plus doxycycline or ceftizoxime alone (two regimens). Nine women (7%) had Chlamydia, and 70 (56%) had gonococci in endometrial specimens (P less than .001). Only two women (3.4%) given monotherapy required altered medical therapy, and none required surgery. Parenteral combination therapy was associated more frequently with adverse clinical and laboratory events.

Acute Disease↗
PubMed1988

Periappendicitis and diagnostic consequences.

A ten year series of 2660 appendicectomies revealed the microscopic diagnosis to be periappendicitis in 50 cases (1, 9%). In 7 cases the appendicectomy was incidental. Of the remaining 43 patients 21 had salpingitis, 15 had other intraperitoneal inflammation, and in 7 cases no obvious explanation could be found. Peroperatively, periappendicitis was suspected in 3 of the 43 cases, in 18 patients the appendix was judged to be normal and in 17 inflamed. It is important to be aware of the existence of periappendicitis as it often produces signs of intraperitoneal inflammation.

Adolescent↗
PubMed1987

Piperacillin and a combination of clindamycin and gentamicin for the treatment of hospital and community acquired acute pelvic infections including pelvic abscess.

Therapy for acute polymicrobial pelvic infections is empiric and must include predictable anaerobic coverage. Single agent therapy, if effective, is advantageous for the patient, nurses, pharmacy and hospital. Piperacillin sodium was compared with a combination of clindamycin and gentamicin as therapy for 63 female patients who were hospitalized with acute pelvic infections including pelvic abscess complicating community acquired salpingitis. Over-all clinical efficacy with piperacillin was 96.8 per cent and 90.3 per cent for clindamycin and gentamicin. Fewer bacteria demonstrated in vitro resistance to piperacillin (p = 0.008) and the cost of treatment for these infections was significantly less with piperacillin (p less than 0.05). Serious adverse reactions were not observed with either regimen. Piperacillin provides effective, cost-efficient therapy for women with acute polymicrobial pelvic infections.

Abscess↗
PubMed1988

[Sexually transmissible diseases and female sterility].

Regarding personal studies and a review of the literature, the authors are discussing the consequences of STD on fertility. Thus, through salpingitis, STD represent the main cause of tubal sterility, distal and proximal, and ectopic pregnancies. It seems desirable to look for them in the latter and treat them with a suitable antibiotherapy. The chlamydia serology seems a good screening examination. The best prevention of STD will certainly permit to decrease the frequency of tubal sterility and ectopic pregnancies, in the years to come, limiting therefore the major public health expenses they involve.

Adolescent↗
PubMed1988

[The role of Chlamydia trachomatis in the infectious etiology of extra-uterine pregnancy].

The study was carried out in two different hospital centres on a series of 55 women who had ectopic pregnancies compared with 2 control groups. The study concerned taking samples from cells in the pelvis to culture for Chlamydia trachomatis and to estimate the levels of anti-Chlamydia antibodies. The cultures were positive in 30% of the cases and the serology was positive in 52% of the cases. This difference is significant when compared with the control groups (p less than 0.001). There was no significant statistical difference as far as positive cultures were concerned between the groups of women who had or had not had previous tubal infertility or a history of salpingitis. It seems that Chlamydia trachomatis can itself therefore be a direct cause for the development of an ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1986

[Experience with imipenem/cilastatin sodium in the field of obstetrics and gynecology].

Fundamental and clinical studies on a new carbapenem antibiotic, imipenem/cilastatin sodium (MK-0787/MK-0791), were carried out in the field of obstetrics and gynecology. The following results were obtained. The concentration of MK-0787 in uterine tissue was 3.5 approximately 8.2 micrograms/g at about 30 minutes after an administration of 0.5 g/0.5 g of MK-0787/MK-0791 by a 30-minute intravenous drip infusion. The concentration decreased to less than 0.5 microgram/g by approximately 3 hours. The level of MK-0787 in the pelvic dead space exudate reached a peak of 24.0 +/- 4.4 micrograms/ml at 1 hour after an administration of MK-0787/MK-0791 0.5 g/0.5 g and was higher than the plasma level at 1 hour. The level in the pelvic dead space exudate was 2.0 +/- 0.8 microgram/ml at about 6 hours. The MK-0787/MK-0791 was administered to 4 patients with gynecologic infections (2 patients with pelvic peritonitis, 1 patient with salpingitis, 1 patient with a vulvar abscess). The clinical efficacy was good in all 4 patients. Neither adverse effects nor abnormal laboratory findings were observed. It appears that MK-0787/MK-0791 is a safe and useful antibiotic for the treatment of obstetrical and gynecological infections.

Abscess↗
PubMed1987

Chlamydial infections in gynaecology and obstetrics.

Chlamydia trachomatis is a sexually transmitted intracellularly growing rod, causing cervicitis, endometritis, salpingitis and urethritis. Inclusion conjunctivitis and pneumonia are the sequelae of maternal cervicitis in newborns. In treatment tetracyclines and erythromycin are the drugs of choice.

Chlamydia Infections↗
PubMed1986

Anatomy and pathology of tubal pregnancy.

The prevalence of tubal pregnancy has increased markedly during the past decade. The reasons for this are obscure. A systematic gross and histopathologic study of 25 consecutive ectopic pregnancies has been performed using a clearing method not used previously for this purpose. In addition, the presence of the corpus luteum and its location in reference to the tubal pregnancy are documented. Results indicate that trophoblastic spread was predominantly intraluminal in 67% of cases. Intratubal hemorrhage, generally in parallel to trophoblastic spread, often led to marked tubal destruction. Histologic evidence of salpingitis was noted in only seven of 24 specimens (29%). The corpus luteum was contralateral to the ectopic pregnancy in five of 21 cases (23.8%). Clinical correlates and areas of future research are discussed. Results indicate that segmental resection of the tubal pregnancy is appropriate in selected cases.

Adolescent↗
PubMed1986

[Prostanoids of the peritoneal fluid and sterility with or without pelvic lesions (endometriosis, postinfectious adhesions)].

Peritoneal fluid levels of 6-keto-PGF1 alpha, TxB2, PGE2 and PGF2 alpha were measured in 62 infertile women undergoing coelioscopy. In 10 patients with mild endometriosis, the levels of all prostanoids were significantly enhanced as compared to control group (15 infertile patients without pelvic lesion). In 5 patients with moderate endometriosis, only PGF2 alpha exhibited a significant enhancement. The results confirmed the prostanoid component alteration of peritoneal fluid in infertile women with mild or moderate endometriosis, which however not has been found by all authors. In 6 patients with chronic salpingitis, no difference was found in prostanoid levels as compared to control group. The 26 patients with pelvic adhesions were distributed in 3 groups on the criterion of easy lysed or not adhesions. In group I (not lysed adhesions, 7 patients), no difference was found in prostanoid levels as compared to control group. In group II (mixed adhesions, 13 patients), the levels of all prostanoids, particularly 6-keto-PGF1 alpha, were significantly higher than that found in control group. In group III (easy lysed adhesions, 6 patients), the levels of 6-keto-PGF1 alpha, TxB2 and particularly PGF2 alpha were significantly enhanced as compared to control group. The results of this study suggest that prostanoids are implicated in physiopathology of endometriosis and pelvic adhesions and perhaps in mechanism of the associated infertility.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Chlamydia trachomatis infection of the female genital tract. Pathogenetic and clinicopathologic correlations.

Further studies are needed to define the clinicopathologic manifestations of CT infection. Many questions remain regarding the natural history and pathogenetic mechanisms of CT and its biologic and clinical interactions with other prevalent STDs. However, it is apparent that CT is a major cause of STD in the Western world and that its incidence and prevalence have increased to epidemic proportions in young, sexually active women and men. As with other STDs, epidemiologic control of CT infection is of paramount importance. The clinician and pathologist should develop a heightened awareness of the probability of Chlamydia infection in all patients at risk for STD, and in clinical settings, only a high index of suspicion will result in timely therapeutic intervention. Although more simplified and less expensive diagnostic procedures for CT are being investigated, presently, culture isolation is the best and most accurate diagnostic method for CT genital infection and its use should be popularized and made more easily available. Immunofluorescent staining using monoclonal and heterologous antibodies to extracellular CT elementary bodies in preselected smears appears promising as a diagnostic technique and requires further study. There is no apparent role for the use of routine cyto- and histologic microscopy in the diagnosis of CT infection and the practice of diagnosing presumed chlamydial vacuoles or inclusions from cervicovaginal Pap smears should be actively discouraged. Although CT cervicitis plays a dominant role in the pathogenesis and dissemination of CT infections, it should be remembered that multiple sites of genital involvement occur commonly with CT infection and this multifocality should be considered when CT cervical cultures are negative and in post-treatment follow-up. Cultures should be obtained from sites of suspected involvement and should include scrapings or biopsy sampling of the tissue surface to insure the presence of sufficient numbers of epithelial cells. Local secretions or exudate should not be considered adequate. In the female, sampling of the urethra, rectum, and endometrium may facilitate accurate diagnosis. Scraping or sampling of the tubal epithelium by biopsy may provide diagnostic material in acute salpingitis and PID and should be considered if laparoscopy or laparotomy are performed. Routine screening by culture for CT cervicitis has been suggested in high-risk clinical groups and in antepartum patients for prophylaxis of fetal and neonatal disease and requires serious consideration because of the high prevalence of CT infection.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1987

Management of common gynecologic problems encountered during abdominal exploration.

Although general surgeons receive little training in the management of gynecologic conditions, they should be able to make intraoperative decisions about unexpected gynecologic abnormalities encountered during abdominal exploration. This report examines the six most common gynecologic problems found during abdominal exploration (salpingitis, tubo-ovarian abscess, ectopic gestation, endometriosis, uterine mass, and ovarian mass) and reviews their proper management with particular emphasis on conserving reproductive function.

Abdomen↗
PubMed1979

[Cefazedone in infectious diseases in gynecology. Clinical tests on efficacy and tolerance].

A clinical trial on efficacy and tolerance of Cefazedone, a new semisynthetic Cephalosporine-derivate, was carried out in a gynaecological clinic on 75 patients. In 38 of these cases, besides the gynaecological affection, urinary tract infections were determined microbiologically (E. coli, P. mirabilis, klebsiella or enterococci). Inflammation of the lower abdominal area was established in the remaining 37 patients (adnexitis, pelvic peritonitis, endometritis, salpingitis). The average duration of treatment was 10 to 11 days. Cefazedone was injected intravenously twice a day, the daily dose was 2 to 4 g. The clinical assessment of the treatment was very good in 28 cases, good in 43 cases, moderate in 3 patients and poor in 1 case. All initially identified pathogens were eliminated after treatment. A slight transitory diarrhea was observed in 5 cases. There were no further side-effects. The values of gamma-GT, serum-creatinin, hemoglobin and erythrozytes were controlled before and after medication and showed no detremental effect of the drug. The local tolerance of Cefazedone was good in more than 90% of the cases treated.

Adult↗
PubMed1986

Diagnosis and treatment of chlamydial infections.

The major chlamydial infections are conjunctivitis and pneumonia in infants and urethritis, cervicitis, salpingitis and ocular infection in adults. Tetracyclines are usually the drugs of choice for the treatment of chlamydial infections. Erythromycin therapy is preferred for pregnant women and for neonates with conjunctivitis. Follow-up examination and treatment of sexual partners are required for the control of chlamydial infections.

Adult↗
PubMed1986

[Effect of the etiology of sterility on the results of tubal microsurgery].

The authors have carried out a prospective study from the 1 January 1977 to the 31 December 1981 on 168 women, 89.3% of whom (150/168) had pure distal tubal microsurgery and 10.7% (18/168) had mixed surgery. The results were studied in relationship to the aetiological reason for tubal sterility, which was: salpingitis in 60 cases = 35.7%; appendicitis in 23 cases = 13.7%, endometriosis in 29 cases = 17.3%, termination of pregnancy in 22 cases = 13.1% and unknown causes in 34 cases = 20.2%. The figures for intra-uterine pregnancies were 32.74% after 24 months using a classical method of determining it and 31% using an actuarial method. There was a significant difference between endometriosis and the four other aetiologies. These latter could not be differentiated between one another. The level of ectopic pregnancies was 5.3% at 24 months, or 6.3% using an actuarial method. It was higher after endometriosis. It would therefore appear from the results of this study that endometriosis seems to be poor from a prognostic point of view when compared with the other aetiological causes and the results shown in the literature. Finally the authors discuss in cases of endometriosis whether it is correct to carry out a second operation after the first or to resort to the other possibility, namely in vitro fertilisation.

Adult↗
PubMedDate not supplied

Influence of sexually transmitted diseases on sterility and ectopic pregnancy.

Infective diseases are the most common cause of functional damage to the fallopian tubes with subsequent infertility, subfertility or ectopic pregnancy. In this paper the Author presents the results of a prospective long-term follow-up on the reproductive events in a group of patients with acute salpingitis after sexually transmitted diseases.

Acute Disease↗
PubMed1985

Association of actinomyces and intrauterine contraceptive devices.

We analyzed the clinicopathologic aspects of 19 cases of actinomycosis associated with intrauterine devices (IUDs) seen and treated at hospitals affiliated with the State University of New York at Buffalo between 1972 and 1982. Clinical manifestations included the following: (1) asymptomatic IUD-associated Actinomyces colonization, (2) endocervicitis, (3) endometritis, (4) endometritis with salpingitis and/or tuboovarian abscesses and (5) abdominopelvic abscesses. No consistent relationship was found between the total peripheral lymphocyte count and/or degree of histologic lymphocytic reaction and the clinical picture. Abnormal uterine bleeding and/or discharge, pain, fever and abdominopelvic masses were among the symptoms and signs encountered. Patients with endocervicitis and/or endometritis responded to removal of the IUD, dilatation and curettage and antibiotic therapy for two to four weeks. Those who developed abscesses were treated successfully with surgical drainage and added antibiotic treatment.

Abscess↗
PubMed1985

Chlamydia trachomatis infection in women.

Chlamydia trachomatis is found worldwide and is probably the most common sexually transmitted disease, infecting both females and males, adults as well as children. The organism is responsible for a variety of infections in women--urethral syndrome, cervicitis, endometritis and salpingitis. C. trachomatis may colonize the lower genital tract and result in asymptomatic infection, ultimately resulting in sterility. In addition, infection of the female genital tract during pregnancy may result in spontaneous abortion, premature labor, postpartum endometritis, neonatal conjunctivitis or pneumonia.

Acute Disease↗
PubMed1985

[Peritubal adhesions and hysterosalpingography].

Hysterosalpingography cannot directly show pelvic adhesions due to pelviperitonitis, salpingitis, perimetritis or parametritis. Nevertheless this method is able to evidence an eventual tubal involvement by adhesive tissue. Located pools of contrast medium around the tubae is a well known radiological sign, but not the only nor the most frequently one observed. If the adhesions include the proximal end of the tubae, the contrast pooling may be absent. This paper analyzes, in controlled series of patients with pelvic adhesions, all the hysterosalpingographic signs which can indicate an adhesive tubal involvement.

Adult↗