RESUMO
Objective: to estimate the frequancy of genital tuberculosis [T.B] among infertile women undergoing laparoscopic evaluation in El Minia University Hospital.-Secondly to assess different diagnostic modalities of genital T.B
Design: a prospective study
Setting: Department of Obstetrics and Gynacolgy, Department of Pathology and Department of Microbiology, Faculty of Medicine, Minia University
Methods: 150 infertile women undergoing laparoscopy were included into the study from December 2003 to September 2005, Laparoscope criteria of genital T.B were observed, any suspicious lesions for T.B. adnexities or peritonitis were biopsied, peritoneal fluid was obtained for detection of mycobacteria by automated radiometric BACTEC 460 system and culture in Lowenstein Jensen medium [L.J], lastly Whole endometrial curettage was taken for histopathology
Results: the incidence of genital T.B as diagnosed by Laparoscopy was 8% among study group, the incidence of positive patients was more among rural, low socioeconomic and low educational level patients. Both laparoscopic findings confirmed by biopsy and BACTEC showed high sensitivity and specificity [93-95%] compared to endometrial biopsy [81-83%] and culture in L.J [72-76%] for diagnosis of genital T.B. Moreover BACTEC showed shorter detection time than L.J
Conclusion: it is essential for a gynecologist working in developing countries to anticipate possibility of genital T.B in infertile patients. For the diagnosis of genital T.B the simultaneous use of BACTEC and L.J is recommended to provide maximal optimal recovery of isolates from clinical specimens. The time-Saving in BACTEC provides an excellent facility for gynecologists in patient's management
RESUMO
Early detection of malignant changes in premalignant lesions of both endometrium and cervix, using P53 nuclear immunostaining and cytophotometric technique for DNA nuclear contents. Forty seven endometrial and cervical biopsies from patients suffering of pre or postmenopausal bleeding [18 simple and complex endometrial hyperplasia with atypia 10 CIN, 12 endometrial carcinoma, and 7 cervical carcinoma] and 12 control cases were evaluated by histopathology, P53 immunostaining and DNA cytophotometric study. Three cases [one simple, 2 complex] out of 18 atypical endometrial hyperplasia [16.7%] were aneuploid and showed positive P53 immunostaining [malignant criteria]. Two cases out of 10 CIN [20%] were aneuploid and 4 were positive P53 immuno-staining [40%]. Aneuploidy and P53 immunostaining were directly proportional to the tumour grade in both endometrial and cervical carcinoma with increasing aneuploidy and staining positivity in higher than lower tumour grades. Adding P53 immunostaining or cytophotometric study to histopathology in cases of atypical simple and complex endometrial hyperplasia and CIN will help in early detection of malignant changes for better operative and post operative management. Both methods may help in measurement of the power of invasion and tumour aggressiveness in frank endometrial and cervical malignancy for better evaluation of operative and postoperative management