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At least 1,711 records · Page 95Linked to original sources
PubMed1975

Evaluation of diagnostic ultrasound in gynecology.

The experience with 300 consecutive gynecologic patients undergoing diagnostic ultrasound has been evaluated. Follow-up was obtained by recording the clinical course and/or the operative findings. The ultrasound studies were diagnostic in 21 per cent, confirmatory in 74 per cent, and misleading in 5 per cent of the patients. Certain conditions lend themselves to diagnosis with ultrasound: hydatidiform mole, intrauterine pregnancy, dermoid cyst, ascites, simple ovarian cyst, and lost intrauterine contraceptive devices (IUCD's). The studies in patients with chronic pelvic inflammatory disease or adhesions were occasionally misleading. Diagnostic ultrasound was particularly helpful in the obese patient, in whom adequate pelvic examination was difficult.

Adnexal Diseases↗
PubMed1975

Histochemical demonstration of lysosomal hydrolase activity in endometrial mononuclear cells. II. Abnormal endometrium.

The mononuclear cells in the endometrial stoma change in reactivity for lysosomal hydrolases during the menstrual cycle. Lymphoid follicles may occur in the stroma in any phase of the cycle and have been found in gestational endometrium. However, these cells have no significant lysosomal activity. Alterations in the endometrium are reflected in modified patterns of activity. Endometritis, association with an intrauterine contraceptive device, pregnancy, and adenocarcinoma result in increased numbers and staining intensity of mononuclear cells. In contrast, no consistent changes were apparent in foci of glandular hyperplasia, and decreased staining was seen in atrophic areas of endometrium. These data suggest that interstitial mononuclear cells are a sensitive monitor of morphologic changes in the endometrium.

Acid Phosphatase↗
PubMed1977

Unilateral tuboovarian abscess: a distinct entity.

In a 30 month interval at the Los Angeles County-University of Southern California Medical Center, 85 patients had tuboovarian abscesses removed that were unrelated to complications of pregnancy. Thirty-seven patients (44 per cent) of the 85 had unilateral abscesses. Twenty patients (54 per cent) of the 37 patients with a unilateral abscess were using an intrauterine contraceptive device (IUD). In 13 (65 per cent) of the 20 women using an IUD, the foreign body was a Dalkon Shield. Unilateral pelvic abscesses can occur with or without the presence of an IUD.

Abscess↗
PubMed1977

Hysteroscopy: a clinical experience with 320 patients.

Hysteroscopy has added a new dimension to the management of patients with common clinical problems, increasing the accuracy of diagnosis and serving as an adjunct in treatment of intrauterine conditions. This report summarizes the hysteroscopic experience with 320 selected patients, 104 in the reproductive age group with abnormal uterine bleeding, 91 who underwent hysteroscopy for location and retrieval of intrauterine contraceptive devices, 36 with primary or secondary infertility, 36 with postmenopausal bleeding, and 15 with uterine leiomyomas. Paracervical block anesthesia was used successfully in 214 patients. General anesthesia was used in the remainder because of planned additional surgical intervention. Uterine distention was achieved with D5W in 270 patients, with dextran 32% in 30 patients, and with CO2 gas insufflation in 20 patients. In 71.6 per cent of the patients,visually recognizable or pathologically suspicious intrauterine abnormalities were found. This study further demonstrated the utility of hysteroscopy in diagnosis of endometrial polyps, uterine submucous leiomyomas, uterine malformations, and intrauterine adhesions. Hysteroscopy was also helpful in taking directed biopsies of selected areas of the endometrium in patients with adenomatous hyperplasia and early adenocarcinoma of the endometrium and helpful in removal of intrauterine foreign bodies and evaluation of the recently pregnant uterus when there was a question of persistent pregnancy. Hysteroscopy is a safe ambulatory procedure that is appealing to both patient and gynecologist in its economy and simplicity.

Adolescent↗
PubMed1980

Tubo-ovarian abscess: a retrospective review.

The charts of 160 patients with tubo-ovarian abscesses (TOAs) were reviewed. Patients were divided into two groups according to their response to initial medical therapy. Predictive factors were identified for the two groups. Prognosis was predictable on the basis of extent of disease at diagnosis and the initial response to medical therapy. There was no apparent association between a unilateral TOA and the use of an intrauterine contraceptive device. A minimum pregnancy rate of 8% was observed in patients maintaining reproductive function. No patient with a bilateral TOA conceived. Of all patients admitted to the hospital with TOA, 53% ultimately required surgical therapy. High residual morbidity and/or resultant infertility mandates more aggressive attempts at prevention.

Abscess↗
PubMed1981

Copper and contractility of the human fallopian tube.

Muscle specimens were obtained from human oviducts during legal surgical sterilizations. Muscle strips (1 mm wide) were dissected from the circular and longitudinal muscle layers at the ampullary-isthmic junction, and contractile activity was recorded during short-term experiments in an organ bath. Administration of copper chloride induced a clear-cut excitatory response in both muscle layers. The response was, in many respects, similar to that evoked by low concentrations of prostaglandin F2 alpha (PGF2 alpha) but differed from the response induced by PGE2. Pretreatment of the tissue with indomethacin blocked the excitatory action of copper and frequently reversed the response into an inhibition of the contractile activity. After maximal stimulation of contractility by exogenous PGF2 alpha, copper was ineffective as a stimulant, whereas a maximal response elicited by copper could be further augmented by the addition of PGF2 alpha. The conclusion is that copper ions released from a copper intrauterine contraceptive device may increase contractility of the oviducts by an action on endogeneous synthesis of prostaglandins, predominantly of the F series. In addition, copper also seems to possess an inhibitory influence on motility of the oviducts, which becomes apparent only when the excitatory effect is blocked pharmacologically.

Adult↗
PubMed1985

Current trends in the diagnosis and treatment of tuboovarian abscess.

Tuboovarian abscess is a well-recognized complication of acute salpingitis and has been reported in as many as one third of hospital admissions for acute salpingitis. The incidence of tuboovarian abscess is expected to increase as a result of the current epidemic of sexually transmitted diseases and their sequelae. Patients with tuboovarian abscess most commonly present with lower abdominal pain and an adnexal mass(es). Fever and leukocytosis may be absent. Ultrasound, computed tomographic scans, laparoscopy, or laparotomy may be necessary to confirm the diagnosis. Tuboovarian abscess may be unilateral or bilateral regardless of intrauterine contraceptive device usage. Tuboovarian abscess is polymicrobial with a preponderance of anaerobic organisms. An initial conservative antimicrobial approach to the management of the unruptured tuboovarian abscess is appropriate if the antimicrobial agents used can penetrate abscesses, remain active within the abscess environment, and are active against the major pathogens in tuboovarian abscess, including the resistant gram-negative anaerobes such as Bacteroides fragilis and Bacteroides bivius. However, if the patient does not begin to show a response within a reasonable amount of time, about 48 to 72 hours, surgical intervention should be undertaken. Suspicion of rupture should remain an indication for immediate operation. Once operation is undertaken, a conservative approach with unilateral adnexectomy for one-side tuboovarian abscess is appropriate if future fertility or hormone production is desired.

Abscess↗
PubMed1986

Infective endocarditis in obstetric and gynecologic practice.

Infective endocarditis is an important but uncommon complication in obstetric or gynecologic practice; we found only 124 cases reported in English and selected European papers during the last 40 years. The majority of cases (74%) were caused by streptococci; viridans streptococci predominated, while enterococci and group B streptococci were uncommon except after abortion. The overall mortality rate was 29%, while the mortality rate for the fetus when the mother developed infective endocarditis was 23%. The incidence of endocarditis in this setting is low and seems to be decreasing. Therefore, the risk-benefit ratio may not favor routine use of prophylaxis for endocarditis. We conclude that antibiotics need not be given for prevention of endocarditis before most common obstetric and gynecologic procedures. These include uncomplicated vaginal deliveries, uncomplicated spontaneous or induced abortions, dilatation and curettage, insertion or removal of intrauterine contraceptive devices (in the absence of pelvic infection), and biopsies of the cervix. For patients in whom both the underlying heart lesion and the obstetric or gynecologic procedure seem to pose significant risk for endocarditis, prophylaxis should be given. Two parenteral regimens for patients at highest risk are recommended: ampicillin plus gentamicin or vancomycin plus gentamicin. For lower-risk situations, one oral regimen is suggested: amoxicillin.

Abortion, Spontaneous↗
PubMed1987

Microbiology of the female genital tract.

Patients who contract genital tract infections are predominantly young, are otherwise healthy, and generally respond well to treatment for bacterial infections. These infections are most commonly polymicrobial in etiology, with several noteworthy exceptions. Often there is an inciting event such as childbirth, surgical intervention, pregnancy termination or intrauterine contraceptive device insertion. With treatment, prognosis for cure is excellent; however, sequelae such as recurrent infections, infertility, or ectopic pregnancy can be serious. Bacteria encountered in the female genital tract can be divided into aerobic and anaerobic organisms. Among the aerobic gram-positive organisms, several varieties of streptococci such as Group B streptococci and enterococci occur frequently. Staphylococcus aureus is an infrequent but important pathogen. Among the aerobic gram-negative organisms, the most common is Escherichia coli. Klebsiella sp. and Proteus sp. occur in about 5% of genital tract infections. Species that are more resistant to antibiotics, such as Pseudomonas aeruginosa and Enterobacter sp., occur in approximately 1% or 2% of these cases and are more likely to appear in patients who have previously received antibiotic therapy or who have been hospitalized for some time. Among the anaerobic organisms, the most common gram-positive isolates are Peptostreptococci and Peptococci. Clostridia sp. occurs less frequently. Among the anaerobic gram-negative organisms, the Bacteroides sp. most frequently encountered are Bacteroides bivius and Bacteroides disiens. Bacteroides fragilis is still a common problem but appears to be less predominant. Other organisms encountered are Chlamydia trachomatis, the genital mycoplasmas, yeasts, protozoa, and viruses.

Bacteria↗
PubMed1988

A comparative study between panoramic hysteroscopy with directed biopsies and dilatation and curettage. A review of 276 cases.

A total of 276 women underwent both panoramic hysteroscopy and dilatation and curettage. All of these patients underwent directed endometrial biopsies through the hysteroscope. Indications for operation included abnormal bleeding, postmenopausal bleeding, suspected leiomyoma with bleeding, follow-up for adenomatous hyperplasia, intrauterine contraceptive device with bleeding, retained products of conception, infertility with bleeding, abnormal hysterosalpingogram with bleeding, and abnormal endometrial cells on Papanicolaou smear. In 223 cases the results of hysteroscopy and curettage were in agreement. Hysteroscopy revealed more information than curettage in 44 patients, whereas curettage revealed more information than hysteroscopy in only nine patients. When the results of this study are combined with those of previous studies, there is little doubt that panoramic hysteroscopy is superior to curettage in making an accurate diagnosis of pathologic conditions in the uterine cavity.

Adult↗
PubMed1993

Epidemiology of bacterial vaginosis.

Studies of the prevalence of and risk factors for bacterial vaginosis are flawed by imprecision in diagnosis, failure to study large and well-characterized populations, selection bias, and failure to correct for confounding variables. Prevalences range from 5% for women without any symptoms to 25% for those with gynecologic symptoms. Although bacterial vaginosis is associated with nonwhite race and intrauterine contraceptive device use, these may represent surrogate markers for other presently unappreciated risk factors.

Female↗