11/94. Focal necrotizing endometritis: a clinicopathologic study of 15 cases. From routine sign-out of endometrial biopsy specimens, a group of 15 endometria were identified that have a characteristic histologic pattern of inflammation that is not included in present classifications of endometritis. All but one of the women were premenopausal, and all presented with abnormal vaginal bleeding. The lesion is characterized by a patchy, focal inflammation, usually composed of lymphocytes with a variable number of neutrophils and rare macrophages centered around endometrial glands and extending into the glandular lumen with disruption and partial or subtotal necrosis of the endometrial glandular epithelium. These foci were widely dispersed, never confluent, and could be overlooked easily. plasma cells were not found in any of the endometrial specimens despite methyl green pyronine staining of the samples. Based on the histologic characteristics of this process we have designated it focal necrotizing endometritis. The clinical significance, if any, of focal necrotizing endometritis is currently unknown. ( info) |
| Human infections with pasteurella multocida are frequently attributed to transmission from animals. Although some cases of prosthetic implant infections have been described few gynecological cases have been reported. We describe a case of intrauterine device endometritis due to P. multocida. ( info) |
13/94. A case of uterine artery pseudoaneurysms. uterine artery pseudoaneurysms is a rare cause of haemorrhage but is potentially life-threatening and can occur after common gynaecological operations such as a Caesarean section or a hysterectomy. A 33-year-old woman who developed secondary postpartum haemorrhage after a Caesarean section was diagnosed to have uterine artery pseudoaneurysms on ultrasound scan. She was treated with bilateral uterine artery embolisation via selective catherisation of uterine arteries. Good outcome with the aneurysms remaining obliterated was obtained. Angiographic embolisation is a safe and effective method of treating postpartum haemorrhage in haemodynamically stable patients and should be an option before resorting to surgery in appropriately selected cases. ( info) |
14/94. copper accumulation in actinomyces druses during endometritis after long-term use of an intrauterine contraceptive device. A 32-year-old woman carried a copper intrauterine contraceptive device (IUCD) or intrauterine pessar (IAP) for more than 5 years. She had acyclic menstrual bleedings and underwent a corpus abrasio after explantation of IUCD. The histological study of paraffin sections showed an actinomycotic endometritis with brown to black deposits in or around typical actinomyces druses, but there was no carcinoma. The electron microscopic study of these accumulations by electron energy loss spectroscopy (eels) in TEM demonstrated copper deposits in the shell and matrix of these druses as well as inside the bacteria. With scanning electron microscopy (SEM) and Energy Dispersive X-Ray Analysis (EDX), the electron-dense accumulations revealed high signals for copper and sulfur, but also of phosphorus and oxygen in a lower extent. This copper accumulation is discussed as an active uptake and concentration by these actinomyces bacteria. ( info) |
| BACKGROUND: placenta accreta is the abnormal attachment of the placenta to the uterus. It occurs when the decidua basalis is either absent or incomplete. It is uncommon and most often presents with a retained placenta and hemorrhage. CASE: A 29-year-old gravida 1 had an uncomplicated antenatal course and delivery. The third stage of labor was complicated by a retained placenta necessitating manual removal. Her postpartum course was complicated by a persistent endometritis. The diagnosis of placenta accreta was made with the help of sonohysterography. CONCLUSION: Sonohysterography is a useful tool in discriminating a solid intracavitary mass from a placenta accreta postpartum. ( info) |
| Acute fatty liver of pregnancy can produce a great variety of complications. Of these, infections are important. We describe two cases, one of them complicated with uterine sepsis. Both gave evidence of the necessity for multidisciplinary treatment, which reduces the maternal-fetal morbidity and mortality produced by this disease. ( info) |
17/94. Endometrial fluid accumulation during controlled ovarian stimulation for ICSI treatment. A report of three cases. The occurrence of endometrial fluid accumulation was examined in patients undergoing ovarian stimulation in a program of intracytoplasmic sperm injection (ICSI), by vaginal ultrasound. Endometrial fluid accumulation was recorded in three cycles out of 124. In one case, the fluid was absorbed before embryo transfer (ET), but in the other cases it was present in ET. In these three cases, the endometrium had been evaluated as normal before ovarian stimulation. Fluid accumulation in the endometrial cavity possibly affects the implantation process negatively. Therefore, alternative options should be considered as cancellation of the embryo transfer and cryopreservation of embryos to be available in a subsequent mild stimulated cycle. ( info) |
18/94. Granulomatous endometritis associated with histologically occult cytomegalovirus in a healthy patient. This report describes the case of a 32-year-old female with chronic pelvic pain who was otherwise in good health. Endocervical curettings contained rare cells with intranuclear and cytoplasmic inclusions characteristic of cytomegalovirus (CMV) infection. Endometrial curettings demonstrated a stromal lymphocytic and plasmacytic infiltrate as well as numerous small, non-necrotizing granulomas, but no CMV by microscopic examination. However, CMV was identified by the polymerase chain reaction in dna extracted from a paraffin section of the endometrial tissue. In conjunction with previous reports, the clinical and pathologic features of this case suggest that CMV can cause chronic endometritis in nonimmunocompromised patients. Furthermore, CMV infection should be considered in the differential diagnosis of granulomatous endometritis. This case demonstrates the usefulness of using the polymerase chain reaction to detect CMV in paraffin-embedded material. ( info) |
19/94. Group A streptococcus and streptococcal toxic shock syndrome: a postpartum case report. Streptococcal toxic shock syndrome from group A streptococcal disease is rare in the postpartum period, yet it is associated with high morbidity and mortality. early diagnosis and treatment can lessen complications. Midwives can improve provision of postpartum care by being adequately educated about signs and symptoms of this disease, thereby enhancing their ability to recognize it and obtain the appropriate referral or collaborative medical care. A clinical presentation of postpartum streptococcal toxic shock syndrome, including provider follow-up, is presented. ( info) |
20/94. enoxaparin for postpartum ovarian vein thrombosis. A case report. BACKGROUND: Intravenous heparin is a recognized treatment for ovarian vein thrombosis. Although an effective, less cumbersome alternative exists with lowmolecular-weight heparins, the literature does not contain reports of their use for this condition. We report a case of postpartum ovarian vein thrombosis managed with enoxaparin. CASE: A 29-year-old woman, gravida 1, para 1001, was readmitted with postpartum endomyometritis. After 5 days of appropriate antibiotics, computed tomography of the abdomen/pelvis demonstrated a right ovarian vein thrombus. enoxaparin was initiated, resulting in a rapid clinical improvement, and hospital discharge was achieved within 36 hours. CONCLUSION: enoxaparin treatment for avarian vein thrombosis is an alternative to intravenous heparin that may permit a shorter hospital stay without the need for coagulation profile monitoring. ( info) |