Chlamydial infection in female lower genital tract and its correlation with cervical smear abnormalities.

BACKGROUND: It is widely known that infection by Chlamydia trachomatis (CT) is the most common curable sexually transmitted infection (STI) among the young population.Chlamydial cervicitis has been suspected in the past to be a risk factor for squamous intraepithelial neoplasia (SIL) and cervical cancer on the basis of case-control comparisons of serological tests. METHODS: A total of 110 women with symptomatic cervicitis were examined and samples for microbiologic detection of Chlamydia trachomatis antigen were obtained. Colposcopic, cytologic and microbiologic analyses were performed. All results were statistically analysed and correlated. RESULTS: 41 patients (37.2 %) were found positive for Chlamydia trachomatis antigen (Group I) and 69 patients (62.8 %) were negative for Chlamydia trachomatis antigen (Group II). When compared to group II, the chlamydia-infected group I of women presented a larger percentage of dyspareunia (60 %), and the dysuric complaints were more common. The chlamydia-positive group revealed a higher incidence of atypical squamous metaplasia (52.5 % vs 27.9 %). Among the women with positive ELISA for chlamydia, a higher percentage of low-grade SIL was observed (6.3 % vs 3.6 %). CONCLUSIONS: Chlamydial infection, especially chlamydial cervicitis occurs often among young women of reproductive age. In these women, a good clinical assessment is necessitated including previous clinical history record, as well as detailed microbiologic, cytologic and colposcopic evaluations (Tab. 5, Ref. 19).

Exacerbation of liver cirrhosis in pregnancy: a complex emerging clinical situation.

Pregnancy in women with liver cirrhosis is an infrequent situation. In general the incidence of cirrhosis in pregnancy is very low and it is estimated approximately about 1 in 5,950 pregnancies. We report a descriptive management of pregnancy in a woman suffering from chronic viral hepatitis B with D and C coinfection exacerbated finally to severe cirrhosis of the liver. Caesarean section was performed giving birth to a viable male infant. Two months after the operation the patient underwent a liver transplantation with good outcome. Management of such severe cases requires a multidisciplinary medical approach. Data regarding cirrhosis caused by chronic viral agents in pregnancy are limited.

Pentasomy 49,XXXXY diagnosed in utero: case report and systematic review of antenatal findings.

OBJECTIVES: Pentasomy 49,XXXXY is a rare sex chromosome polysomy usually diagnosed postnatally by the combina- tion of mental retardation, facial dysmorphism, and genital, cardiac and skeletal malformations. Prenatal detection of 49,XXXXY is unusual and may be incidental due to non-specific ultrasound (US) findings. We report a case of 49,XXXXY diagnosed prenatally and present a literature review of the few prenatally diagnosed cases. METHODS: We searched the PubMed electronic database without year and language restriction, using the keywords 'Prenatal', 'Diagnosis', and '49,XXXY', performing a systematic review. RESULTS: We report a 35-year-old patient with normal first-trimester US but increased combined risk for trisomies 18 and 13. Amniocentesis at 16 weeks of gestation revealed a 49,XXXXY karyotype. Pregnancy was terminated at 19 weeks' gestation, and a male fetus with facial dysmorphism and hypospadia was delivered. A total of 12 articles were identified in the systematic review. All were case reports and dated from 1980 until 2008. The mean maternal age was 34.8 years (range 30-41). The most common prenatal US feature was cystic hygroma, present in 5 cases. Hypogenitalism was the most common macroscopic clinical feature identified after pathology examination in 7 cases. In 2 cases, there was an increase in first-trimester combined risk for trisomy 21. CONCLUSIONS: Pentasomy 49,XXXXY is associated with a variety of non-specific US findings, of which cystic hygroma was the commonest. No specific sequence of findings could be identified in this review.

Spontaneous hepatic rupture during third trimester of pregnancy.

Hepatic rupture is a rare and devastating complication in pregnancy, mainly associated with pre-eclampsia and HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count). It has an incidence of 1 case in 45,000-225,000 births. Nearly 200 cases have been reported in the international literature. We report a case of a hepatic rupture with severe haemorrhage caused by HELLP in a third trimester pregnancy. The case was managed successfully with no pathological complications for either the mother or the infant. The physician should be aware of this condition when dealing with intra-abdominal haemorrhage during pregnancy.

[Treatment of leiomyomas with uterine artery embolization. Review of literature].

Embolization of the uterine artery represents a widely accepted invasive method for treatment of fibroids. It is indicated for women in perimenopause with symptomatic leiomyomas who do not require preservation of their fertility functions. The method should be used with caution excluding infectious diseases and malignancies. A experienced interventional radiologist is needed for the completion of the method. Complications are infrequent with rate reaching almost 5%. Few knowledge exists about pregnancy outcomes after uterine artery embolization. For this reason it should be used with caution in young women with symptomatic leiomyomas willing to conceive.

Complementary treatment with oral pidotimod plus vitamin C after laser vaporization for female genital warts: a prospective study.

This is a prospective study to assess a complementary treatment for genital warts after laser vaporization. 62 patients were enrolled in two randomized groups: Al: laser vaporization alone. A2: laser vaporization, followed with Pidotimod plus vitamin C for 2 1/2 months. The latter treatment shortened the time of warts remission and marginally decreased the rate of the warts' recurrence: 81% versus 67% (N.S.). Despite the non-significant difference, this complementary treatment seems to have some efficiency.

Management of large retroperitoneal lipoma in a 12-year-old patient.

Retroperitoneal lipomas are rare tumors. The etiology of their proliferation is uncertain. Metabolic and genetic causes have been reported. We present the case of a 12-year-old patient with a large pelvic lipoma causing dysuria and pelvic pain. Magnetic resonance imaging revealed the existence of a large retroperitoneal fat tumor. Ultrasound-guided fine needle biopsy was performed to exclude malignancy. The biopsy specimen revealed tissue consistent with a benign lipoma tumor. Exploratory laparotomy revealed a solid lipoma of the retroperitoneal space 8 x 6 cm and weighing 300 g. The patient had a good postoperative performance status. Lipomas should be considered in the differential diagnosis of a solid tumor in the retroperitoneal space.

Amniotic fluid embolism managed with success during labour: report of a severe clinical case and review of literature.

BACKGROUND: AFE (amniotic fluid embolism) is widely known as a disastrous rapid-progressing clinical entity. The incident ranges from 1:800 to 1:8,000. The mortality rate reaches 61-86%. Neonatal survival is reported at 70%. METHODS: We describe the case of a healthy 29-year old primigravida developing amniotic fluid embolism during labour. Acute respiratory failure and hypotension combined with seizures were the initial symptoms. The patient under went an urgent caesarean section with extreme blood loss, complicated by disseminated coagulopathy. RESULTS: A total hysterectomy was performed due to profuse bleeding. Aggressive management was practiced with continuous transfusion of blood products and administration of vasocopressors. CONCLUSION: Amniotic fluid embolism or anaphylactoid syndrome of pregnancy is a life-threatening condition. Diagnosis is one of the exclusion. Its management is very difficult and requires quick management and cooperation of physicians from different specialties.