Relationship Between TCM Syndrome Pattern and Immuno-endocrine Function in Patients with Infertility Induced by Chronic Pelvic Inflammation / 广州中医药大学学报

0.05) . Serum P level was much decreased in pattern 2 patients as compared with those in other pattern patients ( P0.05). [Conclusion] Serum P level is lower in the patients with CPI-induced infertility than that in the healthy, and varies in the patients with different patterns.

Risk factors for tubal infertility. Influence of history of prior pelvic inflammatory disease.

In order to explore possible etiologic differences between tubal infertility in women who had been physician-diagnosed as having pelvic inflammatory disease ("overt" PID) and in women who had not ("silent" pelvic inflammatory disease), we made use of self-reported data from a large, population-based, case-control study of infertility in King County, Washington. Responses from 33 infertile women with no history of physician-reported PID and 129 infertile women with such a history were compared to those of 501 fertile women. No cultures or blood for antibody titers were obtained. Logistic regression was used to compute the relative risks for silent and overt PID-related tubal dysfunction associated with various lifestyle and contraceptive habits in an effort to identify practices that potentially affect these outcomes. In general, practices associated with an increased risk of overt tubal disease, such as use of Dalkon Shield and other types of intrauterine devices, were also associated with an increased risk of silent tubal disease, but to a lesser extent. Women who used oral contraceptives for longer than three years had a decreased risk for silent disease (relative risk = 0.5, 95% confidence interval = 0.3-0.8), but their risk for overt disease did not decrease to the same extent (relative risk = 0.9, 95% confidence interval = 0.3-2.5). These results suggest that silent and overt tubal disease share many common lifestyle risk factors.

Standardised management of PID in a developing country.

During a 15 month period, 464 patients admitted to hospital with pelvic inflammatory disease (PID) were classified according to Monif's staging and treated following strict guidelines. Stage II, PID with peritoneal reaction, was treated with intravenous antibiotics. Stage III, PID with tubo-ovarian mass, was drained by posterior colpotomy when indicated or treated with triple antibiotics when high abdominal masses were present. Stage IV, ruptured tubo-ovarian abscess, was always surgically treated. Mortality was almost limited to patients with stage IV PID, 15% (3/20) of whom died. Morbidity included the need for laparotomy (in 1.6% (6/368) of stage II, 59.3% (45/76) of stage III, and 100% of 20 stage IV patients) and draining pus (in 6.6% (5/76) of stage III cases and 50% (10/20) of stage IV patients). This study also shows that unspecialised hospital staff are able to use Monif's staging correctly, and that acceptable results can be obtained with the limited resources that are available in most developing countries.

[Clinical aspects of acute pelvic inflammation: our experience in 118 cases]. / Clinica della flogosi pelvica acuta: nostra esperienza in 118 casi.

PIP: The authors examined 118 patients with acute pelvic inflammation between January 1978-June 1984. Acute pelvic inflammation data are not very different in women with (32%) or without (68%) an IUD. The average age of the patients was 29.8 years while 33% had neither been pregnant nor had had children. 41% of the women suffered from leukocytosis, 31% from hyperpyrexia, and BST was high in 70% of the cases when patients were admitted to the hospital. During the course of acute pelvic inflammation, pelvic pain was experienced by 97% of the women, hyperpyrexia by 35%, and metrorrhagia by 10%. Therapy was surgical in 25% of the cases and the hospital stay lasted an average of 12.6 days. Considering the diagnostic and therapeutic difficulties which are often connected with acute pelvic inflammation, the authors emphasize that it is necesary to pay great attention to this illness which mainly affects young women and which can, as a consequence, lead to chronic pelvic pain, extrauterine pregnancies, and infertility. (author's modified)^ieng

Nongonococcal pelvic inflammatory disease.

Nongonococcal PID remains a major concern in gynecology and an important public health problem. Although debate continues as to the etiologic role of nongonococcal organisms in acute PID, anaerobic and aerobic bacteria, C. trachomatis, and mycoplasmas have all been implicated. Actinomycotic PID is uniquely related to IUD use. The optimal treatment for nongonococcal PID is unknown, but tetracycline and its derivatives are effective against a broad spectrum of nongonococcal organisms. Abscesses and infertility, in particular, are serious complications of nongonococcal PID. While evolving knowledge about the polymicrobial etiology of acute PID has challenged traditional concepts, continued research should clarify the epidemiology, treatment, and prevention of this important disease.

PIP: Several obstacles to the investigation of nongonococcal pelvic inflammatory disease (PID) are described. The incidence and selected epidemiologic features of this disease are reviewed along with the major nongonococcal pathogens and their treatment, and several theories of microbial etiology are summarized. The late sequelae from this disease are also described. Conventional techniques of diagnosing acute PID seem to be imprecise when applied to nongonococcal PID. Its clinical presentation is often unlike gonococcal PID, but signs and symptoms frequently lead to incorrect diagnosis. Most studies of acute PID lack an objective case definition. Some authors advocate wider use of laparoscopy in diagnosing acute PID, but cost remains an important limitation. The visual criteria for diagnosing PID may be so stringent that mild or early cases of endosalpingitis are missed. The external appearance of the fallopian tube may not be an accurate reflection of pathology involving the lumen. The bacteriology of acute PID seems to vary geographically. The time when the patient seeks medical attention for PID may influence the results of bacteriologic studies. The recovery rates for potential pathogens in acute PID may not accurately reflect the microbial etiology. There may be errors of underdiagnosis and overdiagnosis. In 1976, over 229,000 cases of gonorrhea associated with PID were reported in the U.S., and at least as many nongonococcal cases were estimated to have occurred. Most studies of the epidemiology of acute PID have not distinguished between gonococcal and nongonococcal disease. In the U.S., nongonococcal anaerobic and aerobic bacteria can be isolated from 46-90% of culdocentesis or laparotomy specimens of patients with acute nongonococcal PID. Experiments with grivet monkeys support an etiologic role for chlamydia trachomatis in acute PID. Mycoplasmas are widely found in the genital tracts of sexually active women, but their role in causing acute PID appears less certain than that of chlamydia trachomatis. Actinomycosis represents a unique nongonococcal PID related to IUD use. The optimal treatment for nongonococcal PID is unknown, but tetracycline and its derivatives are effective against a broad spectrum of nongonococcal organisms. Abscesses and infertility are serious complications of nongonococcal PID. Continued research needs to clarify the epidemiology, treatment, and prevention of this important disease.

Prophylactic antibiotics in first-trimester abortions: a clinical, controlled trial.

The efficacy of prophylactic antibiotic therapy in induced first-trimester abortions was investigated in a double-blind study. Of the 493 women in the study, 254 received doses of 2 million IU of penicillin G intramuscularly one-half hour before and 3 hours after the procedure, followed by 350 mg of pivampicillin three times daily for 4 days, and 239 women received corresponding doses of placebo. The incidence of pelvic infectious complications was 5.5% in the treated group and 10.9% in the control group (p = 0.05). The difference could be attributed to a selective prophylactic effect in women who had earlier suffered from pelvic inflammatory disease (N = 105). The rate of infection in this group was 22.4% among those receiving placebo and 2.1% among those receiving antibiotics (p = 0.006). Prophylactic administration of antibiotics for first-trimester abortions should be used in women who have earlier had pelvic inflammatory disease.

PIP: The efficacy of prophylactic antibiotic therapy in induced first trimester abortions was investigated in a double-blind study. Of the 493 women in the study, 254 received dosed of 2 million IU of penicillin G intermuscularly 1/2 hour before and 3 hours after the procedure, followed by 350 mg of pivampicillin 3 times daily for 4 days, and 239 women received corresponding doses of placebo. The incidence of pelvic infectious complications was 5.5% in the treated group and 10.9% in the control group (P=0.05). The difference could be attributed to a selective prophylactic effect in women who had earlier suffered from (PID) pelvic inflammatory disease (N=105). The rate of infection in this group was 22.4% among those receiving placebo and 2.1% among those receiving antibiotics (P=0.006). Prophylactic administration of antibiotics for first trimester abortions should be used in women who have earlier had PID.