Shrinkage of recurrent endometrioma, after danazol.

A 29-year-old woman presented with a history of primary infertility one year after excision of endometrioma of the left ovary. On the first pelvic examination at the Infertility Clinic, the uterus was of normal size, retroversion and rather fixed with 0.5 cm firm nodule at its posterior surface. There was a tense cystic mass about 4-5 cm at the right adnexa. Three months later this mass was noted to have increased in size and the ultrasound revealed a slight, thick wall cystic mass with the largest diameter of 7 cm. The impression was endometriotic cyst of the right ovary. The patient was put on danazol 200 mg daily. After 6 months of treatment, the right ovarian mass was found to be 3.3 cm in the largest diameter by ultrasound. So the medication was discontinued. The patient conceived on the third cycle after discontinuing danazol. A healthy male infant, birth weight 3,320 g was delivered by elective cesarean section at term.

Prevalence of genital herpes simplex infection and abnormal vaginal cytology in late pregnancy in asymptomatic patients.

A study was undertaken to determine the prevalence of genital herpes simplex virus (HSV) infection in 809 asymptomatic, late pregnant women attending the antenatal clinic (ANC) at Ramathibodi Hospital. There was only one case where the cervico-vaginal swab specimen was positive for HSV by cultivation and the biotin-streptavidin enzyme-linked immunosorbent assay (B-SA ELISA), for detection of viral antigens. This gave a prevalence rate of 0.12%. The anti-HSV IgM in cord blood of the infant born to this mother was negative. The Papanicolaou (Pap) smear was performed in 554 cases, including the above patient, but none showed evidence of HSV infection. The high prevalence of lower genital tract infection in these subjects was noted in both Pap smear (31.05%) and wet preparation of the cervico-vaginal discharge (46.72%). Thus, examination of the cervico-vaginal discharge during late pregnancy should be of benefit to the patients, in revealing asymptomatic infections of the lower genital tract.

Recovery frequencies of herpes simplex virus types 1 and 2 from symptomatic and asymptomatic genital herpes cases and antiviral sensitivities of isolates.

Herpes simplex viruses were isolated from 40.8 to 56.0 per cent of the patients with genital herpes. The frequency of recovery seemed to be higher in females than in males, particularly during the first episode of infection. Asymptomatic shedding of the virus from female genitalias was approximately 0.7 per cent. Herpes simplex virus type 2 represented 98.4 per cent of all isolates and the remaining isolates were type 1. These isolates exhibited a wide range of sensitiveness to 9-(2-hydroxyethoxymethyl) guanine (acyclovir) as demonstrated by antiviral inhibition assay and no single strain exhibited high in vitro drug ID50 value.

Evaluation of biotin-streptavidin enzyme-linked immunosorbent assay for detection of genital herpes simplex virus infection.

A biotin-streptavidin enzyme-linked immunosorbent assay (B-SA ELISA) was evaluated for detection of herpes simplex virus (HSV) in clinical specimens which were cervico-vaginal swabs from 205 asymptomatic women and swabs from the genital lesions of 163 suspected patients. All specimens were also subjected to a conventional virus isolation in cell culture. A blocking B-SA ELISA had 100% specificity and 98% sensitivity compared with viral isolation from patients, but had only 40% sensitivity using specimens from asymptomatics. The conventional B-SA ELISA might also be used; it gave results corresponding to B-SA ELISA blocking test except for a single specimen which was considered a false positive.

Ectopic pregnancy after tubal sterilization. Mechanism of recanalization. A case report.

PIP: A case of tubal pregnancy occurring 8 years after a modified Pomeroy's tubal sterilization is reported. The gross and microscopic findings of the resected tubes and the possible mode of recanalization are discussed. A 36 year old Thai woman, para 3-0-0-2, with her last para 8 years previously had puerperal tubal sterilization by modified Pomeroy's technique. The patient was seen at Ramathibodi Hospital on March 28, 1975 because of unimproved left lower abdominal pain for 1 week and a few days of vaginal spotting. She had been treated with antibiotics and analgesic previously. Her last normal menstrual period was in early March, 1975. Pelvic examination revealed pus-like, foul smelling vaginal discharge. Cervical excitation pain was positive. The uterine size was normal, deviated to the right side and slightly tender. A tender, ill-defined, soft cystic mass was palpable at the left adnexa extending to the left side of cul-de-sac. The right adnexa was normal. Exploratory laparotomy revealed that the left adnexal mass consisted of blood clots and a ruptured enlarged ampullar portion of the left tube. The left ovary was normal. At the isthmic portion of the left tube which had previously been resected, there was a constriction. The stumps of both cut ends of the right tube were well healed and widely separated. Left salpingo-oophorectomy was performed. The microscopic finding of the left ampulla was ectopic pregnancy. From serial sections of the constriction site of the left tube, there were multiple small lumina lined by low columnar epithelium surrounded by a thin layer of fibromuscular tissue.^ieng

Primary ovarian pregnancy and the intrauterine contraceptive device.

A case is reported of primary ovarian pregnancy in a patient with an intrauterine device (IUD) in place. The diagnostic criteria from history, signs, and symptoms, and the management of this case and 9 other cases reported in the literature are discussed.