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PubMed2005

Paratubal and tubal abnormalities.

The fallopian tubes are the essential genital ducts that convey the female sex cells for fertilization. They are differentiated and detectable early in fetal life. There are numerous paratubal and tubal abnormalities that can occur at any point in the female life. Some of these are rare but may initiate significant morbidity and/or manifest as life-threatening clinical problems. A comprehensive understanding of symptoms, diagnosis, optimal imaging modalities, and medical and surgical management is vital to identify the best treatment option. The clinical entities described in this article include torsion, hydatids of Morgagni, paraovarian cysts, infections including tuboovarian abscess/pyosalpinx and salpingitis isthmic nodosa, ectopic pregnancy, tumors, and genetic disorders.

Fallopian Tube Diseases↗

PubMed2001

Acute abdomen caused by Salmonella typhimurium infection in children.

Salmonella spp. infections can be particularly challenging when they manifest as acute abdominal problems and lead to emergency surgery. Examples of such serious conditions are Salmonella-related intestinal perforation, gallbladder involvement, salpingitis, and peritonitis. Mesenteric lymphadenitis associated with Salmonella typhimurium mimics acute appendicitis and can make it difficult to establish a timely and definitive diagnosis in young patients who present with right lower abdominal pain. Paralytic ileus is a fairly common manifestation of Salmonella infection at all ages, but complete intestinal obstruction requiring surgical intervention is very rare. Because of the nature of the diagnostic process, a significant number of patients with Salmonella infection present with acute abdomen and undergo needless operations. This report describes the cases of 2 pediatric patients who underwent surgery to address persistent pain in the right lower abdominal quadrant and complete intestinal obstruction, respectively. The first patient had inflamed mesenteric lymph nodes that caused appendicitislike symptoms, and the second had dense adhesions between the mesentery and the terminal segments of the ileum that led to intestinal blockage. Serology results showed that both patients' titers for BO ("B and O agglutinating [BO]") antibodies rose to 1:640 in the week after their admission to hospital, a pattern and level that is indicative of S typhimurium infection. J Pediatr Surg 36:1849-1852.

Abdomen, Acute↗

PubMed2004

Tubo-ovarian abscess in a sexually inactive adolescent patient.

Tubo-ovarian abscess as a complication of acute salpingitis or salpingo-oophoritis is very uncommon in pre-menarchal and/or sexually inactive girls. It is generally the result of a blood-borne or genitourinary infection. Early diagnosis and treatment are essential to prevent future sequelae causing infertility. Laparoscopic surgery which minimises postoperative complications should be the first option in the treatment of TOA.

Abscess↗

PubMed1982

[Ultrasound diagnosis of pathologic changes of the uterine tube].

The possibilities of sonographic diagnosis of pathologic changes in the uterine tube are examined by means of a computerised automatic real-time scanner with a statistical B-scan of high resolution. It is not possible to isolate sonographically the anatomically unchanged tube or the tube obliterated as a result of salpingitis. Nevertheless, it is possible to effect an indirect diagnosis if the tube is at least unilaterally patent or if it is bilaterally occluded, by means of an extended form of sonography within the scope of a sonographically controlled hydropertubation via a phenomenon which the author describes an "positive" or "negative" "phenomenon of Douglas". Hence, sonographically monitored hydropertubation, together with hysterosalpingography or laparoscopic chromopertubation--with reservations--is a valuable diagnostic tool to help in clarifying the cause of sterility. Pathological changes of the tubes in the sense of a sactosalpinx of different contents (retained secretions) can be differentiated by sonography. A characteristic sonographic echo pattern is also seen if the tubes are conglutinated with an extremely low amount of liquid collected in the tube. Various pathological changes of the tube can be recognised sonographically directly and indirectly by means of sonography extended in this manner.

Diagnosis, Differential↗

PubMed1989

[Changes in the diagnosis and therapy of extra-uterine pregnancy].

A total of 332 extrauterine pregnancies were treated between 1973 and 1975 (32) and between 1981 and 1987 (300). Of these, 195 (58.74% or of 300 = 65%) were operated on while employing endoscopy. The incidence of extrauterine pregnancy in relation to the total number of operations increased from 1.48% to 2.59%; in relation to the deliveries, the incidence rate increased from 0.99% to 4.15%. Diagnosis in an early stage where signs are only few, was made possible by specific determination of human chorionic gonadotropin in the urine (1981-1987: 84.1% positive) and by sonography (in 195 extrauterine pregnancies, 91.3% were found to be suspicious). Laparoscopic treatment, which has since become a standard method in extrauterine pregnancy, was possible in 45.7% of the cases in 1982 and in 89.9% of the patients in 1986. 11 relapses were seen after laparoscopic procedure while preserving the salpinges, whereas after laparotomy there were 20 recurrences. In four women intrauterine pregnancies became possible and were successful even after bilateral extrauterine pregnancy. In endoscopically conducted operations both the duration of anaesthesia and the postoperative course were clearly shortened, less associated with complications and subjectively easier for the patients. Complications were largely confined to repeated operations in cases where the pregnancy had not been fully removed, which could have been avoided (5.12%). Endoscopic treatment of extrauterine pregnancy is recommended.

Chorionic Gonadotropin↗

PubMed1988

[Distribution of the incidence of various pelviscopic (laparoscopic) surgical procedures and their complication rates. A statistical analysis in West Germany 1983 up to and including 1985].

The 3rd German pelviscopy (laparoscopy) statistics includes in all 207,823 laparoscopies from 310 clinics and 41,644 laparoscopies from 121 private practises. This is a percentage of 39% from clinics and 59.3% from private practises. There appeared 429 serious complications in the clinics and in the practises 63, which is a complication rate of 1.97%. In 415 cases (1.66%), a laparoscopy was required. The most important of the complications was injury of the intestinal organs, when putting in the Veress-needle or the optical trocar, followed by injury of the main blood vessels, as well as hemorrhages of the salpinges on detached omental fragments. Where tubal sterilization is concerned, 87.7% of the clinics ans private practises used the bipolar HF technique; 32.4% used the endocoagulation according to Semm. In 8.3% of the cases, the monopolar high frequency method was applied. After sterilization in the clinics, 2.8% intra- and extrauterine pregnancies occurred, while in the private hospitals this percentage was 3.3%. The intra- or extrauterine pregnancies occurred mainly after sterilization by the bipolar HF technique or after clip-sterilization. 46.1% of the investigated clinics and 36.4% of private practises, intend to increase the indication of endoscopic operational methods.

Cross-Sectional Studies↗

PubMed1983

[Antibiotic prevention in hysterectomy. Effectivity of a single preoperative ceftriaxon dose].

In a prospective study, 50 women patients were given 2 g Ceftriaxon (Rocephin) as a short infusion before performing hysterectomy. A control group of 50 patients remained without any antibiotic treatment. In 31 patients, the concentration of Ceftriaxon in the serum and tissue was determined at the time the uterus was removed. Due to the long half-life of Ceftriaxon (8 hours), high serum and tissue levels were found for a period of many hours. After 4-5 hours, the serum level was still 100 micrograms/ml, whereas the concentration in the endometrium, myometrium and in the salpinges were 21 micrograms/g, 24 micrograms/g and 31 micrograms/g, respectively. Due to these long-lasting serum and tissue levels, the protective effect against infections was also very high. 15 infections in the control group are contrasted by one infection only in the treated group. The efficacy of the prophylaxis is objectively assessed by measuring the temperature curve and by determining the number and the spectrum of the postoperatively isolated germs. The germs isolated in the treated group are exclusively such germs which are resistant to Ceftriaxon (enterococci) or which are only moderately sensitive to Ceftriaxon, such as Bacteroides.

Adult↗

PubMed1993

Laparoscopy in adnexal pathology in the child: a study of 28 cases.

We report our experience with laparoscopy in adnexal pathology in the child. Twenty-eight children (mean age 13 years; range 8 to 16) underwent 30 laparoscopy procedures. Therapeutic laparoscopy was performed in 3 cases: transposition of an ovary before radiotherapy, bilateral gonadal excision for Turner's syndrome and ovarian fixation after contralateral torsion of normal adnexa (TNA). Diagnostic and potentially therapeutic laparoscopy was performed in 25 cases: 12 suspected torsion of adnexa (6 confirmed), 4 possible ovarian or appendicular pathology (1 appendicitis), 4 to confirm the histological nature of an ovarian tumor (2 functional cysts, 1 old TNA, 1 dermoid cyst), 3 suspected salpingitis (2 confirmed), and 2 chronic pelvic pain (1 endometriosis). No pathology was found in 2 cases, and in 1 case pelvic adhesions prevented confirmation of the diagnosis. Thirteen laparoscopically-guided surgical acts were performed: 2 detorsions of adnexa, 2 excisions of necrosed adnexa and 9 punctures with or without biopsy for functional cysts. Intralaparoscopic detorsion of TNA was complicated in one case by fibrinolysis requiring secondary laparotomy. Mean hospitalisation was 3 days (range 1 to 16). the preferential therapeutic indications for laparoscopy in the child are transposition of an ovary and ablation of the gonads in case of sexual ambiguity. It is used diagnostically in cases of sudden pelvic pain. In addition to this diagnostic role, it now allows most treatments to be carried out (detorsion with or without fixation, transparietal cystectomy), including those for associated lesions (appendicectomy). Its morbidity is quite low, which warrants increasing the number of indications in pediatric pathology.

Adolescent↗

PubMed1984

Effect of treatment regimens for Neisseria gonorrhoeae on simultaneous infection with Chlamydia trachomatis.

We evaluated the effect of treatment of gonorrhea on simultaneous Chlamydia trachomatis infection by randomly assigning 293 heterosexual men and 246 heterosexual women with gonorrhea to receive one of the following treatment regimens: (1) 4.8 million units of aqueous procaine penicillin plus 1 g of probenecid, (2) nine tablets of trimethoprim-sulfamethoxazole daily for three days, or (3) 500 mg of tetracycline four times a day for five days. Among the men, gonococcal infection was cured in 99 per cent given penicillin plus probenecid, 96 per cent given trimethoprim-sulfamethoxazole, and 98 per cent given tetracycline. Among the women, only 90 per cent given tetracycline were cured, in contrast to 97 per cent given penicillin plus probenecid and 99 per cent given trimethoprim-sulfamethoxazole. Chlamydial infection, present in 15 per cent of the men and 26 per cent of the women, was cured in 30 of 32 patients given trimethoprim-sulfamethoxazole and 27 of 29 given tetracycline, but in only 10 of 23 given penicillin plus probenecid. Among chlamydia-positive patients, postgonococcal urethritis in men and cervicitis in women occurred more often in patients given penicillin plus probenecid. Salpingitis developed in 6 of 20 women given penicillin plus probenecid, but in only 1 of 26 given trimethoprim-sulfamethoxazole and in none of 24 given tetracycline. We conclude that the use of penicillin plus probenecid alone for gonorrhea in heterosexual patients carries an unacceptably high risk of postgonococcal chlamydial morbidity. Trimethoprim-sulfamethoxazole and tetracycline were highly effective against both pathogens and were well tolerated in men, but both drugs caused frequent side effects in women. The failure of tetracycline to cure gonorrhea in 10 per cent of women argues against its use alone; treatment with penicillin followed by tetracycline has been recommended for further trial.

Adolescent↗

PubMed2000

Transrectal ultrasonographically guided drainage of gynecologic pelvic abscesses.

OBJECTIVE: This study assessed the feasibility of ultrasonographically guided transrectal aspiration of gynecologic pelvic abscesses to treat patients for whom intravenous antibiotic therapies failed and whose abscesses were not optimally amenable to colpotomy drainage or transabdominal or transvaginal ultrasonographically guided aspiration. STUDY DESIGN: This was a retrospective review of the first 15 women with pelvic abscesses that resulted from salpingitis or complications of gynecologic surgery who underwent transrectal pelvic abscess drainage after failure of antibiotic therapy. RESULTS: Purulent material was aspirated from the abscesses in 14 of the 15 women. All 14 women with aspirated material were successfully treated with real-time ultrasonographically guided transrectal drainage; only 4 of the 14 had indwelling catheter placement. CONCLUSION: Ultrasonographically guided transrectal drainage of gynecologic pelvic abscesses is a safe and effective treatment of pelvic abscesses for women who do not have an adequate response to antibiotic therapy.

Abscess↗

PubMed2006

Risk factors in developing pregnancy-related pelvic girdle pain.

BACKGROUND: In this prospective epidemiologic cohort study the aim was to identify possible risk factors for developing four different syndromes of pelvic girdle pain during pregnancy. METHODS: Over a one-year period a total of 2,269 consecutive pregnant women -- at week 33 of gestation -- responded to a structured questionnaire and underwent a thorough physical examination. Women who at baseline reported daily pain from pelvic joints and had corresponding objective findings were allocated, according to symptoms, into one of four classification groups, and followed up with questionnaires and physical examinations up to two years after delivery. RESULTS: Multivariate analysis could distinguish the four pelvic pain sub groups from the "Pelvic healthy" group with respect to 13 of 24 variables. The pelvic girdle syndrome group revealed a history of previous low back pain, trauma of the back or pelvis, multiparae, had a relatively higher weight, a higher level of self reported stress and of job At a higher risk of developing symphysiolysis were women who were multiparae, had a relatively higher weight, and were smokers. If a woman had vocational training or a professional education, was stressed, had a poorer experience of previous delivery, had previous low back pain, trauma of back, or previous salpingitis, she had an increased risk of developing one-sided sacroiliac syndrome. The risk factors for developing double-sided sacroiliac syndrome were previous low back pain and trauma of the back or pelvis, multiparae, poorer relationship with spouse, and less job satisfaction. CONCLUSIONS: This study demonstrates no single dominant risk factor for developing pelvic girdle pain in pregnancy, but reveals a set of physical and psychosocial factors. The risk factors for developing pelvic girdle pain in general are: history of previous low back pain, trauma of the back or pelvis, multivariate, higher level of stress, and low job satisfaction.

Back Injuries↗

PubMed1992

Benefits and risks of oral contraceptive use.

As a general rule, the lowest-dose oral contraceptive should be prescribed that minimizes side effects while maintaining contraceptive protection. A woman who experiences mild side effects should be encouraged to tolerate symptoms for three menstrual cycles before a decision is made to change the prescription. Compliance may also be improved by informing women of the noncontraceptive health benefits of oral contraceptives: less menstrual blood loss and a lower incidence of menorrhagia, irregular bleeding, benign breast disease, endometrial cancer, dysmenorrhea, ovarian cysts or tumors, and salpingitis. Adequate patient education and supportive counseling are key factors in patient satisfaction and hence compliance.

Age Factors↗

PubMed2006

Ectopic pregnancy treatment by laparoscopy, a short glimpse.

Ectopic pregnancy is a life-threatening emergency, the incidence of which is increasing globally. There are a number of factors predisposing to this condition; today, the most common of these is salpingitis. Due to advancements in diagnostic technology it is possible to diagnose this condition early and thus try to achieve a favourable outcome for the patient. Treatment options in the form of medical and surgical modalities are widely available. As minimally invasive therapy techniques are rapidly advancing, laparoscopic treatment has become the most popular and preferred method for treating ectopic pregnancy. Both salpingotomy as well as salpingectomy can be performed through the laparoscope. This paper gives a short glimpse at the predisposing factors and the diagnostic investigations available for ectopic pregnancy and an insight into its laparoscopic treatment. It also reviews the pregnancy outcome and laparoscopic treatment of cases at the Department of Obstetrics and Gynaecology, Campus Kiel, University Hospitals Schleswig-Holstein.

Female↗

PubMed1954

The selective localization of murine pleuropneumonia-like organisms in the female genital tract on intraperitoneal injection in mice.

Acute oophoritis and salpingitis were commonly observed in weanling mice injected intraperitoneally with murine pleuropneumonia-like organisms of the catarrhal type (4 strains). Organisms of the injected strain were regularly recovered in cultures from the ovary or uterus during the 3rd to the 5th week but not after the 12th week. They were also obtained from the vagina through the 5th week and with varying results, depending on the strain, from the heart's blood through the 1st week. PPLO injected into the vagina survived for some weeks but did not migrate inwardly nor were they transmitted outwardly to exposed mice. In male mice peritoneal abscesses were sometimes present but the genital organs were normal and free from PPLO. Otitis media, with positive exudate cultures, occurred more often in females and varied in rate with the strain of PPLO. PPLO of the conjunctival type failed to survive in the abdominal cavity of mice and produced no reaction in either the genital or the respiratory tract.

Animals↗

PubMed1999

Antibody response to the chlamydial heat-shock protein 60 in an experimental model of chronic pelvic inflammatory disease in monkeys (Macaca nemestrina).

A primate model of chlamydial pelvic inflammatory disease was used to characterize serum antibody responses to the 60 kDa chlamydial heat shock protein (CHSP60). Forty monkeys were infected in the fallopian tubes with Chlamydia trachomatis and then were treated. Twenty-three (58%) monkeys developed antibodies against CHSP60, of whom 6 (15%) had CHSP60 responses that persisted throughout the study and 17 (42.5%) had a transient response. A persistent CHSP60 antibody response was correlated with being culture- or ligase chain reaction-positive in the fallopian tubes (P=.004), but not in the cervix pretreatment, and with being tubal-positive posttreatment (P=. 02). Compared with tubal-negative monkeys, tubal-positive monkeys had more intense CHSP60 responses (P=.006) that lasted longer (P=. 002). Among CHSP60 responders, an OD>0.5 was correlated with more severe salpingeal pathology before treatment (P=.04). CHSP60 antibody response may be useful as a marker of persistent chlamydial infection in the fallopian tubes.

Animals↗

PubMedDate not supplied

Use of quinolones in chlamydial infection.

The activity of fluoroquinolones against Chlamydia trachomatis has been studied in vitro. Those agents with an MIC of less than 2.0 mg/L may be of clinical value, and clinical trials have been conducted with ciprofloxacin, ofloxacin, and fleroxacin. Ciprofloxacin has given variable results in the treatment of Chlamydia-positive urethritis in men; some studies have shown an unacceptably high reisolation of the organisms with prolonged posttreatment surveillance. Ofloxacin may be an effective drug for the treatment of lower genital tract infections with C. trachomatis in men and women, and there are indications that ofloxacin may also be of value in the treatment of chlamydial epididymitis and salpingitis. Early studies of fleroxacin suggest that this drug may also be an effective antichlamydial agent.

4-Quinolones↗

PubMed1993

Occurrence of Mycoplasma genitalium in different populations and its clinical significance.

Mycoplasma genitalium is predominantly flask-shaped with cytadsorptive and glass-adhering properties. These biological features of pathogenicity are reflected in its ability to cause urethritis and salpingitis in subhuman primates when given experimentally, although its role in human disease is less clear. M. genitalium was initially recovered by culture of specimens from two of 13 men with acute nongonococcal urethritis (NGU), but culture remains a laborious and insensitive means of detection. This organism has, however, been detected in the urethra of > or = 20% of men with acute NGU by using a polymerase chain reaction (PCR) and in a similar proportion of men with chronic NGU. The possibility of sexual transmission of M. genitalium is supported by the fact that by using the PCR it has been detected in the lower genital tract of about 20% of women who were attending a clinic for sexually transmitted diseases. It has also been detected, together with Mycoplasma pneumoniae, in a joint of a hypogammaglobulinemic patient who was suffering from polyarthritis after pneumonia and has been isolated, again with Mycoplasma pneumoniae, from the throat in culture. Such detection raises the question of the preferred mucosal site of M. genitalium, which has yet to be determined.

Animals↗

PubMedDate not supplied

Treatment of intraabdominal infection with moxalactam.

Forty-eight case report forms for patients with cultures positive for intraabdominal infection treated with moxalactam were reviewed. The infections included abscess or peritonitis due to appendicitis (26); intraabdominal abscess of other causes (7); peritonitis due to bowel perforation (6), bowel infarction (5), or salpingitis (3); and gangrenous cholecystitis (1). Cultures of peritoneal fluid or abscess contents were performed for all patients. Seventy-eight aerobes and 118 anaerobes were isolated from the 48 patients. Thirty-eight patients (79.2%) were cured, therapy failed in nine (18.8%), and one (2%) developed fatal superinfection with Candida. The nine patients for whom treatment failed had a higher frequency of resistant anaerobes in their initial cultures (59%) than did the patients who were cured (29%; P = 0.036). An enterococcal isolate appeared to play a role in at least one treatment failure. There were no serious adverse reactions; eosinophilia (greater than 500 eosinophils/mm3) occurred in 17.4% of the patients, and phlebitis at the intravenous administration site occurred in one patient. Thus moxalactam shows promise as a single agent for the treatment of intraabdominal infections.

Abdomen↗