Term Delivery following ruptured tubo-ovarian abscess in early pegnancy / Philippine Journal of Obstetrics and Gynecology

@#Tubo-ovarian abscess in pregnancy is extremely rare. Its occurrence increases the maternal and fetal morbidities and mortalities. The clinical presentation is variable ranging from asymptomatic abscess to diffuse peritonitis. In this report, we present a rare case of tubo-ovarian abscess complicating a pregnancy on its 6 weeks and 5 days age of gestation. The patient presented with frank peritonitis. Internal examination revealed uterine, adnexal and cervical tenderness with no masses palpated. A laparotomy was done and intra-operative findings showed an 8 x 4 cm-sized, right, ruptured tubo-ovarian abscess with purulent contamination of the whole pelvic cavity. Right salpingooophorectomy was performed and parenteral antibiotics were given. The pregnancy was eventually carried to term and the patient delivered by repeat low segment cesarean section without fetal and maternal complications.

Predictors of treatment failure of medical management among patients with pelvic inflammatory disease with tubo-ovarian abscess admitted in a tertiary hospital

@#OBJECTIVE: This study aimed to identify the predictors for treatment failure of medical management among admitted female patients diagnosed with pelvic inflammatory disease with tubo-ovarian abscess. METHODS: This was a retrospective nested case-control study, using chart review of all cases of pelvic inflammatory disease with tubo-ovarian abscess/complex (N = 49) admitted at the Department of Obstetrics and Gynecology, Philippine General Hospital from January 1, 2014 to December 31, 2018. RESULTS: Medical treatment failure was observed to be significantly higher (51.9%) among patients 40 years old and above as compared to patients less than 40 years old (13.6%). The risk of patients ≥40 years for failed management was 14x higher than those <40 years old (OR=14.00; 95% CI=1.06 to 185.5;p=0.04). The failed management group has significantly higher TOA size of 7.8 (7.8 ± 1.6) as compared to only 5.8 (5.8 ± 1.4) for medical treatment alone group. Correspondingly, those who failed have a significantly bigger volume of 120.4 ml (120.4 ± 84.5) as compared to only 55.2 ml (55.2 ± 40.6) for medical treatment alone group. Other predictive factors such as parity, admitting White blood cell count(WBC), C-Reactive Protein (CRP), and neutrophil-lymphocytic ratio(NLR) were all not significant. CONCLUSION: Tubo-ovarian abscess size of more than or equal to 7 cm, or a volume of more than or equal to 120 ml and advanced age of >40 were all predictive of failed response to medical treatment. Early recognition and intervention whether surgery or drainage may be beneficial to reduce morbidity and long-term sequelae of PID.

Infertility caused by salpingitis treated based on theory of kidney deficiency and blood stasis / 中国中药杂志

Infertility caused by salpingitis is one of the main causes of secondary infertility in women. In recent years,the incidence has been increasing year by year. Modern medicine believes that this disease is a complication due to incomplete or delayed treatment of acute and chronic salpingitis,with no satisfactory drug therapy at present. Clinical therapies mainly include surgical treatment,interventional treatment and assisted reproductive technology. After summarizing the experience of predecessors and the clinical practice of treating infertility for many years,the author considers that the disease location is the cell veins,and the nature is mostly mixed of deficiency and excess. Kidney deficiency and blood stasis are the main pathogenesis of infertility caused by salpingitis. Blood stasis is the pathological basis,while kidney deficiency is the fundamental pathogenesis. Long-term kidney deficiency will lead to blood stasis,and blood stasis will aggravate kidney deficiency. Both of them are cause and effect to each other. Infertility caused by salpingitis is difficult to cure. Based on the theory of kidney deficiency and blood stasis,the basic principles of clinical treatment are tonifying kidney and activating blood circulation,removing blood stasis and dredging collaterals. Oral administration with traditional Chinese medicine combined with external therapies,such as enema,external application,acupuncture and moxibustion,have been achieved a good efficacy in repairing fallopian tube function and improving pregnancy rate. Therefore,the treatment of infertility caused by salpingitis based on " kidney deficiency and blood stasis" is worthy of further discussion in both clinical and experimental aspects.

Terapia Su Jok en pacientes con diagnóstico de hidrosalpinx / Su Jok therapy in patients with hydrosalpinx diagnosis

Se realizó un estudio cuasiexperimental de 56 pacientes con diagnóstico de hidrosalpinx, que acudieron a la consulta de Medicina Natural y Tradicional del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba - remitidas de las consultas de Ginecología e Infertilidad -, desde septiembre de 2014 hasta diciembre de 2015, para evaluar la respuesta a la terapia Su Jok. Entre las variables analizadas figuraron: edad, factores de riesgo, manifestaciones clínicas, síndromes tradicionales, evolución clínica y respuesta al tratamiento. En la casuística predominaron las féminas de 30-39 años, la enfermedad inflamatoria pélvica y las infecciones de trasmisión sexual como antecedentes patológicos (71,4 por ciento), el dolor y la secreción vaginal como síntomas principales, así como el estancamiento de Qi de hígado, Qi de riñón no firme y frío-humedad en bazo como síndromes más frecuentes. Finalmente, se logró una evolución favorable y una respuesta adecuada al tratamiento

A quasi-experiment of 56 patients with hydrosalpinx diagnosis that went to the Natural and Traditional Medicine Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba - referred from the Gynecology and Infertility Services -, was carried out from September, 2014 to December, 2015, to evaluate the response to Su Jok therapy. Among the analyzed variables there were: age, risk factors, clinical features, traditional syndromes, clinical course and response to the treatment. In the case material there was a prevalence of women aged 30-39, pelvic inflammatory disease and sexually transmitted infections as pathological history (71.4 percent), pain and vaginal secretion as main symptoms, as well as Qi liver stagnation, not firm Qi kidney and coldness-humidity in spleen as most frequent syndromes. Finally, there was a favorable clinical course and an appropriate response to the treatment

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.

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.

Tubercular Pyosalpinx Mimicking Ovarian Torsion.

Ovarian torsion is a gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females. Whereas Tuberculosis is a chronic infectious disease, and the morbidity associated with it has major health implications. When tuberculosis affects the genital organs of young females, it has the devastating effect of causing irreversible damage to their fallopian tubes, resulting in a possible tubercular pyosalpinx and infertility. However, the disease often remains silent . In this case study, suspecting the diagnosis of genital tuberculosis and of establishing the differential diagnosis with ovarian tumors in the presence of large pyosalpinges is highlighted.

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.

H1 Magnetic Resonance Spectroscopy of Cystic Ovarian Lesions

On H1 MRS (magnetic resonance spectroscopy), malignant tumors show higher concentration of metabolite than benign lesions. Lactate double peak was detected in malignant tumor and endometriosis, and more prominent high concentration was demonstrated in endometriosis. Tuboovarian abscesses and salpingitis do not show prominent peak. Dermoid cysts show high levels of lipid peak. Paratubal cyst and follicular cyst can be showed the lipid peak, however, the concentration of lipid is lower than that of dermoid cyst. H1 MRS of ovarian cystic lesions can give valuable information about the presence of metabolites of ovarian cystic lesions.

Doença inflamatória pélvica aguda: ensaio iconográfico com enfoque em achados de tomografia computadorizada e ressonância magnética / Acute pelvic inflammatory disease: pictorial essay focused on computed tomography and magnetic resonance imaging findings

O objetivo deste trabalho é descrever os principais achados em tomografia computadorizada e ressonância magnética em pacientes com dor abdominal aguda decorrente de doença inflamatória pélvica. Dois radiologistas em consenso selecionaram e analisaram exames de tomografia computadorizada e ressonância magnética, realizados entre janeiro de 2010 e dezembro de 2011, de pacientes com quadro comprovado de doença inflamatória pélvica levando a um quadro de abdome agudo. Os principais achados foram coleções líquidas intracavitárias, realce anômalo na escavação pélvica e densificação dos planos adiposos anexiais. A doença inflamatória pélvica é uma das principais causas de dor abdominal em mulheres em idade reprodutiva e tem sido progressivamente diagnosticada mediante uso da tomografia computadorizada e ressonância magnética, que complementam o papel da ultrassonografia. É crucial que os radiologistas se familiarizem com os principais aspectos diagnósticos em imagem seccional desta causa comum de abdome agudo.

The present study was aimed at describing key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain derived from pelvic inflammatory disease. Two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed between January 2010 and December 2011 in patients with proven pelvic inflammatory disease leading to presentation of acute abdomen. Main findings included presence of intracavitary fluid collections, anomalous enhancement of the pelvic excavation and densification of adnexal fat planes. Pelvic inflammatory disease is one of the leading causes of abdominal pain in women of childbearing age and it has been increasingly been diagnosed by means of computed tomography and magnetic resonance imaging supplementing the role of ultrasonography. It is crucial that radiologists become familiar with the main sectional imaging findings in the diagnosis of this common cause of acute abdomen.

Oxiuriasis tubárica como causa de dolor abdominal en estudio: reporte de un caso / Fallopian tube as a likely cause of abdomal pain in study: case report

INTRODUCCIÓN: La oxiuriasis es una parasitosis causada por Enterobius vermicularis, cuyo ciclo vital es exclusivo en humano. En chile se subestima su prevalencia, debido a su baja notificación, sin embargo es causante de múltiples entidades clínicas como trastornos del sueño, lesiones de la mucosa nasal, vulvovaginitis,salpingitis, ooforitis, enfermedad inflamatoria pélvica, e incluso peritonitis secundaria a perforación de asa intestinal infestada. PRESENTACIÓN DEL CASO: Mujer de 33 años que ingresa al servicio de urgencia del Hospital El Pino, Santiago de Chile, con manifestaciones clínicas compatibles con apendicitis aguda. Se realiza apendicectomía y como hallazgo operatorio se constata tumor de bordes mal definidos en trompa uterina derecha, interpretado como embarazo ectópico, por lo que se realiza salpingectomía unilateral. Sin embargo, en el estudio anatomopatológico posterior se diagnostica enterobiasis tubárica DISCUSIÓN: La infestación por Enterobius vermicularis es considerada endémica en nuestro país, con una prevalencia de hasta un 41por ciento, por lo que es necesario incorporarlo como diagnóstico diferencial de abdomen agudo.

INTRODUCTION: Estrongyloides is a parasitic disease caused by Enterobius vermicularis, Humans are hosts only to this parasite. In Chile, there are an underestimated prevalence due to its low notification, however, it causes many clinical entities as sleep disorder, nasal mucosal damage, vulvovaginitis, salpingitis, oophoritis, pelvic inflammatory disease and even peritonitis due to rupture of infested intestinal loop. CASE REPORT: A 33 years old admitted to the emergency department of Hospital El Pino with clinical manifestations compatible with acute appendicitis. Appendectomy was performed, operative findings suggested an ill-defined tumor in fallopian tube, interpreted as ectopic pregnancy. Then underwent unilateral salpingectomy after pathological examination fallopian tube salpingeal was diagnosed. DISCUSSION: Given the high prevalence and the fact that mimic acute appendicitis it´s a significant part of the differential diagnosis for acute abdomen.

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)

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.

Multidetector Computed Tomographic Image Characteristics of Clinically Severe Pelvic Inflammatory Disease in an Emergency Department

PURPOSE: Diagnosis of pelvic inflammatory disease (PID) is based on clinical history and examination; however, it may be difficult to distinguish from other disease entities. Multidetector computed tomography (MDCT) is a useful radiologic modality, which can be performed in an emergency department (ED). The aim of the current study was to clarify the MDCT characteristics of clinically severe PID by comparison of patients with clinically more severe and less severe forms of PID. In addition, we evaluated the independent predictors of MDCT findings in the severe PID group. METHODS: We conducted a retrospective study of female patients with symptoms and signs of PID who visited the ED at our institution during a five-year period. Patients who underwent abdominal MDCT and were diagnosed with PID were retrospectively enrolled in the study. For determination of CT characteristics, each patient was evaluated for pelvic edema, amount of ascites, Hounsfield units (HU) of ascites, salpingitis, oophoritis, intrauterine devices, peritoneal fat infiltration, cervicitis, abnormal endometrial enhancement, tubo-ovarian abscess, adjacent bowel wall thickening, localized ileus, and perihepatitis. Patients were divided into two groups: clinically more severe and less severe forms of PID. Patients having the clinically more severe form of PID were defined as follows: (1) initial body temperature over 38.3degrees C, (2) initial systolic blood pressure < 90 mmHg, (3) intractable abdominal pain, or (4) uncontrollable nausea or vomiting despite medication. We compared data between the two groups. RESULTS: A total of 136 patients were enrolled in this study. Thirty eight patients had the clinically more severe form (28%) and 98 patients had the less severe form (72%). In comparison with subjects in the group having the less severe form, the amount of ascites (p<0.001), salpingitis (p<0.05), and tubo-ovarian abscess (p<0.01) differed statistically between the groups. The HU value of ascites in the more severe group, 19.56+/-11.14 HU, was significantly greater, compared with that of the group having the less severe form. Results of multivariate logistic regression analysis revealed an association of the amount of ascites, a high HU value, and atubo-ovarian abscess with increased odds of the more severe form (adjusted OR 3.25, 95% CI 1.01-10.45; adjusted OR 5.84, 95% CI 1.80-18.95; and adjusted OR 8.42, 95% CI 1.73-40.96, respectively). CONCLUSION: Patients with clinically more severe PID show more clinically important findings on MDCT, such as a greater amount of ascites, higher HU value of ascites, and tubo-ovarian abscess. Leukocytosis, increased neutrophil percentage, and elevated CRP were observed in patients with severe PID.

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.

Xanthogranulomatous salpingitis as a rare pathologic aspect of chronic active pelvic inflammatory disease.

Xanthogranulomatous salpingitis (XGS) is a rare form of chronic inflammation of the fallopian tubes. A 41-year old woman with a history of secondary infertility for 2 years is presented. The patient underwent bilateral salpingooopherectomy with presumptive diagnosis of adnexal mass with cystic component. Intraoperative pathology consultation was done. The diagnosis of bilateral XGS associated with chronic active follicular salpingitis was made. XGS is reported to be caused by an unsuccesfully treated pelvic inflammatory disease. Its association with chronic active follicular salpingitis has not been previously reported. Chronic active follicular salpingitis with xanthogranulomatous inflammation might give the impression of a cystic adnexal mass with septations on preoperative pelvic computed tomography. Frozen sections are necessary to rule out malignancy as done in our case.

Obstrução tubária em mulheres com imunofluorescência indireta positiva para clamídia / Tubal occlusion in women with indirect positive immunofluorescence for chlamydia

Objetivos: Avaliar o desempenho da imunofluorescência indireta para Chlamydia trachomatis em rastrear obstrução tubária. Métodos: Este é um estudo retrospectivo com 204 pacientes atendidas em um centro universitário e particular de infertilidade na cidade de Goiânia no período de 2006 a 2009. Para avaliar o risco de obstrução tubária as pacientes foram divididas em dois grupos: pacientes “expostas” à clamídia (imunofluorescênciaindireta ≥1:16) e “não expostas” (imunofluorescência indireta <1:16). Verificou-se, então, as pacientes que tiveram a “doença” (obstrução tubária) e “controles” (sem obstrução tubária) na histerossalpingografia. Para os cálculos foram utilizados os testes Qui-quadrado (χ2) e Exato de Fisher. O nível de p escolhido foi 0,05. Resultados: Das 72 pacientes com titulação significativa, 34 (47,2%) apresentaram a ocorrência de obstrução tubária. Em relação às 132 pacientes com titulação não significativa, somente 18 (13,7%) apresentaram obstrução tubária (p<0,001). Foi observado também um aumento progressivo entre os níveis de anticorpos e a probabilidade de obstrução tubária (p<0,001). Conclusões: Os resultados deste estudorevelaram que a sorologia para Chlamydia trachomatis é válida para rastreamento de lesão tubária, portanto, pode facilitar decisões naquelas mulheres que devem prosseguir com novas investigações.

Purpose: To evaluate the ability of indirect immunofluorescence for Chlamydia trachomatis to screening tubal occlusion. Methods: This is a retrospective study with 204 electronic records of patients attended at a university and private infertility center in the city of Goiania, in the period of 2006 to 2009. To evaluate the risk of tubal occlusion the patients were divided into two groups: patients “exposed” to chlamydia (IFI≥1:16) e “unexposed” (IFI<1:16). It was verified patients who had the “disease” (tubal occlusion) and “control” (without tubal occlusion) in the hysterosalpingography. For the calculations the Chi-square (χ2) and Fisher Exact Test were used. The p chosen level was 0,05. Results: Of the 72 patients with significant titers, 34 (47,2%) showed the occurrence of tubal occlusion. Concerning the 132 patients with no significant titers, only 18 (13,7%) had tubal occlusion(p<0,001). We also observed a progressive increase in the levels of antibodies and the likelihood of tubal occlusion (p<0,001). Conclusions: The results indicate that serology for Chlamydia trachomatis is valid for screening of tubal damage and may facilitate decisions on which women should proceed with further investigations.

Lymphoid Leucosis and Coligranoluma in a Budgerigar [Melopsittacus undulates]

An adult female budgerigar [Melopsittacus undulates] presented with abdominal enlargement. The condition of the bird deteriorated after needle aspiration for cytological examination. The budgerigar was euthanatized and a complete necropsy was performed. Microscopic sections were prepared and stained with hematoxylin and eosin, Gram staining, periodic acid-Schiff [PAS] and acid-fast staining. Escherichia coll was isolated in pure culture. Necropsy revealed the presence of granulomatous lesions of varying sizes at different locations and hepatomegaly, oviduct impaction and oophoritis. Histopathologically, typical granuloma with a central area of coagulation necrosis and bacterial colonies surrounded by lymphocytes, macrophages and multinucleated giant cells were found. These granulomas were present in the liver, oviduct and intestinal tract. A sheet of neoplastic cells and disruption of the normal hepatic architecture was seen. The diagnosis was lymphoid leucosis and coligranuloma

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.