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PubMed2004

[Abdominopelvic actinomycosis: a tumoral syndrome due to bacterial infection].

The purpose of this review is to define the diagnostic steps and treatment of abdominopelvic actinomycosis. Three cases are described which illustrate the variety of clinical presentations ranging from acute peritonitis to chronic pseudo-tumor. The diagnosis of actinomycosis is rarely made pre-operatively. Bacteriologic culture is seldom helpful and imagery findings are non-specific. The diagnosis is usually made retrospectively based on histologic examination. In women, an intrauterine contraceptive device is often a concomitant factor. Long-term antibiotic treatment (several Months) with high-dose penicillin-based medications is the mainstay of therapy. Despite a high risk of complications, surgery is often necessary both for diagnosis and treatment. Resection or drainage may diminish the dosage and duration of antibiotic therapy, and helps to minimize infectious complications. Actinomycosis should be included in the differential diagnosis of abdominopelvic tumors, inflammatory bowel disease, and endometriosis-particularly in a woman with an intrauterine contraceptive device.

Abdominal Abscess↗
PubMed1976

Ovarian pregnancies with Dalkon Shield IUCDs in situ: laparoscopic visualization.

Two ovarian pregnancies coexistent with intra-uterine contraceptive devices are described. In one case, the ovary appeared to contain a cyst at laparoscopy and rupture of the cyst and extrusion of the fetus were witnessed. In the second case, a hemorrhagic ovarian cyst bled at laparoscopy and laparotomy resulted in the diagnosis of ovarian pregnancy. These two cases reveal that laparoscopic examination could be misleading and result in inappropriate management if the diagnosis of ovarian pregnancy is not entertained. The cases described add to the growing number of reports of extrauterine pregnancies occurring in patients using intra-uterine contraceptive devices.

Adult↗
PubMedDate not supplied

Pelvic actinomycosis. Urologic perspective.

PURPOSE: Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli. This paper reviews the etiology and clinical presentation associated with Actinomycosis that often presents as a pelvic mass that mimics a pelvic malignancy. MATERIALS AND METHODS: A combination of patients treated by the authors in the recent past and a literature review of patients with pelvic Actinomycosis were assessed for demographic, clinical and predisposing co-factors. An analysis is made of age distribution, gender, diagnostic methods and treatment concepts. RESULTS: Thirty-three patients were included in the study that included 2 current patients and 31 obtained from literature review. There were 27 females (age range 16 - 69 years, mean 38 years) and 6 males (16 - 55 years, mean 36 years). Presenting signs and symptoms were lower abdominal mass in 28 (85%); lower abdominal pain in 21 (63%); vaginal discharge or hematuria in 7 (22%). Two patients developed fistulae (entero-vesico 1; vesico-cutaneous 1). Nineteen (70%) of the 27 female patients had intra-uterine contraceptive devices (IUD). Four patients (12.5%) (3 males and 1 female) had urachus or urachal remnants. Cystoscopy in 12 patients noted an extrinsic mass effect, bullous edema and in one patient " vegetative proliferation " proven to be a chronic inflammatory change. Exploratory laparotomy was performed in 32 of the 33 patients who had excision of mass and involved organs. Diagnosis was established by histologic examination of removed tissue. Penicillin (6 weeks) therapy was utilized to control infections. CONCLUSION: Pelvic actinomycosis mimics pelvic malignancy and may be associated with the long-term use of intra-uterine contraceptive devices, and persistent urachal remnants. Removal of infected mass and antibiotic therapy will eradicate the inflammatory process.

Actinomycosis↗
PubMed1975

The use-effectiveness of two contraceptive methods in a Navajo population: the problem of program dropouts.

Navajo Indian intrauterine contraceptive device (IUD) and oral contraceptive users between 1966 and 1971 were followed up to estimate life table rates of complications and continuation. Because of high rates of dropping out, 41.6 per cent of 291 oral contraceptive users and 18.2 per cent of 534 IUD users, a 26 per cent sample survey of the dropout population was used to collate the dropout population data into the life table analysis. Estimates of the IUD continuation rates for one, two, and three years are similar to rates published elsewhere; however, continuation rates for the oral contraceptive are clearly lower than those for other populations, which only 33 per cent continuing after one year, 23 per cent after two years, and 12 per cent after three years. The IUD user is two to three times more successful than the oral contraceptive user in this population.

Adolescent↗
PubMed1979

Complications associated with IUD use in a family practice setting.

This study compares the complication rate of intrauterine contraceptive devices (IUD) with other contraceptive measures in a residency practice. The study population included 220 randomly selected women who had IUDs inserted by residents over a five-year period. One hundred similarly selected women started on birth control pills (BCP) were used as a control group. Of the IUD patients, 8.6 percent developed pelvic inflammatory disease vs 2 percent of the BCP patients. The incidence of gonorrhea was not significantly different between the two groups: 8.2 percent for the IUD groups vs 7 percent for the BCP group. Discontinuation of IUDs for reasons other than desiring pregnancy was significantly higher than discontinuation of BCPs: 41 percent vs 12 percent. Of the total IUD insertions, there were 21 expulsions (10 percent) and one uterine perforation (0.4 percent). Five pregnancies occurred in the IUD group, yielding a pregnancy rate of 1.7 per 100 women-years. There was a four percent rate of gynecologic hospitalizations in the IUD group as contrasted with one percent rate in BCP group. IUD use in the family practice setting under study is associated with comparatively poor long-term acceptance and a relatively high rate of complications.

Adolescent↗
PubMed2001

Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features.

PURPOSE: To assess the computed tomographic (CT) features of abdominopelvic actinomycosis involving the gastrointestinal tract. MATERIALS AND METHODS: CT scans were analyzed in 18 patients with pathologically proved abdominopelvic actinomycosis involving the gastrointestinal tract. Eight patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness, length, bowel involvement patterns, inflammatory infiltration, and features of peritoneal or pelvic mass, if present, were evaluated at CT. RESULTS: Of the gastrointestinal tract, the sigmoid colon was most commonly involved (50%). All patients showed concentric (n = 15) or eccentric (n = 3) bowel wall thickening, with a mean thickness of 1.2 cm and a mean length of 8.3 cm. The thickened bowel enhanced homogeneously in nine patients and heterogeneously in the other nine. Inflammatory infiltration was mostly diffuse and severe. In 17 patients, a peritoneal or pelvic mass (mean maximum diameter, 3.2 cm) was seen adjacent to the involved bowel and appeared to be heterogeneously enhanced in most cases; infiltration into the abdominal wall was seen in four patients. CONCLUSION: Actinomycosis should be included in the differential diagnosis when CT scans show bowel wall thickening and regional pelvic or peritoneal mass with extensive infiltration, especially in patients with abdominal pain, fever, leukocytosis, or long-term use of intrauterine contraceptive devices.

Actinomycosis↗
PubMed2005

A survey of knowledge, attitudes and practices relating to emergency contraception among health workers in Manisa, Turkey.

OBJECTIVE: to determine knowledge, attitudes and practices relating to emergency contraception among health-care providers (general practitioners, nurses and midwives). DESIGN: a cross-sectional design using face-to-face interview methods plus questionnaire in the work setting. Researchers were able to maintain privacy by using priority strategies. SETTING: 18 primary health-care units in Manisa, western Turkey. SAMPLE: 182 health-care providers (general practitioners [n = 72]; nurses and midwives [n = 110] were invited to participate in the study, but 26 of them declined. PARTICIPANTS: 156 health-care providers. As 16 participants had not heard of emergency contraception, 140 health-care providers (general practitioners [n = 51] and nurses and midwives [n = 89]) were included. FINDINGS: of the health-care providers, almost one in 10 was unfamiliar with the term 'emergency contraception'. Only a few health-care providers knew how to use the intra-uterine contraceptive device (IUCD) for emergency contraception and the doses of emergency contraceptive pills. Some health-care providers included emergency contraception in routine consultations, but many did not support the use of emergency contraception in Turkey. Many of the providers thought that young people should not know about emergency contraception. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: knowledge among health-care providers about emergency contraception is inadequate. All health-care providers should know about emergency contraception and include it in routine contraceptive consultations. Thus, continuing education information programmes are required. Further research into the knowledge, practices and attitudes of health-care providers is needed to understand the underlying reasons for the hesitant attitudes among health professionals.

Adult↗
PubMed2005

Withdrawal users' perceptions of and experience with contraceptive methods in Manisa, Turkey.

OBJECTIVE: To gain an understanding of the knowledge, perceptions and experiences of using contraceptive methods among Turkish withdrawal users. DESIGN: Population-based, cross-sectional and descriptive study using a questionnaire conducted face to face. SETTING: Women who live in the Number 6 primary health unit area in Manisa, Turkey. PARTICIPANTS: 276 women who used the 'withdrawal' method for contraception. MEASUREMENTS AND FINDINGS: Almost all women were aware of modern contraceptive methods. The condom, intrauterine contraceptive device (IUCD) and oral contraceptives were the most known methods. The most common reasons for using 'withdrawal' were that this method was reliable, husbands preferred it, it was healthier, easier to use or more convenient than other methods. CONCLUSION AND IMPLICATIONS FOR PRACTICE: It is important for midwives and nurses to recognise the effects of cultural beliefs on women's contraceptive use. Educational programmes should be individualised to meet the specific needs of women and their partners.

Attitude to Health↗
PubMed1994

Prostaglandin synthesis inhibitors in menorrhagia, intrauterine contraceptive device-induced side effects and endometriosis.

Primary menorrhagia, IUD side effects and endometriotic symptoms may be a result of excessive PG release in the reproductive organs. These conditions and symptoms can be prevented or markedly alleviated by a PG synthesis inhibitor, such as tolfenamic acid. This treatment, which is used only intermittently, has been well tolerated with no serious side effects.

Cyclooxygenase Inhibitors↗