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.

Rare complications of multikinase inhibitor treatment

ABSTRACT Objective: The advent of multikinase inhibitor (MKI) therapy has led to a radical change in the treatment of patients with advanced thyroid carcinoma. The aim of this manuscript is to communicate rare adverse events that occurred in less than 5% of patients in clinical trials in a subset of patients treated in our hospital. Subjects and methods: Out of 760 patients with thyroid cancer followed up with in our Division of Endocrinology, 29 (3.8%) received treatment with MKIs. The median age at diagnosis of these patients was 53 years (range 20-70), and 75.9% of them were women. Sorafenib was prescribed as first-line treatment to 23 patients with differentiated thyroid cancer and as second-line treatment to one patient with advanced medullary thyroid cancer (MTC). Vandetanib was indicated as first-line treatment in 6 patients with MTC and lenvatinib as second-line treatment in two patients with progressive disease under sorafenib treatment. Results: During the follow-up of treatment (mean 13.7 ± 7 months, median 12 months, range 6-32), 5/29 (17.2%) patients presented rare adverse events. These rare adverse effects were: heart failure, thrombocytopenia, and squamous cell carcinoma during sorafenib therapy and squamous cell carcinoma and oophoritis with intestinal perforation during vandetanib treatment. Conclusions: About 3 to 5 years after the approval of MKI therapy, we learned that MKIs usually lead to adverse effects in the majority of patients. Although most of them are manageable, we still need to be aware of potentially serious and rare or unreported adverse effects that can be life-threatening.

Fatal disseminated cytomegalovirus infection with necrotizing oophoritis in a patient with acquired immunodeficiency syndrome

Disseminated human cytomegalovirus (CMV) disease occurs mainly as a congenital infection and among immunocompromised hosts. Patients with acquired immunodeficiency syndrome (AIDS) are at increased risk for CMV infection, and the most prevalent clinical manifestation is retinitis, followed by colitis, esophagitis, pneumonitis, and encephalitis. CMV oophoritis is poorly described in the literature with some cases reported in patients with hematological or solid malignancies, bone marrow or solid organ transplantation, immunosuppressive therapy, and advanced AIDS cases. We report the case of a 61-year-old woman with a recent diagnosis of AIDS, which was associated with a wasting syndrome. The patient presented with abdominal pain, headache, cutaneous vesicular lesions on the abdomen, anemia, lymphopenia, and hyponatremia; she died suddenly on the fourth day of hospitalization. The autopsy was performed and demonstrated disseminated CMV infection with hemorrhagic encephalitis as the immediate cause of death. Additionally, pneumonitis, extensive adrenalitis, ulcerated enteritis, focal hepatitis, and necrotizing oophoritis were found.

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.

Histopathologic findings in uteri and ovaries collected from clinically healthy dogs at elective ovariohysterectomy: a cross-sectional study

Opinions on ovariohysterectomy (OHE) of bitches vary depending on region and country. In this descriptive, prospective cross-sectional study, uterine tracts and ovaries exhibiting gross pathologic findings (n = 76) were collected post-surgery from a reference population of 3,600 bitches (2.11% incidence) that underwent elective OHE during September to November 2013 and evaluated by histopathology examination. Data were evaluated by using descriptive statistics and chi-squared tests. Bitches were of crossbred background with average age 5 years (range 0.6–8.0 years) and most were nulliparous (69.7%) with no anamnesis of reproductive diseases (81.6%). Frequencies of proestrus, estrus, and diestrus were 42.1%, 6.6%, and 19.7%, respectively. The presence of mammary gland masses (5.3%) significantly correlated with histopathologic findings in ovaries and age of the bitch (p < 0.05). Predominant uterine histopathologies included cystic endometrial hyperplasia, periglandular fibrosis, lymphoplasmocytary endometritis, and adenomyosis (19.7%, 14.5%, 4.0%, and 2.6%, respectively). In ovaries, hyperplasia of rete ovarii, follicular cysts, oophoritis, adenoma of the rete ovarii, cysts of superficial structures, and granulosa cell tumors (10.5%, 10.5%, 7.9%, 4.0%, 2.6%, and 2.6%, respectively) were observed. The results reveal the presence of subclinical pathologies in healthy bitches, suggesting that OHE at an early age is beneficial for prevention of reproductive pathologies.

Effects of acupuncture and electroacupuncture on estradiol-induced inflammation and oxidative stress in health rodents

PURPOSE:To investigate the effects of classical acupuncture (Ac) and electroacupuncture (EAc) on estradiol-induced inflammation and oxidative stress in health rodents. METHODS: Twenty-four eight-week old female rats were treated with estradiol valerate (EV) 4.0 mg i.m. single dose and randomly assigned to four groups (n=6): G1(control), G2 (Ac), G3 (EAc 2 Hz) and G4 (EAc 100 Hz). After 60 days all rats were anesthetized with chloral hydrate 10% (0.1 ml/30 g weight of the animal) and submitted to Ac/EAc for twenty minutes. The procedures were repeated on days three, five, seven and nine of the study. The equivalent of the human right ST-36 (Zusanli) and SP-6 (Sanyinjiao) acupoints were chosen for needling and electrical stimulation. On the 10th day of the experiment, all rats were anesthetized for collection of blood and tissues (ovaries) samples for biochemical analysis and histological examination. RESULTS:Glutathione (GSH) and malonaldehyde (MDA) concentrations increased significantly in all groups (plasma and ovary) while myeloperoxidase (MPO) activity decreased significantly in all groups compared with control group (G1). CONCLUSIONS:Both classical acupuncture and electroacupuncture decrease systemic and local oxidative stress and ovary inflammation in healthy rats exposed to estrogenic stimulation. EAc enhances lipid peroxidation at systemic and local levels in female rats exposed to estrogenic stimulation.

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.

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

A case of xanthogranulomatous oophoritis developed in a virgin / 대한산부인과학회지

Xanthogranulomatous inflammation is an uncommon form of chronic granulomatous inflammation that is characterized by the presence of lipid-filled histiocytes with lymphocytes, plasma cells and neutrophils. It is best known to occur in the kidney. Other organs in which xanthogranulomatous inflammation has been reported are the gallbladder, stomach, anorectal area, bone, urinary bladder, testis, epididymis and female genital tract. Only a few cases of xanthogranulomatous oophoritis have been reported to date. Infection has been thought to be the main etiologic factor in the pathogenesis of xanthogranulomatous lesion. The pathogenesis of xanthogranulomatous inflammation remains still unclear. Other proposed causes are abnormality in lipid metabolism, endometriosis and ineffective clearance of bacteria by phagocytes. We describe a case of a xanthogranulomatous oophoritis in a 23-year-old virgin which associates with hemorrhagic ovarian cyst and minimal association of pelvic inflammatory disease.

Absceso de ovario y embarazo a término / Ovary abscess and term pregnancy

Se describe el raro caso de una salpingooforitis en una gestante de 27 años de edad, que luego de su parto eutócico comenzó a referir dolor abdominal intenso, provocado por un absceso perforado en ovario derecho, de aproximadamente 10 cm de diámetro, y adherencias de este a las asas intestinales según hallazgos operatorios. Luego de 9 días de tratamiento antimicrobiano para combatir el Staphilococcus aureus, unido a oportunos cuidados posoperatorios, recibió el egreso hospitalario por su evolución satisfactoria

Histopathological and bacteriological studies on the cull laying hens' reproductive system

Disorders of laying hens' reproductive system such as: egg-peritonitis, salpingitis and oophoritis have been gaining increasing attention due to immense economic losses that are being inflicted by these conditions on the growing poultry industry. In order to determine the incidence of salpingitis, oophoritis and egg peritonitis in cull laying hens, 1041 cull laying hens from commercial laying farms in Fars province were necropsied. Among these 86 [8.26%] cases showed at least one lesion in their reproductive system, of which 37 [3.55%] carcasses exhibited gross lesions of both egg peritonitis and salpingitis, salpingitis 37 [3.55%], egg peritonitis 7 [0.67%] and oophoritis 5 [0,48%]. The overall condition was found to be 86 [8.26%]. Bacterial culture of 86 suspected cases of inflammatory reactions of the ovary, the oviduct and the peritoneal cavity yielded Esherichia coli in 62 [5.95%] of cases, Salmonella spp in 4 [0.38%] of cases, Proteus Vulgaris in 2 [0.19%] of cases and Klebsiella in 1 [0.09%] of cases and mixed bacterial infection in 9 [0.86%] cases. No bacteria was isolated from 8 [0.76%] of suspected cases. Lesions at gross and microscopic level and also bacteriological findings were recorded and compared with other workers results

Salpingooforitis xantogranulomatosa asociada a malformaciones urorrectogenital en una adolescente / Xanthogranulomatous salpingitis and oophoritis in an adolescent female with urorectal and genital malformation

Presentamos el caso de una adolescente de 17 años con una malformación urorrectogenital compleja que incluía maga vejiga con desembocadra uretral en la vagina,fístula rectovagina(recto con desembocadura normal de ano)y dos hemiuteros con su correspondiente cuello y anexo,ambos desembocando en una sola vagina.La detección de una tumoración anexial izquierda llevó a la extirpación del hemiútero y anexo izquierdos.En este último se comprobó salpingitis y ooforitis xantogranulomatosa.La inflamación xantogranulomatosa ha sido reconociada en diferentes sitios,siendo la pielnefritis xantogranulomatosa la localización más frecuente.La malformación genitourinaria compleja con fístula rectovaginal seguramente ha actuado en este caso como factor predisponente a la infección ascendente.Esta asociación,que no hemos hallado previamente,amplía el espectro de las patologías asociadas a la inflamación xantogranulomatosa

Xanthogranulomatous oophoritis and salpingitis: late sequelae of inadequately treated staphylococcal PID.

We describe the case of a 42-year-old woman who was a follow-up case of incompletely treated pelvic inflammatory disease, and presented with menorrhagia and bilateral ovarian masses. Subtotal hysterectomy with bilateral salpingo-oophorectomy was performed. Purulent material was obtained from the cystic masses, which grew Staphylococcus aureus. Histological examination of right-sided cystic mass revealed a simple cyst of the ovary. Left sided tuboovarian mass revealed the presence of lipid filled macrophages with lymphocytes, plasma cells and neutrophils; this established the diagnosis of xanthogranulomatous salpingitis and oophoritis. The case is of interest in view of the rarity of this condition; five cases of xanthogranulomatous salpingitis and oophoritis have been reported in the world literature till date.

A Case of Xanthogranulomatous Oophoritis / 대한산부인과학회잡지

Xanthogranulomatous oophoritis is uncommon forms of chronic granulomatous inflammation in the female genital tract. It is characterized by the presence of foamy histiocytes with admixed lymphocytes, plasma cells, and neutrophils. We describe a case of xanthogranulomatous oophoritis in a 75-year-old woman, which was misdiagnosed as uterine sarcoma preoperatively.

A Case of Xanthogranulomatous Oophoritis / 대한산부인과학회잡지

Xanthogranulomatous oophoritis is uncommon forms of chronic granulomatous inflammation in the female genital tract. It is characterized by the presence of foamy histiocytes with admixed lymphocytes, plasma cells, and neutrophils. We describe a case of xanthogranulomatous oophoritis in a 75-year-old woman, which was misdiagnosed as uterine sarcoma preoperatively.

An Epidemiologic Investigation on Mumps Outbreak in Cheju-do, 1998 / 예방의학회지

OBJECTIVES: To describe the characteristics of a mumps epidemic in Cheju-do, 1998 and to identify the risk factors associated with mumps infection. METHODS: To estimate attack rate, previously collected data from the Nationally Notifiable Communicable Disease Reporting System and School Health Reporting System, temporarily administered by Division of Education, as well as additional surveillance data were used. In order to identify the clinical characteristics and risk factors associated with mumps, we conducted a questionnaire survey in 17 schools (9 elementary, 4 middle, and 4 high schools) among a population that included healthy students. RESULTS: From March 3 to August 31, 2,195 cases of mumps were identified, and patients under 20 years of age accounted for 2,162 cases (attack rate 13.2, 95% CI 12.6-13.7/1,000). The attack rate for the population under 20 years of age was the highest in Nam county (44.7/1,000), and in the 7-12 years old sub-group(>20.0/1,000). There was no sexual difference. 80.9% and 59.7% of patients presented periauricular and submandibular swelling respectively. Aseptic meningitis was a complication in 2.9% of cases, orchitis in 1.3%, epididymitis in 0.9% and oophoritis in 0.6% respectively. The overall MMR vaccination rate was 59.1% and it decreased in accordance with increasing age. In students aged 10 years old or below, household contact and MMR vaccination status was significantly associated with infection, and only among students with household contact, the risk of one dose MMR(OR=10.22, 95% CI 2.92-35.78) and non-vaccination (OR=11.62, 95% CI 1.96-68.96) was significantly greater when compared with that of two dose vaccination. Among students aged 11 years old or above, household contact history was significantly associated and MMR vaccination status was not associated. CONCLUSIONS: Low vaccination rate and vaccine failure were thought to predispose the population for this large outbreak. To prevent sustained mumps outbreaks, a second MMR vaccination should be encouraged and catch up vaccinations should be given to elderly children who remain susceptible.

Falla ovárica prematura inmunológica / Immunological premature ovarian failure

Se presenta el cuadro de falla ovárica prematura de etiología inmunológica, describiendo sus características fisiopatológicas y clínicas, diagnóstico, tratamiento y pronóstico. Se reporta un caso clínico atendido en el Servicio de Ginecología y Obstetricia del Hospital San Juan de Dios, discutiendo alternativas diagnósticas y terapéuticas