Behavioral changes before metritis diagnosis in dairy cows.

Metritis is common in the days after calving and can reduce milk production and reproductive performance. The aim of this study was to identify changes in feeding and social behavior at the feed bunk, as well as changes in lying behavior before metritis diagnosis. Initially healthy Holstein cows were followed from 3 wk before to 3 wk after calving. Behaviors at the feed bunk were recorded using an electronic feeding system. Lying behavior was recorded using data loggers. Metritis, based upon the characteristics of vaginal discharge at d 3, 6, 9, 12 and 15 after calving, was diagnosed in 74 otherwise healthy cows. Behavior of these cows, beginning 2 wk before calving until the day of diagnosis, was compared with 98 healthy cows (never diagnosed with any health disorder, including ketosis, mastitis, and lameness) during the transition period. During the 2 wk before calving, cows later diagnosed with metritis had reduced lying time and fewer lying bouts compared with healthy cows. In the 3 d before clinical diagnosis, cows that developed metritis ate less, consumed fewer meals, were replaced more often at the feed bunk, and had fewer lying bouts of longer duration compared with healthy cows. We concluded that changes in feeding as well as social and lying behavior could contribute to identification of cows at risk of metritis.

Changes in feeding, social, and lying behaviors in dairy cows with metritis following treatment with a nonsteroidal anti-inflammatory drug as adjunctive treatment to an antimicrobial.

Dairy cows with metritis display sickness behaviors, and nonsteroidal anti-inflammatory drugs (NSAID) have the potential to reduce these responses. The objective of this study was to investigate changes in feeding, social, and lying behaviors in dairy cows with metritis that had been treated with the NSAID meloxicam. After parturition, cows were housed in a dynamic, mixed-parity group of 20 animals with access to 12 electronic feed bins, 2 electronic water bins, and 24 lying stalls in a freestall pen. Every third day after parturition, vaginal discharge was evaluated to diagnose metritis based on the presence of foul smell and characteristic visual appearance. When diagnosed with metritis, animals (n = 87) were randomly allocated to receive either a single dose of meloxicam (0.5 mg/kg of body weight subcutaneously) or a placebo solution. All metritic animals received an antimicrobial (ceftiofur) for 5 d. We measured feeding and social behaviors at the feed bunk, as well as lying behaviors, and assessed within-cow changes from the day before to the day of (d 0) NSAID treatment, and from the day before to d 1 to 5 after treatment. Generally, behaviors changed around the day of diagnosis of metritis. Compared with the placebo group, cows that received meloxicam had a greater increase in the number of visits to the feeder, but tended to show less of an increase in dry matter intake and feeding time. These differences did not persist beyond 24 h after NSAID treatment. We observed no differences in changes in number of meals and feeding rate on d 0, but from d 1 to 5 cows treated with meloxicam had a lesser decrease in the number of meals and tended to have a greater decrease in feeding rate than did placebo-treated cows. In multiparous cows on d 0 and from d 1 to 5, meloxicam treatment was associated with decreased lying times. In primiparous cows, lying time changes were similar between treatments on d 0, but lying times increased more on d 1 to 5 for meloxicam than for placebo cows. Overall, cows changed the number of lying bouts on d 0, and this increase tended to be smaller for the meloxicam cows. There were no treatment differences in changes of social behavior. In summary, we observed inconsistent and generally small effects of a single dose of meloxicam in addition to antimicrobial therapy on the behavior of cows with metritis.

Clinical characteristics of genital chlamydia infection in pelvic inflammatory disease.

BACKGROUND: Chlamydia infection in acute pelvic inflammatory disease (PID) is associated with serious complications including ectopic pregnancy, tubal infertility, Fitz-Hugh-Curtis syndrome and tubo-ovarian abscess (TOA). This study compared clinical and laboratory data between PID with and without chlamydia infection. METHODS: The medical records of 497 women who were admitted with PID between 2002 and 2011 were reviewed. The patients were divided into two groups (PID with and without chlamydia infection), which were compared in terms of the patients' characteristics, clinical presentation, and laboratory findings, including inflammatory markers. RESULTS: The chlamydia and non-chlamydia groups comprised 175 and 322 women, respectively. The patients in the chlamydia group were younger and had a higher rate of TOA, a longer mean hospital stay, and had undergone more surgeries than the patients in the non- chlamydia group. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and CA-125 level were higher in the chlamydia group than in the non-chlamydia group, but there was no significant difference in the white blood cell count between the two groups. The CA-125 level was the strongest predictor of chlamydia infection, followed by the ESR and CRP level. The area under the receiving operating curve for CA-125, ESR, and CRP was 0.804, 0.755, and 0.663, respectively. CONCLUSIONS: Chlamydia infection in acute PID is associated with increased level of inflammatory markers, such as CA-125, ESR and CRP, incidence of TOA, operation risk, and longer hospitalization.

MDCT of pelvic inflammatory disease: a review of the pathophysiology, gamut of imaging findings, and treatment.

Representing an ascending, sexually spread pyogenic infection of the female genital tract, pelvic inflammatory disease (PID) is a commonly encountered cause for emergency visits and hospitalizations among young and adult female patients. Though gynecologic evaluation and sonography constitute the mainstay of diagnosis, multidetector CT imaging of the abdomen and pelvis is not uncommonly performed, often as the initial imaging modality, due to the frequently vague and indeterminate clinical presentation. As such, knowledge and attenuation to the often subtle early imaging features of PID afford the radiologist a critical chance to direct and expedite appropriate pathways of patient care, minimizing the risk for secondary complications, including infertility, ectopic pregnancy, and enteric adhesions. In this paper, we will review the pathophysiology, clinical presentation, early and late imaging features of PID as well as potential secondary complications and treatment options. Additionally, we will discuss published data metrics on CT performance regarding sensitivity and specificity for diagnosis as well as potential imaging differential diagnostic considerations.

Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005.

BACKGROUND: Indigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI). The association of severe pelvic inflammatory disease (PID) with these factors has not been studied. The purpose of this study is to associate the factors with severe PID, as indicated by hospitalization in a high risk population in North Queensland Indigenous communities. METHODS: A cross-sectional association of 1445 Indigenous women using linked hospital separation and survey data during 1998-2005. RESULTS: The mean age of participating women was 37.4 years, 60% were of Aboriginal and 40% were Torres Strait Island (TSI) people. More than half of them (52.5%) were smokers, 9.3% had chlamydia and 2.6% had gonorrhoea with the overall prevalence of STI among those less than 25 years of age being 23.9%. Among the 47 participants diagnosed with PID in the study period, 42.5% were under 25 years and 95.7% (45 cases) were under 55 years (OR 2.5, 95% CI 1.2-4.1 among women younger than 25 compared to those 25 years and over). PID was strongly associated with smoking (OR 3.1, 95% CI 1.4-9.2) independent of age, ethnicity, STI and folate status. Low red cell folate increased PID hospitalization by 4 times (95% CI 1.5-13.2 of lowest quartile compared to the highest quartile) regardless of age. Having a STI significantly increased the likelihood of severe PID by 2.2 times (95% CI: 1.03-4.5) in Indigenous women younger than 45 years, independent of smoking and folate level. The risk of PID hospitalization was higher for gonorrheal infections (OR 3.2, 955 CI 1.1-9.6) compared to chlamydial infections (OR 1.5 95% CI 0.7-3.5). CONCLUSIONS: Young Indigenous women in North Queensland communities are at very high risk for STI and PID. Smoking, low folate, and STI are clustered, and are associated with PID hospitalizations. Much of this can be prevented with improved nutrition and access to preventive services, especially tobacco control, regular STI screening and treatment, as well as more investment in sexual health education and awareness.

Unusual ectopic pregnancies: a retrospective analysis of 65 cases.

AIM: The aim of this study was to retrospectively investigate unusual ectopic pregnancies (EP) and compare them with fallopian ones. MATERIAL AND METHODS: A total of 1000 cases of ectopic pregnancies were analyzed, including 65 unusual cases. We discussed distribution, incidence, risk factors, examinations, treatments and prognoses. RESULTS: Ovarian pregnancy was associated with placement of intrauterine device and pelvic inflammatory diseases. Extratubal EP have a high rate of misdiagnosis and presented more serious manifestations. Some unusual EP could be diagnosed by ultrasonography. Ovarian pregnancy was usually manifested as positive culdocentesis. Most of the unusual EP underwent surgery, except some early cervical and corneal pregnancies. CONCLUSION: Although extratubal pregnancies are difficult to diagnose, some histories and auxiliary examinations could make diagnosis easier for clinical physicians. Surgery is still the most effective approach for treatment of unusual EP, while conservative treatment of mifepristone combined with methotrexate or curettage could be used for early diagnosis and treatment of cervical pregnancy.

The sensitivity and specificity of transvaginal ultrasound with regard to acute pelvic inflammatory disease: a review of the literature.

PURPOSE: This review aims to sum up current knowledge on the sensitivity and specificity of ultrasound features suggestive of acute pelvic inflammatory disease (PID). METHODS: A PubMed database search was undertaken, using the MeSH terms "(pelvic inflammatory disease or salpingitis or adnexitis) and ultrasonography". We included original articles evaluating the performance of vaginal ultrasound in detecting acute PID. RESULTS: Seven articles were selected, including between 18 and 77 patients each. The golden standard used was laparoscopy/endometrial biopsy in six studies and mostly clinical evaluation in one. "Thick tubal walls" proved to be a specific and sensitive ultrasound sign of acute PID, provided that the walls of the tubes can be evaluated, i.e., when fluid is present in the tubal lumen (100 % sensitivity). The cogwheel sign is also a specific sign of PID (95-99 % specificity), but it seems to be less sensitive (0-86 % sensitivity). Bilateral adnexal masses appearing either as small solid masses or as cystic masses with thick walls and possibly manifesting the cogwheel sign also seems to be a reasonably reliable sign (82 % sensitivity, 83 %specificity). Doppler results overlap too much between women with and without acute PID for them to be useful in the diagnosis of acute PID, even though acutely inflamed tubes are richly vascularized at color Doppler. CONCLUSIONS: Even though the results of our review suggest that transvaginal ultrasound has limited ability to diagnose acute PID, it is likely to be helpful when managing women with symptoms of acute PID, because in some cases the typical ultrasound signs of acute PID can be detected.

Pelvic inflammatory disease.

Pelvic inflammatory disease is a polymicrobial infection of the upper genital tract. It primarily affects young, sexually active women. The diagnosis is made clinically; no single test or study is sensitive or specific enough for a definitive diagnosis. Pelvic inflammatory disease should be suspected in at-risk patients who present with pelvic or lower abdominal pain with no identified etiology, and who have cervical motion, uterine, or adnexal tenderness. Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly implicated microorganisms; however, other microorganisms may be involved. The spectrum of disease ranges from asymptomatic to life-threatening tubo-ovarian abscess. Patients should be treated empirically, even if they present with few symptoms. Most women can be treated successfully as outpatients with a single dose of a parenteral cephalosporin plus oral doxycycline, with or without oral metronidazole. Delay in treatment may lead to major sequelae, including chronic pelvic pain, ectopic pregnancy, and infertility. Hospitalization and parenteral treatment are recommended if the patient is pregnant, has human immunodeficiency virus infection, does not respond to oral medication, or is severely ill. Strategies for preventing pelvic inflammatory disease include routine screening for chlamydia and patient education.

Pelvic inflammatory disease in the adolescent and young adult: An update.

Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).

Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease.

BACKGROUND: Women with pelvic inflammatory disease (PID) often present with a spectrum of symptoms. The characteristics of nongonococcal, nonchlamydial PID have not been well described. Our objective was to examine the characteristics of Mycoplasma genitalium infection among women with clinically suspected PID. METHODS: We evaluated 722 women who were enrolled in the PID Evaluation and Clinical Health study. Women with M. genitalium monoinfection were compared with women with Neisseria gonorrhoeae monoinfection or Chlamydia trachomatis monoinfection. RESULTS: Compared with women with gonococcal PID, women with M. genitalium infection were less likely to have elevated systemic inflammatory markers, including an erythrocyte sedimentation rate >15 mm/h (5 [22.7%] of 22 patients vs. 45 [60.8%] of 74 patients; P = .002), a white blood cell count >10,000 cells/mL (4 [28.6%] of 14 patients vs. 42 [64.6%] of 65 patients; (P = .018), and an oral temperature > or =38.3 degrees C (0 [0.0%] of 22 patients vs. 10 [13.9%] of 72 patients; (P = .001). In addition, they were less likely to present with mucopurulent cervicitis (9 [47.4%] of 19 patients vs. 60 [83.3%] of 72 patients; P = .001), elevated vaginal pH (P = .018), and high pelvic pain score (P = .014). In contrast, women with chlamydial PID had signs and symptoms that were similar to those in women with M. genitalium infection. CONCLUSIONS: Because symptoms might be mild, women with M. genitalium infection might not seek PID treatment. Further studies are needed to assess the potential reproductive tract sequelae of M. genitalium infection of the upper genital tract.

Clinical manifestations and epidemiology of the new genetic variant of Chlamydia trachomatis.

BACKGROUND: In 2006, a new genetic variant of Chlamydia trachomatis (nvCT) was discovered in Sweden. Clinical manifestations of this infection were studied in a high-risk population. METHODS: During 2007, a prospective case-control study on sexual lifestyle and urogenital infections was performed at the Centre for Sexual Health (CSH), affiliated to Malmo University Hospital. A total of 629 C. trachomatis positive cases and 1252 negative controls were included. At Malmo University Hospital, Department of Obstetrics and Gynecology, all cases of pelvic inflammatory disease (PID) were assessed and correlated to the prevalence of nvCT. RESULTS: Patients with nvCT or wild type C. trachomatis (wtCT) infection did not differ regarding their sexual lifestyle. Men with nvCT or wtCT infection did not differ in uro-genital symptoms or clinical findings. Women with nvCT infection reported painful urination (12.2% vs. 25.8%, P = 0.02) and were diagnosed with urethritis (11.1% vs. 40.0%, P = 0.04) less often than women with wtCT infection. The ratio of lower abdominal pain in women with nvCT infection was only half of that in women with wtCT infection (13.4% vs. 27.8%, P = 0.02). PID was detected in 0.8% of women with C. trachomatis infection in Malmo. All these cases were due to wtCT infection. CONCLUSIONS: Symptomatic urethral infection and lower abdominal pain was less common in women with nvCT as compared to wtCT. Infection with nvCT was more frequently asymptomatic suggesting a possible difference in virulence between the nvCT strain and the wtCT strain.

[Pelvic inflammatory diseases]. / Physiopathologie, diagnostic et prise en charge des infections génitales hautes.

Pelvic inflammatory diseases (PID) include salpingitis and endometritis. They usually result from the infection of upper genital tract by pathogens ascending from the cervix or the vagina. Since the clinical signs of uncomplicated forms are frequently mild or misleading, diagnosis require other exams such as microbiology (samples from the cervix and, if applicable, from the pelvis) and laparoscopy. Acute complications (pelvic abscesses, peritonitis) can occur, that call for both surgical drainage and antibiotics. Pelvic sequelae with permanent tubal alterations due to immuno-allergic reactions can also happen, that lead to chronic pelvic pain and infertility. Treatment consists in broad-spectrum antibiotics by oral route, combined with non steroid anti-inflammatory drugs. Atraumatic laparoscopic procedure can also be performed.

Association of pelvic tuberculosis with tubal factor infertility.

Tubal block is a common cause of infertility. Therefore Laparoscopy or Hysterosalphingoraphy or Hydrosonosalphingography are accepted methods for diagnosis of tubal block. Genital tuberculosis has a world wide distribution, more common in developing countries. Tubal block is the sequel of that disease. This prospective study by determination of Acid Fast Bacilli (AFB) in the endometrium of infertility patients was carried out in 60 patients at the Infertility unit, department of Obstetrics & Gynecology Bangabandhu Sheikh Mujib Medical University (BSMMU) during January 2005 to December 2006. In this study AFB positive in endometrium was in 14(46.7%) cases and 4(13.3%) in control. Out of 30 cases 60% had primary sub-fertility and 40% had secondary sub fertility. Most common tubal pathology was adhesion in 11(36%) cases. Others were beaded and tortuous in 8(26.7%) and hydrosalphix in 6(20%) and tube was dilated in 2(6.7%) cases. There were bilateral tubal block in 18(60%) and unilateral tubal block in 12 (40%) cases.

Chlamydia trachomatis detection in a population of asymptomatic and symptomatic women: correlation with the presence of serological markers for this infection.

A study of 371 women (261 asymptomatic and 110 symptomatic subjects with clinical PID) was performed to detect the presence of Chlamydia trachomatis (C.t.) and to correlate the serological markers against this microrganism, such as antibody to chlamydial hsp60 (Ab-Chsp60) and different levels of IgG, IgM and IgA, with epidemiology, pathology, sexual habits, age, diagnostic methods in the groups of women with and without pelvic inflammatory disease (PID). We found a statistically significant difference between the asymptomatic and symptomatic women regarding the presence of C.t. (3.4% versus 20%; p<0.0001). This presence was affected by the age of women (more in the group < or =25 years old), by having sex with new partners mainly if they did not undergo an antibiotic treatment. The association of antibody Chsp60 with the presence of clinical PID was quite striking. We also found a strict correlation between the detection of Ab-Chsp60 and previous chlamydial infection as well as between Ab-Chsp60 and elevated serum chlamydial IgG or IgA levels. Due to these findings, we can say that the use of serological markers for C.t. in clinical practice may be an important tool for an early screening and diagnosis of women at high risk of chlamydial infection.

Ozone therapy ameliorates inflammation and endometrial injury in rats with pelvic inflammatory disease.

As a common cause of infertility, pelvic inflammatory disease (PID) is characterized by chronic pain, ectopic pregnancy as well as inflammation and infection of the female upper genital tract. Ozone water, also known as O3, has been previously reported to be a distinctly effective agent in treating inflammation. During the present study, we asserted the hypothesis that O3 could be applied by pelvic inflammation and works to regulate the expression of inflammatory factors including interleukin-6 (IL-6), IL-2 and tumor necrosis factor-α (TNF-α). In an attempt to evaluate the effect of O3 on PID, an acute PID rat model was subsequently established. O3 at concentrations of 45 µg/mL and 60 µg/mL in addition to levofloxacin (LVLX) was injected respectively into the PID rats in a bid to alter the contents of inflammatory factors and immunologic markers. Hematoxylin-eosin (HE) staining was applied to analyze endometrial inflammation. Reductions to the contents of IL-6 and TNF-α were recorded, while that of IL-2, IgA, IgG, IgM, C3 and C4, and E rosette formation rate and transformation rate of T lymphocytes exhibited notably elevated levels after the PID rats had been injected with 45 µg/mL O3, 60 µg/mL O3 or LVLX. The pathological condition of the endometrium in rats with PID was alleviated among the PID rats after injected with the 45 µg/mL O3, 60 µg/mL O3 or LVLX. Taken together, the key findings of the current study present evidence demonstrating that the administration of O3 to the pelvic cavity ameliorated the PID conditions among rat models via inhibition of the necrosis of the endometrial epithelial cells as well as alleviated the inflammatory reactions, highlighting a potential novel PID treatment target.

Elderly Fitz-Hugh-Curtis syndrome observed with superb microvascular imaging system.

Fitz-Hugh-Curtis syndrome (FHCS) is defined as inflammation on the surface of the liver following sexually transmitted chlamydia infection. We successfully observed the microvascular structure of the inflamed portion between the abdominal wall and surface of the liver in an elderly patient with FHCS using a superb microvascular imaging (SMI) system, a new technology developed for observing minute vascular flow. An 80-year-old Japanese female with right dorsal to lateral abdominal pain and fever came to our hospital. Anti-chlamydia antibodies were positive. SMI revealed signals suggesting small vessels passing from the liver surface to the hypoechoic space.

The obesogen tributyltin induces abnormal ovarian adipogenesis in adult female rats.

Tributyltin chloride (TBT) is an obesogen associated with various metabolic and reproductive dysfunctions after in utero exposure. However, few studies have evaluated TBT's obesogenic effect on adult ovaries. In this study, we assessed whether TBT's obesogenic effects resulted in adult ovarian adipogenesis and other reproductive abnormalities. TBT was administered to adult female Wistar rats, and their reproductive tract morphophysiology was assessed. We further assessed the ovarian mRNA/protein expression of genes that regulate adipogenesis. Rats exposed to TBT displayed abnormal estrous cyclicity, ovarian sex hormone levels, ovarian follicular development and ovarian steroidogenic enzyme regulation. Rats exposed to TBT also demonstrated abnormal ovarian adipogenesis with increased cholesterol levels, lipid accumulation, and PPARγ, C/EBP-ß and Lipin-1 expression. A negative correlation between the ovarian PPARγ expression and aromatase expression was observed in the TBT rats. Furthermore, TBT exposure resulted in reproductive tract atrophy, inflammation, oxidative stress and fibrosis. Ovarian dysfunctions also co-occurred with the uterine irregularities. Abnormal ovarian adipogenic markers occurring after TBT exposure may be associated with uterine irregularities. A positive correlation between the ovarian cholesterol levels and uterine inflammation was observed in the TBT rats. These findings suggest that TBT leads to ovarian obesogenic effects directly by abnormal adipogenesis and/or indirectly through adult reproductive tract irregularities.

[Effect of pelvic inflammatory disease grades on in vitro fertilization-embryo transfer outcome].

OBJECTIVE: To evaluate the effect of different grades of pelvic inflammatory disease (PID) and of salpingectomy on outcomes of in vitro fertilization-embryo transfer (IVF-ET). METHODS: Two hundred and twenty three cycles of IVF-ET were divided into three groups, including mild group, moderate group and severe group, according to different grades of sequelae of PID finding in exploratory operations before IVF. Patients in each group were divided into two subgroups according to receiving salpingectomy or not. The data of total dose of gonadotrophin (Gn), oocyte number, low response rate, fertilization rate, good embryo number and pregnancy rate were analysed between three groups and the two subgroups of each group, respectively. RESULTS: All parameters were related to PID grades except fertilization rate. The total dose of Gn, oocyte number, good embryo number, low response rate and pregnancy rate were (2057 +/- 503) IU/L, (16 +/- 6), (6.0 +/- 4.3), 4.2%, 63.9% in mild group; (2204 +/- 603) IU/L, (12 +/- 6), (4.5 +/- 3.5), 13.9%, 46.8% in moderate group; and (2372 +/- 1018) IU/L, (9 +/- 6), (3.1 +/- 2.9), 33.8%, 41.2% in severe group. The total dose of Gn and low response rate increased with the aggravation of the grades of PID (P < 0.05). The oocyte number, good embryo number and pregnancy rate also had significant differences between three groups (P < 0.01, P < 0.01, P < 0.05, respectively). In mild and severe groups, the salpingectomy had no contribution to the outcome of IVF-ET treatment. In moderate group, patients receiving salpingectomy had more oocytes and good embryos and higher pregnancy rate than the others who retained oviducts (P < 0.05). CONCLUSIONS: Grades of PID have an adverse effect on IVF-ET outcomes. Receiving salpingectomy or not should be based on different grades of PID, but operations of ovary-free should be performed in all patients.