Oviductal cilial phagocytosis in patients undergoing tubal reanastomosis

Chronic salpingitis has been reported in patients undergoing reversal of sterilization. For investigation of a possible microbial etiology for this process and characterization of its ultrastructural features, segments from the midportion of the fallopian tubes of five patients who underwent sterilization reversal were studied by comprehensive tubal cultures, and light and electron microscopy. Three patients undergoing sterilization by partial salpingectomy were studied as controls. Chlamydial IgG and IgM antibody titers were performed on serum samples. No microbiologic or serologic evidence for active infection by known pathogens was found. In three of the study patients mild oviductal mural fibrosis was present. However, in two other study patients chronic salpingitis with phagocytosis of cilia by luminal macrophages was demonstrated. It is suggested that if this active process persists after tubal reanastomosis, it may result in impaired oviductal function.

Serologic evidence of prior chlamydial infection in patients with tubal ectopic pregnancy and contralateral tubal disease

Oviductal damage from infectious salpingitis is a principle cause of ectopic pregnancy. To examine the role of Chlamydia trachomatis in patients with ectopic pregnancy, 24 patients undergoing laparotomy for ectopic pregnancy were evaluated by assessment of chlamydial serology and chlamydial cultures of tubal biopsy specimens. The patients were divided into two groups based on the presence or absence of gross abnormalities in the fallopian tube contralateral to the ectopic gestation. Ten patients in group I showed gross evidence of chronic salpingitis in the contralateral tube; 14 patients in group II had normal-appearing contralateral tubes. Chlamydial cultures were negative in both groups. Chlamydial immunoglobulin M antibodies assayed by indirect microimmunofluorescence were negative in both groups (less than or equal to 1:32). Mean geometric immunoglobulin G titers for C. trachomatis were significantly higher in the patients with evidence of contralateral chronic salpingitis (78.9 versus 13.1). These findings suggest that C. trachomatis may be a major cause of oviductal damage, which predisposes to ectopic pregnancy.

Acute modulation of the hypothalamic-pituitary axis by intravenous testosterone in normal women

Intravenous testosterone was infused for 6 hours in 23 ovulatory women, divided into five groups according to dose, to assess the effects of testosterone on gonadotropin secretion. Serum testosterone increased from 0.24 +/- 0.08 to steady-state levels of 1.63 +/- 0.18 ng/ml in the lowest-dose group (1) and to 42.1 +/- 3.3 ng/ml in the highest-dose group (4). In another group (5), patients were pretreated with testolactone, which prevented the estradiol rise associated with testosterone infusion. All groups except group 1 exhibited significant reductions in the delta maximum responses of luteinizing hormone to gonadotropin-releasing hormone during testosterone infusion compared with pretreatment levels (p less than 0.01). This was also evident for the testolactone group (5). There were no observed changes in serum follicle-stimulating hormone. Luteinizing hormone pulse frequency was decreased (p less than 0.05) with testosterone concentrations of 27.2 +/- 0.77 and 42.1 +/- 3.3 ng/ml (groups 3 and 4), but only in the highest group (4) was there a decrease in pulse amplitude (p less than 0.05). No luteinizing hormone pulse changes were observed with lower concentrations of testosterone. Plasma immunoreactive gonadotropin-releasing hormone levels remained undetectable or low in some of the groups sampled. These data suggest that short-term infusions of testosterone inhibit hypothalamic-pituitary function of normal women when high doses are used, and this effect may be independent of aromatization to estrogen.

Retroverted impacted gravid uterus with acute urinary retention: report of two cases and a review of the literature

Two cases of acute urinary retention in association with a retroverted impacted gravid uterus are described. Manual replacement of the uterus into an anterior position resolved the urinary retention in both cases. A review of the literature for retroverted impacted gravid uterus and related disorders is given. Successful treatment of retroverted impacted gravid uterus can usually be performed by initial bladder catheterization followed by manual replacement of the uterus, or by chronic bladder drainage until the uterus ascends out of the pelvis.

Semipermanent right atrial catheter in gynecologic cancer patients

The indications for insertion of semipermanent right atrial silicone catheters and immediate and long-term complications in patients admitted to a gynecologic oncology service, are described. Eight-five catheters were inserted in 79 patients for a variety of indications. Most catheters were placed under local anesthesia, in the patient's hospital room. Immediate morbidity caused by damage to the pleura was limited to three patients (3.5%). Infectious morbidity related to catheter use was seen in five patients (5.9%). Two patients were unable to administer daily heparin boluses through the catheter, and in both of these patients catheter thrombosis was seen (2.4%). A right atrial catheter can easily be inserted at the patient's bedside or in an outpatient setting. This device should be offered to any patient in whom intermediate or long-term vascular access is desired for nutritional support, chemotherapy, pain control, or similar indications.

Use of fetal scalp hematocrit in the diagnosis of severe hemorrhage from vasa previa

Described in a case in which a timely diagnosis of severe fetal anemia from bleeding vasa previa was made with the aid of a fetal scalp hematocrit. This technique can be used in patients in labor when bleeding vasa previa is suspected, and scalp sampling is feasible.

Management of condyloma acuminatum

This article describes an approach to the evaluation and treatment of condyloma acuminatum (anogenital warts) that is based on the results of new clinical research on the biology of the human papillomavirus. A more extensive diagnostic protocol, including routine cervicovaginal examination and Papanicolaou smear, is proposed for female patients because of the close association of genital human papillomavirus infections with cervical carcinoma. Two highly effective therapies, cryosurgery and carbon dioxide laser photocoagulation, are described and compared with older regimens. Recent developments in immunotherapy for resistant condyloma acuminatum are also discussed.