Síndrome de celulitis-adenitis inguinal por Streptococcus agalactiae / Cellulitis-adenitis syndrome inguinal Streptococcus agalactiae

Las infecciones de tejidos blandos en la infancia son producidas habitualmente por el Staphylococcus aureus pero, en los primeros meses de vida, el Streptococcus agalactiae (SGB) puede ser responsable de celulitis con afectación sistémica. El síndrome de celulitis-adenitis por SGB constituye una presentación infrecuente de la infección tardía causada por este germen. Las manifestaciones clínicas consisten en fiebre, mal estado general y signos inflamatorios locales. La localización más frecuente es la submaxilar, siendo excepcional la inguinal. Aportamos el caso de un paciente de 30 días de vida con fiebre, con una placa eritematosa y adenopatías en la zona inguinal derecha. En el hemocultivo se aisló SGB. El tratamiento inicial fue cloxacilina y cefotaxima parenterales cambiándose a las 48 horas, tras la recepción del hemocultivo, por cefotaxima y ampicilina. La evolución fue favorable. En niños menores de 3 meses, ante la presencia de celulitis y adenitis regional, debemos considerar al SGB como posible agente etiológico y contemplar la posibilidad de bacteriemia y afectación del sistema nervioso central para no diferir el tratamiento adecuado.

Soft-tissue infections in children are most often caused by Staphylococcus aureus but, in the first months of life, group B streptococcus (GBS) can be the etiologic agent of cellulitis with systemic involvement. Group B streptococcus cellulitis-adenitis syndrome is a rare form of late-onset disease for this germen. Clinical manifestations include fever and local inflammatory signs. Typical localization is submandibular but the inguinal form is exceptional. We present a case of a 30-day-old infant with fever, an erythematous plaque and lymphadenopathy in the right inguinal area. Blood culture was positive for GBS. Evolution was good with initial parenteral therapy with oxacylin and cefotaxime that was changed at 48 hours of treatment, after the blood culture reception, to ampicilin and cefotaxime. In cases of cellulitis and adenitis in infants during the first 3 months of life, GBS has to be considered the probable etiologic agent, and severe invasive disease has to be ruled-out in order to establish the appropriate antimicrobial therapy.

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.

Síndrome adenitis-celulitis: una presentación infrecuente de infección tardía por streptococcus agalactiae / Adenitis-cellulitis syndrome: an infrequent presentation of a late onset infection by Streptococcus agalactiae

A pesar de los avances en las estrategias de prevención en décadas anteriores, las infecciones por Streptococcus agalactiae constituyen una causa importante de infecciones neonatales. La mayoría ocurren durante la primera semana de vida (enfermedad precoz). Las infecciones tardías ocurren en niños mayores de una semana hasta los tres meses de edad. Entre estas últimas, el síndrome adenitis celulitis es usa manifestación inhabitual de las infecciones tardías por S. agalactiae transformándose en un marcador de infección invasora. Reportamos el curso clínico de un lactante con un síndrome adenitis celulitis de localización inguinal asociado a bacteriemia por S. agalactiae y discutimos la presentación clínica, hallazgos de laboratorio y evolución de esta condición basados en una revisión de la literatura.

Evaluación de los parametrios uterinos / Evaluation of the parametrium uteris

La evaluación no oncológica de los parametrios, como parte del examen ginecológico rutinario, ha venido en desuso como refleja en la bibliografía médica de los últimos 50 años. El propósito de este trabajo fue la evaluación clínica de los parametrios, a través del tacto ginecológico en 1250 pacientes de una consulta privada entre enero de 1999 y diciembre de 2001. En este grupo se evidenció la afectación parametrial en 102 casos. En estos, el parametrio más afectado fue el izquierdo con 83 casos (81,4 por ciento), luego el derecho en 14 casos (13,7 por ciento) y por último la afectación fue bilateral en 5 casos (4,9 por ciento). Se evalúan variables como la edad, la menarquía, las primeras relaciones sexuales, el método anticonceptivo, el tipo de regla, el número de gestaciones y la paridad

Clinical Trial of Vaginal Approach in Gynecologic Pelvic Surgery / 대한산부인과학회잡지

OBJECTIVE: To analyse the clinical aspects of vaginal approach for gynecologic pelvic surgery, we evaluated age distribution, parity, indications for hysterectomy, postoperative pathology, operating time, bleeding amount, weight of uterus, postoperative complications. resected uterus weight, operating time and bleeding amount based on operative procedure type. METHODS: We reviewed the medical records of the 136 patients who underwent vaginal approach for gynecologic pelvic surgery for the indications other than uterine prolapse from Jan. 1998 to April. 1998, and from July. 1999 to Sep. 2001 at Chosun University Hospital. RESULTS: We performed 136 cases of vaginal approach for gynecologic pelvic surgery. We performed 132 cases of total vaginal hysterectomy, 4 cases of transvaginal ovarian cystectomy, a high increased rate of vaginal approach for gynecologic pelvic surgery significantly. The most common indication for vaginal approach for gynecologic pelvic surgery was uterine leiomyoma (63.2%), followed by HSIL, adenomyosis, MIC of the cervix, and ovarian cyst. The operating time was within 90 min in almost cases (47.1%). The most common postoperaive pathologic finding was uterine leiomyoma (47.1%), followed by adenomyosis, uterine leiomyoma with adenomyosis, MIC of the cervix, HSIL, LSIL, ovarian serouscys- tadenoma, and endometrioma. There were 4 cases (2.9%) of cuff cellulitis, 2 cases of pelvic cellulitis (1.5%), 3 cases of hematoma formation (2.2%), 1 case of laparatomy (0.7%) as postoperative complications. etc. CONCLUSION: Vaginal approach for hysterectomy and ovarian cystectomy is a safe method for removing uterus even in the absence of prolapse. Recently it's indication is widened to the patient who has larger uterus and history of previous pelvic surgery. Because of it's advantage, Vaginal approach for hysterectomy and ovarian cystectomy would be the preferred method of gynecologic pelvic surgery in the future.

Características clínicas do abortamento séptico na Maternidade da Encruzilhada / Clinics characteristics of septic abortion at the Maternity of Encruzilhada

Entre maio de 1988 à novembro de 1989, 110 pacientes hospitalizados na Maternidade - FESP - Recife, afirmaram ter realizado manobras abortivas. O principal objetivo desse estudo foi caracterizar as formas clínicas de aborto infectado e correlacioná-las com algumas variáveis. Os achados principais foram: Endometrite foi a forma clínica mais encontrada. O aborto ocorreu mais frequentemente no primeiro trimestre de gestaçäo. O esquema tríplice de antibióticos foi o mais comumente empregado. A média de permanência hospitalar foi de 3 dias

Estudo clinico do diclofenac sodico e piroxicam em ginecologia. / The clinical study of sodium diclofenac and piroxicam in gynecology

O autor estudou os efeitos do diclofenac sodico e piroxicam em 60 pacientes portadoras de ginecopatias inflamatorias nao especificas.Apos 10 dias de tratamento com dose diaria de diclofenac sodico 150 mg ou piroxicam 20 mg, ambas as drogas mostraram-se eficazes. Na avaliacao dos sintomas isoladamente e, em especial, a dor abdominal espontanea, os resultados evidenciaram contudo, um diferenca estatisticamente signifactiva (p < 0,05) favoravel ao diclofenac no 4o. dia de tratamento. Verificou-se, igualmente, uma tendencia de regressao mais rapida da dispareunia e anexos aumentados e dolorosos no grupo com diclofenac. Nao foram verificados efeitos colaterais durante o estudo