RESUMO
Primary ovarian abscess is a rare infection. A new case has led us to carry out a literature review in order to optimize the treatment. Exceptionally isolated, primary ovarian abscess usually belongs to the postoperative complications. Nevertheless, its etiopathogenies are numerous. The symptoms are often poor; therefore the diagnosis is difficult to establish. The curative treatment must associate surgery and antibiotherapy. Even if laparoscopic surgery is the first line treatment in many cases, laparotomy remains the choice procedure. Ultrasonographically-guided evacuation has to be further evaluated. Preventive treatment is of major importance.
Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/terapia , Adolescente , Adulto , Anti-Infecciosos/uso terapêutico , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Histerectomia , Pessoa de Meia-Idade , Doenças Ovarianas/microbiologia , UltrassonografiaRESUMO
OBJECTIVE: Among obstetricians and midwives, estimate the percentage of smokers, appraise the proportion of medical professionals who mention the subject of nicotine addiction to their pregnant patients, and assess the quality of the information delivered to patients as well as their own experience in the field of tobacology. PATIENTS AND METHODS: Between February and March 2002, 188 postal questionnaires were sent to obstetricians and gynecologists, midwives and midwife students of public hospitals in Limousin and private clinics in Limoges. RESULTS: The response rate was 75,5% (142 answers) and the median age was 37 years old (20-59). 43,6% of the respondents were current smokers. Patients' smoking habits would be asked for and the risks of tobacco smoking would be explained by the majority of praticians and midwives. Minimal counsel to be given was known and given by 34,4% of gynecologists an 26,5% of midwives. Smoking cessation counselling was never proposed by 62% of gynecologists and 79% of midwives. Seventy per cent of them did not have any specific training in the field of tobacology during their studies. DISCUSSION AND CONCLUSION: There seems to be a deficiency in smoking cessation help for pregnant women in Limousin. Specifics programs and trainings for obstetricians, gynecologists, as well as midwives should be organized.
Assuntos
Aconselhamento/métodos , Ginecologia , Tocologia , Obstetrícia , Abandono do Hábito de Fumar , Adulto , Atitude do Pessoal de Saúde , Feminino , Ginecologia/educação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Tocologia/educação , Obstetrícia/educação , Papel do Médico , Gravidez , Cuidado Pré-Natal , Inquéritos e QuestionáriosRESUMO
We report a case of placenta percreta with bladder invasion in a multiparous woman with five previous cesarean sections. At 25 weeks of gestation, because of severe hematuria, antenatal diagnosis was easy. A multidisciplinary management was carried out with conservative treatment. Three repeated artery embolizations were necessary because of placenta volume and collateral vessels. None surgical treatment was realized to avoid hemorrhage and morbidity secondary to hysterectomy and partial cystectomy.
Assuntos
Placenta Acreta/patologia , Placenta Acreta/terapia , Bexiga Urinária/patologia , Adulto , Embolização Terapêutica , Feminino , Idade Gestacional , Hematúria , Humanos , Imageamento por Ressonância Magnética , Placenta Acreta/diagnóstico , GravidezRESUMO
Inherited bleeding disorders contraindicate epidural analgesia because of the risk of epidural haematoma. However, there is no consensus about a minimal rate of factor XI required for its performance. We report here a case of epidural analgesia in a pregnant woman with a moderate and symptomatic factor XI deficiency, despite this theoretical contraindication. Indeed, the factor XI deficiency results in a haemorrhagic risk which is variable and not easily foreseeable. Nevertheless, no neurological after-effect or excessive bleeding occurred although no specific prophylaxis had been performed.
Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Deficiência do Fator XI/complicações , Fator XI/fisiologia , Adulto , Fator XI/uso terapêutico , Feminino , Hemoglobinas/metabolismo , Hemorragia/tratamento farmacológico , Hemorragia/epidemiologia , Humanos , Contagem de Plaquetas , Gravidez , Medição de RiscoRESUMO
BACKGROUND: HPV HR detection test are needed when ASCUS is diagnosed on Pap test. The risk of progression to cervical cancer is dependant on the HPV genotype and three types (HPV 16, 18 and 45) are found in 77.4% of the cervical cancer. Here we have tested a new probe 16/18/45 (Digene) that is able to detect specifically these three types. MATERIAL AND METHODS: Thirty-seven women with a Hybrid Capture 2 High Risk test (Digene) positive were selected to test the new probe 16/18/45. Samples were typed using sequencing reaction after GP5+/GP6+ PCR. Types were given after comparison with the GenBank. Discordant results were controlled with Inno-Lipa HPV genotyping v2 test (Innogenetics). RESULTS: Among the 37 women with HR HPV result, 48.6% were positive with the probe 16/18/45 (18 patients). After genotyping, 12 results were concordant and six discordant (three HPV 31, two HPV 58 et one HPV 59). For the other 19 patients with negative result, 18 are concordant and one discordant (HPV 18). Global concordance for typing between this probe and sequencing was 81% with a kappa test of 0.62 that means a good concordance. Positive predictive value is 66.6% and negative predictive value is 94.7%. CONCLUSION: This study shows a good efficiency of the 16/18/45 probe to detect the genotypes that have the higher risk of progression to cervical cancer. This probe could also allow to follow the epidemiology of HR HPV infection after a large use of HPV vaccines.
Assuntos
Alphapapillomavirus/isolamento & purificação , Sondas de DNA de HPV , Hibridização de Ácido Nucleico/métodos , Infecções por Papillomavirus/virologia , Neoplasias do Colo do Útero/virologia , Alphapapillomavirus/classificação , Alphapapillomavirus/genética , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/isolamento & purificação , Humanos , Infecções por Papillomavirus/diagnóstico , Filogenia , Valor Preditivo dos Testes , Kit de Reagentes para Diagnóstico , Risco , Especificidade da Espécie , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/diagnóstico , Esfregaço VaginalRESUMO
BACKGROUND: Detection of high-risk human papillomavirus has proved its usefulness in complement of abnormal cervical scrape result. The Hybrid Capture 2 (HC2, Digene) test has proven its efficiency. We have compared this test with HPV Consensus kit (HPVC, Argène) and Amplicor HPV test (AHPV, RocheDiagnostics) on a panel of 88 samples with low HC2 ratios or discordant results between HC2 and cervical scrape. MATERIAL AND METHODS: Cervical samples were tested in parallel by the three methods using a nested amplification of L1 region as reference. RESULTS: Eighty-six samples were suitable for analysis. Results of HC2 and AHPV tests were closely related. The use of a "generic" probe in the HPVC test was responsible for undetermined results, which were not clinically relevant. CONCLUSION: Despite the low viral load of the samples chosen, the hybridization (HC2) and PCR (AHPV or HPVC) methods gave comparable results, with false positive and false negative results for all tests, but a 75% concordance and a high sensibility to detect HPV infection. However, a complementary study on a larger population with ASCUS diagnosis and biopsy under colposcopy would be necessary to valid these assays for a clinical indication.
Assuntos
Colo do Útero/virologia , Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , DNA Viral/análise , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Hibridização de Ácido Nucleico/métodos , Reação em Cadeia da Polimerase/métodos , Kit de Reagentes para Diagnóstico , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Many laboratories use the DNA Hybrid Capture 2 HPV-high risk assay (Digene) to detect and type oncogenic HPV. The aim of this work was to compare this assay with a new HPV genotyping assay: HPV Consensus kit (Argène). Actually, this assay is not commercially available. MATERIALS AND METHODS: Ninety-four cervical samples were tested with both the routine assay Hybrid Capture 2 and the HPV Consensus kit. Discordant results were analysed by amplification with a nested PCR and sequencing of amplified products. RESULTS: Only 81 results could be analysed concerning the oncogenic risk. The overall concordance was 92,6%. But we find 13 "generic" results with the HPV Consensus kit, the generic probe including high risk and low risk genotypes. CONCLUSION: HPV Consensus kit results showed a better detection sensitivity for this assay than Hybrid Capture 2 assay. Nevertheless, "generic" results give no information about the oncogenic risk of the HPV detected in a sample.