Acute Salpingitis Research Articles

A Retrospective Study of Leparoscopic Evaluation of Tubal Factors in Case of Infertility

Background: Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The aim of this study was to determine the role of leparoscopic evaluation of Tubal factors in case of infertility. Methods: A retrospective study was carried out at Department of Gynae and Obstetrics UHC, Dhamrai, Dhaka, Bangladesh from January to December 2023. 55 patients were selected for laparoscopic evaluation. Inclusion criteria were patients with no prior pelvic surgery, normal bimanual pelvic examination, normal semen parameters of partner and no ovulatory dysfunction. After obtaining thorough history & detailed examination, patients were informed about the procedure and written informed consent was taken. Results: 55 patients underwent laparoscopy during the study period. Most patients 10 were in the age group of ˂20 yr, 15 were between 21-30 yr & 20 were 31- 40 yr of age and 10 were between 36 – 40 yrs of age. Among these 55 patients 24 patients had primary infertility while 31 had presented with secondary infertility. Diagnostic laparoscopy revealed normal pelvic organs in 9 (16.3%) cases, Chronic pelvic inflammatory disease in 3 (5.4%), endometriosis in 13 (23.6%) and congenital anomalies of uterus in 1(1.8%) cases. 7.2% cases had bilateral tubal block, 27.3% had unilateral block and in 7.2% cases though the tubes were found patent significant peritubal adhesions were noted. Tubal pathology was detected in 55.5% cases of primary infertility and 42.1% cases of secondary infertility. Among those who had tubal pathology, nonspecific pelvic inflammatory disease was noted in 33.3% and genital tuberculosis was diagnosed in 2.7% cases. The most common complications were pyrexia, shoulder tip pain, nausea and vomiting. Conclusion: Laparoscopy is a safe and effective diagnostic tool in evaluating tubal status of infertile patients. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor.

The Treatment of Tubal Inflammatory Infertility using Yinjia Tablets through EGFR/MEK/ERK Signaling Pathway based on Network Pharmacology.

<p>Background: Salpingitis obstructive infertility (SOI) refers to infertility caused by abnormal conditions such as tubal adhesion and blockage caused by acute and chronic salpingitis. SOI has a serious impact on women's physical and mental health and family harmony, and it is a clinical problem that needs to be solved urgently. <p> Objective: The purpose of the present study was to explore the potential pharmacological mechanisms of the Yinjia tablets (Yin Jia Pian, YJP) on tubal inflammation. <p> Methods: Networks of YJP-associated targets and tubal inflammation-related genes were constructed through the STRING database. Potential targets and pathway enrichment analysis related to the therapeutic efficacy of YJP were identified using Cytoscape and Database for Annotation, Visualization, and Integrated Discovery (metascape). E. coli was used to establish a rat model of tubal inflammation and to validate the predictions of network pharmacology and the therapeutic efficacy of YJP. H&E staining was used to observe the pathological changes in fallopian tubes. TEM observation of the ultrastructure of the fallopian tubes. ELISA was used to detect the changes of IL-6 and TNF-α in fallopian tubes. Immunohistochemistry was used to detect the expression of ESR1. The changes of Bcl-2, ERK1/2, p-ERK1/2, MEK, p-MEK, EGFR, and p-EGFR were detected by western blot. <p> Results: Through database analysis, it was found that YJP shared 105 identical targets with the disease. Network pharmacology analysis showed that IL-6, TNF, and EGFR belong to the top 5 core proteins associated with salpingitis, and EGFR/MEK/ERK may be the main pathway involved. The E. coli-induced disease rat model of fallopian tube tissue showed damage, mitochondrial disruption, and increased levels of the inflammatory factors IL-6 and TNF-α. Tubal inflammatory infertility rats have increased expression of Bcl-2, p-ERK1/2, p-MEK, and p-EGFR, and decreased expression of ESR1. In vivo, experiments showed that YJP improved damage of tissue, inhibited shedding of tubal cilia, and suppressed the inflammatory response of the body. Furthermore, YJP inhibited EGFR/MEK/ERK signaling, inhibited the apoptotic protein Bcl-2, and upregulated ESR1. <p> Conclusion: This study revealed that YJP Reducing tubal inflammation and promoting tissue repair may be associated with inhibition of the EGFR/MEK/ERK signaling pathway.</p>.

DEPENDENCE OF THE DEVELOPMENT OF HISTOLOGICAL CHANGES IN THE TISSUES OF THE FALLOPIAN TUBES IN ADOLESCENT GIRLS AND YOUNG WOMEN WITH INFLAMMATORY GENITAL DISEASE ON THE TAXONOMIC AFFILIATION OF PATHOGENS

The aim. To conduct a comparative analysis of the fallopian tubes' clinical, microbiological and histological characteristics in adolescent girls and young women with inflammatory genital disease.&#x0D; Materials and methods. The etiological diagnosis of inflammatory disease was established with the help of complex microbiological and cytological studies of biomaterial from the vagina of teenage girls and the cervical canal of young women before hospitalization and histological examination fragments of fallopian tube – after surgery. The microbiological examination included the cultural detection of bacteria of various taxonomic groups, fungi, mycoplasmas, and ureaplasmas from the biomaterial. A set of methods described in the article was used to detect chlamydia [13]. The degree of bacterial infection of the fallopian tube fragments was assessed by determining the microbial count. Histological examination of biopsy specimens of fallopian tube tissues removed during surgery was performed by the conventional method [9].&#x0D; Results. In the examination of 29 adolescent girls and young women hospitalized for surgical treatment, a comparative analysis was conducted between the clinical manifestations of inflammatory genital disease, identifiable factors, and histological signs of damaged fallopian tubes.When studying the spectrum of factors in the inflammatory focus (fallopian tube biopsies) in adolescent girls (n=12), enterobacteria (33.3%), staphylococci (33.3%), streptococci (8.35%), and Pseudomonas aeruginosa (8.35%) were detected; in 16.7% of adolescent girls, the cultures were sterile. In young women (n=17), microbiological examination of fallopian tube tissues revealed chlamydia (29.4%), mycoplasma (11.6%), ureaplasma (5.8%), gonococci (5.8%), enterobacteria (5.8%), fungi (5.8%); in 6 (35.8%) of the examined women, no bacterial growth was detected. Among young women who had been operated on for tubo-ovarian inflammatory diseases and ectopic pregnancy, chlamydia were most often (29.4%) found in the tissues of the fallopian tubes.&#x0D; Conclusions. The studies have shown that in the development of acute purulent salpingitis in young women, sclerotic changes and signs characteristic of the productive process prevailed in the tissues of the fallopian tubes against the background of genital inflammation, and in adolescent girls, an exudative process was observed against the background of genital inflammation. The peculiarities of the course of genital inflammation depend on the biological properties of pathogens of different taxonomic affiliations.

“SPECTRUM OF HISTOPATHOLOGICAL CHANGES OF FALLOPIAN TUBES AND ITS POSSIBLE RELATION TO THE STATE OF UTERUS AND OVARIES IN SURGICALLY REMOVED SPECIMENS” – A TWO YEAR STUDY IN A TERTIARY CARE HOSPITAL.

Background: The fallopian tube functions as an anatomic and physiologic link between the ovary and the uterus in reproduction by ensuring efcient and orderly ovum transport and providing a proper environment in which fertilization occurs. Not much studies has been done about the lesions of fallopian tube and its relation to the lesions of uterus and ovaries Objectives: To study the various histopathological lesions of uterus, ovaries and fallopian tubes. To correlate the possible relation of the lesions in the uterus and the ovaries to the changes in the fallopian tubes. Materials And Methods: This study was carried out in the department of Pathology, Regional Institute of Medical Sciences, Imphal, Manipur, India . A total of 80(Eighty) specimens of total abdominal hysterectomy with bilateral salpingoophorectomy from patients who underwent surgery in the Obstetrics and Gynecology department of Regional Institute of Medical Sciences Hospital were obtained for study for a duration of 2 years starting from May 2015 to April 2017. Majority of cases were with a clinical Results: diagnosis of uterine broid followed by chronic cervicitis and DUB. The incidence of tubal lesion was 18.75% and tubes with normal ndings comprised 88.75%. It is well appreciated that the Conclusion conditions involving the fallopian tube are frequently non neoplastic pathologic conditions like ectopic pregnancy, acute and chronic salpingitis in contrast to the neoplastic conditions.

A study on histopathological changes in ectopic tubal gestation

Background: Ectopic pregnancy is a serious cause of maternal morbidity and mortality. Fallopian tube is the most common site. Ectopic pregnancy is often the consequence of chronic salpingitis. The aim of the study was to identify the various histopathological changes in the fallopian tube, which are removed following an ectopic tubal gestation. The prevalence of various risk factors in ectopic tubal pregnancy was also investigated. Methods: This descriptive study included 160 cases of ectopic tubal gestation received in the department during the study period. Slides were studied for various changes like chronic salpingitis, acute salpingitis, salpingitis isthmica nodosa, endometriosis, tuberculosis etc. Patient’s clinical details were obtained from the medical records.Results: The most frequent pathological finding was chronic salpingitis followed by salpingitis isthmica nodosa. It was noted that all cases with a positive history of pelvic inflammatory disease (PID), showed evidence of chronic salpingitis during histopathological examination. Chronic salpingitis was also noted in 45% cases who did not give a history of PID. Among the risk factors, a history of tubal sterilization was the most frequent one.Conclusions: Even though the mortality has reduced, ectopic pregnancy causes significant morbidity and affects the fertility of women. The rise in incidence could be due to increase in prevalence of sexually transmitted diseases, increase in tubal sterilization practices and frequent use of assisted reproduction technology. It is evident from the study that many cases of PIDs are left unidentified.

Clinico-histopathological study of ectopic pregnancy in a tertiary care hospital with special focus on histomorphology of fallopian tubes in tubal ectopic pregnancy

Introduction: Ectopic pregnancy can present as an acute life‑threatening emergency when it ruptures and accounts for about 10% of all maternal mortalities; therefore, it is imperative to diagnose the unruptured ectopic pregnancy such that timely intervention will prevent morbidity and mortality. The fallopian tube is the most common site for ectopic pregnancy (90-95%). With an increasing incidence of ectopic pregnancy worldwide, a histopathological study of the resected fallopian tubes becomes important to look for predisposing/associated findings such as acute salpingitis, chronic salpingitis and salpingitis isthmica nodosa (SIN). Objectives: The aim was to study the clinical presentation of ectopic pregnancy and its association with various factors like age and gravida status. It also aims to study the histomorphology of the fallopian tubes with ectopic gestation and note the presence of predisposing factors such as acute salpingitis, chronic salpingitis and SIN. Materials and Methods: A total of 79 specimens of ectopic pregnancy received in Department of Pathology for a retrospective period of 2.5-years from January 2019 to May 2021 were reviewed.

Acute salpingitis presenting with acute abdomen in a pre-pubertal girl

Background: An acute abdomen in children is often a challenging scenario for clinicians as it is caused by various medical and surgical conditions. Although symptomatology and specific clinical findings point directly to few causes, thorough history and in-depth clinical examination help to systematically narrow down the differential diagnosis. Clinical Description: We report a rare case of acute salpingitis in an 8-year-old prepubertal female child presenting with acute abdominal pain and fever for 3 days. Examination revealed diffuse abdominal tenderness with guarding and rigidity along with an ill-defined, tender mass in the right iliac fossa. Management: Abdominal ultrasound showed a hyperechoic mass in the right iliac fossa and the appendix was not visualized. The child was kept nil oral and started on broad-spectrum antibiotics. However, the child developed abdominal distension and worsening of pain over the next 24 h. The child was taken up for emergency laparotomy, and a complex mass in the right iliac fossa adherent to small bowel and covered by omentum was noted. Histopathological examination of the excised right iliac fossa mass showed acutely inflamed right fallopian tube. Normal appendix was noted in the postoperative ultrasonogram. Conclusion: It is important to differentiate surgical causes from nonsurgical ones to avoid unnecessary surgery and its complications. Salpingitis may mimic acute appendicitis because of nonspecific symptomatology and radiological signs and should be considered as a differential diagnosis for acute abdomen, even in a prepubertal female child.

Ectopic Pregnancy: Epidemiological, Clinical, Therapeutical, Anatomopathological Aspects and Prognosis at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo-Dioulasso: About 79 Cases and Literature Review

Objective: To study the epidemiological, clinical, therapeutical, anatomopathological aspects and prognosis of the ectopic pregnancy. Methodology: It was a transversal and descriptive study from January 1st to December 31st 2018 at the department of obstetrics and gynecology of the Teaching Hospital Sourô Sanou of Bobo-Dioulasso. Results: During the study period, we registered 4706 deliveries with 1272 cases of cesareans and 79 cases of ectopic pregnancy with a frequency of 1 ectopic pregnancy for 60 deliveries and 6 ectopic pregnancies for 100 caesareans. The average age of the patients in our study was 28.66 years old (19 - 45 years) and the average parity of 1.96 [0 - 6]. Married women represented 83.54 % of the workforce. The risk factors were dominated by sexual transmitted diseases (25.31%) and abortions (20.25%). Clinical signs were dominated by pelvic pain (100% of cases), metrorrhagea (86.5% of cases) and amenorrhea (64.6% of cases). Culdocentesis brought lysed incoagulable blood in 83.7% cases. The immunological pregnancy test was positive in 100% of cases. Plasma beta dosage was carried out in 2 cases. Salpingectomy was performed in 97.4% cases. The site of the ectopic pregnancy was interstitial in 11.3% cases, isthmic in 8.86% cases, infundibular in 11.3% cases, ampullar in 77.22% cases. On the anatomopathological level, we noted an acute salpingitis in 23.38% cases and a chronic salpingitis in 44.94% cases. Postoperative were simple in 97.7% of cases and we deplored one case maternal death. Conclusion: Ectopic pregnancy is a surgical emergency of the first trimester pregnancy. The delay in diagnosis is common in our context, with as consequence a mutilated treatment. The etiological factors are dominated by the chronic salpingitis and the acute salpingitis. The prevention is based on combatting genital infections, promoting contraceptive methods and a good post abortion care.

Diagnosis and Analysis of Transabdominal and Intracavitary Ultrasound in Gynecological Acute Abdomen.

In order to explore the effective diagnosis method of gynecological acute abdomen, this paper takes hospital gynecological acute abdomen patients as samples and selects gynecological acute abdomen patients admitted to the hospital to be included in this study. They are divided into transabdominal ultrasound group, intracavitary ultrasound group, and combined group. Moreover, this paper uses mathematical statistics to carry out sample statistics. The statistical data mainly include ectopic pregnancy, torsion of ovarian tumor pedicle, acute suppurative salpingitis, torsion of fallopian tube, hemorrhagic salpingitis, acute pelvic inflammatory disease, rupture of corpus luteum cyst, and diagnosis accuracy rate. In addition, this paper compares the diagnostic accuracy of the abdominal ultrasound group, the intracavitary ultrasound group, and the combined group. The experimental research shows that the combined ultrasound diagnosis method can effectively improve the accuracy of the diagnosis of gynecological acute abdomen.

Telocytes (interstitial cajal like cells) of the fallopian tubes in acute and chronic salpingitis

Telocytes (TCs) are a recently described population of cells. Their histogenesis, phytophysiology, function and role in the development of pathological conditions are discussed by many researchers. In particular, the pathophysiological role of TCs in the fallopian tubes affected by inflammation remains unexplored. Objective: to study ultrastructural changes in the TC and their diagnostic significance in the distal fallopian tubes in acute and chronic salpingitis. Histological, immunohistochemical (IHC) and electron microscopic (EM) examination of fragments of the distal fallopian tubes of 10 women (age 37.8 ± 7.1 years) with acute and chronic inflammation, as well as without disease were carried out. IHC study was carried out with antibodies characteristic of stem cells (CD34, CD117) and Cajal cells (CD117, DOG1). We believe that immunophenotyping with well-known markers is not specific and is not suitable for the identification of TCs in the fallopian tubes. An EM study revealed multiple destructive changes in the TC. In acute salpingitis - loss of organelles, cytoplasmic vacuolization, dilatation of the granular endoplasmic reticulum, loss of intercellular contacts, shortening of telopodia, local loss of plasma membrane integrity. In chronic salpingitis, there is an increase in destructive changes and a further decrease in the number of TCs. Changes in TC and a decrease in their number alter the three-dimensional organization of the extracellular matrix in the stromal compartment of the fallopian tube, weaken intercellular signaling and contractility of the fallopian tube, which contributes to impaired organ motility.

Study of spectrum of neoplastic and non-neoplastic lesions in fallopian tube in a tertiary care hospital

Background: Fallopian tubes are affected by a wide spectrum of diseases varying from salpingitis to carcinoma. Most pathological processes involving the fallopian tube are inflammatory and are of clinical significance because they interfere with the function of the fallopian tube and result in infertility. Although fallopian tube is affected by a wide spectrum of diseases, a literature search reveals that there are only occasional studies, documenting histologic changes in the fallopian tube removed for all reasons. This prompts the present study. The aim is to study the gross and microscopic features of the excised fallopian tubes and to study the common and unusual lesions in them and to study the frequency of histological findings and relative frequencies of different findings. Materials and methods: Four hundred and forty-five cases of fallopian tubes that were removed were studied retrospectively, and their histopathological findings documented. Results: The majority of the fallopian tubes had inflammatory changes comprised of acute and chronic salpingitis, salpingitis isthmica nodosa, tuberculous salpingitis, xanthogranulomatous salpingitis, hematosalpinx, and hydrosalpinx. Sixteen cases comprised of ectopic pregnancy. One case of primary fallopian tube adenocarcinoma and two cases of metastatic adenocarcinoma. Conclusion: The majority of the fallopian tubes remain unremarkable in a majority of the surgical pathology specimens, yet the fallopian tube must be subjected to a thorough histopathological examination to evaluate the various pathological lesions.

Whole genome sequence comparison of avian pathogenic Escherichia coli from acute and chronic salpingitis of egg laying hens

BackgroundInfection in the oviduct (salpingitis) is the most common bacterial infection in egg laying hens and is mainly caused by Escherichia coli. The disease is responsible for decreased animal welfare, considerable economic loss as well as a risk of horizontal and vertical transmission of pathogenic E. coli. The outcome of salpingitis may be either acute or chronic. It has not yet been clarified whether the pathological manifestation is a result of the characteristics of the E. coli or whether the manifestation is associated with host factors such as host immunity.ResultsFrom the core- and accessory genome analysis and comparison of 62 E. coli no genetic markers were found to be associated to either acute or chronic infection. Twenty of the 62 genomes harboured at least one antimicrobial resistance gene with resistance against sulfonamides being the most common. The increased serum survival and iron chelating genes iss and iroN were highly prevalent in genomes from both acute and chronic salpingitis.ConclusionOur analysis revealed that no genetic markers could differentiate the E. coli isolated from acute versus chronic salpingitis in egg laying hens. The difference in pathological outcome may be related to other factors such as immunological status, genetics and health of the host. These data indicate that salpingitis is another manifestation of colibacillosis.

Study of resected specimens of ectopic pregnancy: A-5 year experience in Regional Institute of Medical Sciences Hospital, Imphal

Background: Ectopic pregnancy remains the leading cause of maternal death in early pregnancy. It is assuming greater importance because of its increasing incidence and its impact on woman's fertility. Objectives: To study the histomorphological changes of ectopic pregnancy and its correlation with relevant parameters such as age, site, parity, and gestational age. Materials and Methods: This study was conducted in the Department of Pathology, Regional Institute of Medical Sciences, Imphal, for a period of 5 years (January 2015–December 2019). All the specimens with a clinical diagnosis of ectopic pregnancy were included in the study. Histomorphological changes and other relevant parameters such as age, site, parity, and gestational age were analyzed. Results: A total of 160 ectopic pregnancies were diagnosed during the study period. A total number of pregnant women attending antenatal outpatient department during the study period was found to be 121,1941 giving an overall rate of occurrence of 0.13% or 1.31/1000 pregnancies. The most common site of involvement was fallopian tube (95%), mostly on the right side (64.37%). The most common age group was 30–39 years (mean age 30.8 years). Nearly 91.25% of cases were multiparous presenting mostly in their first trimester. Predominant-associated histopathological findings were chronic salpingitis (43.12%), acute salpingitis (20.62%), and salpingitis isthmica nodosa (7.5%). One case was found to be associated with paratubal cyst. Conclusion: Histopathological examination of resected ectopic pregnancy specimens can give an insight into the etiopathogenesis of ectopic pregnancy, thereby helping in early treatment and preventing recurrence.

Experience with Diagnostic Laparoscopy in the Evaluation of Tubal Factor Infertility

Context and Objectives: Tubal factor infertility accounts for a large portion of female factor infertility. Tubal disease is responsible for 25% - 35% of female infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Various modalities for investigating tubal factor infertility exist including: saline Infusion sonography (SIS), Hystero-contrast sonography (HyCoSy), hysterosalpingography (HSG) and laparoscopy with chromopertubation, the latter being the gold standard. The aim of this study was to determine the role of diagnostic laparoscopy in the evaluation of tubal factor in infertile women. Settings and Design: A retrospective descriptive study on all diagnostic laparoscopic procedures carried out to evaluate tubal factor infertility in the endoscopic gynecology unit of a tertiary-level hospital from 2010 to 2019. Methods: A retrospective descriptive study was conducted in the Department of Obstetrics and Gynaecology of a tertiary-level hospital in Ghana. A total of three hundred and ninety-one (391) records of all diagnostic laparoscopy procedures performed because of infertility in the endoscopic gynecology unit of a tertiary-level hospital between 2010 and 2019 were analyzed. Clients who underwent diagnostic laparoscopy to assess tubal factor infertility in the Obstetrics and Gynaecology Directorate of Komfo Anokye Teaching Hospital (KATH), Kumasi, from 2010 to 2019 were included in the study. Tubal patency was tested by laparoscopy and chromopertubation using methylene blue dye. The clinical characteristics of these women (age, parity, type of infertility), the intra-operative findings and complications were evaluated. Data on age, parity, type of infertility and intra operative findings were extracted using a proforma. Cases in which the bio-data or other clinical and laparoscopic findings were missing were excluded from the study. Ethical approval for the study was obtained from the Institutional Review Board (IRB) for Research and Development (R & D). A simple percentage method was used for statistical analysis. Results: A total of 391 women underwent diagnostic laparoscopy for investigation of tubal factor infertility between 2010 and 2019. The women’s mean age was 33.16 years. The youngest patient was 20 years and the oldest was 46 years. 232 (59.3%) patients were in primary infertility group while 159 (40.7%) patients were in secondary infertility group. 265 (66.8%) of the women were in the age group 20 - 35 years. The main laparoscopic findings for tubal factor were: 57.28% with bilateral tubal occlusion, 16.39% with unilateral tubal occlusion and 7.92% with hydrosalpinx. 18.41% had bilateral tubal patency. Other findings were identified during the laparoscopic procedure. For peritoneal abnormalities, 200 (51.15%) had normal findings, 184 (47.06%) had adhesions and 7 (1.79%) had peritoneal endometriosis. For uterine factor, 185 (47.31%) had normal uterus with no fibroids or adenomyosis, 202 (51.67%) had uterine fibroids, 2 (0.51%) had uterine anomaly and 2 (0.51%) had adenomyosis. For ovarian pathology, 13 (3.32%) had simple cyst, 2 (0.51%) had endometrioma, 184 (47.07%) had the ovaries involved in adhesions. 192 (49.10%) of patients had normal looking ovaries. There was no mortality or conversion to open laparotomy in this series. Conclusions: Unilateral and bilateral tubal blockade was detected in 73.67% of cases of infertile women. Diagnostic laparoscopy is a safe procedure.

Acute pelvic inflammatory disease: a narrative review

Background and objective: Pelvic inflammatory disease (PID) is an upper genital tract infection in females that is typically acquired via sexual activity. It usually is initiated by the presence of Chlamydia trachomatis and/or Neisseria gonorrhoeae and escalates into a polymicrobial infection from local genital tract flora. Research identifies various known risk factors including young age, immunopathology and others. This article reviews the epidemiology, differential diagnosis, management, and concepts of prevention for PID. Methods: An electronic search was performed on MEDLINE to identify relevant articles from 2010 to 2018. Key Content and Findings: PID continues to be a major sexually transmitted disease among adolescent and young adult females. Among the 1 million cases that are found in the United States (U.S.) each year, about one-third are in adolescent females. It is typically a polymicrobial infection that can lead to acute salpingitis, perihepatitis, endometritis, oophoritis, pelvic peritonitis and/or tubo-ovarian abscess. Diagnostic criteria and recommended treatment have been developed by the U.S. Centers for Disease Control and Prevention (CDC). Complication of PID include chronic pelvic pain, ectopic pregnancy and infertility. Conclusions: PID is a common sexually transmitted disease that is found in many adolescents and young women. The possibility of PID should be seriously considered by clinicians when evaluating a sexually active teenage or young adult female with lower abdominal pain, vaginal discharge, vaginal bleeding, urinary symptoms, post-coital bleeding and/or dyspareunia. It may be a silent infection as well. Various risk factors for PID are noted including the adolescent age group, ectropion of young adolescent females, immature immune system, multiple coital partners and others. Clinicians should follow treatment protocols established by the CDC and the World Health Organization (WHO). The problem of PID should stimulate clinicians and society to provide comprehensive sexuality education to our youth.

Clinico-Pathological Study of Tubal Ectopic Gestation and Evaluation of Associated Risk Factors in A Tertiary Care Centre

Background: Ectopic gestation is an obstetric emergency with high morbidity and mortality. Most common site for ectopic pregnancy is fallopian tube. Predisposing risk factors include pelvic inflammatory disease (PID) that is acute and chronic salpingitis, previous abortion, Salphingitis Isthmica Nodosa (SIN); and treatment for infertility. This study was done to identify the common risk factors. Method: This was a retrospective study carried out for the period of 6 years (January 2013 - December 2018) in M.G.M. Medical college, Aurangabad. 110 cases of tubal ectopic gestations were studied. Results: Out of 110 ectopic gestations, commonest age of presentation was 25-35years (90.9%), and were multiparous (85.3%). Right sided tube was mostly affected (70.2%), with the risk factors of PID (32%) and previous abortion (30%). Most of the patients presented with pain in abdomen (40.90%) and amenorrhea (31.81%). Predominant histopathological findings were chronic salphingitis with follicular salphingitis (40.90%), acute salphingitis (27.27%) and SIN (22.7%). Conclusion: Pelvic inflammatory disease, Salphingitis Isthmica Nodosa, acute and chronic salphingitis are predisposing factors for tubal ectopic gestation. Early diagnosis, identification of risk factors and timely intervention will reduce the incidence of ectopic pregnancy and also will help in reducing morbidity and mortality associated with it.

Infertility caused by salpingitis treated based on theory of kidney deficiency and blood stasis

Infertility caused by salpingitis is one of the main causes of secondary infertility in women. In recent years,the incidence has been increasing year by year. Modern medicine believes that this disease is a complication due to incomplete or delayed treatment of acute and chronic salpingitis,with no satisfactory drug therapy at present. Clinical therapies mainly include surgical treatment,interventional treatment and assisted reproductive technology. After summarizing the experience of predecessors and the clinical practice of treating infertility for many years,the author considers that the disease location is the cell veins,and the nature is mostly mixed of deficiency and excess. Kidney deficiency and blood stasis are the main pathogenesis of infertility caused by salpingitis. Blood stasis is the pathological basis,while kidney deficiency is the fundamental pathogenesis. Long-term kidney deficiency will lead to blood stasis,and blood stasis will aggravate kidney deficiency. Both of them are cause and effect to each other. Infertility caused by salpingitis is difficult to cure. Based on the theory of kidney deficiency and blood stasis,the basic principles of clinical treatment are tonifying kidney and activating blood circulation,removing blood stasis and dredging collaterals. Oral administration with traditional Chinese medicine combined with external therapies,such as enema,external application,acupuncture and moxibustion,have been achieved a good efficacy in repairing fallopian tube function and improving pregnancy rate. Therefore,the treatment of infertility caused by salpingitis based on " kidney deficiency and blood stasis" is worthy of further discussion in both clinical and experimental aspects.

Histopathology of Surgically Resected Fallopian Tubes with Special Emphasis on Serous Tubal Intraepithelial Carcinoma

Background: The fallopian tube, though very common surgical specimen is rarely studied. It is affected by a spectrum of lesions ranging from inflammatory to rare neoplasms. Recent studies suggest a precursor lesion for high grade serous carcinoma of the ovary in the fallopian tube mucosa and is known as serous tubal intraepithelial carcinoma. In the present study, we analyzed the histopathology of fallopian tube lesions including serous tubal intraepithelial carcinoma. Methods: All the fallopian tube specimens received were grossed according to protocol and were routinely processed and stained. Atypical proliferative lesions of mucosa were subjected to immunohistochemical markers p53 and ki67. Result: Out of 350, 106 specimens showed a spectrum of lesions, of which hydrosalpinx was the commonest. Rest of the lesions were chronic and acute salpingitis, tuberculous salpingitis and tubal endometriosis. We encountered a single case of primary serous carcinoma of the fallopian tube. Immunohistochemistry on ten cases of atypical mucosal proliferations confirmed a single case each of serous tubal intraepithelial carcinoma and serous tubal intraepithelial lesion. Conclusion: Though fallopian tube is unremarkable in most cases, thorough sampling can detect significant pathological lesions including precursor lesions.

Comparative Study between Clinical and Ultrasound Diagnosis of Emergency of Gynecology

AbstractBackground: Acute pelvic pain accounts for up to 40% of the visits to gynecological emergency departments and may indicate a serious condition. Potentially life-threatening gynecological emergencies are acute pelvic conditions that may spontaneously evolve into a life threatening situation. They may also carry a risk of sequelae (organ failure or organ removal) or death in the absence of prompt diagnosis and treatment.The most common gynecological emergencies are ruptured ectopic pregnancy, adnexal torsion, and complicated pelvic inflammatory disease (tubo-ovarian abscess (TOA) and pyos-alpinx). Missing these high-risk conditions may delay treatment that could lead to potentially negative patient outcomes.Methods: This study was carried out over 1 year from September 2016 to September 2017 on 30 female patients. The records of all patients were review and data were collected prospectively. Our study included patients presented to the Emergency Department with gynecological emergencies.These gynecological emergencies included patients pre-sented with acute pelvic pain (e.g. ectopic pregnancy, torsion ovarian cyst, rupture ovarian cyst, pelvic inflammatory disease, tubo-ovarian abscess (TOA), and acute salpingitis) and/or vaginal bleeding (e.g. rupture uterus, and uterine tumors).Results: Ectopic pregnancy was the most common gyne-cological emergency seen in our study (about 46.67% of patients). Other diagnosis found in this study were adnexal torsion (about 16.67%), ovarian cyst rupture (about 13.33%), PID (about 13.33%), and uterine mass (about 10%).In this study, only about 53.33% of patients were diagnosed clinically before ultrasound was done. About 93.33% of patients were diagnosed after assessment by ultrasonography. There was statistically significant difference between clinical diagnosis and diagnosis after ultrasonography. (p<0.05).According to this study, there was a significant difference between clinical and radiological diagnosis using ultrasonog-raphy in diagnosis of ectopic pregnancy, adnexal torsion, and ovarian cyst rupture. (p<0.05).According to our data, physical examination cannot be used alone to safely rule out a surgical emergency in a woman presenting with acute pelvic pain. This suggests the benefit of adding bedside ultrasonography in the first-line diagnostic management of suspected gynecological emergencies.Conclusion: Adding Ultrasonography as a bedside test was found to be superior to physical examination in diagnosis of acute pelvic pain. If a gynecologic disorder couldn't be confirmed, or the sonographic finding are equivocal, Multi-Detector Computed Tomography (MDCT) is another imaging choice.Ultrasound is generally accepted as the first imaging modality used in patients with acute pelvic pain. The true value of ultrasound in acute pelvic pain lies in its ability to detect gynecologic disorders.

Study of conservative treatment in uncomplicated acute appendicitis

Background: Management of acute appendicitis with antibiotics only, without surgery is currently evaluated. Non-operative management of uncomplicated acute diverticulitis and salpingitis has been well established but the non-operative management of acute appendicitis remains controversial. Growing evidence indicates that patients with acute uncomplicated appendicitis can be treated safely with an antibiotics- first approach.Methods: A tertiary care hospital based longitudinal study with duration of 26 month. Patients with clinical and radiological feature of acute appendicitis presenting within 48 hours of initiation of abdominal pain with Modified Alvarado Score ≥5 included. Various demographic, clinico-pathological, radiological factors were studied.Results: 71 patients evaluated, mean age of 30.45±9.71 years. Tenderness in RIF was the commonest finding followed by Fever and rebound tenderness. Leucocytosis seen in 74.65% Modified Alvarado score of 5-6 was present in 18.32% whereas 7-9 was present in 81.68% patients. USG was suggestive of appendicitis in 84.50% patients. Conservative treatment was successful in 74.65% patients with no treatment failure. 25.35% patients, conservative treatment failed. Overall recurrence was seen in 13.11% cases that were successfully managed during primary admission.Conclusions: Majority of cases of first attack of uncomplicated acute appendicitis can be treated successfully by conservative treatment. However, conservative treatment requires monitoring and repeated re-evaluation to identify failure which needs to be treated promptly by surgery. Treatment failure on primary admission as well as the short- term recurrence after conservative treatment is low and acceptable. The outcome of conservative treatment does not depend on Modified Alvarado Score.