[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.

Parametrial anisakidosis.

Anisakidosis is a parasitic infection caused by anisakid nematodes in the genera Anisakis and Pseudoterranova. Infection is not uncommon in the United States due to increased raw seafood consumption. We report the first known case of parametrial anisakidosis in a 42-year-old woman and review existing literature.

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.

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.

[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

Acute upper genital-tract disease in female monkeys provoked experimentally by Mycoplasma genitalium.

The oviducts of two grivet monkeys and three marmosets, all sexually mature animals, were inoculated with Mycoplasma genitalium at laparotomy. The mycoplasma was not recovered from the grivet monkeys, nor from the oviducts of the marmosets although it was isolated intermittently from the vagina of two of the latter animals up to 4-6 weeks after inoculation. In contrast, all of the animals developed antibody to M. genitalium measured by a micro-immunofluorescence technique. It developed rapidly in the grivet monkeys but slowly in the marmosets, being detected first about 1 month after inoculation with a maximal response by 2 months. Furthermore, despite an absence of vaginal discharge or cytological response, all the animals developed a moderate to severe endosalpingitis characterized by the infiltration of acute inflammatory cells into the tubal epithelium, together with a lumenal exudate and adhesions between the mucosal folds. The changes are similar to those produced by Chlamydia trachomatis in simian models and naturally in women.

Monkey animal model for study of mycoplasmal infections of the urogenital tract.

Various experimental monkey models have been used for the study of mycoplasmal infections of the urogenital tract. Direct inoculation of Mycoplasma hominis and Ureaplasma urealyticum into the urethra of male monkeys resulted in successful reisolation of the organisms from the urethra without giving rise to signs of urethritis during the observation period. The organisms were inoculated into the posterior fornix of the vagina of female grivet monkeys. During the ten-week observation period, there was no clinical, histologic, or serologic evidence of lower genital tract infection. Inoculation of M. hominis and M. fermentans into the upper genital tract of grivet monkeys produced parametritis and salpingitis. It was concluded that grivet monkeys are apparently suitable for study of the pathogenicity of genital mycoplasms.

Experimental infection of the genital tract of female grivet monkeys by Mycoplasma hominis.

Mycoplasma hominis, a common inhabitant of the mucosae of the genitourinary tract of human and nonhuman primates, was inoculated directly into the uterine tubes of five laparotomized grivet monkeys. A self-limiting acute salpingitis and parametritis developed within a few days in all animals. Although there were no clinical signs of overt disease, the gross pathology was characterized by pronounced oedematous swelling and hyperaemia of the tubes and parametria. Microscopically, cellular infiltrations of lymphocytes and some polymorphonuclear leukocytes were found in the acute phase in the subserosa and muscularis of the tubes and in the parametria. Granulation tissue and fat necrosis appeared at a later stage in the parametria. The infection was associated with a marked antibody response and a moderate rise of the erythrocyte sedimentation rate and leukocyte counts. The capability of M. hominis to produce salpingitis and parametritis in a nonhuman primate would seem to add rather significantly to the available evidence suggesting an etiological role of this organism in inflammatory diseases of the internal female genitals of humans.