Melioidosis of the Female Genitourinary Tract.

Prostatic abscess is a common manifestation of melioidosis in men, but the characteristics of female genitourinary melioidosis are incompletely defined. There were 453 cases of melioidosis in Far North Queensland, tropical Australia, between January 1998 and April 2023; genitourinary involvement was less common in women than in men (13/140 [9%] versus 76/313 [24%], odds ratio [95% confidence interval]: 0.32 [0.17-0.60], P = 0.0004). In 11 of these 13 (85%) women, other organs were also affected. The two women with disease involving only the genitourinary tract had underlying anatomical abnormalities: one had an ovarian malignancy, the only case to involve the female reproductive system in the cohort, while the other had a urethral diverticulum. In 3 of 13 (23%) women, genitourinary involvement was identified only with computed tomography, emphasizing the importance of early imaging of patients with melioidosis to identify unexpected foci of disease and to inform the optimal duration of antibiotic therapy.

Case Report: Leptospirosis Complicated by Persistent, Bilateral Sensorineural Hearing Loss.

The clinical manifestations of leptospirosis range from mild to life-threatening and can impact on multiple organ systems. A wide array of neurological manifestations of leptospirosis have been reported, although the pathophysiology of neuroleptospirosis remains incompletely understood. We present a case of leptospirosis complicated by bilateral sensorineural deafness, with nodular meningitis demonstrated in the internal auditory meatus on magnetic resonance imaging. The patient was treated with doxycycline, ceftriaxone, systemic and topical steroids, and hyperbaric oxygen therapy, with modest, but incomplete, improvement.

Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: a randomised study.

OBJECTIVE: To compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP). MATERIALS AND METHODS: Twenty-one patients with vault prolapse requiring surgical treatment were randomly assigned in a balanced way to undergo SSF (n = 7), PIVS (n = 7) or SCP (n = 7). The magnetic resonance imaging of the pelvis were performed preoperatively and at 6-12 weeks postoperatively to assess the vaginal configuration using the method described previously. The two main angles measured were: (i) the angle between the lower vagina and pubococcygeal line 'd-angle' (normal: 53 +/- 15 degrees ); and (ii) the angle between the lower and upper vagina planes 'e-angle' (normal: 145 +/- 7 degrees ). RESULTS: The mean preoperative/postoperatively measured d-angles were 69 degrees /62 degrees, 58 degrees /70 degrees, and 49 degrees /52 degrees for SSF, PIVS and SCP, respectively. The corresponding means for the e-angle were 173 degrees /215 degrees, 189 degrees /146 degrees, and 205 degrees /149 degrees. The changes of the e-angles proved to be statistically significant (P < 0.05) in each surgical group, while no significant change in the d-angle could be found in any of the three groups. CONCLUSIONS: Significant improvements in the restoration of vaginal configuration were achieved in patients who underwent PIVS or SCP. Sacrospinous fixation in contrast seems to increase anatomical distortion of the vaginal configuration.