Transvaginal videopelviscopy, a new technique for assessing pelvic cysts.

We evaluated a new technique, transvaginal videopelviscopy, of inspecting the internal architecture of pelvic cysts and verifying the possibility of performing intracystic biopsy through the posterior fornix. The procedure was performed in 33 women with pelvic cysts just before operative videolaparoscopy. A 1.2-mm scope was introduced through the pouch of Douglas under transvaginal ultrasound guidance. The inner surface of adnexal cysts was visualized and attempts were made to secure biopsy tissue. Good images of the inner wall of the lesion were obtained in 26 patients (77.8%). Specimens for histopathology were obtained in 27 women (81. 8%) and were sufficient for classifying the tumor as neoplastic or nonneoplastic. On histopathologic analysis, intracystic biopsy tissue and specimens obtained by laparoscopy were concordant in 25 (92.6%) of 27 patients. No complications occurred. Transvaginal videopelviscopy is an effective procedure for assessing pelvic cysts.

[Sexually transmitted agents in gynecology: incidence and importance]. / Agentes sexualmente transmitidos em ginecologia: incidencia e importancia.

PIP: The study comprised the analysis of 77 patients between May 1985 and May 1986 in the emergency clinic of the Gynecological Clinic of the Faculty of Medicine of the University of Sao Paulo. Three different groups constituted the cases: A) 15 women devoid of infectious symptoms, aged 18-52 with an average of 31.5 years; B) 25 patients who were carriers of mucous purulent cervicitis, aged 16-42 with an average age of 27.6 years; and C) 37 carriers of acute salpingitis, aged 16-48 with an average age of 25 years. All patients had been sexually active, and none of them had used any local or systemic anti-infection medication for 30 days preceding the study. Pap smears were carried out in all patients. Laparoscopy indicated light salpingitis in 17 patients, moderate in 12, and grave in 8 patients. Neisseria gonorrhea was isolated from the endocervix of 14 women (37.8%) with acute salpingitis, and from none of the other 2 groups. Chlamydia trachomatis was found in 1 (6.7%), 3 (12%), and 14 (37.8%) patients in the Groups A, B, and C. Ureaplasma urealyticum was identified in 3 (20%), 9 (36%), and 21 (56.8%) in the respective groups. Mycoplasma hominis was isolated in 1 (6.7%), 1 (4%), and 2 (5.4%) patients in the respective groups. Cervical-vaginal cytology in the different groups broke down in this fashion; in Group A, 4 were normal (26.7%) and 11 were infectious (64.7%); in Group B, 3 were normal (12%) and 21 were infectious (84%), while 1 (4%) was suspected of dysplasia; and in Group C, 2 were normal (5.4%) and 31 were infectious (83%), while 4 (10.8%) were suspected of dysplasia. It is well known that colpocytological alterations are intimately related to sexual activity. These alterations may also have to do with cancer of the cervix. In view of the fact that the analyzed groups had been promiscuous, a high percentage of colpocytological alterations could be expected. Indeed, clear increases of inflammatory alterations and cervical displasias were found in the cervicitis and salpingitis groups.^ieng

Endometrial damage in acute salpingitis.

Histologic and bacteriologic analyses of endometrium were performed before and on day 15 after minocycline treatment of 20 patients with acute salpingitis. Endometritis was diagnosed in 15 patients before and in nine after treatment. Neisseria gonorrhoeae was recovered from the cervix and endometrium of seven patients but was not isolated after treatment. Chlamydia trachomatis was recovered from the cervix of eight, and from the endometrium of three patients, two of whom had negative cervical cultures. After treatment C. trachomatis was recovered from the cervix of three patients, although two of them had taken aluminum hydroxide for gastric symptomatology during minocycline treatment. Culture of an endometrial specimen revealed no growth of C. trachomatis. The histologic study revealed plasma cell infiltrates in specimens from patients who had cultures positive for C. trachomatis. The results showed that although endometritis is an important manifestation of acute salpingitis, there is no correlation between severity of endometritis and degree of tubal damage.

O acido pipemidico no tratamento da infeccao urinaria. / Pipemidic acid in the urinary tract infection treatment

Vinte e quatro pacientes de sexo feminino, acometidas por infeccoes do trato urinario que procuraram o Pronto-Socorro de Ginecologia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, foram tratadas com acido pipemidico, 400 mg 2 vezes ao dia por via oral, por um periodo de sete dias. Do estudo foram excluidas pacientes com molestia imflamatoria pelvica, vulvovaginites ou gestantes.Exame de urina tipo I, cultura e teste de sensibilidade bacteriana foram realizados antes e 10 dias apos o tratamento. O agente mais frequente encontrado foi o E. coli seguido por Staphylococcus saprophyticus, alem de Proteus mirabilis e Citrobacter sp O acido pipemidico mostrou-se altamente eficaz, proporcionando cura bacteriologica e desaparecimento ou melhora da sintomatologia em 87,5% dos casos. A tolerabilidade do medicamento foi muito boa, tendo sido observado apenas um caso de desconforto abdominal e um outro de sensacao de plenitude epigastrica com prurido cutaneo generalizado, anbos transitorios e de leve intensidade

Cesarea com feto morto. / Cesarean section in fetal demise

Para analisar a indicacao da operacao cesariana diante de situacao com feto morto e a evolucao materna nesta circunstancia, os autores apresentam 96 casos atendidos na Clinica Obstetrica do Hospital das Clinicas da Faculdade de Medicina da Univerdade de Sao Paulo (Prof. B. Neme), de 1973 a 1981. A idade media das parturientes foi de 28,5 anos e a idade gestacional variou de 20 a 42 semanas. As pacientes foram divididas em dois grupos de acordo com o tratamento obstretrico: Grupo I - 58 pacientes com indicacao imediata de cesarea a internacao; e, Grupo II - 38 pacientes em que inicialmente permitiu-se o trabalho de parto, numa tentativa frustra de parto vaginal. As principais indicacoes de cesarea em ambos os grupos foram o DPP (67,7%), placenta previa (7,3%) e cesarea anterior (10,5%). A morbidade foi alta em ambos os grupos, com 34 parturientes afetadas durante a cirurgia, principalmente pela atonia uterina. Ainda, 26 pacientes tiveram complicacoes puerperais, tais como anemia severa, deiscencia de parede e foram realizadas tres histerectomias puerperais por infeccao puerperal