Chlamydial infection in female lower genital tract and its correlation with cervical smear abnormalities

BACKGROUND

It is widely known that infection by Chlamydia trachomatis (CT) is the most common curable sexually transmitted infection (STI) among the young population.Chlamydial cervicitis has been suspected in the past to be a risk factor for squamous intraepithelial neoplasia (SIL) and cervical cancer on the basis of case-control comparisons of serological tests.

METHODS

A total of 110 women with symptomatic cervicitis were examined and samples for microbiologic detection of Chlamydia trachomatis antigen were obtained. Colposcopic, cytologic and microbiologic analyses were performed. All results were statistically analysed and correlated.

RESULTS

41 patients (37.2 %) were found positive for Chlamydia trachomatis antigen (Group I) and 69 patients (62.8 %) were negative for Chlamydia trachomatis antigen (Group II). When compared to group II, the chlamydia-infected group I of women presented a larger percentage of dyspareunia (60 %), and the dysuric complaints were more common. The chlamydia-positive group revealed a higher incidence of atypical squamous metaplasia (52.5 % vs 27.9 %). Among the women with positive ELISA for chlamydia, a higher percentage of low-grade SIL was observed (6.3 % vs 3.6 %).

CONCLUSIONS

Chlamydial infection, especially chlamydial cervicitis occurs often among young women of reproductive age. In these women, a good clinical assessment is necessitated including previous clinical history record, as well as detailed microbiologic, cytologic and colposcopic evaluations (Tab. 5, Ref. 19).

The effect of hysterectomy on sexuality and psychological changes

Every year, many women all over the world will undergo a hysterectomy, the removal of their uterus. The majority of hysterectomies are performed to treat conditions such as fibroids, heavy bleeding, endometriosis, adenomyosis and prolapse. A hysterectomy is not often a procedure that needs to be performed urgently, except in the case of cancer. Therefore, a woman considering the procedure should take time to investigate all her options, including other possible treatments. Deciding whether to have a hysterectomy can be a difficult and emotional process. Signs of depression may include severe and prolonged feelings of sadness and hopelessness; diminished interest in activities; significant weight loss or gain; insomnia; fatigue; and thoughts of death or suicide. Every person reacts differently, and reactions are a combination of emotional and physical responses. We still have much to learn about the effects of hysterectomy on sexual function. We investigated many studies published in different journals relative to this subject and we compare their results. Women are more likely to report improved sexual functioning after the surgery when their symptoms have been alleviated. A new hysterectomy procedure that 'spares' abdominal ligaments and nerves is quicker and results in less blood loss and shorter hospital stays and seems to respect the tissues more, without affecting the sexuality of the women.

Imperforate hymen with hematocolpometra combined with elevated Ca125

In the present case, ultrasound examination ruled out the presence of hematosalpinx or other gynecological tumors. This was of great importance to the surgical intervention, especially for avoiding laparotomy. Dilatation of the vagina and uterus, due to imperforate hymen with retrograde menstruation should be considered in the differential diagnosis of abdominal pain in premenarchal girls (Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

The role of three-dimensional imaging in the investigation of IUD malposition

OBJECTIVES

The aim of this study was to present a systematic review of the use of three-dimensional ultrasound for the detection and evaluation of intrauterine device malposition in a patient of our department.

BACKGROUND

Transvaginal sonography failed to detect IUD misplacement in about 9% of cases. Whereas the three-dimensional ultrasound (3D), a new emerging technology, that could provide precise evaluation of IUD malposition.

METHODS

The data were extracted from the literature using computerised Medline system. The use-effectiveness and acceptance of three-dimensional imaging in the detection of IUD malposition was examined as an alternative method to two-dimensional ultrasound.

RESULTS

Three-dimensional ultrasound was more accurate than two-dimensional for the identifying IUD device. Three-dimensional technique enables assessment of IUD length in the longitudinal section synchronically with imaging arms of the device. Examination with 2D ultrasound is limited to transverse views of the shaft. The arms or other smaller parts cannot be investigated completely because of the frontal view of an IUD is rarely presented.

CONCLUSION

Three-dimensional ultrasound is a new and promising imaging tool which provides much better view of the endometrial cavity. This is especially useful in uterus examination and in the detection of IUDs because structures that are not located in one single plane can be imaged simultaneously. Three-dimensional ultrasound is considered to be more secure and safer diagnostic technique to determine the location of IUDs than hysteroscopic evaluation (Fig. 2, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Detection of large histiocytes in pap smears: role in the prediction of endometrial pathology?

OBJECTIVE

The objective of this study was to clarify the prognostic significance of large histiocytes in Papanicolaou smears.

METHOD

During a 2-year period, 893 smears were assessed by the Cytology Laboratory of our Hospital. Twenty-one smears were reported including large histiocytes (2.4%). Colposcopy was also performed in all of these women.

RESULTS

9/21 of the women (43%) presented vaginocervicitis, whereas 3/21, 1/21, 1/21, 1/21 and 1/21 revealed endometrial polyps, complex hyperplasia with atypia, simple hyperplasia after tamoxifene use, submucosal myoma and endometrial carcinoma respectively. On the other hand, colposcopy revealed suspicious cervical areas in none of the patients. Therefore, the positive prognostic value for endometrial pathology was 7/21 (33.3%).

DISCUSSION

Various forms of histiocytes are found in inflammatory processes in vaginal and cervical smears. According to our results, large histiocytes could be considered as an indicator for endometrial pathology but not for endometrial cancer. However, when histiocytes are found, further clinical evaluation and work up should be done. Finally, in the present study, the detection of large histiocytes seems to be a good prognostic factor for cervical pathology (Ref. 10).

Preeclampsia or initial diagnosis of chronic renal disease during pregnancy

An unusual case of early nephrotic syndrome without hypertension which slightly resolved after delivery is documented. Renal biopsy was performed postpartum and the diagnosis was focal and segmental glomerulosclerosis with moderate chronic renal changes. It is questioned whether the case was due to preeclampsia or was the initial diagnosis of chronic renal disease which was made during pregnancy. The role of renal biopsy in such cases is briefly discussed (Tab. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Misoprostol use as a method of medical abortion

AIM

The aim of our study was to verify with the use of ultrasound (US) scanning the effectiveness of misoprostol in medical abortion.

MATERIALS AND METHODS

The study population included women with a medical miscarriage attending the 2nd Department of Obstetrics and Gynecology, University of Athens in Aretaieion Hospital, Athens, Greece. All women < 49 days since their last menstruation received 800 microg vaginal misoprostol. The diagnosis of complete abortion was possible by the US measurements as endometrial thickness of 15 mm by transvaginal US was used as a cutoff level for successful abortion.

RESULTS

The mean age of the study population was 27 years (ranging from 19 up to 37 years). Complete evacuation with misoprostol was performed in 149 women. The success rate was 85.2% (127/149). Twenty-two women experienced intrauterine echogenic structures with a diameter > 15 mm and all of them underwent surgical evacuation (14.8%). Vaginal bleeding was present in 17 patients after the procedure (11.4%). Less usual reported side-effects included nausea, vomiting, pain, or diarrhea.

CONCLUSION

Misoprostol use is an effective, safe and acceptable method of medical abortion for women.

Three-dimensional hysterosonography versus hysteroscopy for the detection of intracavitary uterine abnormalities

OBJECTIVE

To compare 3-dimentional hysterosonography (3-DHS) and diagnostic hysteroscopy for the evaluation of intrauterine lesions.

METHODS

In this prospective study 124 women with suspected intrauterine abnormality on 2-D ultrasonography or on hysterosalpingography were scheduled to undergo hysteroscopy, 3-DHS, and 3-D power Doppler (3-DPD) examination. However, 3-DHS could not be performed in 3 of the women because of cervical stenosis. The sensitivity and specificity of 3-DHS and 3-DPD were compared with those of hysteroscopy.

RESULTS

Of the 121 women found to have an intracavitary abnormality, 20 had polyps, 11 had myomas, 2 had Müllerian duct anomalies, and 6 had synechiae on hysteroscopy. There was agreement between hysteroscopy and 3-DHS in 19 of the polyp cases, 11 of the myoma cases, 2 of the Müllerian anomaly cases, and 4 of the synechiae cases. Examination with 3-DHS and 3-DPD reached a sensitivity of 91.9% and specificity of 98.8%, with a positive predictive value of 97.1% and a negative predictive value of 96.5%, respectively.

CONCLUSIONS

Examination with 3-DHS and 3-DPD both allows for accurate assessment of intrauterine abnormalities.

The role of three-dimensional (3D) sonography and 3D power Doppler in the preoperative assessment of borderline ovarian tumors

PURPOSE OF INVESTIGATION

To determine the value of three-dimensional (3D) sonography and 3D power Doppler in distinguishing borderline ovarian tumors from benign cysts and malignant tumors.

METHODS

One hundred and seventy-two women with a mean age of 37 years (range 28-45) and diagnosis of a confirmed pelvic mass were referred for preoperative evaluation with 3D sonography and 3D power Doppler. Sonographic criteria used for the diagnosis of borderline tumors were based on a system that included morphological characteristics, histological evaluation and power Doppler imaging.

RESULTS

Ten lesions were histopathologically diagnosed as borderline ovarian tumors, 42 as malignant and 120 as benign. Three-dimensional sonography revealed 120 ovarian tumors which scored below 7 (benign), according to Kurjak's scale, 12 tumors which scored between 7-8 and 40 tumors between 9-13 (malignant).

CONCLUSIONS

Preoperative assessment of borderline tumors by 3D imaging may promote improved patient care and introduce laparoscopic management as an alternative surgical approach.

Evaluation of abnormal uterine bleeding by transvaginal 3-D hysterosonography and diagnostic hysteroscopy

AIM

To compare 3-D hysterosonography (3-DHS) and diagnostic hysteroscopy in women with abnormal uterine bleeding.

MATERIALS AND METHODS

Of 248 women with abnormal uterine bleeding who were referred to our department, 3-D hysterosonography and hysteroscopy were performed in 242 women and the results were estimated. In six women 3-DHS could not performed because of cervical stenosis. Sensitivity and specificity of 3-DHS compared to those of hysteroscopy.

RESULTS

From the 242 women who underwent examination, we found 30 patients with polyps, 22 with myomas, four with mullerian anomalies, ten with endometrial cancer, 12 with adhesions and 165 with a normal uterine cavity. There was agreement between the two methods in 28 cases of polyps, 22 cases of myomas, four cases of mullerian anomalies, ten cases of endometrial cancer, eight cases of adhesions and in 165 cases of normal endometrium. The sensitivity and specificity of 3D hysterosonography was 93.5% and 99.4%, respectively, with a positive prognostic value (PPV) of 98.6% and a negative prognostic value (NPV) of 97%. The sensitivity and specificity of hysteroscopy was 98.7% and 99.4%, respectively, with a PPV of 98.7% and a NPV of 99.4%.

CONCLUSIONS

Three-D hysterosonography accurately assessed intrauterine pathology.

The role of laboratory testing of free peritoneal fluid during an explorative laparotomy in the diagnosis of an extra-ovarian neoplasm

We present a case in which the diagnosis of the ovarian carcinoma was made only by the free peritoneal fluid cytology as all the other specimens were negative for malignancy. We discuss the role of laboratory testing of the free peritoneal fluid even in small amounts or of the peritoneal drainage in cases of ovarian cystic neoplasms not only for the staging, but also for the diagnosis itself (Ref 16). Full Text (Free, PDF) www.bmj.sk.

Assessment of ovarian tumors using transvaginal color Doppler ultrasonography

In our study we used transvaginal color Doppler ultrasonography in a token of 127 women presenting with unilateral ovarian tumor. The characteristics of the tumors were analyzed, the presence of vascularization was checked and the resistance index (RI) was calculated. Consequently, based on a concrete scoring system, we attempted to discriminate these tumors as benign or malignant. It was proven that 24 of 127 ovarian tumors were malignant. Transvaginal color Doppler correctly identified 21 of the 24 malignant tumors, as well as 94 of the 103 benign tumors. In nine other cases we had false-positive results. The sensitivity and the specificity of the method was 87.5% and 91.2%, while the positive and negative predictive values were 70% and 96.9%, respectively.