Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ADNEXITIS”

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.

At least 19 recordsLinked to original sources
PubMed2005

[Diagnosis of adnexal torsion and predictive factors of adnexal necrosis].

OBJECTIVE: To determine the most relevant findings for diagnosis of adnexal torsion and predictive factors of adnexal necrosis. PATIENTS AND METHODS: Clinical, biological, ultrasound, pathologic and surgical findings in surgically confirmed cases of adnexal torsion treated over a five-year period in a gynaecologic emergency department were retrospectively reviewed. RESULTS: A total of 52 cases of adnexal torsion were studied. Abdominal pain was present in 80.8%, vomiting in 13.5% and fever only in 9.6%. Leukocytosis was noted in 19 (36.5%). The most frequent ultrasound findings were ovarian enlargement in 22 patients (42.3%), ovarian cysts in 26 (50%), and hyperechogenic parenchyma with follicles along the periphery of the ovary in 13 (25%). Age over 40 years and a delay to surgery longer than 10 hours were significantly associated with diagnosis of adnexal necrosis. DISCUSSION AND CONCLUSION: Prompt diagnosis of adnexal torsion requires a combination of clinical, biological and radiological evidence. No predictive factors of necrosis are found. Risk of adnexal torsion is potentially increased by waiting period for surgery and patient's age.

Adnexa Uteri↗
PubMed2006

High (nuclear) grade adnexal carcinoma with microcystic adnexal carcinoma-like structural features.

Microcystic adnexal carcinoma (MAC) is a slow growing, locally aggressive sweat gland tumor. It predominantly affects the face and tends to recur despite local excision. Microscopically, MAC is characterized by a stratified proliferation of microcysts, cords, and ducts of cells that show squamous or adnexal differentiation. Atypia and mitoses are almost completely absent and metastatic deposits are rare and mostly limited to the regional lymph nodes; rather than real metastases, they might be the result of local extension of the tumor through perineurial spaces. We report a case of adnexal carcinoma with architectural features of MAC that displayed also marked nuclear pleomorphism and hyperchromasia with squamous pearl formation and a widespread strong p53 immunoreaction. The lesion behaved as a high-grade neoplasm with rapid growth, carcinosarcomatous metaplastic transformation in a relapse, and what were clinically suspected to be metastases. The literature contains several other examples reported as metastatic high-grade MAC, one of them with widespread distant metastases. We therefore want to sound an alert about the possible existence of tumors displaying microscopic findings characteristic of the aggressive forms of sweat gland carcinoma (nuclear pleomorphism and hyperchromasia, vascular invasion, and necrosis) in addition to architectural features of MAC. Whether these tumors should be called high-grade MACs or belong to a separate category remains an open issue until more cases are reported and bridge cases are eventually documented.

Aged↗
PubMed1999

Wolffian adnexal tumor, so-called female adnexal tumor of probable Wolffian origin (FATWO): immunohistochemical evidence in support of a Wolffian origin.

Wolffian adnexal tumor (WAT) is a rare neoplasm believed to originate from wolffian remnants on the basis of its location in areas where these remnants are abundant. To study its histogenesis, the immunoprofile of 25 WATs was compared with that of 10 cervical and vaginal mesonephric remnants and 12 rete ovarii. WATs were unilaterally located in the broad ligament (n = 10), mesosalpinx (n = 9), ovarian hilus (n = 5), and pelvis, not otherwise specified (n = 1). They showed varying morphologies with solid (spindle cells), tubular (lined by columnar cells), retiform and multicystic (spaces lined by cuboidal and attenuated cells) patterns. WATs were immunoreactive for pan-cytokeratin (AE1/3, CK1) (100%), CAM 5.2 (100%), cytokeratin 7 (CK7) (88%, focal staining), keratin 903 (17%), epithelial membrane antigen (EMA) (12%), estrogen receptor (28%), progesterone receptor (24%), androgen receptor (78%), inhibin (68%), calretinin (91%), and vimentin (100%). No immunostaining was detected with monoclonal carcinoembryonic antigen and cytokeratin 20. The pattern of staining was nearly identical to that of the rete ovarii and differed somewhat from mesonephric remnants, which were diffusely immunoreactive for CK7, immunopositive for EMA (apical staining), and nonreactive for inhibin. Our findings provide immunohistochemical support for the derivation of WATs from wolffian remnants, in particular from the rete ovarii. Because of immunoreactivity for inhibin and calretinin in a significant number of WATs, our results further show that these immunostains alone do not allow absolute distinction of WATs from sex cord-stromal tumors and adenomatoid tumors, respectively, with which they may be confused.

Adnexal Diseases↗
PubMed2000

Accuracy of the pelvic examination in detecting adnexal masses.

OBJECTIVE: To estimate sensitivity, specificity, positive predictive value, Youden J statistic, and likelihood ratio of pelvic examination in adnexal assessment under ideal circumstances. METHODS: One hundred forty women consented to have pelvic examinations under general anesthesia before laparoscopy or laparotomy. They were assigned to examiners masked to indications for surgery, including attending gynecologists, gynecology residents, and medical students. Surgeons' findings were compared with examiners' findings. Variables assessed included adnexal diameter, presence of adnexal masses, and effect modifiers such as examiner experience and body mass index. RESULTS: Forty-nine left adnexal and 33 right adnexal masses were found during surgery. Examiners tended to underestimate adnexal size. Sensitivity of pelvic examinations for detecting left adnexal masses was 0.23-0.36 and for right adnexal masses was 0.15-0.28. Positive predictive value was low for left adnexal masses (0.50-0. 69) and right adnexal masses (0.26-0.39). Differences among examiner groups were not statistically significant. Patient obesity noticeably reduced detection of adnexal masses on either side. CONCLUSION: Bimanual pelvic examination has marked limitations for evaluating adnexa, even with ideal circumstances. Experience during postgraduate training in gynecology did not seem to improve examination accuracy. Patient characteristics such as obesity, uterine size, and abdominal scars limit the accurate palpation of the adnexa.

Adnexal Diseases↗
PubMed2002

Adnexal torsion in children may have a catastrophic sequel: asynchronous bilateral torsion.

BACKGROUND/PURPOSE: Adnexal torsion is a serious condition that frequently may result in ovarian removal, and there always is a risk of castration if the contralateral ovary undergo torsion as well. In this study, the authors present their experience with adnexal torsion in 15 children and describe a catastrophic event, asynchronous bilateral adnexal torsion, with review of the literature. METHODS: Between November 1993 and November 2000, 15 children under 15 years of age who had undergone operation because of torsion of uterine adnexal structures were evaluated. Two illustrative cases with asynchronous bilateral adnexal torsion are presented. RESULTS: Fourteen cases were associated with additional adnexal pathology, whereas in 1 case the torsion was of normal uterine adnexa. Sonographic studies improved the preoperative diagnosis. Hemorrhagic necrosis of the adnexa secondary to the torsion was found in all cases except 3 and necessitated adnexal resection. In only 3 cases preservation of the adnexa was possible. Asynchronous adnexal torsion occurred in 2 patients in the time course. Both were treated by laparotomy and adnexal untwisting and fixation by permanent multiple interrupted sutures. In their final evaluation at 40 and 8 months after the operation, they were found to have good ovarian function. CONCLUSION: Considering the risk of subsequent contralateral torsion and its impact on future fertility, the authors believe that conservative management (untwisting the ovary and pexing, both retained detorsed and contralateral, ovaries) should be considered in cases of ovarian torsion in children.

Abdominal Pain↗
PubMed2004

Imaging of adnexal masses in pregnancy.

OBJECTIVE: To illustrate the imaging appearances of a variety of adnexal masses in pregnancy. METHODS: Cases of adnexal masses in pregnancy were chosen to illustrate the appearance on ultrasonography and magnetic resonance imaging. RESULTS: Adnexal masses in pregnancy have a wide spectrum of imaging characteristics and clinical manifestations. Sonography is important in diagnosing, monitoring, and determining the malignant potential of these masses. Common adnexal lesions seen in pregnancy include simple cysts, hemorrhagic cysts, leiomyomas, and hyperstimulated ovaries in patients who have undergone assisted fertility. Uncommon adnexal lesions specific to pregnancy include hyperreactio luteinalis, theca lutein cysts with moles, and luteomas. Adnexal masses associated with pain include ovarian torsion and heterotopic pregnancy. Adnexal lesions that are found incidentally include teratomas, endometriomas, hydrosalpinx, cystadenomas, and cystadenocarcinomas. When the diagnosis of the adnexal mass cannot be made on the basis of sonographic appearance alone, magnetic resonance imaging may help. CONCLUSIONS: Familiarity with the clinicopathologic and sonographic features of common and uncommon adnexal masses in pregnancy is important for diagnosis and treatment.

Adnexa Uteri↗
PubMed1999

Ocular adnexal lymphoma-comparison of MALT lymphoma with other histological types.

AIMS: To correlate histological features of ocular adnexal lymphoma using the revised European American lymphoma classification (REAL), with stage of disease at presentation, treatment modalities, and patient outcome. MALT lymphoma defines an extranodal marginal zone B cell lymphoma as outlined in the REAL classification. Comparison groups of patients included those with primary ocular adnexal MALT lymphoma versus primary ocular adnexal lymphomas of other types, MALT lymphoma versus non-MALT lymphomas (primary and secondary), and primary ocular adnexal lymphoma (MALT lymphomas and other types) versus secondary ocular adnexal lymphomas. METHODS: A retrospective review of the National Ophthalmic Pathology Laboratory records identified 20 cases of ocular adnexal lymphoma over a 10 year period which were reclassified using appropriate immunohistochemical stains. Patients' medical records were examined for data including stage of the disease at presentation, mode of treatment, and patient outcome. RESULTS: Among the 20 cases identified 14 had primary ocular adnexal lymphomas. 10 of the primary lymphomas had histological features of MALT lymphoma. One case was a primary ocular adnexal T cell lymphoma, one a follicular centre, follicular B cell lymphoma, and two were large cell B cell lymphomas. Six cases had systemic disease, four large B cell, one follicular centre, follicular B cell, and one mantle cell. A significantly higher proportion of patients with MALT lymphomas had early disease (p = 0.005), initially required local treatment (p = 0.005) and were alive at last follow up (p = 0.001) than those without. Two patients with MALT lymphoma had recurrence of lymphoma which responded to further treatment. CONCLUSIONS: Patients with primary ocular adnexal MALT lymphomas present with localised disease requiring local treatment and have a better outcome compared with patients with other types. As a small percentage of these tumours recur, patients should be followed up indefinitely.

Adult↗
PubMed2006

Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization.

OBJECTIVE: To report a case of unilateral adnexal torsion and subsequent contralateral adnexal torsion after in vitro fertilization. DESIGN: Case report and literature review. SETTING: Academic fertility center; university hospital. PATIENT(S): A 28-year-old woman with tubal factor infertility conceived with IVF and experienced mild-to-moderate ovarian hyperstimulation syndrome. Right adnexal torsion occurred at 7 weeks of gestation, and laparoscopic detorsion was performed. Subsequent contralateral adnexal torsion occurred at 19 weeks and was managed with laparotomy and salpingo-oophorectomy. INTERVENTION(S): Laparoscopic right adnexal detorsion and laparotomy with salpingo-oophorectomy for left adnexal torsion. MAIN OUTCOME MEASURE(S): Preservation of torsed adnexa and successful pregnancy. RESULT(S): Successful pregnancy and birth complicated by two episodes of adnexal torsion after IVF, and viable right adnexa after laparoscopic detorsion. CONCLUSION(S): Subsequent contralateral adnexal torsion is a rare complication of IVF and can occur in the second trimester. Data support preservation of the torsed adnexa despite the ovary's appearance.

Adnexa Uteri↗
PubMed1998

Intraoperative laparoscopic sonography for improved preoperative sonographic pathologic characterization of adnexal masses.

This study compares the diagnostic accuracy of laparoscopic sonography and transvaginal sonography in the evaluation of adnexal masses. Fifty-eight women underwent transvaginal sonography, which showed 69 adnexal masses, and laparoscopic ultrasonography, which showed 68 adnexal lesions. Conventional gray-scale ultrasonography (using transvaginal sonography and laparoscopic ultrasonography) was performed with morphologic characterization of internal architecture, followed by color Doppler imaging with spectral Doppler analysis where possible. A specific diagnosis was obtained with transvaginal sonography and laparoscopic ultrasonography based on a combination of imaging features. The specific diagnosis obtained with each imaging modality was compared with the final histologic diagnosis as the gold standard in 57 patients with 68 adnexal masses who underwent cystectomy or oophorectomy. The ability of laparoscopic sonography to detect the contralateral ovary and any residual ovarian tissue in the presence of a mass was also compared with transvaginal sonography. The accuracy of laparoscopic ultrasonography in the characterization of adnexal masses was 83.8% and that of transvaginal sonography was 73.5% (P < 0.05). Laparoscopic sonography showed greater morphologic detail than that obtained with transvaginal sonography, allowed more precise and specific characterization of adnexal masses, and detected additional adnexal lesions not evident on preoperative transvaginal sonography. Laparoscopic ultrasonography showed the contralateral ovary in 86.2% of patients, compared with 81.0% using transvaginal sonography (P = 0.51). In addition, laparoscopic ultrasonography was able to demonstrate the presence of residual ovarian tissue in the side affected pathologically in 76.5% of patients compared with 59.4% using transvaginal sonography (P < 0.005). Laparoscopic sonography allows more precise morphologic characterization of internal architecture and histologic diagnosis of adnexal lesions, but it is as yet unable to increase the diagnostic accuracy of borderline or malignant lesions, possibly due to the small sample size. Laparoscopic sonography is superior to transvaginal sonography in the evaluation of residual ovarian tissue in the side affected pathologically, which may help in surgical planning between cystectomy and oophorectomy, and also in the identification of the contralateral ovary, which may potentially increase the detection of bilateral pathologic conditions.

Adnexal Diseases↗
PubMed2004

Benefits and limitations of ultrasonographic evaluation of uterine adnexal lesions in early detection of ovarian cancer.

Ovarian cancer is the most frequent cause of death from gynaecological malignancies in the Western world. Most cases of epithelial ovarian cancer are detected at late stages and the resultant overall five-year survival is poor. However, when epithelial ovarian cancer is detected with the disease confined to the ovary the prognosis is favorable. Transvaginal gray-scale ultrasonography and colour Doppler assessment of blood flow have been evaluated as methods to predict risk of malignancy in ovarian tumours. In order to reduce the number of unnecessary surgical procedures for uterine adnexal tumours, ultrasonomorphologic scoring systems have been developed, assigning numerical ultrasonographic parameters of the tumours. However, the positive predictive value of these scoring systems is low and this is due to the fact that the appearance of many benign ovarian lesions overlaps with that of malignant disease. In addition, some ovarian malignancies are ultrasonographically detected as simple cysts without exhibiting a complex morphology. Moreover, the cut-off size of uterine adnexal tumours for surgical intervention in the early detection of cancer is not yet well determined. The application of colour blood-flow imaging is very helpful in the detection of uterine adnexal malignancy because of the presence of neovascularization in malignant tumours. When gray-scale ultrasonography detects the presence of septum or papillary projections or solid components in uterine adnexal lesions and Doppler flow is present within these lesions malignancy is likely. However, the detection of vascularity within the papillary projection of a malignant tumour may not be detected when it is very small. When colour-flow imaging is used in premenopausal patients attention is needed to avoid confusion of luteal flow with flow of cystic lesions. Initial reports using pulsed Doppler ultrasonography showed high sensitivity and specificity in the detection of ovarian cancer when levels of the resistive index (RI) less than 0.4 and levels of the pulsatility index (PI) less than 1 were used. Subsequent studies have shown considerable overlap of RI and PI rates between benign and malignant uterine adnexal masses, suggesting that pulsed Doppler ultrasonography is not an independent indicator for malignancy. Serum CA-125 levels have been used in conjunction with ultrasonography to identify as many of the false-positive results in order to avoid unnecessary surgery. In postmenopausal women with a uterine adnexal mass the combination of physical examination with serum CA-125 levels and pelvic ultrasound scan seems to improve the sensitivity and specificity of predicting adnexal malignancies. In contrast, in premenopausal women the consideration of CA-125 levels with Doppler ultrasonographic findings might confuse the differential diagnosis of ovarian masses. In conclusion, accurate selection of patients with uterine adnexal tumours for surgical intervention is not provided by pelvic ultrasonography. Pelvic ultrasonography as a screening method for the early detetection of ovarian cancer should be probably limited to those women who are at increased risk for development of ovarian cancer and not in the general population.

CA-125 Antigen↗
PubMed1999

Chemical analysis of adnexal cyst fluid.

OBJECTIVE: The purpose of the study was to determine if adnexal cyst fluid glucose, protein, and lactate dehydrogenase (LDH) levels can discriminate between cancerous and noncancerous adnexal masses. METHODS: Intracystic fluid was aspirated from adnexal masses immediately after operative excision. Patient age and menopausal status, mass size, and cyst fluid specific gravity were recorded. Cyst fluid and intraoperative serum glucose, protein, and LDH levels were measured. Masses were grouped by histopathologic diagnosis. Cyst fluid chemical levels and cyst fluid/serum ratios were compared among and between the groups. RESULTS: Fifty-eight adnexal masses were analyzed: 15 nonneoplastic (group 1), 23 benign neoplastic (group 2), and 20 malignant (group 3). There were no significant differences among the groups with regard to patient age, menopausal status, or cyst fluid specific gravity. Cyst size (cm2) was significantly different among the three groups (P < 0.01), with the largest mean size found in the cancer group. No significant differences in cyst chemistries or cyst fluid/serum ratios were found between groups 1 and 2. Comparing groups 1 and 3, all values were significantly different (P < 0.05), with the greatest level of significance attained by comparison of cyst fluid LDH levels (P < 0.001). Groups 2 and 3 statistically differed in cyst fluid levels and cyst fluid/serum ratios of both protein and LDH, with the highest levels of significance achieved by comparisons of cyst fluid levels and ratios of LDH (P = 0.001 and P < 0.001, respectively). The cyst fluid LDH level was found to be the best single chemistry for distinguishing noncancerous (groups 1 and 2) from cancerous (group 3) adnexal masses. A cyst fluid LDH level of >/=451 U/L imparted a 90% sensitivity and 71% specificity for detecting malignancy. CONCLUSIONS: Evaluation of adnexal cyst fluid LDH may help to distinguish benign from malignant adnexal masses. More cases are needed to adequately assess the predictive value and clinical utility of this approach.

Adnexal Diseases↗
PubMed2006

Adnexal torsion involving hydatids of Morgagni: a rare cause of acute abdominal pain in adolescents.

OBJECTIVE: Hydatids of Morgagni are common embryonal remnants of the müllerian duct and among the infrequent causes of adnexal torsion. The purpose of this study was to investigate the occurrence of adnexal torsion involving hydatids of Morgagni, as well as its possible mechanisms. METHODS: A database search was conducted for cases of adnexal torsion treated in our institution from January 2002 to July 2005. These cases were analyzed, focusing on a subgroup of adolescents with adnexal torsion involving the hydatids of Morgagni. RESULTS: There were 76 patients with adnexal torsion. The rate of hydatid of Morgagni torsion was 26% (4 of 15 cases, 95% confidence interval [CI] 0.15-0.51) in the adolescent subgroup (10-19 years old), compared with 0% (0 of 61 cases, 95% CI 0-0.048) in the adult subgroup. The difference between the hydatid torsion rates in the two subgroups was statistically significant (P = .01, 95% CI 0.001-0.532). The four patients with hydatid torsion (postmenarchal girls, aged 13-18 years) were managed with laparoscopic adnexal detorsion and cystectomy of the affected hydatid of Morgagni. At surgery, we noted three different mechanisms of hydatid torsion: torsion of the adnexa together with torsion of the hydatid of Morgagni, torsion of the hydatid of Morgagni with intact adnexa (n = 2), and entanglement of the hydatid's pedicle around the distal fallopian tube. The hydatids of Morgagni were observed on the preoperative transabdominal ultrasonogram in only one patient and appeared as a simple cyst. CONCLUSION: Adnexal torsion involving the hydatids of Morgagni appears to be more common in adolescents than previously thought. LEVEL OF EVIDENCE: III.

Abdominal Pain↗
PubMed1997

The frequency and significance of adnexal lesions incidentally revealed by CT.

OBJECTIVE: This paper describes the frequency of incidental adnexal findings revealed by routine CT scanning and determines the significance of these lesions in premenopausal and postmenopausal women, particularly in those with an already known malignancy other than ovarian carcinoma. MATERIALS AND METHODS: A computerized search of all radiology reports from 1992 identified 3448 women who underwent abdominopelvic or pelvic CT scans for an indication other than ovarian carcinoma or a known or suspected pelvic mass. Patients were divided into two subgroups: premenopausal and postmenopausal. CT reports were reviewed to identify patients with incidentally discovered adnexal lesions. Imaging characteristics and lesion size were recorded. To determine the significance of the lesions, we also reviewed clinical, radiologic, and histopathologic data. Lesions were judged to be benign on the basis of 12-month clinical follow-up, additional imaging that revealed stability or resolution, or histopathology. Lesions were judged to be malignant on the basis of progression of the lesion on subsequent imaging or histopathology. Lesions were classified as undetermined in patients with a serious or life-threatening illness who consequently underwent no further evaluation of the lesion. RESULTS: An incidental adnexal lesion was revealed by CT scanning in 168 cases (5%). Seventeen of these patients were lost to follow-up. Of the remaining 151 patients, 104 (69%) had incidental adnexal lesions that represented benign disease, 45 (30%) had undetermined lesions, and two (1%) had malignant lesions. In analyzing the two subgroups of patients, we determined that 56 (81%) of 69 premenopausal patients and 48 (59%) of 82 postmenopausal patients had benign adnexal lesions. On the basis of chart review, 67 patients had a known malignancy. Of these patients, 30 (46%) had benign adnexal disease, and 31 (48%) had undetermined findings. Four (6%) were lost to follow up, and the remaining two patients (3%) who were postmenopausal had metastatic disease of the ovaries. No primary ovarian malignancies were discovered incidentally in our study population. CONCLUSION: Our results indicate that in both premenopausal and postmenopausal women a significant proportion of adnexal lesions incidentally revealed on routine CT scanning are benign, even in women with known malignancies other than ovarian carcinoma.

Adnexal Diseases↗
PubMed2004

Uterine adnexal torsion: pathologic and gray-scale ultrasonographic findings.

INTRODUCTION: Uterine adnexal torsion is a rare and potentially lethal condition that may arise most unexpectedly in women of any age. It may be partial or complete, the later often resulting in necrosis, gangrene and peritonitis if untreated. The purpose of the study was to determine the spectrum of the histologic and gray-scale sonographic pictures in a series of surgically proven cases of uterine adnexal torsion. METHODS: The study population for the pathologic analysis of twisted uterine adnexa included 92 patients with surgical confirmation of torsion of the uterine adnexa; all the patients were treated radically. All the pathology records were reviewed retrospectively over a 10-year period (from 1992 to 2002) by the coding of ovarian, fallopian tube or adnexal torsion. The gray-scale sonographic findings were analysed in 20 patients who underwent sonographic examination before surgery and adnexal torsion was confirmed at surgery. RESULTS: Neoplasms constituted 46% (42/92) and cysts formed 48% (44/92) of all the twisted uterine adnexa. Normal-sized twisted adnexa were found in five patients (5%) while in one patient simultaneous torsion of both normal fallopian tubes was found (1%). The prevalence of the twisted neoplasms was 16 mature teratomas, nine serous cystadenomas, five mucinous cystadenomas, three serous borderline carcinomas, two fibroma/thecomas, two mucinous borderline carcinomas, two malignant granulosal-stromal cell tumours, one malignant dysgerminoma, one immature teratoma and one clear cell adenocarcinoma. The twisted cysts were 18 serous cysts, 11 paraovarian cysts, nine corpus luteum cysts, three hydrosalpinges, one mucinous cyst and one endometrioma. In one case the torsion of the right ovary was due to hyperstimulation of the ovaries with gonadotropin therapy for IVF treatment. Gray-scale sonographic examination demonstrated cystic lesions in 80% (16/20), solid masses in 5% (1/20) and normal adnexa in 15%; cul-de-sac fluid was present in 55% (11/20). Laparotomy revealed reactive cul-de-sac fluid in ten of these cases (50%) and haemoperitoneum in one (5%). CONCLUSION: Adnexal torsion is most commonly associated with benign processes (89%) and usually occurs in patients under 50 years old (80%). The spectrum of sonographic findings varies due to the adnexal pathology, the degree and the duration of adnexal torsion.

Adnexal Diseases↗