Influence of follicular fluid and cumulus cells on oocyte quality: clinical implications

An equilibrium needs to be established by the cellular and acellular components of the ovarian follicle if developmental competence is to be acquired by the oocyte. Both cumulus cells (CCs) and follicular fluid (FF) are critical determinants for oocyte quality. Understanding how CCs and FF influence oocyte quality in the presence of deleterious systemic or pelvic conditions may impact clinical decisions in the course of managing infertility. Given that the functional integrities of FF and CCs are susceptible to concurrent pathological conditions, it is important to understand how pathophysiological factors influence natural fertility and the outcomes of pregnancy arising from the use of assisted reproduction technologies (ARTs). Accordingly, this review discusses the roles of CCs and FF in ensuring oocyte competence and present new insights on pathological conditions that may interfere with oocyte quality by altering the intrafollicular environment.

Septic Shock and Multiple Organ Failure After Office Endometrial Sampling

BACKGROUND: Office endometrial biopsy with a Pipelle cannula is the main method for sampling the endometrial lining. The Pipelle biopsy is safe, efficient, and cost effective. This office endometrial sampling method is also an accurate and safe procedure for endometrial sampling of patients with endometrial carcinoma. It is associated with minimal pain and does not require anesthesia. CASE: Pipelle is the most common method used for sampling the endometrial lining. No data are available of infectious complications related to endometrial biopsy. The incidence is presumed to be negligible. We present an unusual case of a 52-year-old woman who experienced septic shock and multiple organ failure following Pipelle endometrial sampling. CONCLUSION: Lower abdominal pain is the cardinal presenting symptom in woman with pelvic infection. Our case emphasizes that an atypical symptom such as abdominal pain after endometrial biopsy could be a sign of infectious complications.

Risk Factors and Adverse Pregnancy Outcomes of Succenturiate Placenta: A Case-Control Study

OBJECTIVE

To identify risk factors associated with succenturiate placenta and to evaluate the association between adverse pregnancy outcomes and succenturiate placenta in singleton pregnancies.

STUDY DESIGN

The total population of women (n = 28,256) with singleton pregnancies who delivered in Zhangqiu City Hospital during the study period between 2002 and 2012 was reviewed. Risk factors. and adverse pregnancy outcomes were evaluated separately among women with and without succenturiate placenta by means of χ² and logistic regression analyses.

RESULTS

The incidence of succenturiate placenta among women with singleton pregnancies was 1.04% (n = 294 of 28,256). Independent risk factors for succenturiate placenta were gestational age, prepregnancy BMI, pelvic infection, prior cesarean section, infertility, and preeclampsia. The succenturiate placenta was associated with a 1.076-, 1.056-, 12.076-, 1.894-, 5.217-, and 4.814-fold increased risk, respectively, as compared to pregnancies with normal cord insertion. For pregnancy outcome comparisons, cases of premature birth, low birth weight, and 5-minute Apgar score ≤ 7 were higher in cases with succenturiate placenta than in those without succenturiate placenta. The rate of cesarean section was increased.

CONCLUSION

The results suggest that the incidence of succenturiate placenta increases along with an increase in pelvic infection, infertility, and preeclampsia. The condition of succenturiate placenta increases the risks for prematurity, impaired fetal growth, and cesarean delivery.

Actinomycosis: an unusual cause of unresectable rectal cancer

We present a very unusual case of a woman with an intrauterine contraceptive device (IUCD) who developed pelvic actinomycosis during long course chemoradiotherapy for rectal cancer, which presented a significant diagnostic challenge and eventually rendered the cancer unresectable. IUCDs are often implicated in the development of pelvic actinomycosis but there is no current evidence or guideline to suggest that they should be removed prior to oncological treatment. Owing to the devastating consequences of this combination of disease, we suggest that it may be prudent to remove IUCDs in this setting.

CT-guided percutaneous pelvic abscess drainage in Crohn's disease

BACKGROUND

Percutaneous abscess drainage (PAD) is the current therapy for abdominal or pelvic collections. PAD has poorer curative rate for abscesses in Crohn's disease (CD), commonly complicated by wide fistulas and multiloculations.

METHODS

We retrospectively evaluated abscess cure rate, complications and final outcome in 87 CD patients, 70 with spontaneous and 17 with postoperative pelvic abscesses, all treated with CT-guided PAD during the last 7 years.

RESULTS

A 77% primary success rate and an 84.3% secondary success rate were obtained without major complications. The higher success rate for PAD was for postoperative (88.2%) rather than spontaneous abscesses (74.2%). Seventy-two percent of treated patients did not develop recurrent abscesses and underwent elective surgery up to 40 months later.

CONCLUSION

PAD in pelvic abscess complicating CD is an effective alternative to early surgery with satisfactory curative success rates. In unsuccessful cases, due to wide fistulas or postoperative anastomotic dehiscence, PAD helped in planning elective surgery, reducing surgical complications.

[Fistula as a complication of pelvic actinomycosis--two case reports]

OBJECTIVE

The presentation of two unusual cases of pelvic actinomycosis.

SUBJECT

Case reports.

SETTINGS

Department of Obstetrics and Gynecology, Hospital Kladno.

SUBJECT AND METHOD

The observation of two cases of pelvic actinomycosis. These cases were complicated by the abdominal wall fistula in one case and vaginal fistula in the other.

CONCLUSION

Actinomycosis is a chronic disease with tendency to progress per continuitatem into neighbouring tissues and with tendency to formation of fistulas. Two less common localisations of progress of the disease are described; it means the abdominal wall and vagina. In spite of a more advanced stadium, if adequately treated, a recovery ad integrum is common.

Actinomycose abdominopelvienne : un syndrome tumoral lié à une bactérie

The purpose of this review is to define the diagnostic steps and treatment of abdominopelvic actinomycosis. Three cases are described which illustrate the variety of clinical presentations ranging from acute peritonitis to chronic pseudo-tumor. The diagnosis of actinomycosis is rarely made pre-operatively. Bacteriologic culture is seldom helpful and imagery findings are non-specific. The diagnosis is usually made retrospectively based on histologic examination. In women, an intrauterine contraceptive device is often a concomitant factor. Long-term antibiotic treatment (several Months) with high-dose penicillin-based medications is the mainstay of therapy. Despite a high risk of complications, surgery is often necessary both for diagnosis and treatment. Resection or drainage may diminish the dosage and duration of antibiotic therapy, and helps to minimize infectious complications. Actinomycosis should be included in the differential diagnosis of abdominopelvic tumors, inflammatory bowel disease, and endometriosis-particularly in a woman with an intrauterine contraceptive device.

Changes of soluble fas and soluble fas ligand in serum and peritoneal fluid of infertile patients with endometriosis

OBJECTIVE

To evaluate the relationship between levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in serum and peritoneal fluid of endometriosis-associated infertility.

METHODS

The soluble Fas ligand and soluble Fas levels in serum and peritoneal fluid of 20 infertile patients with endometriosis were assessed with enzyme-linked immunosorbent assay, and were compared with 14 infertile patients due to chronic pelvic infectious disease and 16 fertile controls.

RESULTS

The sFasL levels were significantly higher in infertile patients with endometriosis (175.09 +/- 80.55 pg/mL in serum and 284.50 +/- 152.38 pg/mL in peritoneal fluid) than those of infertile controls (88.47 +/- 43.55 pg/mL in serum and 17.30 +/- 9.62 pg/mL in peritoneal fluid) and fertile controls (16.13 +/- 11.75 pg/mL in serum and 8.84 +/- 2.31 pg/mL in peritoneal fluid). In contrast, as for the sFas levels, infertile patients with endometriosis (828.60 +/- 429.65 pg/mL in serum and 349.61 +/- 288.89 pg/mL in peritoneal fluid) did not show any significant difference compared with those in infertile patients resulting from pelvic infectious disease (868.75 +/- 570.48 pg/mL in serum and 181.76 +/- 157.78 pg/mL in peritoneal fluid) and fertile control (822.26 +/- 129.12 pg/mL in serum and 318.42 +/- 145.16 pg/mL in peritoneal fluid).

CONCLUSIONS

Based upon these results, high level of sFasL in serum and peritoneal fluid and thus apoptosis mediated by it may be implicated in the mechanism involved in endometriosis-related infertility.

Pelvic lymphocyst infection associated with maternally inherited diabetes mellitus

A 45-year-old woman with 20-year history of diabetes mellitus was admitted to our hospital because of high fever and abdominal pain. Radical hysterectomy and bilateral pelvic lymphadenectomy had been performed 4 months before admission for invasive cervical cancer. On admission, elastic hard tumors were palpable in the lower abdomen. Laboratory examination showed positive C-reactive protein (CRP), anemia and renal dysfunction. Computed tomography (CT) revealed several lymphocysts in the pelvis. She was diagnosed with infection of pelvic lymphocysts. Since her mother also had diabetes associated with deafness, we examined mitochondrial DNA in leukocytes and detected an A to G transition at the nucleotide position of 3243 (A3243G mutation). She was diagnosed as maternally inherited diabetes mellitus and deafness (MIDD). Puncture of the cysts followed by administration of antibiotics resulted in marked improvement of symptoms and laboratory findings. This is a rare case of pelvic lymphocyst infection in a patient with a mitochondrial disorder. Although the exact mechanism of infection is not clear, MIDD may represent an unusual risk factor for infection, and further investigation is necessary to assess the influence of mitochondrial dysfunction on the immune system. Pelvic lymphocyst infection should be considered in the differential diagnosis of abdominal pain and fever in patients with MIDD after abdominal surgery.

Priapism caused by infection and an inflammatory process in the pelvic region

Priapism caused by an inflammatory process is rare. We report on a 25-year-old man with priapism due to an infiltration in the pelvic region, enclosing the right sacral plexus. Blood cultures revealed Staphylococcus aureus to be the causal organism. Treatment consisted of parenteral antibiotics, aspiration of the corpora cavernosa and injection of epinephrine, resulting in a flaccid penis and full recovery of potency after 3 weeks. A literature review was conducted for infection and inflammatory processes as a cause for priapism.

Ureteral obstruction and reconstruction in pelvic actinomycosis

We present a case of ureteral obstruction secondary to pelvic actinomycosis. Despite stenting, prolonged antibiotic therapy, and debridement, the patient required ureteral resection and reconstruction. This condition may simulate advanced malignancy, and diagnostic suspicion lessens the need for radical extirpative surgery.