Kidney-tonifying and blood-activating in treatment of infertility due to pelvic inflammatory disease:clinical experience of Professor MA Kun / 中国中药杂志

Pelvic inflammatory disease(PID) has become one of the leading causes of female infertility, with an increasing incidence in recent years. Modern medicine believes that risk factors of PID will affect the formation of eggs and embryo implantation, especially on the encounter of gametes, fertilization, and transport of fertilized eggs to the uterine cavity. Therapies for infertility due to PID include medication, sonographic hydrotubation, surgery, and assisted reproductive technology. Professor Ma Kun believes that the disease is located in the uterus with appendages with the main pathogenesis of kidney deficiency and blood stasis. Blood stasis is the pathological basis, and kidney deficiency is the fundamental pathogenesis, which exhibits deficiency-excess in complexity. Kidney deficiency will cause blood stasis over time, while blood stasis will aggravate kidney deficiency in turn, making PID-induced infertility refractory. In clinical practice, basic therapies follow the principles of kidney-tonifying and blood-activating, removing blood stasis, dredging collaterals, and coordinating thoroughfare and conception vessels. The oral administration of Chinese medicine combined with enema, external application, and external washing displays better efficacy in improving the pelvic microenvironment and increasing the pregnancy rate and pregnancy success rate in the treatment of PID-induced infertility.

Absceso de tubo-ovárico causado por neumococo / Pneumococcal tube-ovarian abscess

Streptococcus pneumoniae es un patógeno habitual en infecciones del tracto respiratorio y representa la causa más frecuente de neumonía, otitis media y sinusitis. Excepcionalmente, y de forma transitoria, puede colonizar el tracto genital inferior y ser causa de enfermedad pélvica inflamatoria y peritonitis secundaria. El objetivo es presentar un caso con el diagnóstico de absceso tubo-ovárico izquierdo con un germen poco común en esta localización. Se presenta el caso de una paciente de 52 años, histerectomizada desde hace 12 años con una inmunodepresión secundaria como factor predisponente para el desarrollo de esta complicación. Se realizó laparotomía y se realizó exéresis de la tumoración y el cultivo microbiológico del contenido de ella. Se diagnosticó una infección por Streptococcus pneumoniae. La evolución posoperatoria fue satisfactoria(AU)

Streptococcus pneumoniae is a common pathogen in respiratory tract infections and the most common cause of pneumonia, otitis media, and sinusitis. Exceptionally, and transiently, it can colonize the lower genital tract causing pelvic inflammatory disease and secondary peritonitis. The objective is to present a case with left tube-ovarian abscess diagnosis, with a rare germ at this location. The case of a 52-year-old patient is reported here. She was hysterectomized 12 years before with secondary immunosuppression as a predisposing factor for developing this complication. A laparotomy was performed and excision of the tumor and microbiological culture of the contents of the tumor were completed. Streptococcus pneumoniae was diagnosed. Postoperative evolution was satisfactory(AU)

Infección del tracto genital superior femenino: revisión pictográfica por tomografía computada según clasificación clínica / Infection of the female upper genital tract: pictorial review by computed tomography according to clinical classification

La infección del tracto genital superior (ITGS) femenino o enfermedad inflamatoria pélvica (EIP) comprende una serie de condiciones inflamatorias del tracto reproductivo femenino. La presentación clínica es variada y la mayoría se presenta como un dolor abdominal de cuadrantes inferiores o dolor pélvico, pudiendo ser incluso difuso y muchas veces manifestarse como un dolor abdominal agudo de difícil diagnóstico. Las formas de presentación clínica y el compromiso anatómico son variados. En 1982 Monif diseñó una clasificación que se basa en el compromiso anatómico de las estructuras afectadas, desde una infección localizada como salpingitis, hasta cuadros más graves con riesgo vital como un absceso tubo oválico (ATO) roto. Las imágenes junto a la clínica forman un pilar fundamental para el diagnóstico y así definir una conducta terapéutica. En el siguiente artículo se presenta una serie de casos con sus principales hallazgos a la tomografía computada (TC) clasificados por los estadios de Monif.

Abstract: Upper genital tract infection (UGTI) or female pelvic inflammatory disease (PID) comprises a number of inflammatory conditions of the female reproductive tract. The clinical presentation is varied and most occur as a lower quadrant abdominal pain or pelvic pain, and may even be diffuse and often manifest as an acute abdominal pain difficult to diagnose. The clinical presentation and anatomic involvement are varied. In 1982 Monif designed a classification based on the anatomical commitment of the affected structures, from a localized infection such as salpingitis, to more serious conditions such as life-threatening ruptured tubo-ovarian abscess (TOA). Images together with case history form a fundamental basis for the diagnosis and so define therapeutic management. In the following article a series of cases are presented with their main findings to the computed tomography (CT) classified according to Monifs staging.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Differential usefulness of pelviscopy for PID: 4 cases of acute appendicitis / 대한산부인과학회지

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.

Clinical review of 40 cases of Fitz-Hugh-Curtis syndrome incidentally found by laparoscopy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyse the characteristics, severity of Fitz-Hugh-Curtis syndrome (FHCS), pelvic adhesions and hematologic findings of incidentally founded FHCS in laparoscopy. METHODS: We retrospectively reviewed the medical records of 40 patients incidentally found laparoscopically as FHCS at the department of obstetrics and gynecology of Yeungnam University Hospital from Jan. 2001 to Dec. 2006. Severity of FHCS and pelvic adhesions were classified and characteristics of patients, hematologic findings, past medical histories and symptoms after surgery were analysed. RESULTS: The ages of the cases varied between 16 and 65 years old. Mean age of cases was 32.9 years. Indications of surgery were uterine myoma, benign adnexal mass, ectopic pregnancy, endometriosis, chronic pelvic pain and pelvic tuberculosis. From this study we can notice that FHCS can be found out most frequently in the patient with pelvic inflammatory disease (PID). Past medical history were pelvic inflammatory disease, ectopic pregnancy, abdominal surgery and pelvic tuberculosis. 17 patients had been suffered from RUQ pain and 10 patients (58.8%) were in good health after adhesiolysis. CONCLUSION: Laparoscopy is a confirmative tool in the diagnosis of FHCS. Direct observation of perihepatic space is the most definitive method of diagnosing this syndrome. From our study, we can find that FHCS can be diagnosed frequently in the patient with pelvic inflammatory disease, ectopic pregnancy and pelvic tuberculosis. So, We recommend that investigating the perihepatic space during surgery is a good treatment especially in patients with PID, vague abdominal discomfort and pains.

Clinical review of 40 cases of Fitz-Hugh-Curtis syndrome incidentally found by laparoscopy / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyse the characteristics, severity of Fitz-Hugh-Curtis syndrome (FHCS), pelvic adhesions and hematologic findings of incidentally founded FHCS in laparoscopy. METHODS: We retrospectively reviewed the medical records of 40 patients incidentally found laparoscopically as FHCS at the department of obstetrics and gynecology of Yeungnam University Hospital from Jan. 2001 to Dec. 2006. Severity of FHCS and pelvic adhesions were classified and characteristics of patients, hematologic findings, past medical histories and symptoms after surgery were analysed. RESULTS: The ages of the cases varied between 16 and 65 years old. Mean age of cases was 32.9 years. Indications of surgery were uterine myoma, benign adnexal mass, ectopic pregnancy, endometriosis, chronic pelvic pain and pelvic tuberculosis. From this study we can notice that FHCS can be found out most frequently in the patient with pelvic inflammatory disease (PID). Past medical history were pelvic inflammatory disease, ectopic pregnancy, abdominal surgery and pelvic tuberculosis. 17 patients had been suffered from RUQ pain and 10 patients (58.8%) were in good health after adhesiolysis. CONCLUSION: Laparoscopy is a confirmative tool in the diagnosis of FHCS. Direct observation of perihepatic space is the most definitive method of diagnosing this syndrome. From our study, we can find that FHCS can be diagnosed frequently in the patient with pelvic inflammatory disease, ectopic pregnancy and pelvic tuberculosis. So, We recommend that investigating the perihepatic space during surgery is a good treatment especially in patients with PID, vague abdominal discomfort and pains.

A Case Report of Fitz-Hugh-Curtis Syndrome due to Chlamydia in 19-year-old Woman

Fitz-Hugh-Curtis syndrome (FHCS)-inflammation of the liver capsule (Perihepatitis) associated with genital tract infection-occurs in 4~14% of patients with pelvic inflammatory disease (PID). Generally presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis. It needs differential diagnosis such as cholecystitis, pyelonephritis. The pathogenesis of FHCS is incompletely understood. But Neisseria gonorrhoeae and Chlamydia trachomatis are thought to be the primary causative germs of FHCS. We make a report about FHCS in 19-year-old woman who had been sexual history recently.

Chlamydia trachomatis Antibody in Fitz-Hugh-Curtis Syndrome / 대한진단검사의학회지

BACKGROUND: Fitz-Hugh-Curtis (FHC) syndrome is inflammation of the liver capsule associated with pelvic inflammatory disease. We measured Chlamydia trachomatis antibodies in 30 female patients with acute abdominal pain for diagnosis of FHC-syndrome, and the results were compared with other tests. METHODS: A dual-polymerase chain reaction was used for the detection of C. trachomatis in the cervix, and a micro-immunofluorescence test was performed to measure the antibody to C. trachomatis in serum. Cervical specimens were stained with Gram stain and cultured on chocolate agar for detection of Neisseria gonorrhoeae, and abdominal computed tomography (CT) and pelvic examinations were performed. RESULTS: Of the 30 patients examined, 19 were diagnosed as having FHC-syndromes and 11 abdominal pains without FHC-syndrome. C. trachomatis was detected from one of the five patients studied, and no N. gonorrhoeae was isolated from the patients with FHC-syndrome. High titers of IgG antibody (1:512-1:1,024) to C. trachomatis were demonstrated in all patients with FHC-syndrome. The CT scan revealed perihepatitis in 14 patients with FHC-syndrome. CONCLUSIONS: All patients with FHC-syndrome are associated with C. trachomatis infections, and a high titer of C. trachomatis antibody (IgG) is a very useful marker for FHC-syndrome.

Leukocytes and lactobacilli of vaginal discharge as a predictor of pelvic inflammatory disease / 대한산부인과학회지

OBJECTIVE: We performed this study to evaluate whether the vaginal polymorphonuclear leukocytes and few lactobacilli on microscopic evaluation of a saline wet preparations would be associated with pelvic inflammatory disease (PID) in Korean women. MATERIALS AND METHODS: We performed a cross-sectional study of 556 women between 16 and 78yrs of age from May 2001 to May 2003. Wet-mount microscopic examination of vaginal discharge was done on all patients. Positive vaginal polymorphonuclear leukocytes was defined as more than 10 white blood cells per high-power field on microscopic examination, and few lactobacilli was defined as less than 30 per high-power field on microscopic examination. The diagnosis of PID was relied on the minimal criteria delineated by the Centers for Disease Contral and Prevention, elevated CRP or ESR and positive anaerobic cultures. RESULTS: On univariate analysis, positive vaginal polymorphonuclear leukocytes and few lactobacilli were associated with PID, but age (less than 25) and marital status were not. On multivariate analysis using multiple logistic regression, odds ratios of positive vaginal polymorphonuclear leukocytes and few lactobacilli for PID were 5.995 (95%CI: 3.056-11.761) and 24.39 (95%CI: 10.989-55.556) respectively. The sensitivity and negative predictive value of positive vaginal polymorphonuclear leukocytes or few bacilli for predicting PID were 90.6% and 94.42% respectively. CONCLUSION: Positive vaginal polymorphonuclear leukocytes and few lactobacilli were strongly associated with PID. Positive vaginal polymorphonuclear leukocytes and few lactobacilli have a high sensitivity and negative predictive value for predicting PID. Therefore the existence of vaginal polymorphonuclear leukocytes and few lactobacilli are thought hereafter to be useful marker to diagnose PID.

Serodiagnosis of Chlamydia trachomatis infections by the micro-immunofluorescence test / 대한임상병리학회지

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is an obligatory intracellular parasite which causes trachoma, inclusion conjunctivitis, pneumonia in infants, nongonococcal urethritis, epididymitis, cervicitis, and salpingitis. Salpingitis frequently produces tubal damage and infertility. The micro-immunofluorecence (MIF) test is the standard method for chlamydial serology and is highly sensitive and specific. This study aimed to evaluate the prevalence of C. trachomatis antibodies in healthy individuals and patients with various diseases as well as the clinical value of chlamydial serology by MIF testing. METHODS: A total of 692 serum samples were collected. Of these, 388 samples were obtained from healthy individuals (male 209, female 179). Cord blood samples were collected from 38 healthy babies. Serum samples of 53 female patients with infertility due to PID (group 1), 107 patients with respiratory diseases (group 2; pneumonia, bronchitis, etc.), and 106 patients with cardiovascular diseases (group 3; angina pectoris, acute myocardial infarction, etc.) who were admitted to Hanyang University Hospital from March 1995 to June 1998 were enrolled in this study. Serological diagnosis of a previous infection was made when IgG antibody titers to C. trachomatis were 1:32 or higher. A single titer of antibody of > or =1:512 for IgG or > or =1:16 for IgM was considered to indicate a recent infection. RESULTS: The IgG antibody detection rate in healthy individuals was 27%, broken down by age as follows: or =61 years old, 24%. For cord blood, the antibody was detected in 29% of the samples. There were 1 case (0.3%) of recent infection with C. trachomatis by IgG, and 6 cases (1.5%) for IgM. The incidence of IgG antibodies to C. trachomatis in the disease group was 70%, 28%, and 19% for group 1, group 2, and group 3, respectively. There were 3 cases of recent infection detected by IgG and 4 cases by IgM in group 1. Recent infection with C. trachomatis was detected by IgG in 1 case of group 2 and by IgM in another case of group 3. CONCLUSIONS: In healthy individuals, the prevalence of antibodies to C. trachomatis was highest in those between the ages of 21-40 years. Patients with infertility due to PID showed a significantly higher positive rate (P=0.000 by Chi-square test) and more cases of recent infection to C. trachomatis than others. The results suggest that a positive chlamydial serology indicates a higher risk for infertility due to PID.