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PubMedDate not supplied

Mechanisms of mucosal invasion by pathogenic Neisseria.

Neisseria gonorrhoeae are transported across the mucosa of human fallopian tubes in organ culture by mucosal cells. The steps in this process are (1) attachment of gonococci to microvilli of nonciliated cells, (2) phagocytosis of gonococci by these cells, (3) transport of phagocytic vacuoles containing gonococci to the base of the cell, and (4) exocytosis of gonococci with phagocytic vacuoles into the subepithelial tissues. In vivo gonococci in the subepithelial tissues may cause extensive local disease (e.g., salpingitis) or invade 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. They subsequently appear in subepithelial tissues, but the route they take is not yet certain. These observations suggest that the mechanisms of attachment to and penetration of fallopian tube and nasopharyngeal mucosa by N. gonorrhoeae and N. meningitidis are similar or possibly identical.

Adhesiveness↗
PubMed2001

Serological investigation of Mycoplasma genitalium in infertile women.

BACKGROUND: The role of Mycoplasma genitalium in the pathogenesis of pelvic inflammatory disease has not been characterized. METHODS: Sera from 308 infertile women were investigated for antibodies to M. genitalium by immunoblotting. Women with tubal factor infertility (TFI) made up 132 of the patients, 67 of the women had an infertile male partner and 109 were infertile for unknown reasons. RESULTS: Of the TFI patients 29 (22.0%) were seropositive to the major adhesin, MgPa, of M. genitalium versus 11 (6.3%) in the group of women with normal tubes. No cross-reactions between MgPa and P1 of the related Mycoplasma pneumoniae were found. Besides, MgPa positive sera were confirmed by immunoblotting using a cloned fragment of the C-terminal part of MgPa specific to M. genitalium. Chlamydia trachomatis is known to be able to cause infertility as a result of salpingitis. Therefore, the sera were tested against C. trachomatis using a commercial ELISA test. Seventy-five (56.8%) of the TFI patients were seropositive to C. trachomatis. Eight (27.6%) TFI patients seropositive to MgPa were negative to C. trachomatis. CONCLUSIONS: This study indicates that M. genitalium may be an independent risk factor in the development of an inflammatory process leading to scarring of the uterine tubes in women and thereby causing infertility.

Adhesins, Bacterial↗
PubMed2006

Laparoscopic creation of a neovagina and recovery of menstrual function in a patient with Rokitansky syndrome: a case report.

A 16-year-old woman experiencing primary amenorrhoea and cyclic pelvic pain was diagnosed with Rokitansky syndrome, which was characterized by the absence of the uterus and the upper two-thirds of the vagina, normal salpinges and ovaries and a 4 x 3 cm Müllerian remnant containing functioning endometrium located near the left adnexa. With a combined laparoscopic-vaginal operation, the remnant was anastomized with the apex of the retrohymenal fovea. The operation allowed not only the creation of a neovagina but also the recovery of a regular menstrual activity and the theoretical restoration of the reproductive capacity of this patient. An accurate pre- and intra-operative evaluation of patients with Rokitansky syndrome is necessary to identify those who might benefit from this procedure.

Adolescent↗
PubMed1978

Penicillinase-producing Neisseria gonorrhoeae: results of surveillance in the United States.

In September 1976 the Center for Disease Control (Atlanta, Georgia) initiated surveillance for cases of infection due to penicillinase-productin Neisseria gonorrhoeae in the United States. One hundred ninety-one cases of penicillinase-producing gonococcal infection were confirmed through June 30, 1977. Of 177 cases for which histories of sexual exposure were available, 69 were traced to sexual contact in the Far East, and one was traced to sexual contact in West Africa. Of 181 cases for which clinical information was available, 174 were uncomplicated anogenital infections, but local complications, such as salpingitis, epididymitis, and a Bartholin's gland abscess, were reported. Spectinomycin is the only drug now recommended by the U.S. Public Health Service for treatment of gonorrhea that is effective against uncomplicated infections due to penicillinase-producing gonococci. For these organisms, the distribution of minimal inhibitory concentrations (MICs) of penicillin, ampicillin, tetracycline, erythromycin, and spectinomycin was higher than and significantly different from the distribution of MICs for isolates of non-penicillinase-producing gonococci collected in this country. Since surveillance began the incidence of confirmed cases of penicillinase-producing gonococcal infection has decreased from 20.8 cases per month in 1976 to 16.8 cases per month in 1977.

Gonorrhea↗
PubMed1996

Beyond recanalizing proximal tube occlusion: the argument for further diagnosis and classification.

Proximal tube occlusion (PTO) accounts for 20% of tubal factor cases. The classification into nodular (salpingitis isthmica nodosa or endometriosis), non-nodular (true fibrotic occlusion) and so-called pseudo occlusion (detritus, polyps, hypoplastic tubes) is essential. Using falloposcopy, PTO that is already diagnosed by laparoscopy and hysterosalpingography (HSG) can be confirmed or bypassed (false PTO); patients with false PTO were placed on a temporary waiting period. Nodular and pseudo occlusion patients were pre-treated with gonadotrophin-releasing hormone analogue (GnRH-a) for at least 6 weeks to shrink the underlying pathology, after which tubal re-catheterization was performed. In a prospective study starting in July 1993, 53 patients prediagnosed as having PTO were examined by falloposcopy. Three of these patients had non-nodular occlusion and were directed to microsurgical repair (conservative treatment not possible). A total of 19 cases revealed patent tubes with healthy mucosa and no underlying pathology (false PTO). Of the remaining 31 patients, 18 were classified as nodular and 13 as pseudo occlusion. In all of these patients at least one tube was patent after GnRH-a treatment. After a 6 month period, 37% of the false PTO patients achieved a spontaneous pregnancy (6% per cycle). The spontaneous pregnancy rate in the true PTO group was significantly lower (10% per patient, 1.6% per month; P < 0.05). Using assisted reproduction techniques, in particular gamete intra-Fallopian transfer (GIFT), as a subsequent treatment for the true PTO group, a pregnancy rate of 50% per cycle was achieved. A retrospective analysis of our entire PTO population (n = 109) showed a spontaneous pregnancy rate after achieving tubal patency (using falloposcopy and GnRH-a) that was dramatically low (1.8%), with no difference between the nodular and pseudo groups. The chance for pregnancy can be enhanced significantly (P < 0.001) using assisted reproduction techniques (GIFT) following tubal re-catheterization and GnRH-a treatment.

Buserelin↗
PubMed1989

Are pregnancy-associated plasma protein-A (PAPP-A) and CA 125 measurements after IVF-ET possible predictors of early pregnancy wastage?

Pregnancy-associated plasma protein-A (PAPP-A), a macromolecular glycoprotein of placental origin, was reported to be depressed in established ectopic pregnancies. CA 125 is a known marker for ovarian cancer found to be elevated during the first trimester of pregnancy and in women with pelvic inflammatory disease. The present study investigated the usefulness of these parameters to predict the outcome of pregnancy in asymptomatic patients with a positive pregnancy test after in-vitro fertilization and embryo transfer (IVF-ET). Blood samples (n = 159) were obtained at different periods of time post-ET from 39 women, 21 of whom experienced a normal pregnancy, 12 had an intrauterine abortion and six had an ectopic pregnancy. PAPP-A and CA 125 were measured by radioimmunoassays. From day 30 onwards in normal pregnancies, PAPP-A was significantly increased over non-pregnant controls. In the spontaneous abortion group, the levels of PAPP-A were significantly lower than in normal pregnancy but higher than in non-pregnant controls. In ectopic pregnancy, PAPP-A remained at the level of non-pregnant controls throughout the entire observation period. CA 125 was significantly increased in all types of pregnancy. However, in two cases of hyperstimulation followed by a normal pregnancy and in four cases of ectopic pregnancy with signs of peritoneal irritation (hydrosalpinx, ruptured ectopic or salpingitis) the levels of CA 125 were 15-50 times higher than in normal pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Spontaneous↗
PubMed1991

Diethylstilbestrol-induced müllerian abnormalities, septate uterus, genital tuberculosis and twin pregnancy with term delivery after in-vitro fertilization.

We report a case of a twin pregnancy at term obtained after five multiple embryo transfers in a patient who presented diethylstilbestrol (DES)-associated cervical and uterine structural abnormalities, a septate uterus and bilateral tuberculous salpingitis. The suitability of in-vitro fertilization/embryo transfer in DES-exposed women is discussed.

Adult↗
PubMed1993

Histological findings in a falloposcopically retrieved isthmic plug causing reversible proximal tubal obstruction.

We present the case of a 33-year-old woman with a 10 year history of infertility. Transvaginal falloposcopy revealed a proximal tubal occlusion (PTO) on the right due to a tissue plug. The plug was removed during dilatation of the tubal lumen. After the procedure patency for dye was restored. Histological and immunohistochemical findings--for the first time, to the best of our knowledge, performed in a falloposcopically retrieved plug--revealed the diagnosis of an inflammatory polyp arising from the tubal mucosa with focal calcifications. Local obstructive inflammatory residues of a previously treated tubal endometriosis, which was accompanied by features of salpingitis isthmica nodosa, are considered the most likely cause for this condition. Other possible aetiological factors responsible for PTO are discussed.

Adult↗
PubMed1982

Endosalpingiosis in the omentum: a study of autopsy and surgical material.

Omenta removed either at surgery or autopsy were examined for benign glandular inclusions. Multiple random sections failed to reveal these inclusions in any of the 37 male or 27 female autopsy specimens. None of the 22 male surgical specimens contained benign cysts, whereas these inclusions were found in 19 of 128 (14.8%) of the female surgical specimens. One female patient had endometriotic cysts, two had mesothelial cysts, and 13 had inclusions histologically similar to oviduct epithelium (endosalpingiosis). Another female had both endometriotic cysts and endosalpingiosis, whereas two had both mesothelial cysts and endosalpingiosis. All 16 patients with endosalpingiosis had inflammatory tubal disease (e.g., chronic salpingitis, hydrosalpinx, tubal pregnancy). Four of these 16 females also had an ovarian tumor. These ovarian tumors included one serous cystadenoma, two serous cystadenomas of borderline malignancy, and one serous cystadenocarcinoma. We conclude that the endosalpingiotic inclusions are benign and occur exclusively in females. Since they are found in association with ovarian tumors, it is important to exclude well-differentiated metastases. Our findings support a close relationship between inflammatory tubal disease and endosalpingiosis.

Adolescent↗
PubMed1992

Laparoscopic appendectomy. Initial experience in a teaching program.

From February 1990 to December 1991, 16 laparoscopic procedures were performed for right lower quadrant pain. There were nine men and seven women, aged 16 to 47 years (mean, 27.2 years). All procedures were performed by surgical chief residents with prior experience in laparoscopic cholecystectomy, first-assisted by an attending surgeon. The appendix was visualized and a definitive diagnosis was made in all patients. One patient with acute salpingitis underwent diagnostic laparoscopy only; two patients underwent laparotomy (perforated appendicitis, perforated diverticulitis). A fourth patient had an acute torsion of an ovarian cyst managed laparoscopically. Laparoscopic appendectomy was successfully performed in 12 patients (acute appendicitis, 9; fibrosis or chronic inflammation, 2; normal appendix, 1). Mean operative time for laparoscopic appendectomy was 95.7 minutes, and mean postoperative stay was 2.5 days. The authors conclude that operative time, diagnostic accuracy, and complication rates for laparoscopic appendectomy are acceptable. Within the context of a training program, laparoscopic appendectomy provides an opportunity for surgical residents to expand laparoscopic skills.

Adolescent↗
PubMed1993

Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease.

OBJECTIVE: The authors review their experience, evaluating the incidence and examining the various modalities employed in the diagnosis and treatment of patients with Crohn's disease complicated by fistulae. SUMMARY BACKGROUND DATA: Although common, internal and external fistulae in Crohn's disease may pose challenging problems to the surgeon. METHODS: Of 639 patients who underwent surgical treatment at the University of Chicago between 1970 and 1988 for complications of Crohn's disease, 222 patients (34.7%) were found to have 290 intra-abdominal fistulae. RESULTS: A fistula was diagnosed preoperatively in 154 patients (69.4%), intraoperatively in 60 (27%), and only after examination of the specimen in 8 (3.6%). The fistula represented the primary or single indication for surgical treatment in 14 patients (6.3%) and one of several indications in the remaining patients. Of 165 patients with an abdominal mass or abscess, 69 (41.8%) had a fistula. All patients underwent resection of the diseased intestinal segment; 160 (73.1%) with primary anastomosis and the remaining 62 with a temporary or permanent stoma. The fistula was directly responsible for a stoma in only 16 patients (7.2%) and was never responsible for a permanent stoma. Resection of the diseased bowel achieved en bloc removal of the fistula in 145 cases. Removal of 93 additional fistulae required resection of the diseased bowel segment along with closure of a fistulous opening on the stomach or duodenum (n = 14), bladder (n = 35), or rectosigmoid (n = 44). When the fistula drained through a vaginal cuff (n = 4), the opening was left to close by secondary intention; when the fistula opened through the abdominal wall (n = 46), the fistulous tract was debrided. In the remaining two entero-salpingeal fistulae, en bloc resection of the involved salpinx accomplished complete removal of the fistula. There was a dehiscence of one duodenal and one bladder repair; 14 patients (6%) experienced postoperative septic complications and one patient died. CONCLUSIONS: Fistulae are diagnosed preoperatively in 69% of cases and can be suspected in as many as 42% of patients with an abdominal mass. Fistulae are the primary or single indication for surgical treatment and are directly responsible for a stoma only in a few patients. Treatment, based on resection of the diseased bowel and extirpation of the fistula, can be accomplished with minimal morbidity and mortality.

Adult↗
PubMed1989

Liesegang rings in the female genital tract. A report of three cases.

Three cases of Liesegang rings (LRs) within the female genital tract are reported; only one similar case has been previously documented. The patients were 32-57 years of age and underwent operations for ovarian endometriosis (two cases) and uterine leiomyomas (one case). Innumerable eosinophilic, acellular, ring-like structures, similar to previously described LRs, were found on microscopic examination and were confined to an endometriotic cyst (two cases) or the mucosa of a fallopian tube involved by chronic salpingitis (one case). Liesegang rings within the female genital tract, as in other sites, occur within cysts or within areas of inflammation. These structures have been confused with and should be distinguished from parasites and foreign material on histologic examination.

Adult↗
PubMed1999

Bilateral lymphangiomas of the ovary: an immunohistochemical characterization and review of the literature.

Lymphangiomas of the ovary are rare tumors, with only 13 cases reported. The diagnoses of these tumors have been based on histologic findings without immunohistochemical confirmation of endothelial cell origin. It is uncertain if these tumors are true neoplasms or if some represent reactive lesions. In this report, the literature is reviewed, and a 53-year-old woman with bilateral ovarian lymphangiomas is described. The ovarian masses were composed of numerous, thin-walled, cystic spaces containing a proteinaceous fluid, mature lymphocytes, and occasional erythrocytes. The cyst walls were lined by flat, benign-appearing cells that were immunoreactive for factor VIII-related antigen, CD34, and CD31. Further examination of the specimen showed absent fallopian tube fimbriae, tuboovarian adhesions, and chronic follicular salpingitis, suggesting that the lymphatic proliferation in the ovaries was a reactive change secondary to impaired regional lymphatic drainage.

Antigens, CD34↗
PubMed2000

Mucosal epithelial proliferation of the fallopian tube: prevalence, clinical associations, and optimal strategy for histopathologic assessment.

The prevalence and clinical significance of mucosal epithelial proliferation or hyperplasia of the fallopian tube are controversial in the few studies reported. Some authors have retrospectively examined "routine" sections (one or two submitted from each tube), whereas others have prospectively blocked the entire tubes. In the current study, we prospectively studied a total of 168 tubes from 98 women who had various indications for salpingectomy and compared the diagnosis in an initial single section (to simulate the usual practice) with that in the remainder of the entirely sectioned and submitted tube (mean total number of sections, 9.0). Some degree of mucosal epithelial proliferation was found in 83% of all tubes examined, with no difference between the tubes removed for routine tubal ligation and those in women who had benign ovarian lesions, malignant gynecologic tumors, uterine leiomyomata, or benign tubal lesions (salpingitis or ectopic pregnancy). Mucosal epithelial proliferation graded as more than mild, however, was seen in only 4.5% of the otherwise normal ligated tubes versus 35 to 46% of tubes associated with the other lesions. When the initial sections were compared with the subsequent ones, the diagnosis was identical in 96 tubes (57%). In the other 72 tubes (43%), the difference in diagnosis was never greater than one grade (no, mild, moderate, severe mucosal epithelial proliferation), with the diagnosis more often upgraded (50 tubes) than downgraded (22 tubes) in the additional sections. It is concluded that there is no reason to submit an entire tube for histologic examination to detect clinically significant lesions, and the usual practice of submission of one or two sections is clinically appropriate.

Cell Division↗
PubMed1986

Severe pneumococcal peritonitis complicating IUD: case report and review of the literature.

A case of pneumococcal peritonitis associated with an IUD is presented and four previously reported cases of pneumococcal peritonitis with IUD are reviewed. The infection may occur in previously healthy women who were fitted with an IUD, possibly by ascending infection from the genital tract via the fallopian tubes. The condition is usually accompanied by bilateral salpingitis and may be severe, with fatal outcome. We suggest that any woman over 30 using an IUD, who presents with peritonitis without obvious cause, should be given antibiotics with activity against Streptococcus pneumoniae, following removal of the IUD.

Adult↗
PubMedDate not supplied

Pelvic inflammatory disease in the United States. Epidemiology and trends among hospitalized women.

The Hospital Discharge Survey, conducted by the National Center for Health Statistics (Rockville, Md.), provides national estimates for conditions causing hospitalization in short-stay hospitals in the United States. The venereal Disease Control Division of the Centers for Disease Control (Atlanta, Ga.) obtained survey data for 1970-1975 and analyzed the epidemiology of pelvic inflammatory disease (PID) in women hospitalized for this disease. An average of greater than 211,000 female patients older than 10 years of age were hospitalized annually for PID. Acute salpingitis occurred predominantly in women younger than 30 years of age. Women of all races other than white had a PID rate 3.3 times greater than that of white women. Data obtained from the Commission on Professional and Hospital Activities were used for determination of the trend in hospitalizations for PID. In all races other than white, the trend appears stable; however the trend among white women is increasing.

Adolescent↗
PubMedDate not supplied

Serum concentration of protein CA-125 in women with pelvic inflammatory disease.

The concentration of the protein CA-125 in serum was determined in women with a normal pelvis visualized at laparoscopy (control group, n = 15) and compared with serum levels of this protein in women with pelvic inflammatory disease (PID) (n = 14). Mean serum concentrations of CA-125 were similar in the two groups: 17.4 +/- 2.3 (SE) units/ml for the control group vs. 17.0 +/- 4.3 units/ml for those with PID (P greater than 0.05). In addition, women with chlamydial cervicitis, histologically confirmed endometritis, and laparoscopically documented salpingitis had CA-125 levels that were not significantly different from those of controls. We conclude that serum levels of CA-125 will not be useful in the diagnosis of PID.

Antigens, Tumor-Associated, Carbohydrate↗
PubMedDate not supplied

Postabortal infectious morbidity after antibiotic treatment of chlamydia-positive patients.

The postabortal infection rate in chlamydia-positive women after antibiotic treatment (doxycycline or erythromycin) was compared with infectious morbidity among untreated culture-positive women in a comparable previous study. Of 69 chlamydia-positive patients, 5 (7.2%) developed endometritis and one (1.4%) salpingitis during the first postoperative month. The corresponding figures during the previous regimen were 16 (23.2%) and 10 (14.5%), respectively, i.e. a highly significant decrease (P less than 0.001). The infection rate among the chlamydia-negative women was unchanged. It is suggested that preoperative screening for C. trachomatis should precede legal abortion. Initiation of treatment of culture-positive cases before or at least in conjunction with the abortion seems to reduce the risk of infectious complications to the same level as in chlamydia-negative women.

Abortion, Induced↗