Metronidazole for Prevention of Pelvic Cellulitis and Abscess after Laparoscopic Hysterectomy: A Triple-blinded, Randomized, Placebo-controlled Clinical Trial.

STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.

[How is agonizing leg pain associated with an intrauterine device?]. / In welchem Zusammenhang stehen quälende Beinschmerzen und eine intrauterine Spirale?

We report on a typical clinical course of pelvic actinomycosis: initial uncharacteristic discomfort develops into a systemic illness associated with a pelvic mass, which progresses so fast that along with the systemic infection further symptoms can be reduced to its growth rate--tiredness, abdominal pain, micturition deficiency, and leg pain. Distinction between malignancy and pelvic actinomycosis could be made only intraoperative. After hysterectomy and with antibiotics the patient recovered quickly.

Pelvic surgical site infections in gynecologic surgery.

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

Cervicitis associated with lateral cervical displacement.

Lateral cervical displacement has been recognized as a sign of endometriosis; however, other causes of the finding have not been explored. In our experience, patients without endometriosis are presenting with lateral cervical displacement, mainly towards the left of midline. The common finding in these cases is the presence of cervicitis leading us to hypothesize the role of cervicitis in causing lateral displacement of the cervix. Future research into this area will provide us with a stronger understanding of the role that lateral cervical displacement plays in the development of pelvic pathology and the development of cervical cancer.

An analysis of risk factors for postoperative pelvic cellulitis after laparoscopic-assisted vaginal hysterectomy.

OBJECTIVE: To assess risk factors for postoperative pelvic cellulitis in women undergoing laparoscopic-assisted vaginal hysterectomy (LAVH). MATERIALS AND METHODS: A total of 195 patients who underwent LAVH for benign gynecological diseases during the period 2007-2008 were enrolled. Among them, 11 patients developed pelvic cellulitis (group 1, cases) and 184 did not (group 2, controls). RESULTS: The proportion of patients in American Society of Anesthesiologists physical status scale (ASA) class II was significantly higher in group 1 (p=0.017). The grade of pelvic adhesion was significantly more severe in group 1 (p=0.044). The mean length of hospital stay in group 1 was significantly longer than in group 2. Logistic regression analysis revealed that patients in ASA class II were six times more likely to develop postoperative pelvic cellulitis than patients in ASA class I. In addition, the analysis showed that there was a twofold increase in risk for pelvic cellulitis with each single-grade increase in the degree of pelvic adhesion. Women with postoperative pelvic cellulitis also had a significantly increased length of hospital stay. CONCLUSION: Understanding the risk factors for postoperative pelvic infection, such as systemic disease, pelvic adhesion, and prolonged hospital stay, comprehensive care of patients, and correction of modifiable risk factors will help reduce the rate of postoperative pelvic cellulitis in women undergoing LAVH.

Síndrome de celulitis-adenitis inguinal por Streptococcus agalactiae / Cellulitis-adenitis syndrome inguinal Streptococcus agalactiae

Las infecciones de tejidos blandos en la infancia son producidas habitualmente por el Staphylococcus aureus pero, en los primeros meses de vida, el Streptococcus agalactiae (SGB) puede ser responsable de celulitis con afectación sistémica. El síndrome de celulitis-adenitis por SGB constituye una presentación infrecuente de la infección tardía causada por este germen. Las manifestaciones clínicas consisten en fiebre, mal estado general y signos inflamatorios locales. La localización más frecuente es la submaxilar, siendo excepcional la inguinal. Aportamos el caso de un paciente de 30 días de vida con fiebre, con una placa eritematosa y adenopatías en la zona inguinal derecha. En el hemocultivo se aisló SGB. El tratamiento inicial fue cloxacilina y cefotaxima parenterales cambiándose a las 48 horas, tras la recepción del hemocultivo, por cefotaxima y ampicilina. La evolución fue favorable. En niños menores de 3 meses, ante la presencia de celulitis y adenitis regional, debemos considerar al SGB como posible agente etiológico y contemplar la posibilidad de bacteriemia y afectación del sistema nervioso central para no diferir el tratamiento adecuado.

Soft-tissue infections in children are most often caused by Staphylococcus aureus but, in the first months of life, group B streptococcus (GBS) can be the etiologic agent of cellulitis with systemic involvement. Group B streptococcus cellulitis-adenitis syndrome is a rare form of late-onset disease for this germen. Clinical manifestations include fever and local inflammatory signs. Typical localization is submandibular but the inguinal form is exceptional. We present a case of a 30-day-old infant with fever, an erythematous plaque and lymphadenopathy in the right inguinal area. Blood culture was positive for GBS. Evolution was good with initial parenteral therapy with oxacylin and cefotaxime that was changed at 48 hours of treatment, after the blood culture reception, to ampicilin and cefotaxime. In cases of cellulitis and adenitis in infants during the first 3 months of life, GBS has to be considered the probable etiologic agent, and severe invasive disease has to be ruled-out in order to establish the appropriate antimicrobial therapy.

Granulocytic sarcoma manifested as a parametrial mass mimicking a haemorrhagic abscess: a case report with CT and MR findings.

Granulocytic sarcoma is a neoplasm arising from myeloid precursor cells and frequently accompanies leukaemia and myeloproliferative disorders. Granulocytic sarcoma can arise anywhere, and it frequently involves bones, perineural tissues and lymph nodes. However, granulocytic sarcoma in the female genital organs is uncommon, and it is extremely rare that it presents as an adnexal or parametrial mass. We report here the CT and MR findings in a case of granulocytic sarcoma that manifested as a uterine cervical and parametrial mass mimicking a haemorrhagic abscess in a 50-year-old woman with chronic myelogenous leukaemia.

MRI appearances of pelvic malakoplakia.

We report the MRI appearances in a patient with parametrial malakoplakia. The patient complained of pelvic pain and vaginal discharge. Physical examination revealed a "frozen" pelvis suggestive of malignancy. MRI showed bilateral parametrial "infiltration", but no overt primary pelvic tumour. The combination of these findings together with the inflammatory symptoms suggested an inflammatory condition. Malakoplakia was confirmed at resective biopsy.

Síndrome adenitis-celulitis: una presentación infrecuente de infección tardía por streptococcus agalactiae / Adenitis-cellulitis syndrome: an infrequent presentation of a late onset infection by Streptococcus agalactiae

A pesar de los avances en las estrategias de prevención en décadas anteriores, las infecciones por Streptococcus agalactiae constituyen una causa importante de infecciones neonatales. La mayoría ocurren durante la primera semana de vida (enfermedad precoz). Las infecciones tardías ocurren en niños mayores de una semana hasta los tres meses de edad. Entre estas últimas, el síndrome adenitis celulitis es usa manifestación inhabitual de las infecciones tardías por S. agalactiae transformándose en un marcador de infección invasora. Reportamos el curso clínico de un lactante con un síndrome adenitis celulitis de localización inguinal asociado a bacteriemia por S. agalactiae y discutimos la presentación clínica, hallazgos de laboratorio y evolución de esta condición basados en una revisión de la literatura.

Evaluación de los parametrios uterinos / Evaluation of the parametrium uteris

La evaluación no oncológica de los parametrios, como parte del examen ginecológico rutinario, ha venido en desuso como refleja en la bibliografía médica de los últimos 50 años. El propósito de este trabajo fue la evaluación clínica de los parametrios, a través del tacto ginecológico en 1250 pacientes de una consulta privada entre enero de 1999 y diciembre de 2001. En este grupo se evidenció la afectación parametrial en 102 casos. En estos, el parametrio más afectado fue el izquierdo con 83 casos (81,4 por ciento), luego el derecho en 14 casos (13,7 por ciento) y por último la afectación fue bilateral en 5 casos (4,9 por ciento). Se evalúan variables como la edad, la menarquía, las primeras relaciones sexuales, el método anticonceptivo, el tipo de regla, el número de gestaciones y la paridad

[Tumorous actinomycosis of the pelvis with in situ intrauterine device]. / Tumorförmige Aktinomykose des kleinen Beckens bei liegendem Intrauterinpessar.

PIP: The case is described of a 53-year old woman who had given birth three times and had undergone one abortion. After she was treated as an outpatient because of back pain in the lower waist area suppuration occurred from a fistula laterally right to the sacral bone in the area of the buttocks triangle, which persisted even after several outpatient surgical interventions. In addition, she had experienced a weight loss of 24 kg. At admission she had a temperature of 39 degrees Celsius, anemia, and leukocytosis. Sonography indicated slight hepatomegaly, hydroureter, right-sided hydronephrosis, and an right ovarian cyst of 4 cm size. Computer tomography showed a blurry structure that extended from the right kidney pole along the M. iliopsoas caudally up to the small pelvis, pressing against the organs caudally-ventrally, which also broke through dorsally between the lumbar region vertebrae and pelvis in the gluteal region percutaneously. The process was categorized as a frank paranephritis prolapsus abscess. Cessation of urine was determined. Laparotomy was carried out because of the suspicion of an inflammatory adnexal disease with parametritis. The uterus, including both adnexa as well as the conglomeration tumor, were removed. In the uterine cavity a Dana Cor IUD was found that had been inserted 13 years before and forgotten by the patient. At the site of the right adnexum there was a tumor (9 x 6 x 5 cu. cm) as well as a tube changed by inflammation (7 x 1.5 sq. cm). On the right side there was unspecific, suppurative salpingitis and in the ovary an abscess formation on the grounds of actinomycosis. On the left side there was only a suppurative inflammation of the tube without actinomycosis sediment. Immediately a high-dose antibiotic therapy (Penicillin G, 10 million IU) was started, lasting for 1 year. The kidney cessation with the back complaints rapidly disappeared. The cutaneous fistulae healed with scarring, however, a fully normal right-sided kidney function could not be restored.^ieng

Características clínicas do abortamento séptico na Maternidade da Encruzilhada / Clinics characteristics of septic abortion at the Maternity of Encruzilhada

Entre maio de 1988 à novembro de 1989, 110 pacientes hospitalizados na Maternidade - FESP - Recife, afirmaram ter realizado manobras abortivas. O principal objetivo desse estudo foi caracterizar as formas clínicas de aborto infectado e correlacioná-las com algumas variáveis. Os achados principais foram: Endometrite foi a forma clínica mais encontrada. O aborto ocorreu mais frequentemente no primeiro trimestre de gestaçäo. O esquema tríplice de antibióticos foi o mais comumente empregado. A média de permanência hospitalar foi de 3 dias

Efficacy of cefoxitin for the prevention of postoperative infection in abdominal hysterectomy.

Prophylactic effect of cefoxitin against postoperative infection at a dose of 2 g intravenous (single dose 30 minutes before the operation) was investigated using fever index in patients who underwent the elective, nonradical abdominal hysterectomy. The results obtained are summarized as follows. Total fever index values were 12.9 +/- 10.0 degree-hours in the control group (n = 39), 11.3 +/- 9.7 degree-hours in the study group (n = 39). There were no statistical significance between both groups. Data from this investigation does not suggest the concept that prophylactic antibiotics are beneficial in the reduction of postoperative infection. The results of this prospective study reflected in unnecessity of antibiotic prophylaxis in abdominal hysterectomy.