Objective: To study the epidemiology, the diagnostic elements and the prognosis after laparotomy surgery, of complicated upper genital infections. Patients and method: This is a retrospective study of six cases of com...Objective: To study the epidemiology, the diagnostic elements and the prognosis after laparotomy surgery, of complicated upper genital infections. Patients and method: This is a retrospective study of six cases of complicated upper genital infections collected over a period of 20 months in the Obstetrics and Gynecology department of the Aristide Hospital Center of LEDANTEC. Results: The average age of the patients was 37.67, in two patients;a hysterosalpingography had been performed less than seven days before the start of the symptoms, a notion of multiple sexual partners was noted in two patients. All patients presented with acute abdominal-pelvic pain associated with vomiting in three patients. An infectious syndrome was found in two patients, adnexal pain caused in four patients and signs of peritoneal irritation (guarding and umbilical tenderness) in three patients. Para-clinically, a biological inflammatory syndrome was found in all patients, including an elevation of C-reactive protein in all patients and hyperleukocytosis in four patients and an elevation of CA 125 in two patients. The cytobacteriological examination of the pus taken intraoperatively was positive in two patients, the isolated germs were Pseudomonas aeruginosa and Enterobacter cloacae. Pelvic ultrasound was performed in all patients and revealed a cystic adnexal mass in five cases, a pyosalpinx and peritoneal effusion in two cases. Abdominal & pelvic computed tomography was performed in four patients and revealed a lateral-uterine adnexal mass in two cases, pyosalpinx in two cases, uretero-hydronephrosis and peritoneal effusion in one case. An exploratory laparotomy was performed in each patient and confirmed the diagnosis of tuboovarian abscess, the presence of pelvic adhesion and purulent effusion in four patients, the presence of false membranes in two patients, pyometra and isolated bilateral pyosaplinx were found in one patient. Radical surgical treatment was associated with double probabilistic antibiotic therapy and symptomatic treatment in all patients. The postoperative course was favorable in most cases;postoperative pneumopathy was noted and resolved under treatment.展开更多
“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of...“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech </span><span style="font-family:Verdana;">presentation raise index of suspicion of potential locked twin. However,</span><span style="font-family:Verdana;"> management of such situation is controversial with most authors and colleges re</span><span style="font-family:Verdana;">commending caesarean section to avoid interlocking heads. We report</span><span style="font-family:Verdana;"> another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.展开更多
文摘Objective: To study the epidemiology, the diagnostic elements and the prognosis after laparotomy surgery, of complicated upper genital infections. Patients and method: This is a retrospective study of six cases of complicated upper genital infections collected over a period of 20 months in the Obstetrics and Gynecology department of the Aristide Hospital Center of LEDANTEC. Results: The average age of the patients was 37.67, in two patients;a hysterosalpingography had been performed less than seven days before the start of the symptoms, a notion of multiple sexual partners was noted in two patients. All patients presented with acute abdominal-pelvic pain associated with vomiting in three patients. An infectious syndrome was found in two patients, adnexal pain caused in four patients and signs of peritoneal irritation (guarding and umbilical tenderness) in three patients. Para-clinically, a biological inflammatory syndrome was found in all patients, including an elevation of C-reactive protein in all patients and hyperleukocytosis in four patients and an elevation of CA 125 in two patients. The cytobacteriological examination of the pus taken intraoperatively was positive in two patients, the isolated germs were Pseudomonas aeruginosa and Enterobacter cloacae. Pelvic ultrasound was performed in all patients and revealed a cystic adnexal mass in five cases, a pyosalpinx and peritoneal effusion in two cases. Abdominal & pelvic computed tomography was performed in four patients and revealed a lateral-uterine adnexal mass in two cases, pyosalpinx in two cases, uretero-hydronephrosis and peritoneal effusion in one case. An exploratory laparotomy was performed in each patient and confirmed the diagnosis of tuboovarian abscess, the presence of pelvic adhesion and purulent effusion in four patients, the presence of false membranes in two patients, pyometra and isolated bilateral pyosaplinx were found in one patient. Radical surgical treatment was associated with double probabilistic antibiotic therapy and symptomatic treatment in all patients. The postoperative course was favorable in most cases;postoperative pneumopathy was noted and resolved under treatment.
文摘“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech </span><span style="font-family:Verdana;">presentation raise index of suspicion of potential locked twin. However,</span><span style="font-family:Verdana;"> management of such situation is controversial with most authors and colleges re</span><span style="font-family:Verdana;">commending caesarean section to avoid interlocking heads. We report</span><span style="font-family:Verdana;"> another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.
