Analysis of the causes of long-standing pelvic anterior sacral space infection and discussion of management techniques / 中华肿瘤杂志

Objective: To investigate the causes and management of long-term persistent pelvic presacral space infection. Methods: Clinical data of 10 patients with persistent presacral infection admitted to the Cancer Hospital of Zhengzhou University from October 2015 to October 2020 were collected. Different surgical approaches were used to treat the presacral infection according to the patients' initial surgical procedures. Results: Among the 10 patients, there were 2 cases of presacral recurrent infection due to rectal leak after radiotherapy for cervical cancer, 3 cases of presacral recurrent infection due to rectal leak after radiotherapy for rectal cancer Dixons, and 5 cases of presacral recurrent infection of sinus tract after adjuvant radiotherapy for rectal cancer Miles. Of the 5 patients with leaky bowel, 4 had complete resection of the ruptured nonfunctional bowel and complete debridement of the presacral infection using an anterior transverse sacral incision with a large tipped omentum filling the presacral space; 1 had continuous drainage of the anal canal and complete debridement of the presacral infection using an anterior transverse sacral incision. 5 post-Miles patients all had debridement of the presacral infection using an anterior transverse sacral incision combined with an abdominal incision. The nine patients with healed presacral infection recovered from surgery in 26 to 210 days, with a median time of 55 days. Conclusions: Anterior sacral infections in patients with leaky gut are caused by residual bowel secretion of intestinal fluid into the anterior sacral space, and in post-Miles patients by residual anterior sacral foreign bodies. An anterior sacral caudal transverse arc incision combined with an abdominal incision is an effective surgical approach for complete debridement of anterior sacral recalcitrant infections.

Actinomicosis pélvica invasiva: un desafío para el ginecólogo / Invasive pelvic actinomycosis: a challenge for the gynecologist

Resumen La actinomicosis pélvica es una infección bacteriana supurativa crónica, producida por especies de Actinomyces, principalmente Actinomyces israelii, que afecta el aparato genital interno y las estructuras vecinas, asociada al uso prolongado de dispositivo intrauterino sin control en casi la totalidad de los casos descritos en mujeres. La actinomicosis pélvica suele presentarse como un absceso tubo-ovárico y con menor frecuencia como una actinomicosis pélvica invasiva (API). La API se propaga por contigüidad desde el aparato genital hacia las vísceras adyacentes, originando un tumor pélvico difuso, de consistencia leñosa, pseudotumoral, que a menudo se confunde con una neoplasia pélvica. La API representa un gran desafío para el ginecólogo por las dificultades en su diagnóstico y manejo. Se presentan dos casos de API y se revisan los procedimientos diagnósticos y terapéuticos recomendados actualmente para el enfrentamiento de esta patología.

Abstract Pelvic actinomycosis (PA) is a chronic suppurative bacterial infection, produced by Actinomyces, mainly Actinomyces israelii. It affects the internal genital tract, adjacent structures and is associated with a prolonged intrauterine device use with an inadequate control in almost all described cases in women. Pelvic actinomycosis usually presents as a tube ovarian abscess and less frequently as invasive pelvic actinomycosis (IPA). The IPA spreads contiguously from the genital tract to adjacent viscera, causing a diffuse, woody, pseudotumoral pelvic tumor that is frequently confused with a pelvic neoplasm. The IPA represents a great challenge for the gynecologist due to the difficulties in the diagnosis and management of this disease. Two cases of IPA are presented and the currently recommended diagnostic and therapeutic procedures for dealing with this pathology are reviewed.

Safety of Transrectal or Transvaginal Drainage of Pelvic Abscesses / Segurança da drenagem transretal ou transvaginal de abscessos pélvicos

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.

Septic shock caused by the under-recognized bacterium Eggerthella lenta in a 61-year-old male with a periurethral abscess: a case report

Abstract Eggerthella lenta is a gram-positive anaerobic bacillus that has been associated with life-threatening infections. Bacteremia is always clinically significant and is mostly but not always associated with gastrointestinal disease. We present a unique case of abrupt deterioration and rapid development of septic shock secondary to periurethral abscess caused by E. lenta infection. This case highlights the atypical clinical presentation, risk factors, uncommon source of infection, challenges in therapy, and outcome of this infrequent infection. There is still a gap in the understanding of E. lenta pathogenicity, and more literature is needed to establish clear management recommendations.

Puerperal septic shock and necrotizing fasciitis caused by Staphylococcus caprae and Escherichia coli / 영남의대학술지

Puerperal sepsis is one of the leading causes of maternal morbidity and mortality worldwide. Postpartum pelvic infections can cause various complications, including wound infections and necrotizing fasciitis. Several microorganisms are known to cause such infections; however, no study has reported on Staphylococcus caprae, a coagulase-negative staphylococcus that is isolated frequently from animals and infrequently from human specimens, as a causative agent. Here, we report a rare case of septic shock complicated by necrotizing fasciitis after a cesarean section. This is the first report of a human isolate of S. caprae in association with puerperal sepsis and necrotizing fasciitis.

Prise en charge des vaginites dans les pays à ressources limitées d'Afrique subsaharienne. Quelle place pour l'association ternidazole, néomycine sulfate, nystatine et prednisolone ?

Contexte : La vaginite est un motif fréquent de consultation gynécologique. Dans les pays à ressources limitées, en l'absence de laboratoires d'analyses microbiologiques des sécrétions vaginales, le traitement est prescrit sur la base de l'évaluation clinique.Objectif général : Evaluer l'efficacité de notre pratique concernant la prise en charge des vaginites en situation de vie réelle, par la prescription de l'associationternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®).Méthodologie : Nous avons réalisé, dans trois structures sanitaires d'Abidjan, une étude prospective observationnelle sur cinq mois. Elle a inclus, de façon aléatoire, 233 patientes qui ont donné leur consentement écrit et signé et qui présentaient des signes cliniques évidents de vaginites. N'ont pas été incluses les patientes enceintes et allaitantes, celles qui présentaient des co-infections, des infections sexuellement transmissibles, le VIH, une hypersensibilité ou une idiosyncrasie à l'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®). Les patientes ont été divisées en deux groupes : le groupe de référence (n = 200) pour lequel une analyse microbiologique des sécrétions vaginales était effectuée 2 à 4 jours avant la mise sous traitement et le groupe contrôle (n = 33) pour qui le traitement était débuté d'emblée. Les critères d'évaluation étaient la présence des symptômes cliniques et leur cinétique d'évolution, le bilan microbiologique réalisé 10 à 14 jours après le début du traitement et la survenue d'effets indésirables liés à l'utilisation du médicament (notamment les picotements ou les irritations locales). Les tests statistiques utilisés pour la comparaison des effectifs étaient le khi-deux et le Fisher exact avec un seuil de signification de 5% (p < 0,05).Résultats et discussion : Avant l'instauration du traitement, les leucorrhées pathologiques (178/233) et le prurit vulvaire (157/233) étaient les principaux symptômes rencontrés dans les deux groupes. La prédominance des leucorrhées pathologiques était très significativement différente dans le groupe référence versus le groupe contrôle (p = 0,001).Lors de la visite de contrôle, il n'y avait pas de différence significative entre les deux groupes concernant la présence d'une récidive (p = 0,99). Ainsi l'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®) pourrait représenter une option thérapeutique intéressante chez les femmes présentant des signes cliniques évidents de vaginite, en l'absence d'analyse microbiologique préalable des sécrétions vaginales. L'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®) a démontré son efficacité thérapeutique en cas de vaginite à Candida albicans (VC), de Vaginose Bactérienne (VB), de vaginite à Trichomonas vaginalis (VT), et même en cas d'infection mixte (VM). En effet il a été observé une amélioration significative et rapide (3 à 4 jours maximum) des symptômes (p = 0,001) et un faible taux de récidive biologiquement prouvée dans les deux groupes (3,4%). Durant toute la durée du traitement, les patientes n'ont déclaré aucune réaction allergique liée à l'utilisation de l'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®) (picotements ou irritations locales) et 97,3% des patientes ont été globalement très satisfaites de l'utilisation de l'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®).Conclusion : Dans nos pays à ressources limitées, sous-médicalisés, l'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®) apparaît comme une option thérapeutique intéressante pour traiter les vaginites d'origine mycosique, parasitaire, bactériologique et mixte. Cette étude a montré que l'association ternidazole, néomycine sulfate, nystatine, prednisolone (Tergynan®) pouvait être administrée, en initiation de traitement des vaginites dès leur apparition sans besoin de procéder à des prélèvements préalables des sécrétions vaginales

Influence de la co-infection VIH-VHB sur le taux de lymphocytes TCD4+ et sur la fonction hépatique à Brazzaville au Congo

Introduction : La co-infection VIH-VHB constitue un facteur important de morbi-mortalité dans les pays en développement. L'objectif était d'étudier l'effet de la co-infection sur le taux de lymphocytes TCD4+ et la fonction hépatique des patients.Matériels et méthode : Il s'est agi d'une étude rétrospective transversale descriptive et analytique menée à l'hôpital central des armées de Brazzaville du 1er janvier 2015 au 30 septembre 2016. Les données ont été analysées par les logiciels Excel et SPSS 21.Résultats : Cinquante-huit patients étaient porteurs de l'antigène HBs, la séroprévalence hospitalière était de 6,3%. Les tranches d'âges représentatifs étaient de 18 ans à 29 ans et de 30 ans à 39 ans dans (34,62%). Le sex-ratio (H/F) était de 0,5. La co-infection représentait 37,18%. Le taux de lymphocytes TCD4 était inférieur à 200/mm3 chez 61,54% des patients. Le taux de lymphocytes TCD4 était plus bas chez les co-infectés que chez les mono-infectés VIH ; (P-Valeur = 0.000).Conclusion : La co-infection VIH/VHB a un impact négatif sur la fonction hépatique et l'immunité des patients

Prise en charge de la pelvipéritonite en milieu chirurgical à Dakar : à propos de 62 observations

Buts. Évaluer de façon rétrospective les résultats de la prise en charge des pelvipéritonites dans un service de chirurgie générale et définir la place du traitement médical.Patients et méthodes. Durant une période de 5 ans, 62 dossiers de patientes suivies pour pelvipéritonite ont été colligés et analysés. Les collections des organes génitaux internes (abcès tubo-ovariens, endométrite, pyoovaire etc.…) et celles d'origine digestive (appendicite pelvienne, sigmoïdite etc.…) ont été exclus de l'étude. Le diagnostic de pelvipéritonite reposait sur l'existence de douleurs pelviennes, de leucorrhées purulentes, d'un syndrome infectieux et d'une défense strictement pelvienne, et l'absence de suppuration des organes génitaux internes à l'échographie. Résultats. L'âge moyen des patientes était de 27,5 ans [16-55 ans]. 72% d'entre elles avaient moins de 35 ans. Deux patientes étaient porteuses d'un dispositif intra-utérin et chez une, la pelvipéritonite compliquait une hystérosalpingographie. Le délai moyen de consultation était de 11 jours [1-30 jours]. Des leucorrhées purulentes étaient présentes chez 77% des patientes. La défense abdominale localisée sous ombilicale était présente dans 58 cas (93%). Une collection du Douglas était présente à l'échographie chez une patiente. Un traitement médical a été appliqué avec succès chez 58 patientes. Quatre patientes avaient un tableau clinique suffisamment sévère pour justifier une laparotomie exploratrice pour suspicion de péritonite. Des adhérences multiviscérales sous forme de magma adhérentiel cloisonnant le pelvis ont été notées chez trois d'entre elles et un abcès du Douglas chez une patiente. une récidive de pelvipéritonite à 3 et 5 mois a été notée chez et l'évolution sous traitement médical a été favorable pour les deux. Conclusion. Les signes cliniques (fièvre, leucorrhées purulentes et défense strictement pelvienne) sont suffisants pour poser un diagnostic de pelvipéritonite à Dakar. Le traitement médical doit être la règle en l'absence de collection abcédée

Scheduled maturation in low colorectal and coloanal anastomoses / Maturação programada em anastomoses colorretais baixas e coloanais

Introduction: Anastomotic dehiscence is the main complication after low colorectal and coloanal anastomoses. The techniques commonly used are the double-stapling and hand-sewn anastomoses, both are made with immediate maturation. These techniques do not prevent pelvic sepsis in many patients and are not feasible in all cases. Objective: The study aim is to report the technical details and results with the use of scheduled maturation anastomosis in ten patients. Surgical technique: The scheduled maturation anastomosis is done in two steps. The first step is the closure of colonic stump in a way that keeps the mucosa layer in everted position. The second step is the union of the colon and rectum ends by transanal access. All the sutures are made with 2/0 polyglactin. A diverting stoma must be done in all cases. After 30 days, begins spontaneous opening of the anastomosis. Results: Ten patients underwent this technique. There were two cases of stenosis that were treated with digital dilatation in office. All patients had their diverting ostomy closed. Conclusion: The scheduled maturation anastomosis is feasible in difficult cases and may prevent pelvic sepsis in low colorectal and coloanal anastomoses.

Introdução: A deiscência anastomótica é a principal complicação após anastomoses colorretais baixas e coloanais. As técnicas comumente usadas são o duplo grampeamento e a anastomose manual, ambas são feitas com maturação imediata. Estas técnicas não impedem a sepse pélvica em muitos pacientes e não são exequíveis em todos casos. Objetivo: O estudo mostra os detalhes da técnica e os resultados do uso da anastomose com maturação programada em dez pacientes. Técnica cirúrgica: A anastomose com maturação programada é feita em duas etapas. A primeira fase é o fechamento do coto cólico com pontos que mantém a mucosa evertida. A segunda fase é a união das extremidades do cólon e reto pela via transanal. Todas as suturas são feitas com poliglactina 00. Um estoma para derivação deve ser feito em todos os casos. Após 30 dias, inicia-se a abertura espontânea da anastomose. Resultados: Dez pacientes foram submetidos a esta técnica. Ocorreram dois casos de estenose que foram tratados com dilatação digital em consultório. Todos pacientes tiveram fechamento de sua ostomia de derivação. Conclusão: A anastomose com maturação programada é factível em casos difíceis e pode prevenir a sepse pélvica em anastomoses colorretais baixas e coloanais.

Functional Outcome With Percutaneous Ilio-sacral Screw Fixation For Posterior Pelvic Ring Injuries In Patients Involved In Heavy Manual Laboring

Introduction: Unstable posterior pelvic ring injuries are best treated with operative methods due to better post-op functional score. Our patient cohort was involved in heavy manual laboring frequently required ground level work in their activities of daily living. There are very few outcome studies dealing exclusively with such patients. Materials & Methods: Forty one patients who were treated with percutaneous sacroiliac screw fixation under fluoroscopic guidance and were followed-up for at least one year were analyzed retrospectively for functional outcome using the Majeed score. Results: Twenty one (51.22%) and thirteen (31.70%) patients were found to be in excellent and good categories respectively and majority of the patients (thirty/73.17%) were able to return to their original occupation with or without minor adjustments. Conclusion: Percutaneous ilio-sacral screw fixation for posterior pelvic unstable injuries is an acceptable mode of treatment in patients involved in heavy manual laboring. laboring

Doxiciclina para tratamento da doença inflamatória pélvica / Doxycycline for treatment of pelvic inflammatory disease

CONTEXTO: A Doença Inflamatória Pélvica (DIP) é uma síndrome clínica atribuída à ascensão dos microorganismos do trato genital inferior, com comprometimento do endométrio, trompas, anexos uterinos e/ou estruturas contíguas. Os microorganismos mais comumente envolvidos são Neisseria gonorrhoeae e Chlamydia trachomatis. A Organizaçao Mundial da Saúde (OMS) estima a ocorrência de 1.967.200 casos de clamídia e de 1.541.800 casos de gonorreia na população sexualmente ativa no Brasil, por ano. Dentre mulheres com infecções não tratadas por clamídia e/ou gonorreia, 10 a 40% desenvolvem doença inflamatória pélvica (DIP). A doxiciclina é um dos medicamentos recomendados pelo Ministério da Saúda para tratamento da DIP, mas ainda não é disponibilizado no SUS para essa indicação. TRATAMENTO RECOMENDADO: De acordo com o Manual de Controle das DST (2006)2, do Ministério da Saúde, os tratamentos recomendados para DIP leve, sem sinais de peritonismo ou febre (tratamento ambulatorial), deve ser realizado da seguinte forma: -Esquema 1: Ceftriaxona 250 mg, IM, dose única + Doxiciclina 100 mg, VO de 12/12 horas, por 14 dias + Metronidazol 500 mg, VO, de 12/12 horas, por 14 dias; -Esquema 2: Ofloxacina 400 mg, VO de 12/12 horas por 14 dias Ou Ciprofloxacina 500 mg 12/12horas por 14 dias + Doxiciclina 100 mg, VO de 12/12 horas por 14 dias + Metronidazol 500 mg, VO de 12/12 horas, por 14 dias. CONSIDERAÇÕES FINAIS: A doxiciclina é uma opção de tratamento para a doença inflamatória pélvica (DIP). As estimativas de impacto orçamentário anual resultante da ampliação de uso da doxiciclina no SUS, para tratamento da DIP provocada por clamídia e/ou gonorreia, variaram de R$274.528,36 até R$ 1.098.113,45. DELIBERAÇÃO FINAL: Os membros da CONITEC presentes na reunião do plenário do dia 11/06/2015 deliberaram, por unanimidade, recomendar a ampliação de uso da doxiciclina 100mg, em comprimido, para tratamento da doença inflamatória pélvica (DIP). DECISÃO: PORTARIA Nº 56, de 1 de outubro de 2015 - Torna pública a decisão de incorporar a doxiciclina 100mg comprimidos para tratamento da doença inflamatória pélvica (DIP), conforme normas técnicas definidas pelo Ministério da Saúde, no âmbito do Sistema Único de Saúde - SUS.

Incidence of uterine post abortion infection at Hospital de Clínicas de Porto Alegre. Is prophylactic antibiotic necessary? / Incidência de infecção pós-abortamento no Hospital de Clínicas de Porto Alegre. O antibiótico profilático é necessário?

OBJECTIVE: To identify the incidence of pelvic infection after miscarriage undergoing uterine evacuation in a tertiary hospital in southern Brazil and to compare with the international literature. METHODS: we reviewed electronic medical records of the Hospital de Clinicas de Porto Alegre of all patients who underwent uterine evacuation for miscarriage between August 2008 and January 2012 were reviewed. We included all patients submitted to uterine curettage due to abortion and who had outpatient visits for review after the procedure. We calculated emographic and laboratory data of the study population, number needed for treatment (NNT) and number needed to harm (NNH). RESULTS: of the 857 revised electronic medical records, 377 patients were subjected to uterine evacuation for miscarriage; 55 cases were lost to follow-up, leaving 322 cases that were classified as not infected abortion on admission. The majority of the population was white (79%); HIV prevalence and positive VDRL was 0.3% and 2%, respectively. By following these 322 cases for a minimum of seven days, it was found that the incidence of post-procedure infection was 1.8% (95% CI 0.8 to 4). The NNT and NNH calculated for 42 months were 63 and 39, respectively. CONCLUSION: The incidence of post-abortion infection between August 2008 to January 2012 was 1.8% (0.8 to 4). .

OBJETIVO: Identificar a incidência de infecção pélvica após aborto espontâneo submetido a esvaziamento uterino num hospital terciário do sul do Brasil e comparar com a literatura internacional. MÉTODOS: Os prontuários eletrônicos do Hospital de Clínicas de Porto Alegre de todas as pacientes que foram submetidas ao esvaziamento uterino por abortamento entre agosto de 2008 e Janeiro de 2012 foram revisados. Foram incluídas no estudo todas as pacientes submetidas à curetagem uterina por abortamento e que tiveram consultas ambulatoriais de revisão após o procedimento. Os dados demográficos e laboratoriais da população estudada, number needed for treatment (NNT) e o number needed to harm (NNH) foram calculados. RESULTADOS: Dos 857 prontuários eletrônicos revistos, 377 pacientes foram submetidas ao esvaziamento uterino por abortamento; 55 casos foram perdidos no seguimento, restando 322 casos que foram classificados como aborto não infectado na admissão. A maioria da população era da raça branca (79%); a prevalência de HIV e VDRL positivos foi de 0,3 e 2%, respectivamente. No seguimento desses 322 casos, num período mínimo de 7 dias, verificou-se que a incidência de infecção pós-procedimento foi de 1,8% (IC95%0,8 a 4). O NNT e o NNH calculado para 42 meses foi de 63 e 39, respectivamente. CONCLUSÃO: A incidência de infecção pós-aborto entre agosto de 2008 a janeiro de 2012 foi de 1,8% (0,8 a 4). .

Early pregnancy loss following laparoscopic management of ovarian abscess secondary to oocyte retrieval

Severe pelvic infections following ultrasound-guided transvaginal oocyte retrieval [TVOR] are rare but challenging. Ovarian abscess formation is one of the consequences and management of such cases as highly debated in pregnant patients. In this case report, an early fetal loss following laparoscopic management of ovarian abscess is described and possible etiologies are discussed

Obstetric Complications by the Accessibility to Local Obstetric Service / 農村醫學 地域保健

OBJECTIVES: Pregnant women in rural areas do not have access to sufficient obstetric services in their own communities due to the shortage of obstetricians. Therefore, most of these women must seek obstetrician outside of their communities. The purpose of this study was to investigate the relationship between obstetric complications and accessibility to local obstetric care in Korea. METHODS: This study was an ecological study in which the unit of analysis was an administrative district. Using Korea National Health Insurance Corporation data, the total number of deliveries and the delivery proportion within and outside of the community from 2001 to 2008 were calculated for 232 administrative districts nationwide. Three outflow levels were categorized based on each district's out-of-community delivery proportion: high outflow (upper one third), moderate outflow (middle one third), and low outflow (lower one third). In addition, three obstetric complication rates (the rate of complications following abortion, ectopic and molar pregnancy, the abortion rate, and the eclampsia rate) were calculated for the 232 districts. One-way ANOVA and multivariate linear regression were used to evaluate obstetric complications among the three outflow levels. RESULTS: The high outflow districts had higher rates of eclampsia and complications following abortion, ectopic, and molar pregnancy compared to the other districts (ANOVA, p<0.05). However, there was no significant difference in the abortion rate among the three groups. Multiple linear regression analysis showed that high outflow districts were statistically significant in the rate of complications following abortion, ectopic and molar pregnancy and eclampsia rate after adjusting for local tax per capita (p<0.01). CONCLUSION: These results indicate that poor access to local obstetric care correlate with poor obstetric outcomes (delayed or excessive bleeding, embolism, genital tract or pelvic infection, shock or other complications following abortion and ectopic or molar pregnancy, or eclampsia).

Perda gestacional retida: tratamento baseado em evidência / Missed miscarriage: treatment based on evidence

A perda gestacional é a complicação mais comum da gestação, a qual acarreta sérias repercussões sociais, psicológicas e clínicas para as pacientes. Perda gestacional retida é definida como a visualização do saco gestacional vazio até a décima segunda semana de gestação, gestação intrauterina no primeiro trimestre com perda da atividade cardíaca ou a estabilização da medida comprimento crânio-nádega (CCN) em avaliações ecográficas sucessivas. Historicamente, a conduta cirúrgica tem sido o tratamento de escolha para esse quadro clínico. No entanto, há novas tendências baseadas em estudos recentes que sugerem alternativas terapêuticas válidas como a conduta expectante ou a conduta farmacológica. Esta revisão apresentou a evidência científica atual das diferentes possibilidades de tratamento da perda gestacional, sua eficácia e a relação com possíveis complicações.

Miscarriage is the most common complication of pregnancy which causes serious social, psychological and clinical consequences for patients. Missed miscarriage is defined as the visualization of a gestational sac empty until 12th week of pregnancy, 1st trimester intrauterine pregnancy with loss of heart activity or stabilization of the cranial-rump length measurement (CRL) in successive sonographic evaluations. Historically the surgical approach has been the treatment of choice for this clinical event. However, the new trends based on recent studies suggest that alternative therapies are valid as expectant treatment or pharmacological treatment. This review presented the current scientific evidence of the different possibilities for the treatment of pregnancy loss, its efectiveness and relation to possible complications.

Benign lesions in abdominal hysterectomies in women presenting with menorrhagia

Menorrhagia is a common and debilitating problem. It is one of the major causes leading to hysterectomy in women all over the world. Menorrhagia is most commonly associated with benign pathologies like uterine fibroids, adenomyosis and pelvic infection. Rarely it is secondary to malignant pathology like endometrial carcinoma. Hysterectomy specimens form a major component of histopathological work in Pathology laboratories. The present study was undertaken in Pathology department, Allama Iqbal Medical College, Lahore to find out the morphology and frequency of different benign histopathological lesions in total abdominal hysterectomy specimens in patients presenting with menorrhagia. A descriptive case series study of one hundred total abdominal hysterectomies of patients presenting with menorrhagia carried out. Patients' data and detailed gross examination of specimens were recorded on a proforma. Representative sections were taken for microscopic examination and findings were recorded. The ages of the patients ranged from 30- 59 years with maximum number [73%] of cases in 40 - 49 years age group. Macroscopically fibroids were seen in 69% cases in myometrium. Microscopic examination of cervix revealed features of chronic cystic cervicitis in 100% cases. Endometrial histology showed disordered proliferation [41%] followed by hyperplasia [25%] as the commonest finding. Myometrium revealed foci of adenomyosis in 49% cases. The commonest neoplastic lesion was leiomyoma [69%]. In patients with menorrhagia the commonest neoplastic lesion was leiomyoma [69%], and commonest histopathological cervical lesion as chronic cervicitis [100%]. Endometrial hyperplasia was the most common lesion [41%] on endometrial histology. Myometrium revealed foci of adenomyosis in 49% cases

pelvic hydatid cyst presenting with lower limb edema

Hydatid disease is an infection caused by larval stage of Echinococcus granulosus in humans, which are carried as tapeworms by canines. The most frequent organs affected in humans are liver and lungs. We presented a case of pelvic hydatic cyst which is a rare occurrence. There was a 75 years old man with a history of admission for left lower limb edema suspected to DVT. The patient was suffering from generalized abdominal pains especially in LLQ. On pelvic ultrasound and CT scan, a cystic mass with internal septation on the left side of pelvis was reported. After surgery, pathology report of removed cyst confirmed the hydatid cyst. In endemic regions, in patients complaining of lower limb edema and suspected to have DVT, pelvic mass lesions such as hydatic cyst should be born in mind

A Case of Fitz-Hugh-Curtis Syndrome in a Male / 대한소화기학회지

Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhea and Chlamydia trachomatis. The highest incidence occurs in young, sexually active females. However, the syndrome has been reported to occur infrequently in males, according to the foreign literature. The predominant symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in men and women. In women, the spread of infection to liver capsule is thought to occur directly from infected fallopian tube via the right paracolic gutter. In men, hematogenous and lymphatic spread is thought to be postulated. Recently, we experienced a case of Fitz-Hugh-Curtis syndrome occurred in a man. As far as we know, it is the first report in Korea, and we report a case with a review of the literature.

Pelvic Hydatidosis Mimicking a Malignant Multicystic Ovarian Tumor

Echinococcosis is a multisystem disease and has propensity to involve any organ, an unusual anatomical site, and can mimic any disease process. Primary peritoneal echinococcosis is known to occur secondary to hepatic involvement but occasional cases of primary peritoneal hydatid disease including pelvic involvement have also been reported. We report here 1 such case of primary pelvic hydatidosis mimicking a malignant multicystic ovarian tumor where there was no evidence of involvement of the liver or spleen. Our patient, a 27-year-old female, was detected to have a large right cystic adnexal mass on per vaginal examination which was confirmed by ultrasonography. Her biochemical parameters were normal and CA-125 levels, though mildly raised, were below the cut off point. She underwent surgery and on exploratory laparotomy, another cystic mass was found attached to the mesentery of the small gut. The resected cysts were processed histopathologically. On cut sections both large cysts revealed numerous daughter cysts. Microscopic examination of fluid from the cysts revealed free scolices with hooklets and the cyst wall had a typical laminated membrane with inner germinal layer containing degenerated protoplasmic mass. The diagnosis of pelvic hydatid disease was confirmed and patient was managed accordingly. Hydatid disease must be considered while making the differential diagnosis of pelvic cystic masses, especially in endemic areas.

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.