A study on histopathological changes in ectopic tubal gestation

Background: Ectopic pregnancy is a serious cause of maternal morbidity and mortality. Fallopian tube is the most common site. Ectopic pregnancy is often the consequence of chronic salpingitis. The aim of the study was to identify the various histopathological changes in the fallopian tube, which are removed following an ectopic tubal gestation. The prevalence of various risk factors in ectopic tubal pregnancy was also investigated.Methods: This descriptive study included 160 cases of ectopic tubal gestation received in the department during the study period. Slides were studied for various changes like chronic salpingitis, acute salpingitis, salpingitis isthmica nodosa, endometriosis, tuberculosis etc. Patient’s clinical details were obtained from the medical records.Results: The most frequent pathological finding was chronic salpingitis followed by salpingitis isthmica nodosa. It was noted that all cases with a positive history of pelvic inflammatory disease (PID), showed evidence of chronic salpingitis during histopathological examination. Chronic salpingitis was also noted in 45% cases who did not give a history of PID. Among the risk factors, a history of tubal sterilization was the most frequent one.Conclusions:Even though the mortality has reduced, ectopic pregnancy causes significant morbidity and affects the fertility of women. The rise in incidence could be due to increase in prevalence of sexually transmitted diseases, increase in tubal sterilization practices and frequent use of assisted reproduction technology. Itis evident from the study that many cases of PIDs are left unidentified.

Informe de caso: enfermedad pélvica inflamatoria como complicación de la apendicitis aguda / Case report. Pelvic inflammatory disease as a complication of acute appendicitis

RESUMEN Introducción: la apendicitis aguda es causa frecuente de dolor abdominal. Su complicación más frecuente es la infección del sitio operatorio, siendo el compromiso pélvico muy raro. Presentamos el caso de una paciente sin vida sexual activa, con una enfermedad pélvica inflamatoria como complicación posoperatoria de una apendicitis aguda. Esta ingresó por dolor abdominal, varias semanas después de una apendicetomía, sin signos de infección incisional, pero con una tomografía que reportaba un hidrosalpinx izquierdo. Evolucionó hacia el deterioro clínico a pesar de la reanimación con cristaloides y antibióticos de amplio espectro. Fue llevada a laparotomía para control del foco. Se encontró un hidrosalpinx izquierdo y necesitó de una segunda cirugía por el compromiso anexial derecho. Luego de estas intervenciones hubo recuperación. Conclusión: la enfermedad pélvica inflamatoria es una etiología poco frecuente (aunque posible) de abdomen agudo en pacientes sin vida sexual activa.

SUMMARY Introduction: Acute appendicitis is a frequent cause of abdominal pain and its most frequent complication is surgical site infection, with pelvic involvement being very rare. The following is a case of a patient with pelvic inflammatory disease as postoperative complication after appendectomy. The patient was admitted for abdominal pain several weeks after an appendectomy, without signs of incisional surgical site infection but with a CT scan that re-ported a left hydrosalpinx. The patient progresses with clinical deterioration despite resuscitation with crystalloids and broad-spectrum antibiotics. A laparotomy was performed for infection control. A left hydrosalpinx was found and needed a second surgery due to right adnexal involvement. After this she recovered. Conclusion: Pelvic inflammatory disease is a rare but possible etiology of the acute abdomen in patients who's never had sexual intercourse.

Xanthogranulomatous salpingo-oophoritis: a case report and review of literature

Xanthogranulomatous inflammation of ovary is a rare disease that is characterized by presence of large number of lipid laden macrophages with an admixture of neutrophils, lymphocytes, plasma cells and multinucleated giant cells. It is misdiagnosed as ovarian tumour that leads to extensive surgery including hysterectomy. In this report we describe a case of Xanthogranulomatous salpingo-oophoritis along with review of literature.

Comparative evaluation of tubal patency by hysterosalpingography and laparoscopic chromopertubation

Background: Infertility is defined as one year of unprotected intercourse without pregnancy, primary in which no previous pregnancies have occurred and secondary in which a prior pregnancy not necessarily a live birth has occurred. The objective of the study was to compare the relative efficacy of hysterosalpingography (HSG) and laparoscopy with chromopertubation in the diagnosis of tubal factors in infertile women.Methods: 90 infertile women attending the infertility clinic at Dharmapuri Medical College and Hospital were selected for this study. The study period was from April 2016 to July 2017 these patients were initially counseled along with their partners and a thorough history of both the partners was obtained followed by a general and pelvic examination of female partners.Results: HSG results indicated that 48 patients had tubal pathology and 11 patients had uterine pathology. Of those 11 patients with uterine pathology, 6 patients with synechiae had both tubal and uterine pathology. The remaining 5 had only uterine pathology and tubes were patent in them. The site of tubal occlusion in all those blocked tubes shows that more number of the tubal blockage was seen in mid segment of the tube (24 cases) followed by the fimbrial block in 16 cases. Diagnostic laparoscopy with chromopertubation was performed in all 90 patients and the findings were recorded.Conclusions: HSG has reasonably good sensitivity and specificity in diagnosing tubal pathology of infertile women. But given the high rate of false-positive diagnosis of tubal pathology (29%) in HSG, a follow-up laparoscopy is warranted.

A study of tubal ectopic pregnancy based on the histopathology of fallopian tubes in the age group of 20-35 years

Purpose: Ectopic pregnancy is a life-threatening condition for the mother. Disruptions of the fallopian tube are considered to be important in its pathogenesis. The present study was conducted to observe the histopathology of this dreaded disease which could lead to the development of suitable remedies. Methods: Cases diagnosed with ectopic gestation in the fallopian tube who subsequently underwent salpingectomy were considered for the study. Histopathology of sections from the affected fallopian tubes was studied under the light microscope after staining with H and E. Results: Most cases presented with amenorrhoea, whereas others had dysmenorrhoea, menorrhagia, and menometrorrhagia. Histopathologic findings included the presence of salpingitis (acute and chronic), calcification, sclerosed vessel and. Conclusion: Past history of inflammatory diseases, especially PID plays an important role in the subsequent development of ectopic pregnancy. Its prevention and treatment can lead to a decrease in the incidence of ectopic pregnancy.

Esterilidade por salpingite e tratamento homeopático com nosódio: relato de caso / Sterility caused by salpingitis and nosode homeopathic treatment: case report

A infertilidade em casais frequentemente é multifatorial. Dentre elas alterações tubárias respondem por até 20% dessa causalidade, sendo a histerossalpingografia o exame de escolha para verificarem alterações em sua anatomia, orientando desde a opção por tratamentos mais conservadores até mesmo a salpingectomia com posterior fertilização in vitro. O relato de caso em questão trata de uma mulher que já se encontrava em tratamento para fertilidade há 3 anos e, antes da cirurgia definitiva, optou por buscar o tratamento homeopático como alternativa. Após repertorização chegou-se ao medicamento Sycotic co, um nosódio preparado com Entercococcus faecalis, agente que é um dos principais responsáveis por doenças inflamatórias pélvicas que, por sua vez, encontram-se na etiologia das salpingites. Após trinta dias de utilização a paciente consegue engravidar, demonstrando possivelmente que o organismo recuperou sua capacidade autopoiética (regenerativa) frente ao estímulo ocasionado pela medicação homeopática, embasando novos ensaios capazes de trazer maiores evidências da utilização da homeopatia como possibilidade no tratamento adjuvante da infertilidade. (AU)

Infertility in couples is often multifactorial. Tubal disorders account for up to 20% of causes, and hysterosalpingography is the test of choice to investigate anatomical changes, which orient the option for more conservative treatments or salpingectomy with subsequent in vitro fertilization. The present case report concerns a woman under fertility treatment for 3 years, but choose to seek homeopathic treatment before final surgery. Repertory analysis led to the selection of Sycotic co, a nosode prepared from Enterococcus faecalis, which is one of the main responsible pathogens associated with pelvic inflammatory disease, which is one of the causes of salpingitis. After 30 days of treatment, the patient became pregnant, which possibly shows that her body had regained its autopoietic (regenerative) ability against the stimulus represented by homeopathic medication. These findings support the need to perform new studies to gather further evidence of the use of homeopathy as possible adjuvant treatment for infertility. (AU)

Abdominal and pelvic actinomycosis due to longstanding intrauterine device: a slow and devastating infection

Actinomycosis is a chronic or subacute bacterial infection characterized by large abscess formation, caused mainly by the gram-positive non-acid-fast, anaerobic, or microaerophilic/capnophilic, obligate parasites bacteria from the genus. Although pelvic inflammatory disease is an entity associated with the longstanding use of intrauterine devices (IUDs), actinomycosis is not one of the most frequent infections associated with IUDs. We present the case of a 43-year-old female patient who was referred to the emergency facility because of a 20-day history of abdominal pain with signs of peritoneal irritation. Imaging exams revealed collections confined to the pelvis, plus the presence of an IUD and evidence of sepsis, which was consistent with diffuse peritonitis. An exploratory laparotomy was undertaken, and a ruptured left tubal abscess was found along with peritonitis, and a huge amount of purulent secretion in the pelvis and abdominal cavity. Extensive lavage of the cavities with saline, a left salpingo-oophorectomy, and drainage of the cavities were performed. The histopathological examination of the surgical specimen revealed an acute salpingitis with abscesses containing sulfur granules. Therefore, the diagnosis of abdominal and pelvic actinomycosis was made. The postoperative outcome was troublesome and complicated with a colocutaneous fistula, which drained through the surgical wound. A second surgical approach was needed, requiring another extensive lavage and drainage of the recto-uterine pouch, plus the performance of a colostomy. Broad-spectrum antibiotics added to ampicillin were the first antimicrobial regimen followed by 4 weeks of amoxicillin during the outpatient follow-up. The patient satisfactorily recovered and is already scheduled for the intestinal transit reconstitution.

Histological Patterns in Fallopian Tube Pathology - A Retrospective Study of 200 Consecutive Cases.

The present study was undertaken to evaluate the histological patterns in the various pathological lesions of the fallopian tube. Histology slides of 200 gynaecological specimens containing one or both the fallopian tubes were studied retrospectively and the morphological patterns observed in different tubal pathologies were documented. Tubal pathology was observed in 31% (62/200) of the cases studied. Salpingitis, accounting for 12% (24/200) of the cases was the most common lesion followed by ectopic tubal gestation (10.5%), paratubal cysts (4%), haematosalpinx (1.5%), endometriosis (1%) and torsion of the tube (1%) in decreasing order of frequency. No primary neoplasm of the fallopian tube was observed, however, there were two cases of secondary involvement of the tube by a dysgerminoma ovary and a squamous cell carcinoma of the cervix respectively. Fallopian tubes are primarily involved by inflammatory pathology which manifests either as infertility or as ectopic tubal pregnancy. Recently, the fimbrial end of the tube has been recognized as the site of origin of high grade serous ovarian and peritoneal cancers. Hence, a thorough examination of the fallopian tubes in each gynaecologic specimen is essential for early detection and treatment of these conditions.

The establishment of chronic salpingitis model of New Zealand rabbits caused by Escherichia coli / 中国比较医学杂志

Objective To investigate the possibility of utilizing the mixed bacteria liquid and the Escherichia coli ( E.coli) liquid to establish the chronic salpingitis model of New Zealand rabbits, respectively.Methods Taken as the study object, the un-pregnant New Zealand rabbits (4~5 years old) were randomly divided into three groups: the normal group, the mixed bacteria experimental group and the E.coli experimental group.The trans-vaginal intrauterine intubation operation was performed for the injection of the mixed bacteria liquid and the E.coli liquid.Visual observation was to evaluate the gross pathological changes of the salpingitis and the pelvic cavity.HE staining and the light microscope were used to observe the micro-pathological changes of salpingitis.Results On the 15th day after modeling, increased pelvic effusion, dense peritoneal adhesion, interstitial hyperplasia and infiltration of lymphocytes were observed in both experimental groups. Conclusion Through the trans-vaginal intrauterine intubation operation, the chronic salpingitis model of New Zealand rabbits could be successfully established either by using the mixed bacteria liquid or by using the E.coli liquid.

Late puerperal sepsis, case report and literature review / Caso clínico y revisión de la literatura sepsis puerperal tardía

A case of extremely rare puerperal sepsis is presented in this paper. Postpartum infection is an entity given in between 0.1% and 10% of postpartum patients and has a mortality rate ranging from 2% to 11%. In this case report, a primigravida patient, age 19, presented hypogastric pain, emesis and fever five days after delivery. Postpartum endometritis and retained products of conception were diagnosed; uterine curettage was performed and antibiotic treatment was formulated with satisfactory outcome. The patient was discharged on the fourth day. The patient was readmitted 27 days after delivery with hypogastric persistent pain and fever, vomiting, hypotension and pulmonary dysfunction; gynecological examination showed findings consistent with salpingitis and a laparotomy was performed to confirm the diagnosis, finding salpingitis along with pelvic peritonitis. An intravenous antibiotic treatment, laparotomy and peritoneal washings were provided with satisfactory evolution. The literature on puerperal sepsis, myometritis and postpartum salpingitis is reviewed because, in order to improve morbidity and mortality, timely diagnosis and treatment are determining.

Se presenta un caso de sepsis puerperal de evolución poco frecuente. La infección pos-parto es una entidad que se da entre el 0.1% y 10% de las pacientes en posparto y tie-ne una mortalidad que varía del 2% al 11%. En este reporte de caso, se presenta una paciente primigestante de 19 años, quién a los cinco días posparto presenta cuadro de dolor en hipogastrio, emesis y fiebre. Se diagnostica endometritis posparto y reten-ción de restos, se realiza legrado uterino y se le formula tratamiento antibiótico con evolu-ción satisfactoria y salida al cuarto día. La paciente reingresó a los 27 días pos-parto con dolor en hipogastrio y fiebre, persis-tencia del dolor, vómito, hipotensión y disfun-ción pulmonar; el examen ginecológico arrojó hallazgos compatibles con salpingitis, por lo que fue llevada a laparotomía confirmándose el diagnóstico de salpingitis con pelvi-perito-nitis. Se comenzó tratamiento antibiótico intra-venoso, laparostomía y lavados peritoneales con evolución satisfactoria. Para mejorar la morbimortalidad, es im-portante un diagnóstico y tratamiento oportu-no, por lo cual se revisa la literatura de sepsis puerperal, miometritis y salpingitis posparto.

Salpingite istmica nodosa: revisão e diagnóstico histerossalpingográfico de 4casos de uma clinica radiológica privada / Salpingitis isthmica nodosa: review and hysterosalpingography diagnosis of 4 cases in a private radiology clinic

Objetivo: identificar os achados radiológicos da salpingite ístmica nodosa (SIN) a partir da histerossalpingografia e avaliar o local de comprometimento e sua repercussão na infertilidade. Métodos: em estudo retrospectivo foram revistos 2.800 protocolos, realizadas entre janeiro de 1987 e janeiro de 1997, em pacientes com história clínica de infertilidade feminina, tendo quatro com diagnóstico radiológico de SIN, sendo analisados etnia, idade, estado civil, queixa clínica atual, antecedentes clínicos, local e o lado do comprometimento. Resultados: entre as quatro pacientes com SIN, três eram melanodérmicas e uma caucasiana, com idade média de 35 anos na época do diagnóstico, duas solteiras, uma casada e uma divorciada. As queixas de infertilidade secundária estavampresentes em três pacientes com antecedentes de gravidez tubária prévia e outro de infertilidade primária, sem antecedentes de gravidez. Nas quatro pacientes com SIN, a porção tubária acometida foi a ístmica cornual, tubário bilateral em três e unilateral em uma. Em relação à peritonização, uma apresentava prova de Cotté positiva bilateral, duas com obstrução completa bilateral e uma com Cotté positiva em uma das tubas.Conclusão: SIN é mais frequente em pacientes melanodérmicas, na faixa etária média de 35 anos, com história clínica de infertilidade, de gravidez tubária inicial e recorrente e consequente obstrução tubária caracterizada por lesão na porção ístmica cornual da tuba uterina, geralmente de comprometimento bilateral.

Objective: to identify the radiological findings of salpingitis isthmica nodosa (SIN) through hysterosalpingography and evaluate the site of involvement and its impact on infertility. Methods: 2,800 protocols were reviewed in a retrospective study between January of 1987 and January of 1997, in patients with a clinical history of female infertility; four of them with a radiological diagnosis of SIN. Ethnicity, age, marital status, current clinical complaints, medical history, location, and side of involvement were analyzed. Results: among the four patients with SIN, three were dark-skin, and one was Caucasian, with an average age of 35 years at diagnosis, two single, one married, and one divorcee. Three patients presented complaints of secondary infertility with previous tubal pregnancy history, and another with primary infertility without pregnancy history. In the four patients with SIN, the tubal portion affected was the cornual isthmian, bilateral tubal in three, and unilateral in one. Regarding peritonization, one showed positive bilateral Cotte proof, two with complete bilateral obstruction, and one with positive Cotte in one of the tubes. Conclusion: SIN is more common in dark-skin patients, in the mean age of 35 years, with a clinical history of infertility, with initial and recurrent tubal pregnancy, and subsequent tubal obstruction characterized by lesion in the Isthmian cornual portion of the fallopian tube, usually with bilateral involvement.

MRI diagnosis of the hydrosalpinx and the clinical application value / 实用放射学杂志

Objective To analyze the MRI features of hydrosalpinx and to investigate its clinical value.Methods MRI and ultrasound manifestations in 40 patients with hydrosalpinx in 53 fallopian tubes confirmed by operative and pathological findings were analyzed retrospectively,and these findings were also compared with the results of aparoscopy and pathology.Results Among 53 fallopian tubes with hydrosalpinx,bilateral tubes in 13 patients and 27 unilateral tubes in other patients were found.The tubes were botuliform in 32, retort-shaped in 1 6,pouch-shaped in 5.Incomplete separation of the lumen were found in 1 9.In 9 patients with acute salpingitis,1 5 tubes were found with empyema and expansion.In other 31 patients with chronic salpingitis,38 tubes were with hydrops and expansion,14 of whom were with hematocele.The sensibilities of MRI and ultrasound diagnosis for hydrosalpinx were 94.3%(50/53)and 88.7%(47/53)with no statistical differences(P >0.05),however the specificitis were 90.6%(48/53)and 77.6%(41/53)with obvious statistical differences(P <0.05).Conclusion The locating and qualitative diagnosis of MRI for hydrosalpinx is superior to ultrasound.MRI can discriminate the quality of cyst fluid and thus can definitely diagnose the hydrosalpinx caused by acute or chronic salpingitis.

Salpingite ístmica nodosa: diagnóstico histerossalpingográfico de uma causa de infertilidade / Isthmian nodosa salpingitis: histero-salpingography diagnosis of an infertility cause

Objetivo: demonstrar os achados da salpingite ístmica nodosa (SIN) por meio da histerossalpingografia e avaliar o local de comprometimento e sua repercussão na infertilidade feminina. Paciente e Métodos: em estudo retrospectivo foram revistas 2.800 histerossalpingografias realizadas entre janeiro de 1987 e janeiro de 2007 em pacientes com história clínica de infertilidade feminina. Destas, quatro pacientes apresentavam diagnóstico radiológico de SIN, sendo analisados seus principais aspectos radiográficos, como também os locais de comprometimento e suas repercussões na infertilidade. Resultados: das quatro pacientes em que foi encontrada a doença estudada a partir da investigação histerossalpingográfica da infertilidade, três tinham antecedentes de gravidez tubária, todas com comprometimento ístmico cornual, sendo três delas de comprometimento bilateral e uma unilateral. Uma delas apresentava prova de Cotté positiva bilateral, duas com prova de Cotté negativa bilateral e uma com tuba direita positiva e esquerda negativa. Conclusão: o diagnóstico da SIN é feito com base na histerossalpingografia, caracterizada pelo acúmulo do meio de contraste na parede tubária, distribuída na porção ístmica cornual ou ampolar, uni ou bilateralmente, acompanhado de história clínica de infertilidade, gravidez tubária, abortamento espontâneo e obstrução tubária.

Objective: to demonstrate the findings of isthmian nodosa salpingitis (SIN) through histero-salpingography and evaluate the site of involvement and its impact on female infertility. Patients and Methods: a total of 2,800 histero-salpingographies were reviewed in a retrospective study between January of 1987 and January of 2007 in patients with a clinical history of female infertility. Of these, four patients presented radiological diagnosisof SIN; their main radiographic aspects, sites of involvement, and impact on infertility were analyzed. Results: out of the four patients in which the studied disease was found through the histero-salpingography infertility research, three had a history of tubal pregnancy, all with cornual isthmian involvement; bilateral in three of them and unilateral in one. One of them showed evidence of positive bilateral Cotté, two showed evidence ofnegative bilateral Cotté, and one bilateral with right positive tubal and left negative tubal. Conclusion: the diagnosis of SIN is achieved based on histero-salpingography, characterized by the accumulation of contrast medium on the tubal wall, distributed in the cornual or ampolar isthmian portion, uni- or bilaterally, and accompanied by clinical history ofinfertility, tubal pregnancy, spontaneous abortion, and tubal obstruction.

Ectopic Pregnancy Complicating Tuberculous Salpingitis.

Genital tuberculosis contributes to infertility in a significant proportion of females in developing countries. Although tuberculous salpingitis is not infrequent, it is rarely associated with pregnancy. We present here a case of special interest and rarity of a 27 year old female presenting with ruptured tubal ectopic pregnancy complicating tuberculous salpingitis.

Enfermedad inflamatoria pélvica: un reto en el diagnóstico y tratamiento precoz / Pelvic inflammatory disease: a challenge in the early diagnosis and treatment

Actualizar los datos disponibles en referencia a la enfermedad inflamatoria pélvica para poder unificar criterios diagnósticos y terapéuticos y así minimizar las complicaciones que a corto y/o largo plazo puedan derivar. Método: Revisión de la literatura en Pubmed atendiendo sobre todo a las guías clínicas más actualizadas y ensayos clínicos aleatorizados. Resultados: La enfermedad inflamatoria pélvica es un cuadro infeccioso común entre las mujeres en edad fértil. Su mecanismo de transmisión más frecuente es la vía sexual y comparte factores de riesgo con otras enfermedades de transmisión sexual. Su diagnóstico, que es clínico, puede ser complejo y las formas subclínicas pueden pasar en ocasiones inadvertidas. Generalmente se puede comenzar con un tratamiento médico ambulatorio siguiendo las pautas recomendadas, y si la paciente no mejora o presenta un cuadro grave de inicio se indicará ingreso hospitalario y tratamiento médico endovenoso, reservando la cirugía para aquellos casos rebeldes en que fracasen los pasos anteriores. Conclusión: Es imprescindible reconocer esta entidad e instaurar el tratamiento antibiótico precoz, un retraso en el tratamiento adecuado, puede incrementar las secuelas inflamatorias a corto y largo plazo.

Update the pelvic inflammatory disease to standardize diagnostic and therapeutic criteria and to minimize its complications in the short and/or long term. Method: Search in Pubmed with especial attention to clinical guidelines and randomized clinical trials. Results: Pelvic inflammatory disease is a common infectious condition among women of fertile age. Its mechanism is the most common sexually transmitted shared risk factors and other sexually transmitted disease. Its clinical diagnosis can be complex and subclinical forms can sometimes go unnoticed. Usually it's indicated to start with medical treatment following the recommended guidelines, and if the patient does not improve or has a severe case, hospitalization and intravenous medical treatment is indicated, reserving surgery for those cases in which fail the above steps. Conclusion: It is essential to recognize this entity and establish early antibiotic treatment, so that a delay in appropriate antibiotic treatment, can lead to an increase in inflammatory short and long term sequelae.

Clinical analysis of 12 cases of gynecological infections acute abdomen misdiagnosed as acute suppurative appendicitis / 中国基层医药

Objective To explore the reasons of gynecological infections acute abdomen misdiagnosed as acute suppurative appendicitis and put forward methods to reduce the misdiagnosis.Methods To review and analyze the clinical data of 12 patients with gynecological infectious who had been misdiagnosed as acute suppurative appendicitis.Results The acute pyogenic pelvic inflammatory disease in 6 cases,right salpingitis and empyema in 3 cases,ovarian cysts in 3 cases.Conclusion The lack of clinical experience and examination,omissions and misleading relevant gynecological history,over-reliance on secondary inspections,and lack of consultation are the main reasons of gynecological infectious diseases misdiagnosis.

Lichen Scrofulosorum Occurring in Association with Tuberculous Salpingitis / 대한피부과학회지

Lichen scrofulosorum is a rare disease of children and young adults. The cutaneous lesions of LS are typically symptomless, tiny, flat-topped papular eruptions, which are skin-colored and follicular in distribution. Histopathologically, LS shows perifollicular noncaseating granulomas. LS is usually associated with extrapulmonary tuberculosis, especially of the lymph nodes and bones, and has also been reported in patients with pulmonary tuberculosis. However, the underlying focus is not always obvious, at the time of rash development, and could be diagnosed after the development of LS. Here, we describe a 43-year-old Korean woman with LS who developed tuberculous salpingitis 8 months later.

Embarazo ectópico bilateral / Bilateral ectopic pregnancy

Paciente primigestante en el primer trimestre del embarazo que consulta a urgencias por dolor abdominal y síncope. Fue estudiada en ginecología y por los hallazgos imagenológicos sugirieron embarazo ectópico derecho. Se realizó laparotomía encontrando dilatación tubárica bilateral, motivo por el cual se practicó salpingectomía bilateral. El estudio patológico demostró embarazo ectópico bilateral al encontrar vellosidades coriales en ambas luces tubáricas.

A nulliparous woman in the first trimester of pregnancy presented with abdominal pain and syncope to the emergency room. She was studied in the gynecology service and a pelvic ultrasound suggested a right ectopic pregnancy. She underwent a laparotomy which disclosed a bilateral tubal dilation. A bilateral salpingectomy was performed. Histology confirmed a synchronious bilateral ectopic pregnancy by demonstrating chorionic villi in both tubes.

Doença inflamatória pélvica: atualização / Inflammatory pelvic disease: updating

A doença inflamatória pélvica (DIP) consiste em espectro de infecções do trato genital superior que inclui: endometrite, salpingite, abscesso tubo-ovariano e/ou peritonite pélvica. Constitui-se em infecção polimicrobiana do trato genital superior feminino devido à sua contaminação pelos microrganismos do endocérvice e da vagina. São fatores de risco para o desenvolvimento de DIP: idade entre 15-24 anos, vida sexual ativa, múltiplos parceiros, inserção de dispositivo intra-uterino (DIU) há menos de 20 dias e história pregressa de DIP. Procedimentos e cirurgias pélvicos com manipulação de canal cervical podem predispor à infecção por alterarem a barreira cervical protetora. A DIP é um dos processos infecciosos mais frequentes nas mulheres em idade reprodutiva e é entidade de difícil diagnóstico devido às manifestações clínicas diversas. O diagnóstico é muito provável diante de dor à palpação cervical, uterina e/ou de anexos, acompanhados de febre, corrimento vaginal mucopurulento ou leucorreia, sangramento intermenstrual e pós-coito, dispareunia, disúria e polaciúria. O tratamento da DIP deve prover antibioticoterapia empírica de amplo espectro para os patógenos mais prováveis: N. gonorrhoeae e C. trachomatis, pois o rastreamento negativo para esses organismos não exclui infecção do trato reprodutivo superior. A precocidade das medidas terapêuticas é importante na prevenção de sequelas de longo prazo e a opção por tratamento ambulatorial ou hospitalar deve ser baseada no julgamento médico. Parceiros sexuais de mulheres com DIP devem ser examinados e tratados caso tenham tido relação sexual com a paciente nos 60 dias anteriores ao aparecimento dos sintomas. O rastreamento e tratamento da infecção por clamídia em mulheres sexualmente ativas diminui o risco de elas contraírem DIP. Grávidas com suspeita de DIP devem ser internadas para receber tratamento parenteral. Não foram estabelecidas diferenças nas manifestações clínicas da DIP em mulheres soropositivas e negativas para o HIV. Ambos os grupos respondem igualmente bem aos tratamentos parenteral e oral. (AU)

Pelvic Inflammatory Disease (PID) consists in a spectrum of upper genital tract infections including: endometritis, salpingitis, tube-ovarian abscess and / or pelvic peritonitis. It constitutes polymicrobial infection of upper female genital tract because of its contamination by microrganisms from the vagina and endocervix. Risk factors for the development of PID are: aged 15-24 years, sexual activity, multiple partners, insertion of an intrauterine device (IUD) for less than 20 days and a history of PID. Procedures and pelvic surgery with manipulation of the cervical canal may predispose to infection by altering the cervical protective barrier. PID is one of the most common infectious processes in women in reproductive age and it is an entity of difficult diagnosis due to the diverse clinical manifestations. The diagnosis is most likely on painful palpation of the cervix, uterus or attachments, accompanied by fever, depurulent vaginal discharge or leukorrhea, intermenstrual and postcoital bleeding, dyspareunia, dysuria and pollakiuria. The treatment of PID should provide broad-spectrum empiric antibiotic therapy for the most likely pathogens: N. gonorrhoeae and C. trachomatis, because negative screening for these organisms does not exclude infection of the upper reproductive tract. The early therapeutic measures are important in preventing long-term sequelae and the option for outpatient or hospital treatment should be based on medical judgment. Sexual partners of women with PID should be examined and treated if they had sexual relations with the patient 60 days prior to the onset of symptoms. Screening and treatment of chlamydial infection in sexually active women decreases the risk of them contracting PID. Pregnant women with suspected PID should be hospitalized to receive parenteral treatment. No differences were found in clinical manifestations of PID in women seropositive and negative for HIV. Both groups respond equally well to parenteral and oral treatments. (AU)

Infección por aborto inducido en el Hospital Nacional de San Marcos (Guatemala) / Infection due to induced abortion at San Marcos National Hospital (Guatemala)

Se efectuó un estudio descriptivo y transversal de 40 pacientes con infección por aborto inducido, ingresadas en la Sala de Ginecoobstetricia del Hospital Nacional de San Marcos (Guatemala), desde abril hasta septiembre del 2006, con vista a determinar la manifestación clínica de este proceso séptico. En la serie predominaron las mujeres que habían tenido múltiples embarazos, las amas de casa y las féminas analfabetas o de bajo nivel escolar. Las complicaciones médicas más importantes ocurrieron cuando el proveedor del servicio no estaba calificado para brindarlo (por ejemplo, comadronas), fundamentalmente en adolescentes y desocupadas, en las cuales primó la salpingitis grave.

A descriptive and cross-sectional study of 40 patients with infection due to induced abortion, hospitalized at the Gynecology-Obstetrics Ward from San Marcos National Hospital (Guatemala), was carried out from April, 2006 to September, 2006, in order to determine the clinical manifestation of this septic condition. Women having multiple pregnancies, housewives, as well as illiterate women or with low educational status were predominant in the series. The most important medical complications, such as severe salpingitis, showed up mainly in adolescent and unemployed females when the service provider was not qualified to offer the adequate delivery care (for example, midwives).