11/188. Genital tuberculosis can present as disseminated ovarian carcinoma with ascites and raised Ca-125: a case report. In women with an adnexal mass, ascites and elevated Ca-125 levels, ovarian carcinoma must be ruled out. However, several other conditions, including genital tuberculosis, may present similarly. A 41-year-old woman with weight loss, ascites and elevated levels of Ca-125 was evaluated for ovarian cancer. Computerized tomography revealed an adnexal mass, ascites and lymph nodes on the peritoneal surface. paracentesis of the ascitic fluid revealed a lymphocytic exudate but failed to show any malignant cells. At laparotomy, frozen sections of tissue biopsies were negative for malignancy; however, a total hysterectomy plus adnexectomy was performed. Postoperatively histologic examination revealed typical features of genital tuberculosis. Antituberculosis treatment was effectively given to the patient. serum levels of Ca-125 were undetectable 12 weeks after treatment. In conclusion, genital tuberculosis can be misdiagnosed and confused with ovarian cancer. Intraperitoneal tuberculosis should be considered in the differential diagnosis in cases in which ovarian cancer is suspected, even when malignancy-associated risk factors are present. ( info) |
12/188. cytomegalovirus disease in the lower female genital tract. cytomegalovirus (CMV) can cause life-threatening disease in immunocompromised patients, such as those with human immunodeficiency virus (hiv). It is a rare but important cause of ulceration in the female genital tract. We report on three cases of CMV disease in the female genital tract. One patient presented with vulvar ulceration and fevers, and two patients presented with bleeding cervical lesions. All diagnoses were confirmed by histology. All patients were treated with intravenous ganciclovir with good result. CMV disease of the female genital tract may result in significant morbidity, with fever, pain, bleeding, and superinfection, and it may be associated with the development of pelvic inflammatory disease and cervical intraepithelial neoplasia. There are several options for diagnosis and for safe treatment. ( info) |
| The association of unilateral tubo-ovarian abscess and the presence or use of an intrauterine contraceptive device (IUD) appears to be a definite clinical entity. Four cases of unilateral tubo-ovarian abscess in patients using the IUD are presented. Three patients had a Dalkon Shield IUD and one had a Lippes Loop. Two patients had unilateral salpingo-oophorectomy while the other 2 had total abdominal hysterectomy and bilateral salpingo-oophorectomy. The differential diagnosis, possible etiology, route and mode of infection, and management are discussed. ( info) |
14/188. An unusual case of neonatal peritoneal calcifications associated with hydrometrocolpos. Neonatal peritoneal calcifications usually suggest a diagnosis of meconium peritonitis, but in this case, a premature baby girl, peritoneal calcifications were caused by hydrometrocolpos secondary to imperforate hymen, a rare association. The patient presented with respiratory distress and ascites and demonstrated abdominal calcifications on plain film. Other radiographic work-up revealed hydrometrocolpos without evidence of gastrointestinal tract obstruction. The patient was diagnosed and treated for imperforate hymen; she was recovered fully. ( info) |
15/188. Hydrometrocolpos in a newborn. Hydrometrocolpos was diagnosed in a neonate shortly after birth. A large collection of fluid was immediately removed from the distended vagina; hymenotomy was performed. The infant has remained well for more than a year following treatment. A simple technique for rapid diagnosis permits safe and appropriate management of this potentially serious disorder. ( info) |
| We present a case history of a woman who was diagnosed as having cervical schistosomiasis on histology following investigations for abnormal cervical smear. schistosomiasis of the female genital tract can present with varied symptoms and there is a need for greater awareness of this diagnosis as the number of travellers to schistosomiasis-endemic areas rises. Travellers to these areas should be warned about the risk of swimming in lakes and rivers. ( info) |
17/188. An unusual case of clitoral enlargement: its differential diagnosis and surgical management. Clitoromegaly can be either congenital or acquired. The congenital forms are caused by hormonal disturbances or intersex states. Usually they are obvious at birth. When the clitoromegaly develops later the underlying aetiology should be explored and acquired causes should also be considered. These acquired forms of clitoromegaly are either hormonal or non-hormonal. In the hormonal causes, an androgen excess is the main contributing factor of the clitoral enlargement. Three groups should be distinguished: endocrinopathies, masculizing tumours, or self-injection of long-acting synthetic androgens. The most important endocrinopathies are non-polycystic ovarian hypertenstosteronism and polycystic ovarian syndrome. The only reported non-hormonal cause has been neurofibromatosis. We present a case in which the clitoromegaly developed during puberty. As no hormonal disturbances or other abnormalities had been found, and no signs of neurofibromatosis seen, temporary use of steroids was suspected. To our surprise a large sebaceous cyst was found. ( info) |
18/188. Genitopatellar syndrome: delineating the anomalies of female genitalia. We report the second female with genitopatellar syndrome, a recently identified arthrogryposis syndrome. The salient features include severe mental retardation and microcephaly with absence of the corpus callosum, absent/hypoplastic patellae, genital anomalies, and hydronephrosis. ( info) |
19/188. women's health in northeast thailand: working at the interface between the local and the global. An important first step in translating global statements about women's right to health into action programs is an assessment of the interface between local health culture and public health/medical practice. In this paper, we present the findings of an ongoing research project focusing on women's sexual and reproductive health in Northeast thailand. The project is a prototype illustrating how formative research may be used to guide intervention development as well as midcourse correction. Examples are provided which clearly illustrate why cultural understandings of gynecological health are important to consider before introducing women's health programs. One case featured describes how an iatrogenic fear of cervical cancer has emerged from public health messages and screening programs. A hybrid model of cancer has evolved from preexisting local ideas, resulting in an exaggerated sense of risk wherein women fear that a wide range of common problems may potentially transform into this fatal disease. We argue that public health needs to be held accountable for what transpires when health messages are introduced into a community. Monitoring of community response is necessary. In the second half of the paper we describe efforts to increase community understanding of women's health problems, create gender and culturally sensitive health care services, and enhance the technical and communication skills of health staff. ( info) |
20/188. Spontaneous disappearance of a normal adnexa associated with a contralateral polycystic-appearing ovary. BACKGROUND: Absence of the adnexa may be congenital or acquired. However, the etiology is often uncertain. CASE: A 27-year-old woman presented with a 3-year history of subfertility. Her irregular menstruation was associated with acne vulgaris, alopecia, and elevated body mass index. Transvaginal ultrasonography of the pelvis showed a normal uterus, a normal right ovary, but a polycystic-appearing left ovary. A hysterosalpingogram demonstrated a normal uterine cavity, prompt filling and spilling of contrast material from the left fallopian tube, but no filling on the right. Subsequent laparoscopy showed an unexpected absence of right adnexa and presence of a solitary rounded free-floating mass enshrouded in the omentum. She did not have a history of abdominal pain or surgery. CONCLUSION: The evidence suggests that the patient might have had an asymptomatic infarction of the right adnexa. ( info) |