RESUMO
OBJECTIVE: To evaluate whether size of tuboovarian abscess (TOA) and other clinical characteristics were associated with the need for surgical intervention. STUDY DESIGN: A retrospective chart review of patients hospitalized at an inner city hospital between January 1998 and December 2007 with the diagnosis of TOA. Demographics, medical history, clinical markers of infection, radiology, pathology, and operative reports were examined. Student's t test and Fisher's exact test were utilized to analyze differences between groups. Multiple logistic regression analysis was performed to identify significant predictors of surgery. Receiver operating characteristic (ROC) analysis was used to assess how well TOA size and other significant variables were associated with the need for operative or procedural intervention. RESULTS: A total of 163 patients with TOA were identified; 41 patients were excluded based on specific criteria. Of the remaining 122 women, 65.6% responded to antibiotic therapy, and 34.4% had surgery or ultrasound-guided drainage. Mean TOA size in the medical group was 4.4 cm as compared to 7.3 cm in the surgical group (p < 0.0001). Maximal leukocyte count, older age, and parity were associated with significantly higher risk of surgery. The significant univariate variables remained significant after multivariate analysis. ROC curve analysis revealed an excellent discrimination of the need for surgical treatment as predicted by TOA size, with increased likelihood of surgical or procedural intervention with increasing TOA size. CONCLUSION: Radiographic size, leukocyte count, age, and parity are associated with operative or procedural treatment of tuboovarian abscess.
Assuntos
Abscesso/terapia , Doenças das Tubas Uterinas/terapia , Doenças Ovarianas/terapia , Abscesso/sangue , Abscesso/patologia , Adulto , Fatores Etários , Antibacterianos/uso terapêutico , Drenagem , Doenças das Tubas Uterinas/sangue , Doenças das Tubas Uterinas/patologia , Feminino , Humanos , Histerectomia , Contagem de Leucócitos , Modelos Logísticos , Doenças Ovarianas/sangue , Doenças Ovarianas/tratamento farmacológico , Ovariectomia , Paridade , Curva ROC , Estudos Retrospectivos , Salpingectomia , Falha de TratamentoRESUMO
BACKGROUND: Ochronosis is a manifestation of alkaptonuria, a rare metabolic disorder. It results in the accumulation of pigment in connective tissues. After several years, ochronosis may produce a distinctive form of degenerative arthritis. CASE: Vaginal ochronosis was diagnosed in an asymptomatic elderly woman with vaginal hyperpigmentation and severe degenerative arthritis. CONCLUSION: Vaginal hyperpigmentation is a rare clinical finding that necessitates biopsy.