PURPOSE: To evaluate the treatment outcome of tubo-ovarian abscesses managed by transvaginal ultrasound-guided aspiration. METHODS: Descriptive analysis of all patients with tubo-ovarian abscesses treated with a minimally invasive procedure, ultrasound-guided drainage, at the Department of Gynecology, Centro Hospitalar Vila Nova de Gaia/ Espinho, during a period of 5 years (from June 2009 to June 2014). RESULTS: Twenty-six cases were included in the study. The mean age of the study group was 42.8 years. All patients were submitted to transvaginal ultrasound-guided aspiration and sclerosis with iodated solution, as well as received broad-spectrum intravenous antibiotics. The mean time from admission to drainage was 2.5 days. Cultures for aerobic and anaerobic pathogens were positive in 14 of the 26 cases. A complete response was noted in 23 of the 26 cases. No complications or morbidity were noted as a consequence of the drainage procedures. CONCLUSION: Minimally invasive treatment of tubo-ovarian abscesses by transvaginal ultrasound-guided drainage is an effective and safe approach.
Keywords: minimally invasive treatment surgical approach tubo-ovarian abscess a b s t r a c t Background: Tubo-ovarian abscesses are entities of infectious etiology, mostly as a result of pelvic inflammatory disease. Over the past decades we verified that the treatment is lifesaving and the approach can be, and should be, minimally invasive. The advent of antibiotics, its parenteral combined administration, and the appearance of techniques of drainage, made possible a better treatment of this pathological condition. Objective: Analysis of our experience in tubo-ovarian abscess treatment. Methods: Retrospective study, with database consultation, of all cases of tubo-ovarian abscesses treated in our department during a period of 4 years (2009e2012), with emphasis on our experience using a minimally invasive surgical approach, performed in 22 cases. Results: Forty-five cases medically and surgically treated, with 17 cases undergoing a drainage procedure. Conclusion: A minimally invasive procedure was performed in almost half of the cases with a faster clinical improvement and low morbidity.
Uterine metastases are rare events, but when they occur, the first extragenital neoplasm responsible is breast carcinoma. Toremifene, used in breast cancer hormonotherapy, has a partial estrogenic agonist effect in the endometrium, responsible for potential abnormalities, like polyps. A 53-yearold woman, receiving toremifene due to previously excised breast ductal carcinoma, presented with endometrial thickness during an abdominopelvic ultrasound follow-up. Hysteroscopy revealed an endometrial polyp, which was removed. Microscopic examination showed infiltration by a malignant ductal pattern neoplasm, with signet ring cells. The patient underwent hysterectomy and bilateral salpingo-oophorectomy. The final pathological diagnosis was metastatic breast carcinoma to the endometrium and cervix. This is the first reported case of breast metastases detected in a toremifene-associated endometrial polyp.
2000 and 31st December 2014 were studied. The data was obtained from the National Obstetric Information System, Malta. Results: A total of 39,683 mothers were assessed. In the 20-29 years cohort included 31,037 mothers while 8646 patients were 35 years and over. In the 20-29 year age group 67.77% of mother delivered vaginally while 27.73% delivered by caesarean sections. Contrastingly 56.73% of mothers with advanced age delivered vaginally and a significant 40.08% delivered by caesarean sections. The mean birth weight of neonates of mothers aged 20-29 years was 3228.89 g while the mean birth weight of neonates of the elderly mothers was 3208.52 g (p-value: 0.300653). There was also no statistical difference between the two average Apgar scores at 1 min (p-value: 0.748359). Live births and neonatal survival up to 28 days occurred in 99.09% of babies delivered by mothers of 20-29 years and 98.87% of babies delivered by mothers with advanced maternal age. Conclusions: Mothers with advanced maternal age were found to have a significantly higher caesarean rate when compared to younger aged mothers but there was no statistical difference in the neonatal outcomes.
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