Ovarian abscess with spontaneous vaginal drainage

The occurrence of a rare ovarian abscess, spontaneously drained through the vagina after an abdominal hysterectomy is described. The treatment was an oophorectomy. The various forms of primary ovarian abscess are discussed in connection with these observations. This case illustrates the need for adequate manipulation of the gonad during pelvic surgery in order to avoid parenchymal contamination and the subsequent formation of such abscesses.     

Controlled opening of wounds with the apparatus of pin cutaneous fixation as a method of treatment in anaerobic infections of the lower limbs

BACKGROUND: Transvaginal ultrasound-guided aspiration of ovarian endometrioma has been applied and emphasized as a safe and simple procedure. CASE: Two 27-year-old infertile women, both gravida 0, para 0, underwent medical follow-up examinations for cases of ovarian endometrioma. Both had undergone transvaginal ultrasound-guided aspiration of ovarian endometrioma. Because both were continuously febrile and had abdominal pain and cysts with tenderness in spite of antibiotic therapies, both underwent laparotomies for treatment. In both cases, enucleation of the ovarian abscess revealed purulent and malodorous fluid that demonstrated Peptostreptococcus magnus in culture. CONCLUSION: We theorize that following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol, anaerobic infection by P. magnus occurred, and a cyst formed in the abscess.     

Laparoscopy-assisted and -prepared hysterectomy. A series of 80 cases

OBJECTIVE: Our objective was to determine the interest of laparoscopic assisted vaginal hysterectomy. STUDY DESIGN: Between January 1991 to december 1994, 80 patients had laparoscopically assisted vaginal hysterectomy. We reviewed with particular emphasis characteristic indications, complications. RESULTS: Eighty were performed as laparoscopically assisted vaginal hysterectomy. 14 patients (17.5%) had laparotomy conversion; because of size of uterus in 3 cases, suspected ovarian tumor in 3 cases. Pelvic adherences in 4 cases, urinary tract injuries in 1 case, hypercapnia in 1 case, hemorrhage in 2 cases. 9 patients experienced febrile morbidity and 1 urinary infection. 1 patient received 2 units of packed red blood cells. The hospital stay was 5 days for laparoscopically assisted vaginal hysterectomy versus 5.9 for laparotomic hysterectomy. CONCLUSION: Laparoscopically assisted vaginal hysterectomy offers a technique to convert certain abdominal hysterectomies into vaginal hysterectomies with a 17.5% laparoconversion rate.     

Isolated ovarian polyarteritis nodosa

Polyarteritis nodosa is a rare disorder and a form of systemic vasculitis. A 48 year-old female was admitted to the hospital because menorrhagia and pelvic pain in February 1993. The patient underwent exploratory laparotomy resulting in a total hysterectomy and bilateral salpingo-oophorectomy for myoma of uterus and a right adnexal cystic mass. Histopathologic examination revealed left ovarian periarteritis nodosa. Further investigation and 9 months follow-up failed to show any systemic involvement. To our knowledge the isolated ovarian polyarteritis nodosa is the first case in the literature.     

Role of ultrasonography in the early diagnosis of ovarian cancer

BACKGROUND: Malign ovarian carcinomas are the main cause of death from gynaecological cancer. In fact, only in 30% of cases is it diagnosed at an early stage. In our study the possibility of an early diagnosis of the ovarian malignant neoplasia was evaluated. METHODS: One hundred and thirty-nine women with adnexal swelling were subjected to pelvic echography. The sample was selected during routine gynaecological checkups. RESULTS: All the cases showing a mass diameter exceeding 25 mm were classified as positive. Echotomography showed 129 cases of positive ovarian mass with an accurate diagnosis in 92.27%. Integrating the results of echography with those of radioimmunoassay an early diagnosis of ovarian cancer was achieved in 92.53 of the cases. CONCLUSIONS: A routine pelvic examination associated with pelvic echotomography represent an effective protocol for the diagnosis of ovarian cancer at an early stage.     

Iodixanol in cardioangiography in patients with coronary artery disease. Tolerability, cardiac and renal effects

PURPOSE: Complications following transvaginal ultrasound-directed follicle aspiration are rare, making it difficult to assess their true incidence. During a 4-year prospective study the complications arising from a series of 2670 consecutive procedures were monitored. RESULTS: Vaginal hemorrhage occurred in 229 (8.6%) of the cases, with a significant loss (> 100 ml) in 22 (0.8%). Postoperative pelvic infection occurred in 18 (0.6%) of the cases. Hemorrhage from the ovary with hemoperitoneum formation was seen on two occasions and necessitated emergency laparotomy in one instance. A single case of pelvic haematoma formation from a punctured iliac vessel was also recorded; this settled without intervention. Of the 18 cases with infection, 9 were severe with pelvic abscess formation; microbiological examination of the pus from these cases suggests that the most common route of infection in such cases is probably by direct inoculation of vaginal organisms into the peritoneal cavity by the collecting needle. CONCLUSION: The low incidence of pelvic infection questions the value of using prophylactic antibiotics. No increased risk of infection was demonstrated in cases with preexisting peritoneal damage.     

Dedicated defense team strengthens liability protection

Primary psoas abscess is a relatively rare disease with highest incidence in children and adolescents. It usually presents with fever, abdominal pain and limp. Limping tends to incriminate musculoskeletal problems below the pelvis, but movement of the hip involves the psoas muscle which is mostly retroperitoneal and intimately related to pelvic and intraperitoneal organs. Although the current tendency is to use abdominal sonography, rectal examination is still a valuable step in clinical examination, and may help to assess a pelvic mass or abscess. The following case report describes the elusive nature of psoas abscess and a rare occurrence of abscess rupture and peritonitis, immediately after rectal examination.     

Tuberculous abscess in retromammary region: CT findings

PURPOSE: Our goal was to evaluate CT findings of tuberculous abscess in the retromammary region of the breast. METHOD: Four patients with tuberculosis extending from the retromammary region to the pleura were examined by CT and the findings were evaluated. All cases were also examined with mammography and two cases were evaluated with sonography. Diagnosis was confirmed by acid-fast bacillus stain, culture, and histologic examination. RESULTS: Mammography showed relatively smoothly marginated, round mass density in two cases, nodular density in one, and focal bulging of the pectoral wall in one. A sonogram demonstrated in two cases a fistulous connection from the heterogeneous, fluid-containing lesion with floating internal debris in the retromammary region to the thoracic cavity. In all four cases, CT showed relatively smoothly marginated, inhomogeneous, hypodense lesions with surrounding rims of the cold abscess type. A direct fistulous connection from the retromammary lesion through the thoracic wall into the pleura was seen in two cases. Destroyed rib fragments within the abscess were noted in two cases. CONCLUSION: A tuberculous abscess in the retromammary region usually showed on CT a focal, smoothly marginated, inhomogeneous, hypodense lesion with a surrounding enhancing rim. A direct fistulous connection with the pleura or a destroyed rib fragment in the abscess as revealed by CT can be helpful in the differential diagnosis of other infectious types of retromammary abscess.     

Bidirectional modulatory effect of orphanin FQ on morphine-induced analgesia: antagonism in brain and potentiation in spinal cord of the rat

OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.     

Development of ovarian pathology after hysterectomy without oophorectomy

This study was done to determine the occurrence of disease in retained ovaries after hysterectomy. A retrospective analysis of patient charts was performed, comparing the patient reports of women who had secondary ovarian lesions with those whose ovaries showed no pathologic findings during the ten year period of observation (1980 to 1990). The study included 1,265 women with at least one ovary saved after hysterectomy for benign indications. Main outcome measures were ovarian pathologic findings after hysterectomy requiring repeat operation. The overall incidence of lesions in retained ovaries was 3.95 percent. There was a 3 percent risk of having secondary ovarian pathologic findings within three years after hysterectomy, with a decreased risk for the following seven years (mean follow-up time of 60 months, range of three to 120 months). Histologic findings at reoperation included common benign conditions of the ovary. No instance of carcinoma of the ovary was found. The risk of having pathology in the retained ovaries after hysterectomy was significantly higher in women who had only one ovary saved, compared with those who had both ovaries saved (7.63 versus 3.47 percent; p < 0.05). The mean age at hysterectomy was significantly lower in women who had ovarian disorders subsequent to hysterectomy than in those who did not (39.3 versus 43.9 years; p < 0.001). In the group of women with secondary ovarian lesions, mean parity was significantly lower than in those without reoperation (1.22 versus 1.94; p < 0.0001). Women with unilateral oophorectomy at the time of hysterectomy had twice the risk of secondary ovarian lesions, compared with those without oophorectomy at hysterectomy. Determinants, such as age, parity and gravidity must be considered when deciding whether or not to perform oophorectomy at hysterectomy.     

The perioperative morbidity of scheduled cesarean hysterectomy

OBJECTIVE: To compare the outcomes of patients undergoing scheduled cesarean hysterectomy with those of women treated with cesarean delivery and subsequent hysterectomy. METHODS: Through a retrospective review of 43 patients, we investigated the morbidity associated with scheduled cesarean hysterectomy and compared these findings with the combined morbidity of scheduled cesarean delivery and subsequent abdominal hysterectomy in a control population. Controls were included only if the subsequent hysterectomy was performed within 3 years of the index cesarean delivery. Each study subject was assigned two controls matched for age, parity, number of previous cesarean deliveries, and indications for procedures. The incidence of the following major morbidity events was compared between the groups: transfusion, urinary tract injury, fistula formation, cellulitis or endometritis, postoperative abscess or hematoma formation, ileus, pneumonia, and wound complications requiring prolonged therapy (seroma, hematoma, infection). RESULTS: The number of women receiving transfusions after scheduled cesarean hysterectomy was greater than among controls (39.5 versus 15.1%; P < .05). The proportion of patients with major morbidity, exclusive of transfusion, was significantly greater in the control population (44%) than in women with scheduled cesarean hysterectomy (16%) (P < .05). The cumulative number of women with a major complication, such as transfusion or a morbid event, was 22 of 43 in the study group versus 44 of 86 in the control population, a nonsignificant difference. CONCLUSION: We found no significant difference in the cumulative perioperative complication rates in women undergoing scheduled cesarean hysterectomy compared with a population of similar patients treated with cesarean delivery and subsequent abdominal hysterectomy.     

The clear cell variant of epithelioid intravenous leiomyomatosis of the uterus: report of a case

A case of very rare uterine clear cell epithelioid leiomyomatosis is reported. The patient presented with a recurrent pelvic mass after hysterectomy 2 years earlier. The recurrent tumor was located mainly in the vessels of the broad ligament as worm-like plugs. The reviewed hysterectomy specimen showed a typical multi-lobulated intramural mass together with worm-like plugs within the myometrial vessels. Computer tomography exhibited metastatic nodules in both lungs. According to an histological examination, all the tumor cells were of epithelioid type and contained abundant clear cytoplasm. Characteristic large, thick-walled blood vessels were observed. Immunohistochemical staining and ultrastructural examination supported smooth-muscle origin in this case. Electron microscopic study revealed that the clear cytoplasm was attributed to the presence of numerous dilated mitochondria that had lost their cristae. The patient is still alive with the disease 28 months after surgery.     

Fibrin-film stenting in a porcine coronary injury model: efficacy and safety compared with uncoated stents

Pyogenic liver abscess is an uncommon complication of intra-abdominal or biliary tract infection and is usually a polymicrobial infection associated with high mortality and high rates of relapse. However, over the past 15 years, we have observed a new clinical syndrome in Taiwan: liver abscesses caused by a single microorganism, Klebsiella pneumoniae. We reviewed 182 cases of pyogenic liver abscess during the period September 1990 to June 1996; 160 of these cases were caused by K. pneumoniae alone, and 22 were polymicrobial. When patients with K. pneumoniae liver abscess were compared with those who had polymicrobial liver abscess, we found higher incidences of diabetes or glucose intolerance (75% vs. 4.5%) and metastatic infections (11.9% vs. 0) and lower rates of intra-abdominal abnormalities (0.6% vs. 95.5%), mortality (11.3% vs. 41%), and relapse (4.4% vs. 41%) in the former group. Liver abscess caused by K. pneumoniae is a new clinical syndrome that has emerged as an important infectious complication in diabetic patients in Taiwan.     

Reversal of blood flow in experimental branch retinal vein occlusion

BACKGROUND: The consequences and management of asymptomatic Actinomyces-like organisms detected on cervical cytologic smears continue to be controversial. CASE: A unilateral tuboovarian actinomycotic abscess was discovered in a woman who had undergone a hysterectomy for uterine leiomyomas. She had had an intrauterine device in place for many years without any symptoms of pelvic inflammatory disease. CONCLUSION: Ascending infection of the upper genital tract by Actinomyces may be clinically inapparent. When Actinomyces-like organisms aer detected on cervical cytologic smears, removal of an intrauterine device should be considered.     

A randomized controlled trial of extraperitoneal bupivacaine analgesia in laparoscopic hernia repair

BACKGROUND: This study was designed to determine the frequency of surgical site infection development after discharge from the hospital after abdominal or vaginal hysterectomy and the frequency of use of antimicrobial prophylaxis in this patient group. METHODS: A prospective cohort study was performed on patients undergoing abdominal or vaginal hysterectomy between February 1 and December 31, 1995. Surgeons were contacted 1 month after the operations to determine which patients had acquired surgical site infections. Surgical site infection rates were calculated according to procedure, surgeon, and National Nosocomial Infection Surveillance system risk categories. A retrospective pharmacy record review was conducted to determine antimicrobial prophylaxis use according to procedure and surgeon. RESULTS: A total of 763 cases were surveyed; 55 (7.2%) met criteria for postoperative surgical site infection (7.7% abdominal and 4.5% vaginal hysterectomy). National Nosocomial Infection Surveillance system moderate-risk patients had significantly higher infection rates than did low-risk patients for both abdominal (p = 0.045) and vaginal (p = 0.05) procedures. Most patients (71.1%) were not given antimicrobial prophylaxis. There was a wide range of antimicrobial prophylaxis use by surgeon (3.6% to 94.4% of patients, p < 0.01). CONCLUSION: Despite long-standing and widespread recommendations for antimicrobial prophylaxis before hysterectomy, most of our patients were operated on without such prophylaxis. Surveillance programs permit detailed review of patient care practices that may reveal opportunities for improvement.     

Squamous cell carcinoma in ovarian endometriosis. A case report

A primitive squamous cell carcinoma of the ovary arose in ovarian endometriosis. The patient underwent a radical hysterectomy and radiotherapy. The other few similar reported cases had a poor prognosis. In our case the patient died 11 months after surgery.     

Xenopus laevis fertilisation: analysis of sperm motility in egg jelly using video light microscopy

OBJECTIVE: To evaluate the origin of pseudomyxoma peritonei (PMP) in Chinese women. METHODS: The clinicopathologic features of 15 cases of PMP were reviewed. Immunostaining using antibodies for CK7 and CK20 was performed in the ovarian, appendiceal and peritoneal lesions of these cases. RESULTS: Appendiceal pathology was documented in five cases, including four mucinous cystadenoma and one simple mucocele. Eight ovarian tumors were found, including seven mucinous cystadenocarcinomas of low malignant potential and one mucinous cystadenoma. Synchronous ovarian and appendiceal lesions were discovered in three cases. One patient had adenocarcinoma of the pancreas. The origin of mucin production was not known in four cases with metastatic adenocarcinoma found in two of them. Immunoreactivity for CK20 was demonstrated in the tissues derived from the peritoneum, ovary, appendix and pancreas while only 23% (3 out of 13 women) of the peritoneal lesions and 33% (2 out of 6 women) of the ovarian tumors were immunoreactive for CK7. CONCLUSIONS: PMP is a heterogeneous lesion, which may develop from mucinous metaplasia of the peritoneum or from appendiceal, or ovarian lesions. Careful examination of the ovary and appendix with performance of appendectomy is advised in every case of PMP. Immunohistochemical examination of the peritoneal, ovarian or appendiceal lesions using antibodies, in particular that for CK7 would help in defining the origin of mucin production.     

Quality assurance in roentgen diagnosis. Comparison of constancy test methods according to DIN and IEC and practical consequences in Germany

A total of 437 patients who had undergone hysterectomy in the department of Obstetrics and Gynaecology, Heinrich Braun Clinic, Zwickau, between 1982 and 1992 were asked about vegetative and psychological problems after the operation. All were under 42 years old and had at least one ovary left intact. In all, 245 women returned the questionnaires. After hysterectomy 26.1% reported ovarian failure and 36.7% did not observe typical menopausal symptoms. Symptoms were significantly more frequent in patients where ovary had been removed. It made no difference whether a vaginal or an abdominal incision had been made. Psychic problems were reported by 17.6% of the patients. Patients with ovarian failure had more negative symptoms. Postoperatively, 34 women received hormonal therapy, and 10 of them finished the therapy successfully. The rate of ovarian failure and psychic symptoms can be reduced by adequate information before and after hysterectomy. A decision to perform a hysterectomy should be made only if the operations is strictly indicated. Prophylactic oophorectomy should not be performed in patients under 50 years. Effective hormonal substitution is recommended for patients with menopausal symptoms.     

An autopsy case of an extensive epidural spinal abscess demonstrating necrotizing poliomyelopathy

A 59-year-old man with a history of diabetes mellitus (NIDDM) presented with fever, back pain and weakness in the left lower limb. Three weeks later he suddenly developed flaccid paraklegia, a sensory deficit below the abdomen and sphincter dysfunction. MR images of the spinal cord showed an extensive anterior spinal epidural abscess extending from the seventh cervical to the twelfth thoracic spine and osteomyelitis in the lower thoracic spines. He died of pulmonary infection one year after the disease onset. Postmortem examination revealed a large empyema in the lung. On neuropathological examination, small multiple hemorrhagic or ischemic lesions were found in the basal ganglia and the pons. The spinal cord was markedly atrophic in the lumbar cord. However, there was neither compression deformity in the cord nor occlusion in the anterior spinal artery. Throughout the thoracic cord, rarefaction and focal cavity formation was selectively present in the gray matter, particularly the posterior horns. In the white matter, vacuolar changes were seen peripherally as well as Wallerian degeneration in the lateral and anterior corticospiral tracts and in the fascicles gracilis bilaterally. The mechanisms inducing the cord damage in cases of epidural spinal abscess have been speculated to be either direct compression by the abscess or the secondary circulatory disturbance in the cord due to compression. In our case, the cord showed necrotizing poliomyelopathy, which was similar to that of ischemic myelopathy found in the cases of cardiac arrest or dissecting aneurysm of the aorta. Autopsy study of spinal cord lesion associated with epidural abscess has been limited in number and our case should contribute to the understanding of the pathomechanism of such myelopathy.     

Actinomyces meyeri cutaneous actinomycosis with pulmonary localization

Infections due to Actinomycosis species are located in the cervico-facial region in 50 to 65 percent of the cases. Extra-cervical cutaneous lesions are exceptional. The most frequently encountered germ is Actinomyces israeli, observed in 85 percent of the cases. We report the case of an Actinomyces meyeri infection which presented as a leg abscess and a pulmonary lesion. There was no cervico-facial localization. There was however a chronic parodontitis. A second germ, Capnocytophaga sp. was isolated from the abscess. This case is of particular interest because of the extracervical localization and the rare species isolated (17 other cases of Actinomyces meyeri infection have been reported). The mechanism of the infection can be better understood in light of pulmonary lesions in the lower right lobe due to inhalation and the coexistence of a buccodental germ in the culture of the leg abscess: buccodental origin of the germ, pulmonary lesion secondary to inhalation, septicaemic dissemination with cutaneous metastases.