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PubMed1979

Cefoxitin: single-agent treatment of mixed aerobic-anaerobic pelvic infections.

Cefoxitin (mefoxin), a new semisynthetic cephamycin antibiotic, resistant to degradation by beta-lactamase enzymes produced by bacteria. In vitro, cefoxitin is active against virtually all clinically important gram-negative facultative bacteria other than Pseudomonas and Enterobacter spp., gram-positive aerobic bacteria other than the enterococcus, and clinically important anaerobic organisms, including Bacteroides fragilis. This broad antibacterial spectrum suggested that cefoxitin might be an effective single antibiotic agent for the treatment of mixed aerobic-anaerobic infections in obstetric and gynecologic patients. In this investigation, the efficacy and safety of cefoxitin was evaluated in 109 patients--68 with salpingitis, 25 with endomyometritis, 9 with pelvic cellulitis, and 7 with pelvic abscesses. An average of 2.5 bacteria were isolated from each patient. Aerobic bacteria alone was isolated in 38% of patients, anaerobic bacteria alone in 25%, and a combination of aerobic and anaerobic bacteria was isolated in 37% of patients. Overall, 100 of 109 (92%) infections responded to treatment with cefoxitin alone. The major cause of treatment failure was the presence of abscesses requiring surgical drainage. In addition to being an effective single agent for the management of pelvic infections, cefoxitin proved to be safe and well tolerated by patients.

Abscess↗
PubMed1975

Significance of proliferative epithelial lesions of the uterine tube.

Proliferative epithelial lesions of the oviduct have been called adenomatous hyperplasia or carcinoma in situ. In order to assess the incidence and significance of these lesions, we sectioned entire oviducts from 124 nonselected hysterectomies. We found 23 cases (18.5%) with lesions corresponding to those described in the literature. We have found no justification for diagnosing and treating these lesions as carcinoma in situ. There appears to be an association with salpingitis.

Adult↗
PubMed1983

Human monoclonal antibodies to a genus-specific chlamydial antigen, produced by EBV-transformed B cells.

Stable B cell lines producing human monoclonal antibodies to Chlamydia were established from salpingitis patients in the early convalescence phase. The antibody-producing cells were immortalized by Epstein Barr virus (EBV) transformation. Specific antibody-secreting clones were enriched by a stepwise microtiter plate cloning procedure. The selected B cell clones showed stable antibody production for more than 1 yr in continuous culture. Serologic specificity was demonstrated by micro-immunofluorescence (micro-IF) tests against a panel of Chlamydia reference strains. The antibodies were of the IgG1 subclass, and complement fixation could be demonstrated for one clone. There was no cross-reactivity against a large number of other bacteria. The monoclonal antibodies are directed against a common genus-specific surface antigen of the Chlamydia organism. Infected McCoy cells showed a brilliant, punctuated fluorescence surrounded by an inclusion membrane. Compared with conventional antisera, the monoclonal antibodies showed a clearer fluorescence pattern with very low background.

Antibodies, Bacterial↗
PubMedDate not supplied

[Prolonged fever and latent tuberculous foci].

Two cases of prolonged fever are reported. In the first case a tuberculous abscess of the liver was considered after an ultrasonic examination of the periphery of an hepatic calcification discovered many years ago; a right hepatectomy confirmed the diagnosis. The second patient was treated twenty years ago for a tuberculous exsudative peritonitis. The pelvic examination showed a myoma. A computed body tomogram disclosed a picture of pyometritis. This was confirmed by laparotomy showing tuberculous salpingitis and pyometritis by praevia myoma.

Adult↗
PubMed1984

[Should one operate on bifocal tubal lesions in 1984? Apropos of 54 cases].

We have analysed 54 cases where the patients had two lesions in the tubes and were treated with microsurgery. The results of histological examinations show that chronic salpingitis in the major lesion. Infection was the aetiological cause in 76% of the cases. The results of microsurgical treatment are poor with a low rate of intra-uterine pregnancy: [19.4% (0.08-0.42) at 24-30 months for pregnancies that were continuing and for abortions, 11.7% (0.04-0.33) at 24-30 months using actuarial techniques for estimating pregnancies that were continuing]. There was a high risk of extra-uterine pregnancy [35% (0.18-0.58) at 24-30 months]. These results make us wonder whether microsurgery or in vitro fertilisation should be the treatment of preference in these cases where the tubes are affected in two areas.

Actuarial Analysis↗
PubMedDate not supplied

Monkey animal model for study of mycoplasmal infections of the urogenital tract.

Various experimental monkey models have been used for the study of mycoplasmal infections of the urogenital tract. Direct inoculation of Mycoplasma hominis and Ureaplasma urealyticum into the urethra of male monkeys resulted in successful reisolation of the organisms from the urethra without giving rise to signs of urethritis during the observation period. The organisms were inoculated into the posterior fornix of the vagina of female grivet monkeys. During the ten-week observation period, there was no clinical, histologic, or serologic evidence of lower genital tract infection. Inoculation of M. hominis and M. fermentans into the upper genital tract of grivet monkeys produced parametritis and salpingitis. It was concluded that grivet monkeys are apparently suitable for study of the pathogenicity of genital mycoplasms.

Animals↗
PubMed1981

Culdocentesis.

Culdocentesis is a procedure to obtain free fluid from the cul de sac of women. Physicians who provide comprehensive or gynecologic care to women should be capable of this procedure. The main indications are suspected ectopic pregnancy and suspected acute salpingitis or pelvic inflammatory disease. Although the procedure is not difficult or dangerous, many fine points of technique improve the outcome. Results are usually clear-cut and provide immediate and critical information for the management of the patient.

Ascitic Fluid↗
PubMed1981

[Oxyuriasis of uterine tube (author's transl)].

Salpingitis is very rarely caused by parasites on our latitudes. An account is given of a case of oxyuriasis of the uterine tube which led to tubal occlusion with secondary sterility. Pathogenetically, oxyuriasis of the uterine tube can be defined as ascending infection. In terms of case history, the patient and other members of her family had been afflicted for years with intestinal oxyuriasis.

Diagnosis, Differential↗
PubMed1980

Abdominal pain due to Enterobius vermicularis.

The authors describe an unusual case of an 11-year-old girl who had right lower quadrant pain due to unilateral salpingitis, suppurative omentitis and periappendicitis. The etiologic agent was the parasite Enterobius vermicularis. A review of the literature revealed that pinworm may be the cause not only of appendicitis, but of inflammatory reactions in other intra-abdominal sites and that the frequency of this occurrence is probably higher than has previously been suspected.

Abdomen, Acute↗
PubMed1995

[Pathological findings of proximal tubal occlusive infertility].

Exicised tubal segments (including interstial and isthmic portions) from 33 women with proximal tubal occlusive infertility were examined pathologically. We found that pathologic entities included chronic tubal inflammation (70.59%), tubal endometriosis (9.80%), obliterative fibrosis (7.84%), salpingitis isthmica nodosa (5.88%), tubal tuberculosis (3.92%). Only one of the tubes (1.96%) showed no obvious pathological change. These observations on proximal tubal occlusion in combination with clinical features and pelvic changes indicate that: (1) These are multiple distinct pathologic patterns, and pelvic findings do not predict the pathologic changes of the tubes. (2) Induced abortion and uterine curetage is an important factor for the proximal tubal occlusive infertility. Pelvic inflammatory disease and intrauterine device are other factors.

Abortion, Induced↗
PubMed1979

Ophthalmia neonatorum due to Chlamydia trachomatis: a family problem?

The most frequently seen type of infectious ophthalmia neonatorum, inclusion conjunctivitis, is caused by the organism Chlamydia trachomatis. This agent is known to be transmitted sexually. Until recently, the infections produced by C trachomatis were though to be relatively benign. Recent evidence, however, suggests that the organism may produce urethritis and epididymitis in the male; cervicitis, cervical erosions, salpingitis, and puerperal infections in the female; and prematurity and pneumonitis in the infant. An infant who develops ophthalmia neonatorum should be thoroughly evaluated for the presence of a chlamydial infection. In many instances the first evidence of chlamydial infection within the parents will be the development of inclusion conjunctivitis in their newborn infant. Family members of infants with inclusion conjunctivitis who manifest any evidence of clinical disease should be evaluated and treated with appropriate antibiotics.

Adult↗
PubMed1995

[Incidence of extra-uterine pregnancy and characteristics of treated patients. First results of the Auvergne registry].

OBJECTIVES: To evaluate the course and frequency of ectopic pregnancy in a single population for a prolonged period in order to study the simultaneous changes in distribution of risk factors, identify new risk factors and evaluate the effect of new diagnostic and therapeutic methods on subsequent fertility and the effectiveness of preventive measures. METHODS: All women residing in the Registry zone and treated surgically or medically for ectopic pregnancy were included in the study and followed to the age of 45 years. RESULTS: In 1992, the incidence of ectopic pregnancy was 20.2 per 1,000 live births (n = 160). At least one currently recognized risk factor was found in 80% of the women. A past history of salpingitis was noted in 13% and nearly one half smoked or had smoked at the time of conception. Nineteen percent had a past history of pelvic surgery and 19% had a history of infertility. The ectopic pregnancy recorded was the second one in 9%. Nearly one-third of the ectopic pregnancies recorded (31%) were diagnosed in patients with a intrauterine device. None of these latter patients had other risk factors. Vaginal echography was used for diagnosis in 75% of the cases. Surgery was used as first intention treatment in 94% and medical treatment (methotrexate) was used in 6%.

Adult↗
PubMedDate not supplied

Sexually transmitted diseases and infertility.

In both men and women, STD-associated genital infections may cause permanent damage to the reproductive tract resulting in sub- or infertility. In men, the wide zone between sterility and normal fertility makes it difficult to demarcate the precise role of infection on post-infection fecundity, but it seems less important than in women. The reproductive events were studied in a cohort of 1,309 pregnancy-seeking women, < or = 35 years of age, after laparoscopically verified acute salpingitis, and 451 women with normal laparoscopy. Tubal factor infertility (TFI) was diagnosed in 12.1% of the patients and 0.9% of the controls, and the first pregnancy was ectopic in 7.8% and 1.3%, respectively. Of independent importance for infertility, ectopic pregnancy, and time between PID and first intrauterine pregnancy were number of infections, severity of the infections, contraception at the index laparoscopy, age, and delayed treatment. STD-associated in-subfertility is acquired and, hence, preventable.

Adult↗
PubMed1975

Human immunity to Neisseria gonorrhoeae: acquired serum opsonic antibodies.

Recent studies have demonstrated that virulent (Types 1 and 2) colonial variants of Neisseria gonorrhoeae are highly resistant to phagcytosis by normal human polymorphonuclear leukocytes. To pursue this observation, sera from prostitutes were compared with sera from Catholic nuns in terms of their ability to enhance phagocytosis of Type 1 gonococci. The phagocytic system consisted of a monolayer of normal human polymorphonuclear leukocytes and an inoculum of 107 to 108 colony-forming units of N. gonorrhoeae. In a representative test, the mean percentages of phagocytosis were: 13 nuns, 10 per cent; 32 prostitutes, 30 per cent (p less than 0.01). In a separate set of experiments, 5 (45 per cent) of 11 patients with acute gonococcal salpingitis had significant increases in serum opsonic activity between the acute and one month convalescent bleeding. A pool of prostitute sera retained detectable opsonic activity at dilutions as high as 1:320. The opsonic activity was heat-stable, demonstrable without complement, and resided in both the IgG and IgA fractions of serum. These studies demonstrate the presence of acquried opsonic antibody to N. gonorrhoeae in humans: the significance of such antibodies in proction against gonococcal disease requires further exploration.

Antibodies, Bacterial↗
PubMed1993

Noncontraceptive benefits of oral contraceptives.

The noncontraceptive health benefits of oral contraceptives were initially summarized a decade ago. Studies conducted in the last decade confirmed the findings of earlier studies with high-dose oral contraceptives and extended them to low-dose formulations. Among the noncontraceptive health benefits first cited were reductions in menorrhagia, irregular menses, endometrial cancer, ovarian cancer, functional ovarian cysts, benign breast disease, dysmenorrhea, premenstrual tension and iron-deficiency anemia. In addition, women who used oral contraceptives were less likely to develop rheumatoid arthritis or acute salpingitis, particularly moderate or severe forms, than were women using no method of contraception. Despite the fact that such benefits were identified more than 10 years ago and despite their inclusion in oral contraceptive labeling, women today are largely unaware of the noncontraceptive health benefits associated with oral contraceptive use.

Adult↗
PubMed1993

Pathogenesis of pseudoxanthomatous salpingiosis.

The abnormal localized deposition of lipofuscin-laden macrophages in the lamina propria of the fallopian tube (pseudoxanthomatous salpingiosis) is reported in two women. In both cases there was evidence of longstanding endometriosis; necrotic pseudoxanthomatous nodules of the ovary were present. Histochemical and ultrastructural analysis of the pigment confirmed that it is lipofuscin (ceroid). It is proposed that pseudoxanthomatous salpingiosis develops after an episode of acute salpingitis during which actively bleeding ovarian endometriosis leaks blood into the lumen of the fallopian tube.

Adult↗
PubMedDate not supplied

[Laparoscopy for appendicular syndromes in young women. Results of a prospective study].

OBJECTIVES: Determine whether laparoscopic surgery for painful syndromes of the right iliac fossa in young women can reduce the number of unnecessary appendectomies and shorten hospital stay. METHODS: Thirty-two women (age range 15-43 years) who were admitted consecutively for "acute appendicitis" were included in a prospective study based on laparoscopic surgery for diagnosis and treatment. RESULTS: There were 14 cases of acute appendicitis (all confirmed histologically), 16 cases involving extra-appendicular tissues (mainly salpingitis, n = 7) and 2 cases in which no cause was found. Two unnecessary appendectomies were performed and only one laparoscopy had to be converted to an open procedure. Mean post-operative hospitalization was 3.43 days. These findings demonstrate that laparoscopic surgery effectively reduces the rate of unnecessary appendectomies and probably the duration of hospitalization. Laparoscopic surgery should be more widely used for young women presenting with appendicular syndromes.

Adolescent↗
PubMed1995

[Peritoneal and tubal Schistosoma haematobium bilharziasis. Two case reports].

It is now recognized that eggs of Schistosoma haematobium are most commonly found in the bladder because this parasitic infestation usually affects the urinary tract. However, numerous papers have been published on the occurrence of schistosomiasis of the female genital tract. The frequency of distribution of schistosomal disease of the genital tract has not been estimated because only cases with overt disease are usually considered. The involvement of Fallopian tubes is not rare in endemic areas and may predispose to ectopic pregnancy and infertility. In this paper, we report two cases of Schistosomiasis in black African women due to Schistosoma haematobium localized in the peritoneum and the Fallopian tubes. Our first patient had primary infertility associated with bilateral hydrosalpinx and peritoneal inflammatory reaction. Our second patient had an ectopic pregnancy associated with chronic salpingitis. In the both cases, histological examination showed the presence of schistosomal eggs in the peritoneum and the Fallopian tubes. These cases suggest that bilharziasis should now be considered as a urogenital disease and not only as an urinary tract disease.

Adult↗