Acute salpingitis--laparoscopic and microbiological evaluation.

The diagnosis as well as the severity of acute pelvic inflammatory disease (APID) can be difficult to assess clinically. A study was undertaken to compare the accuracy of clinical findings (Gainesville classification) with laparoscopic findings in 28 patients with APID in terms of: (i) establishing the correct diagnosis; (ii) determining the severity of the disease; and (iii) obtaining specimens to establish the causative organisms. The results were as follows: (i) (a) clinical diagnosis of APID was confirmed by laparoscopic evaluation in 78.6% of cases; (b) clinical staging of APID correlated with laparoscopic findings in 82.6% of cases; (ii) severity of the clinical staging of APID correlated with that of laparoscopic staging; and (iii) polymicrobial cause, as reported by other investigators, was confirmed. Laparoscopic evaluation was of importance in eliminating the inaccuracy of clinical diagnosis in 21.4% of cases and in establishing the causative organisms so that optimal treatment could be given and the long-term after-effects of APID reduced.

[The ultrasonic demonstration of gas in the endometrial cavity--an aid for the diagnosis of puerperal endometritis]. / Die ultrasonografiese aanduiding van gas in die endometriumholte--'n hulpmiddel vir die diagnose van puerperale endometritis.

A pilot study was undertaken to determine the prevalence of gas in the puerperal endometrial cavity and to determine whether this finding has any relationship to the mode of delivery or to the development of puerperal endometritis. On the first day after delivery 192 patients were examinee ultrasonographically and gas was demonstrated in 26 (13.54%). Gas was found significantly more often in relation to caesarean section and intra-uterine manipulation than in normal vaginal deliveries (P less than 0.0001). On the third puerperal day the gas disappeared in 12 patients but persisted in 14, of whom 7 had signs of endometritis. Endometritis was diagnosed in a total of 8 patients and only 1 did not have signs of gas in the endometrial cavity. Although the figures are small it is concluded that ultrasonography of the puerperal uterus might assist in the diagnosis of puerperal endometritis.

Management of term pregnancy with premature rupture of the membranes and unfavourable cervix.

Sixty pregnant patients at term, who had premature rupture of the membranes and an unfavourable cervix were randomised to compare expectant management with oxytocin induction and with the use of prostaglandin E2 vaginal tablets for cervical ripening/induction of labour. Patients treated expectantly were placed on bed rest and observed for labour and infection. Patients managed by intervention were given intravenous oxytocin or 2 prostaglandin E2 tablets (0.5 mg) intravaginally every 6 hours. Between the three groups the duration of labour was longer in the oxytocin group and all 6 caesarean sections were performed on patients in this group. There was only 1 case of proven neonatal sepsis; this occurred in the oxytocin group. Patients with prostaglandin cervical ripening had a shorter hospital stay compared with patients treated expectantly. It is concluded that prostaglandin-induced cervical ripening is the method of choice in handling term patients with premature rupture of the membranes and an unfavourable cervix.

Hysterectomy for septic abortion--is bilateral salpingo-oophorectomy necessary?

Ovarian conservation at the time of hysterectomy for complicated septic abortion is important in this young population group. In a retrospective study, the histological evaluation of the ovaries of 25 patients were compared with the macroscopic description in the operation reports. In 72.3% of the ovaries examined there was no infection. None of the ovaries described clinically as normal at laparotomy showed histological signs of infection. The clinical assessment of infected ovaries was false-positive in 40% of cases but there was no false-negative decision-making. It is concluded that ovaries which appear normal at hysterectomy for septic abortion should be conserved.

Possible toxic shock syndrome in an 18-year-old girl. A case report.

An 18-year-old girl with fulminating disease and severe shock consistent with toxic shock syndrome, which resulted in multiple organ failure and death, is described. This very serious condition, which has a mortality rate of 10-15%, is discussed.

Hysterosalpingo-radionuclide scintigraphy (HERS).

A radionuclide procedure, hysterosalpingo-radionuclide scintigraphy (HERS), was designed to evaluate the migration of a particulate radioactive tracer from the vagina to the peritoneal cavity and ovaries as well as to image and functionally outline the patency of the pathways between these two extremes of the female reproductive system. Technetium-99m human albumin microspheres (99mTc-HAM) were deposited in the posterior fornices of patients who were divided into two specific groups. Group I consisted of patients who were to undergo different elective gynecologic operations, in which besides obtaining sequential images, radioactivity levels were measured in the removed organs and tissues. Group II consisted of patients referred by the Infertility Clinic for evaluation of their reproductive system pathways patency. In this latter group, HERS was compared with contrast hysterosalpingography (HSG) and peritoneoscopy (PCP). The results obtained from measurements of radioactivity levels on the removed surgical specimens and comparison with other conventional gynecologic diagnostic procedures provide accurate evidence of the migration of 99mTc-HAM from the vagina, through the uterus and tubes, to the peritoneal cavity and ovaries, and show that HERS is a simple noninvasive method for functionally imaging and assessing the patency of the female reproductive system pathways.

Double uterus with a unilateral blind vagina. A report of 3 cases.

Uterus didelphys associated with a unilateral imperforate vagina and absence of the kidney on the affected side is rare. Three such cases are described. Early diagnosis and treatment are very important, and certain features that could alert the physician to the presence of such a condition are discussed.

Giant neurofibromas of the labia.

Two cases of giant neurofibroma of the vulva are described. The finding of a solitary neurofibroma in a patient who shows no other stigmata of multiple neurofibromatosis is unusual. Also unusual was the exceptional size of these tumors.

Carcinoid tumour of the appendix discovered at the time of abdominal hysterectomy and incidental appendicectomy.

Two cases of carcinoid tumour of the appendix discovered at the time of abdominal hysterectomy are reported. Aspects of the carcinoid syndrome relevant to the gynaecologist are discussed with reference to the value of routine elective appendicectomy during abdominal surgery.

Endometriosis.

Endometriosis is a fascinating disease--it is common and occurs with increasing frequency. The aetiology remains obscure, but Sampson's theory of retrograde menstruation and implantation is still the most popular and widely accepted. Certain factors play an important role in, predispose to, or stimulate the development of endometriosis. Although the disease can be cured by the menopause, or hysterectomy and bilateral salpingo-oöphorectomy, permanent cure by conservative means is difficult. Better and more effective ways of treatment will solve only part of the problem, and the real solution is prevention of the disease.

Rupture of an ectopic pregnancy in a patient with previous extra-uterine pregnancy and lithopaedion: A case report.

A diagnosis of ectopic pregnancy was made in a patient presenting with abdominal discomfort. Laparotomy showed a tubal pregnancy in the left fallopian tube. On further examination a lithopaedion was found in the omentum. This very unusual combination is discussed.

Postmenopausal endometriosis: A case report.

A case of postmenopausal endometriosis is presented. Symptoms started 14 years after total abdominal hysterectomy and bilateral salpingo-oöphorectomy for endometriosis following oestrogen administration. The disease had a protracted course and eventually responded well to radiotherapy. Certain aspects of postmenopausal endometriosis are discussed.

Advanced extra-uterine pregnancy: A case report.

In most cases of advanced extra-uterine pregnancy the fetus is surrounded by fetal membranes and varying quantities of amniotic fluid. It is, however, possible that the fetus may survive outside the amniotic sac intra-abdominally for varying periods of time. A case of extra-uterine pregnancy is presented where a normal infant was delivered 65 hours after rupture of the membranes.

Incidence of ovarian neoplasms at the Bloemfontein Academic Hospitals, 1972-1977.

In the Orange Free State patients with gynaecological tumours are mainly referred to the National and Pelonomi Hospitals and the Department of Oncotherapy. During the 6 years 1972-1977 there were 1 895 admissions to the gynaecological wards of the National Hospital and 9 807 admissions to those of the Pelonomi Hospital. A total of 205 cases of primary ovarian neoplasia was seen, comprising 97 Whites and 108 Blacks. These cases were further divided into benign and malignant tumours and histologically classified into four main groups. Comparisons were made between cases seen in Bloemfontein and cases at other institutions.

Migration of a particulate radioactive tracer from the vagina to the peritoneal cavity and ovaries.

In this report we describe a radionuclide procedure designed to evaluate the migration of a particulate radioactive tracer from the vagina to the peritoneal cavity and ovaries, as well as the determination of the patency of the pathways between these two extremes of the female reproductive system. 99mTc-labelled human albumin microspheres (99mTc-HAM) were deposited in the posterior fornices of 24 patients a day before they were to undergo different gynaecological operations. During this period sequential images were obtained and after the operation radioactivity levels in the removed organs and tissues were counted with a scintillation detector. In 14 out of 21 cases, the ovaries and fallopian tubes were counted separately from the uterus. Nine were positive (radioactivity levels were sufficiently high in the tubes and ovaries) and 5 were negative (no substantial radioactivity levels could be detected in either the tubes or the ovaries). The 5 negative results all occurred in patients with proved tubal damage as a result of previous infection. All the results were either true positive or true negative, providing evidence of migration, or obstruction, of 99mTc-HAM from the vagina through the uterus and tubes to the peritoneal cavity and ovaries.

[Factors determining the rate of weight gain of the human fetus in utero]. / Faktore wat die Fetale Massatoename in utero beïnvloed.

A brief review is given of the factors determining the rate of weight gain of the human fetus in utero. A number of genetic, metabolic and environmental factors are outlined. Knowledge of these factors is important in modern obstetric care.