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.
We report a case of a 28-year-old woman, with no history of sexual activity, who developed a cul-de-sac abscess and bilateral salpingitis caused by Salmonella group C1. This paper documents our limited experience with such an unusual event and suggests that gastrointestinal pathogens should be considered as potential etiologic organisms in patients presenting with pelvic infection and gastroenteritis.
The purpose of this study, based on data from the register of ectopic pregnancy in Auvergne (centre of France), is to identify risk factors of recurrence of ectopic pregnancy (EP). The social characteristics, gynaecological, surgical and reproductive history and conditions of the conception of 96 women with a previous EP were compared to those for 566 women without previous EP. Risk factors associated with the management of the first EP could not be analysed with the data available. Several factors increased the risk of recurrence: previous proved or suspected salpingitis (OR = 3.6), maternal smoking (OR = 1.7 to 2.0 according to the consumption level), maternal age greater than 30 (OR = 2.0), and previous recurrent spontaneous abortions (SA) among childless women (OR = 3.4 to 11.9 according to the number of SA). The last of these factors may reflect another unknown risk factors common to recurrent SA and recurrent EP (for example hormonal or karyotype factors). Previous use of intra uterine device is associated with a decrease in the risk of recurrence of EP (OR = 0.27), but this contraceptive method should be considered as an indicator of good fertility rather than as a protective factor for EP recurrence.
The case of organ tuberculosis with an enormous abdominal dropsy in a 57 year old woman is presented. It was diagnosed before the operation as ovary cancer. The histopathological examination of the taken during the operation tissues permitted to diagnose of tuberculous salpingitis. The specific therapy of the patient led to her complete recovery.
Mortality and health were studied in laying hens kept in an aviary system on a practical scale. All management inputs were done by university staff. Five batches of birds (trials) during a period of 6 years with approximately 4,700 birds per trial were included in the study. The aviary was a three-tiered "Marielund" system divided into 4 pens. Three hybrids, reared on litter with access to perches, were used; Lohmann Selected Leghorn (LSL), Lohmann Brown (LB) and an experimental cross (SLU-1329). The hens were not beak-trimmed. The stocking density was 17 hens/m2 ground floor. Mortality varied between pens and between batches, ranging from normal rates of 3.4% to 7.8%, except in LSL in Trial 2 and LB in Trial 3 where it was much higher (15.6% and 20.9%, respectively). The dominating causes of total mortality were salpingitis and cannibalism. Coccidiosis and lymphoid leucosis contributed significantly to mortality in Trial 2. An infestation with fowl mites (Dermanyssus gallinae) occurred in Trial 1. Feather loss was most severe in LB. Keel bone deviations were recorded at increasing levels by age. Foot abscesses occurred more frequently at 35 weeks than at 55 weeks. LSL was more severely affected than LB and SLU-1329.
Between 1973 and 1976, laparoscopy was performed on 50 girls aged 12 to 18 years old for evaluation of abdominal pain severe enough to warrant hospitalization. In nine patients, a pelvic mass was suspected on physical examination or ultrasonography. Twenty-three patients had histories of previous episodes of salpingitis, but negative cultures at time of admission. Eighteen patients had no significant past medical history and normal physical findings. Laparoscopy established a diagnosis in 28 of the 50 patients, and in the 32 patients in whom a specific preoperative diagnosis was entertained, laparoscopy proved it to be incorrect in 15. In all cases where laparoscopy resulted in specific treatment, the symptoms were relieved. There was no morbidity or mortality.
OBJECTIVE: --To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model. DATA SOURCES: --Studies were identified for the period 1969 through 1990. A Medline search of the English-language literature was conducted using the subject terms pelvic inflammatory disease or salpingitis and diagnosis. In addition, abstracts and bibliographies of articles and books were reviewed. STUDY SELECTION: --Studies were selected if pelvic inflammatory disease was diagnosed using laparoscopic findings or narrow clinical rules. Of the 15 reports identified, 12 were included in this analysis. The selected studies were grouped by a quality rating based on subject selection, definition of pelvic inflammatory disease, data analysis, and other measures. DATA EXTRACTION: --Diagnostic findings were divided into four categories: historical (symptoms), clinical examination (signs), laboratory, and combinations of the above. Sensitivity and specificity were extracted using raw data. Data were classified by quality rating. DATA SYNTHESIS: --Historical findings were usually not statistically significant predictors of pelvic inflammatory disease, and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously. CONCLUSIONS: --No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill. Research is needed to evaluate the accuracy and acceptability of specific diagnostic models and to investigate new diagnostic indicators.
OBJECTIVE: --To examine available data regarding optimal antimicrobial therapy for pelvic inflammatory disease (PID) and to address selected treatment issues confronting clinicians caring for women with PID. DATA SOURCES: --Studies evaluated to help establish the Centers for Disease Control's 1989 Sexually Transmitted Diseases Treatment Guidelines and other reports published since 1985. A MEDLINE search of English-language literature was conducted using the indexing terms "pelvic inflammatory disease" or "pelvic infections" or "salpingitis" and "treatment". In addition, abstracts and bibliographies of articles and books were reviewed. STUDY SELECTION: --Studies were selected for detailed review if they evaluated the effectiveness of an antimicrobial regimen for treatment of PID. DATA EXTRACTION: --All studies were evaluated to determine the numbers of women treated and the percentage with clinical or microbiologic evidence of cure. DATA SYNTHESIS: --A variety of combination antimicrobial regimens are highly effective in providing clinical and microbiologic evidence of cure; few data are available to assess optimal therapy for prevention of late sequelae. Because PID is polymicrobial in cause, recommended antimicrobial regimens are broad-spectrum in coverage. CONCLUSIONS: --No single agent that provides sufficient coverage is currently available. Several combination regimens appear highly effective clinically even among women with tubo-ovarian abscess formation. Uncertainties regarding the effectiveness of antimicrobial therapy for prevention of late sequelae complicate decisions regarding the choice among regimens and the appropriateness of ambulatory treatment of women with PID. Pending better data, hospitalization should be strongly considered, where feasible, particularly for those women with PID desiring further childbearing. Sex partners of all women with PID should be treated.
Identification of the immunogenic proteins that induce Chlamydia trachomatis (CT)-specific T cell responses is crucial to the development of protective vaccines and understanding the mechanisms of chlamydia-induced pathology. To characterize the targets of the human T cell response we have used chlamydia-reactive human T cell clones as cellular probes to screen a CT genomic library expressed in Escherichia coli using peripheral blood mononuclear cells to present antigens. The library was screened with three chlamydia-reactive T cell clones of unknown specificity and three novel stimulatory chlamydia antigens were identified. These E. coli recombinants were shown to express the chlamydia proteins, enolase, pmpD and CT579. Enolase and pmpD proteins were purified and shown to induce the proliferation of synovial fluid mononuclear cells isolated from the knee joints of patients suffering from chlamydia-associated reactive arthritis. We suggest that these stimulatory antigens are common targets of the T cell response in this group of patients. A greater understanding of T cell-mediated immunity in uncomplicated CT infection, and in patients with CT-induced chronic inflammatory disease (trachoma, salpingitis, arthritis) may identify the principal immune responses associated with immunopathology.
Cytokine gene expression in tumor-infiltrating lymphocytes (TIL) in frozen-tissue sections of 2 types of human solid tumor--ovarian adenocarcinoma and invasive breast cancer--was examined by in situ hybridization with 35S-labeled cDNA probes for human cytokines. The proportion of cells containing mRNA able to hybridize to the antisense c-DNA probes for interleukin 2 (IL-2), tumor necrosis factor alpha (TNF alpha), interferon gamma (IFN gamma) or receptors for IL-2 (either p55 or p70) was also determined in human normal peripheral lymphoid tissues and inflammatory tissues. Few cells were positive for IL2 and TNF alpha mRNA in reactive human lymph nodes and tonsils. Inflammatory lesions, such as salpingitis or chronic active hepatitis, contained 10-20 times more cells positive for cytokine mRNA than reactive lymphoid tissue. In contrast, tumor-infiltrating lymphocytes (TIL) in the stroma of ovarian carcinomas or most ductal breast tumors only rarely expressed mRNA for TNF alpha, IL2 or IFN gamma. The intensity of mononuclear cell infiltration in these tumors correlated positively with the percentage of cells which expressed mRNA for IL-2, TNF alpha and IL-2R. In those ductal breast carcinomas which contained intracellular or intraductal mucins, up to 30% of lymphoid cells in the tumor stroma were positive for IL-2, TNF alpha, IFN gamma and IL-2R. Thus, strong evidence for local activation of mononuclear cells in situ, exemplified by the expression of genes for cytokines, was obtained only in inflammatory lesions and in mucin-producing breast carcinomas. In most carcinomas studied, few TIL expressed genes for cytokines as measured by in situ hybridization. Thus, human solid tumors appear to differ in their ability to induce gene expression for cytokines in TIL.
Bacterial vaginosis is unlike the "classic" sexually transmitted diseases. Unlike cervical infection with Chlamydia or salpingitis caused by N. gonorrhoeae, no single etiologic agent has been identified, and the organisms which are associated with infection have all been found as members of endogenous vaginal flora, with the possible exception of Mobiluncus species. If, as we suspect, BV is due to interactions among various organisms found in the vagina during vaginal health, we must determine what changes in the microbial or chemical ecology determine the development of BV. If, for instance, BV is simply due to an inversion in the concentrations of various organisms such that the anaerobes which are usually present in low numbers become predominant and the lactobacilli which usually predominate become few in number, we must determine which causes what. That is, does some organism or environmental change allow the anaerobes to overgrow and thereby inhibit the lactobacilli, or does some change inhibit the lactobacilli, thereby, allowing the other flora to overgrow? Answers to questions such as these await further research.
A study of Chlamydia trachomatis was conducted in 5270 subjects seen at clinics of the Faculty of Medicine and Surgery at La Sapienza University in Rome, the S. Anna Hospital in Turin, and the Provincial Maternity Hospital Institute in Milan. In these areas, C. trachomatis was present in 5.8% of the cases examined; in addition it was present with statistically significant frequencies in cases of salpingitis (49.1) and epididymitis (21.7). It may also be found in cases of extrauterine pregnancy, sterility and abortion. Those most affected were women who had begun their sexual activity at an early age, were under 25, had several sexual partners and who used the coil and/or spermicides. A routine check for C. trachomatis should be considered for those women with those risk factors.
In recent years Chlamydia trachomatis has emerged as a significant cause of acute salpingitis and reproductory failure. In this study, 85 women suffering from primary infertility and 85 parous women as control group were screened for C. trachomatis genital infection by means of cell culture and antigen detection on genital samples as well as the detection of anti-chlamydial antibodies in blood. C. trachomatis was detected in 31.8% of infertile women and 5.8% of fertile subjects. Isolation of C. trachomatis in cell culture proved to be the most reliable diagnostic tool when compared to immunofluorescence staining on smears and serology. Although the latter may be considered of great value in epidemiological researches, culture isolation should be associated for the diagnosis of active infection.
Chlamydia trachomatis is an obligate intracellular energy parasitic bacterium with a genome of 660 X 10(6) daltons, possessing a plasmid and unique life cycle which includes the differentiation of the infective elementary body to a replicative reticulate body. C. trachomatis is the etiological agent of trachoma, which affects approximately 500 million people in developing countries. Recently it became evident that in industrialised Western nations certain strains of C. trachomatis are the most common cause of sexually transmitted infections such as non-gonococcal urethritis, cervicitis, endometritis, salpingitis and subsequent ectopic pregnancies or infertility, perihepatitis, neonatal conjunctivitis and pneumonia, adult conjunctivitis and epididymitis. Since C. trachomatis infections are often asymptomatic, widespread screening of sexually active young people is needed in order to initiate early antibiotic treatment which may prevent serious complications such as ectopic pregnancies and infertility. Development of sensitive and simple techniques for mass screening for detection of Chlamydia in excretions as well as techniques for detection of specific markers of chronic internal infections (such as Chlamydia specific IgA antibodies) is of great importance.
In order to study the lympho-epithelial relationships in human oviducts, lymphocytes situated in the epithelium were counted and the values found were correlated with differing physiological and pathological changes. In this process the following observations were made: 1. In the secretory phase there are significantly more lymphocytes to be found in the epithelium than during the proliferative phase. 2. In nonspecific purulent salpingitis the number of lymphocytes is not significantly different from that in a normal proliferative phase. 3. The values for fallopian pregnancy are significantly lower than those of a normal secretory phase and do not differ significantly from those of a normal proliferative phase. 4. The values observed for the reproductive period are significantly higher than those found postmenopausally. Examination by electron-microscopy showed that the lymphocytes in the epithelium of the uterine tube are intercellular. Pointers towards degenerative changes were not seen. It is presumed that the number of lymphocytes appearing in the epithelium of the fallopian tube depends on the hormonal activity of the ovaries.
The present communication discusses the possibility of endometritis, perihepatitis and meningoencephalitis being three conditions associated with Chlamydia trachomatis infection. Chlamydial infection of the endometrium can occur as one manifestation of an ascending genital infection also affecting the Fallopian tubes. Perihepatitis may be another manifestation in cases of acute chlamydial salpingitis. However, both chlamydia-associated endometritis and chlamydia-associated perihepatitis can occur in the absence of tubal infection. In cases of meningoencephalitis, evidence of infection with TRIC agents (C. trachomatis) have been documented.
Studies of the interaction between Neisseria gonorrhoeae and human fallopian tube mucosa in organ culture suggest that attachment of gonococci is important, not only to secure th organism in the host, but also to initiate the disease process. The steps observed in gonococcal infection of fallopian tube organ cultures are: 1) attachment of gonococci to microvilli of nonciliated cells; 2) release from gonococci of lipopolysaccharide and possibly other toxic moities to cause mucosa damage; 3) engulfment or phagocytosis of gonococci by nonciliated cells; 4) transport of phagocytic vacuoles containing gonococci to the base of the nonciliated cells; and 5) exocytosis of gonococci within phagocytic vacuoles into the subepithelial tissues. In vivo, these steps might result in extensive local disease (e.g. salpingitis) or in the invasion of blood vessels to cause disseminated disease. Preliminary studies of human nasopharyngeal tissue in organ culture infected with Neisseria meningitidis indicate that meningococci attach to microvilli of nonciliated cells and are phagocytized by these cells. Meningococci subsequently appear in subepithelial tissues, though the route they take is not yet certain. These observations suggest at least some of the ways in which attachment may play a role in disease caused by N. gonorrhoeae and N. meningitidis. Mechanisms to block this attachment may provide new approaches to the prevention of infections caused by the pathogenic Neisseria.
Chlamydiae are Gram-negative bacteria with obligate intracellular reproduction and disability to synthesize high-energy compounds such as ATP. Their cycle of development is unique among the prokaryotes: the host cells, mainly epithelial cells, are infected by so-called elementary bodies (EB) which undergo reorganization to form metabolically active reticulate bodies (RB). These RB multiply by binary fission, and after transition into infectious EB they are released within 48-72 hours. Chlamydiae cause prolonged subclinical infections of the conjunctiva, lung, cervix, and urethra. Complications in newborns are inclusion conjunctivitis, nasopharyngitis and pneumonia; in females, salpingitis, infertility, and perihepatitis; in male patients, epididymitis and prostatitis; and in both sexes, Chlamydiae-induced arthritis. Identification of the pathogenic agent confirms clinical diagnosis; tissue culture identification remains the diagnostic method of choice. Therapeutical drugs are tetracycline, erythromycin, josamycin, and in certain cases quinolone derivatives.
Chlamydial IgG antibodies at a titre of at least 32 were found to occur at approximately the same frequency (76-88%) in three groups of patients who had been treated for genital chlamydial infection. Twenty-four patients who had recovered from acute salpingitis, however, had a higher geometric mean titre (GMT; 176) than 59 pregnant women (GMT 44) or 61 patients with uncomplicated genital chlamydial infection (GMT 57). The chlamydial antibody titres thus seemed to reflect the severity of inflammatory involvement. Antibodies to the new species Chlamydia pneumoniae (previously known as Chlamydia TWAR), did not influence the frequency or titre of antibodies to Chlamydia trachomatis, arguing against the possibility of cross-reactivity or shared antigens. There was assumed to be no cross-immunity, since patients with Chlamydia trachomatis infection did not have a lower frequency of antibodies to Chlamydia pneumoniae.