This above HSG shows b/ l tubal block at the fimbrial end. Do enough metrial tissue for TBPCR.and HPE. Genital tuberculosis can be diagnosed by Entometrial biopsy. pID infection. Blood for TBPCR. Gene expert is easy and report is given immediately,but still it needs wide propagation. Sputum is collected. Based on which treatment started.
Uterus appears normal size and shape . Both side tubes shows beaded appearance with bilateral fimbrial block.findings suggestive of tuberculosis. Can be confirmed by PcR endometrial biopsy for AFB diag laproscopy.
1) Cause for sec.infertility is Bilateral tubal block. 2) bilateral fimbrial tubal block 3 ) TB PCR, Whiff test clue cells for Bacterial Vaginosis , tests for Clamydia Trachomatis like cell culture PCR on first void urine ,Endocervical or Urethral smear for gram negative cells e.g. N gonococci , culture & newer tests like DNA probes and enzyme immunoassay.
Endometrial scrapping for H/P Or Gene expert test or both. Tt as per the reports. Gene expert test report prompt so prompt Tt.
Beaded appearance of bl blocked tubes always suggestive of tb Get tb gold test,1day menstruated blood fr tb culture Start antitb drugs History &pv exam ?with inguinal lymphadenopathy
1.BILATERAL TUBAL BLOCK. 2.UT APPEARS ACCURATE. WORK UP FOR CAUSE USUALLY CHRONIC INFECTIONS KOCH ,STARTING FROM HAEMOGRAM TO P CR COUNTS FOR CONFIRMATION. 2.CONFIRMATION OF FUNCTIONAL BLOCK WE CAN SEE THROUGH LAPAROSCOPY. 3.IF KOCHS +VE COMPLETE TRT. 4.BUT FOR FERTILITY WORK UP BEST IVF WITH MECHANICAL OCCLUSION OF BOTH TUBES BEFORE IVF OR ET.
Do the premenstrual endometrial biopsy for AFB culture and histopathological study. If positive, give AKT and do hysterolaparoscopy after 2 months of AKT. If negative for AFB, do the hysterolaparoscopy (preferably on 10th day). Do peritoneal fluid sampling for culture and microscopy. Then do hysteroscopy and hysteroscopic tubal canulation, identify the site of tubal block by use of methylene blue dye test. She might have peritubal adhesions, release them laparoscopically. Laparoscopic fimbrioplasty gives the best results in such cases.
I agree with Dr.Nisha Bhargava. Chest x ray to r/o pul.TB.
This is a case of tubercular salpingitis. HSG shows bilateral fimbrial block &lead pipe rigidity. To confirm it TB pcr from menstrual blood. AntiTB treatment will resolve this condition but residual tubal block &altered endometrial character may lead to synaechae&infertility.
I agree with Dr.G.Vanaja.
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A PRACTICAL APPROACH TO THE DIAGNOSIS OF PELVIC INFLAMMATORY DISEASE: The diagnosis of PID is usually based on clinical criteria.Although diagnostic accuracy is advocated,antibiotic therapy should be instituted if there is a diagnosis of cervicitis or suspicion of acute PID. The clinician should maintain a high index of suspicion for the diagnosis as she evaluates the lower genital tract for inflammation and pelvic organs for tenderness in women with genital tract symptoms and a risk for sexually transmitted infections. This approach should minimize treating women without PID with antibiotics and optimize the diagnosis in a practical and cost effective way. Acute PID is associated with cervicitis, endometritis,salpingitis and peritonitis. The sigificant sequelae are tubal factor infertility,ectopic pregnancy and chronic pelvic pain. If pelvic examination fails to reveal evidence of inflammation(if there is no leukorrhoea),then the diagnosis of PID is much less likely and antibiotic treatment can be withheld while the remaining diagnostic workup defines the diagnosis. EVIDENCE OF LOWER GENITAL TRACT INFLAMMATION AND PELVIC ORGAN TENDERNESS SUGGESTS THE ADVISABILITY OF INITIATING THE ANTIMICROBIAL THERAPY SYMPTOMS: 1.Abdominal pain. 2.Abnormal discharge. 3.Metrorrhagia. 4.Post coital bleeding. 5.Fever. 6.Dysuria. 7.Low back ache. 8.Nausea,vomiting. CLINICAL CRITERIA: The diagnosis of PID should be considered in all sexually active women. Abdominal tenderness may/may not be present. Bimanual pelvic examination reveals pelvic organ tenderness. Uterine tenderness=endometritis. Adnexal tenderness=salpingitis. Cervical tenderness=cervicitis. Per speculum examination:look for green/yellow mucopus and friability. Microsopy of vaginal secretions should be performed looking for leucorrhea. (>>1 LEUCOCYTE/EPITHELIAL CELL) Evaluation of bacterial vaginosis (vaginal pH,clue cells&whiff test) Nucleic acid amplification test(NAAT) for gonorrhea and chlamydia should be performed. Empiric antibiotic treatment should be initiated in sexually active women,especially those at risk for STDs with lower abdominal or elvic pain ,if no other causes other than PID can be identified and if the following minimum criteria are present on pelvic examination. 1.Lower genital tract inflammation. cervicitis on clinical examination. More than one leukocyte/epithelial cell on microscopy of vaginal secretions. 2.Pelvic organ tenderness. cervical motion tenderness. Uterine tenderness. Adnexal tenderness.Dr. Suvarchala Pratap10 Likes10 Answers
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HSG FINDINGS IN GENITAL KOCHS : Female genital tuberculosis is a major cause of tubal obstruction leading to infertility , especially in developing countries. Genital tuberculosis is difficult to diagnose. DEFINITIVE DIAGNOSIS OF GENITAL TUBERCULOSIS IS MADE BY 1 ) POSITIVE MYCOBACTERIUM CULTURE IN ENDOMETRIAL TISSUE . 2 ) HISTOLOGICAL DIAGNOSIS OF TUBERCLES / GRANULOMAS . HYSTEROSALPINGOGRAM IS THE GOLD STANDARD IMAGING PROCEDURE IN EVALUATING THE INTERNAL ARCHITECTURE OF THE FEMALE GENITAL TRACT. The radiographic features of genital tuberculosis is described in two parts 1 ) PART I / SPECIFIC FEATURES : Related to tubes . BEADED TUBE. PIPESTEM TUBE . GOLF CLUB TUBE . COBBLE STONE TUBE . LEOPARD SKIN TUBE . 2 ) PART II : Related to endometrium. This describes the adverse effects of tuberculosis on the structure of endometrium. DWARFED UTERUS WITH LYMPHATIC INTRAVASATION AND OCCLUDED TUBES "T" SHAPED UTERUS . PSEUDOUNICORNUATE UTERUS. COLLAR STUD ABSCESS. HSG FINDINGS : 1 ) CALCIFICATION OF FALLOPIAN TUBES ,OVARY .Tubal calcification is usually seen in the form of small linear streaks in the course of tubes. 2 ) HYDROSALPINX : HSG shows dilated fallopian tube filed with contrast and absence of free spillage of dye. 3 ) TUBAL OCCLUSION : Distal tubal occlusion causes hydrosalpinx and in proximal tubal occlusion, dye fails to enter the tubes and therefore tubes are not visualized. 4 ) TUFTED LIKE APPEARANCE / ROSETTE LIKE APPEARANCE : Caseous ulceration of tubal mucosa creates an irregular, ragged or diverticular appearance on the contour of tubal lumen in HSG These diverticular cavities surrounding the ampulla produced by caseous ulceration gives the tubal outline "tufted like appearance / rosette like appearance. 5)TB-SIN : TUBERCULOSIS-SALPINGITIS ISTHMICA NODOSA : Penetration of contrast medium between the mucosal folds due to ulceration of tubal mucosa causes diverticular - like outpouchings. 6 ) COTTON WOOL PLUG APPEARANCE: Distribution of contrast medium in a reticular pattern produces cotton wool plug appearance. 7 ) SAW TOOTHED APPEARANCE: when the tubal lumen is filled with putty like caseous material, the HSG outline is irregular with pockets or Laguna giving a saw toothed appearance. 8 ) BEADED TUBE : Multiple constrictions along the fallopian tubes gives a beaded appearance. 9 ) PIPE STEM TUBE : Absence of normal tortuosity and curved / straight pipe like rigid appearance in fibrotic stage of tubercular salpingitis causes pipe stem appearance. 10 ) LEOPARD SKIN TUBE : Multiple rounded filling defects following intra luminal granulomas formation within the hydrosalpinx gives leopard skin appearance . 11 ) GOLF CLUB TUBE : Sacculation of tubes in distal portion with an associated hydrosalpinx gives a golf club like appearance. 12 ) COBBLE STONE APPEARANCE : Intra luminal scarring gives rise to cobble stone pattern which indicates intra luminal adhesions . 13 ) TOBACCO POUCH APPEARANCE : Eversion of fimbria secondary to adhesions with a patent orifice produces tobacco pouch appearance.Dr. Suvarchala Pratap13 Likes21 Answers
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30 yr f plz suggest urs valuable opinion nd managementDr. Preety Maurya5 Likes17 Answers
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GONORRHEA MANIPULATES AN ANTI-INFECTION MECHANISM IN THE FEMALE REPRODUCTIVE TRACT. April 13, 2017. PLoS Pathog 13(4): e1006269. DOI: 10.1371/journal.ppat.100626 The BACTERIUM that CAUSES GONORRHEA INFECTS the FEMALE REPRODUCTIVE TRACT BY BREAKING CONNECTIONS BETWEEN CELLS IN the tract's PROTECTIVE LINING, according to new research published in PLOS Pathogens. GONORRHEA is a widespread sexually transmitted disease caused when NEISSERIA GONORRHOEAE bacteria infect the normally protective inner lining of human genital tissues. In women, the opening of the uterus, known as the ENDOCERVIX, SERVES AS A PRIMARY INFECTION SITE for N. gonorrhoeae. HOWEVER, the STRATEGY USED BY N. gonorrhoeae TO PENETRATE THE LINING OF THE ENDOCERVIX HAS BEEN UNCLEAR. TO INVESTIGATE THIS MECHANISM, Liang-Chun Wang of the University of Maryland, College Park, and colleagues NEEDED to develop AN ALTERNATIVE TO the MOUSE MODELS normally used to study gonorrhea, since they have been inadequate for this purpose. The team developed a NEW MODEL using tissue samples obtained from the human endocervix. The RESEARCHERS INFECTED the ENDOCERVIX TISSUE, AS WELL AS LAB-GROWN CELLS OF the SAME TYPE as those that line the endocervix, with N. gonorrhoeae. They THEN employed a VARIETY OF MOLECULAR AND IMAGING TECHNIQUES to examine the infection mechanism. The RESULTS DEMONSTRATE that N. gonorrhoeae PENETRATES the ENDOCERVIX LINING BY INTERFERING WITH A NORMALLY PROTECTIVE PROCESS. Usually, infected cells in the lining can be shed and disposed of without breaking the tight connections between cells that keep the lining uncompromised. N. gonorrhoeae APPEARS to be able TO BREAK these CONNECTIONS AND INDUCE CELL SHEDDING, OPENING PATHS FOR PENETRATION without reducing its ability to adhere to and invade the cells of the lining. The SCIENTISTS SHOWED that N. gonorrhoeae CAUSES DISRUPTION OF CELLULAR CONNECTIONS AND CELL SHEDDING BY promoting ACTIVATION AND ACCUMULATION OF a human protein known as NON-MUSCLE MYOSIN II. Depending on the PARTICULAR GENES being EXPRESSED BY N. gonorrhoeae at any given time, the team found, it can EITHER PROMOTE OR INHIBIT this PENETRATION MECHANISM. THIS STUDY REPRESENTS the FIRST LABORATORY DEMONSTRATION OF the PENETRATION OF N. gonorrhoeae INTO the human ENDOCERVIX and provides new insights into gonorrhea infection. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ MORE INFORMATION: Wang L-C, Yu Q, Edwards V, Lin B, Qiu J, Turner JR, et al. (2017) Neisseria gonorrhoeae infects the human endocervix by activating non-muscle myosin II-mediated epithelial exfoliation. PLoS Pathog 13(4): e1006269. DOI: 10.1371/journal.ppat.1006269 ____________________________________ PROVIDED BY: Public Library of Science. ****************************+****************************** PREVIOUS STUDIES :- 1 ) Gonorrhea infections start from exposure to seminal fluid March 4, 2014. Provided by: American Society for Microbiology. 2 ) Antibiotic treatment speeds up spread of resistance in the gonorrhea superbug May 19, 2016. Fingerhuth SM, Bonhoeffer S, Low N, Althaus CL (2016) Antibiotic-ResistantNeisseria gonorrhoeae Spread Faster with More Treatment, Not More Sexual Partners. PLoS Pathog 12(5): e1005611. DOI: 10.1371/journal.ppat.1005611 3 ) Researchers identify novel pathway responsible for infection of a common STD pathogen February 27, 2012. Provided by: Boston University Medical Center. 4 ) Failure of dual antimicrobial therapy for gonorrhea reported June 23, 2016. More information: Full Text Copyright © 2016 HealthDay. 5 ) Commercial brand of mouthwash can help kill off gonorrhea in the mouth (Update) December 20, 2016. Antiseptic mouthwash against pharyngeal Neisseria gonorrhoeae: a randomised controlled trial and an in vitro study, Sexually Transmitted Infections, sti.bmj.com/lookup/doi/10.1136/sextrans-2016-052753 =========================================Dr. Puranjoy Saha16 Likes15 Answers
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F36. Primary infertility. Married for 8yrs. HSG.Dr. Syam Sundar Patro6 Likes19 Answers