Female ; Humans ; Pelvic Inflammatory Disease/diagnosis* ; Intrauterine Devices

Pelvic actinomycosis is an uncommon infectious disease. It induces a chronic, suppurative illness characterized by an infiltrative and granulomatous response and, thus, the clinical and radiologic findings may mimic other inflammatory and neoplastic conditions. A 56-year-old female with a long-standing intrauterine device was diagnosed with pelvic actinomycosis manifesting as a large uterine mass with locally infiltrative spread into surrounding tissue that mimicked uterine malignancy. Actinomyces israelii infection was confirmed with a surgical specimen, and the patient was treated with antibiotic medication. Pelvic actinomycosis must be included in the differential diagnoses of patients with an infiltrative pelvic mass extending across tissue planes or in patients with findings of multiple microabscesses, particularly in a patient with an intrauterine device, even the lesion primarily involves the uterus.
Actinomyces ; Actinomycosis ; Communicable Diseases ; Diagnosis, Differential ; Female ; Humans ; Intrauterine Devices ; Middle Aged ; Pelvic Inflammatory Disease ; Uterus

PURPOSE: Differential diagnosis of acute abdominal pain of the childbearing age woman is a difficult challenge to the emergency physician. Clinical scoring systems for pelvic inflammatory disease (PID) and acute appendicitis have already been introduced. We want to validate these scoring systems externally. METHODS: This study was conducted at a single urban teaching hospital emergency department from May 2011 to September 2013. Retrospective analysis of a prospectively collected registry for reproductive-aged women was performed. RESULTS: A total of 1432 patients were registered. Among them, 322 patients diagnosed as PID (177 patients) or acute appendicitis (145 patients) were finally analyzed in this study. Among the PID and acute appendicitis scored, lower and higher cut-off points were 3 and 8 for PID risk score, and 6 and 10 for appendicitis risk score. PID risk score of PID patients was 7.0 (+/-1.9), acute appendicitis patients was 4.3 (+/-2.1), and other patients was 4.0 (+/-2.2) (p<0.001). Appendicitis risk score of PID patients was 5.7 (+/-1.9), acute appendicitis patients was 9.0 (+/-2.1), and other patients was 5 (+/-1.6) (p<0.001). The areas under the receiver operating characteristic curves were 0,832 and 0,950 for diagnosis of PID with PID risk score and acute appendicitis with appendicitis risk score, respectively. CONCLUSION: These scoring systems have appropriate diagnostic power for diagnosis of PID and acute appendicitis.
Abdominal Pain* ; Appendicitis* ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital* ; Female ; Hospitals, Teaching ; Humans ; Pelvic Inflammatory Disease* ; Prospective Studies ; Retrospective Studies ; ROC Curve

PURPOSE: In the emergency department (ED), identification of the obstetrical and gynecologic history for diagnosis of child-bearing aged women who present with abdominal pain is very important. We compared the usefulness of self-registry using a tablet computer and a traditional paper registry for taking history of child-bearing aged women. METHODS: We reviewed the prospective registries of child-bearing aged women presenting with abdominal pain without underlying disease to the ED of the Seoul Metropolitan Boramae Medical Center. We used a paper version of this registry from April 2008 to April 2011. From May 2011 to October 2012, we used the Smart Medical Registry (SMR), where the patient used a tablet computer to record her own data. The registries of child-bearing aged women included information on the patient's basic information, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. We performed statistical analysis of the difference between the paper registry and SMR. RESULTS: A total of 1193 patients were registered. Among them, 835 patients were registered using the SMR. There were no statistically significant differences in the patients' basic information and diagnostic classification. However, the SMR group reported more recent history of pelvic inflammatory disease (p<0.01), higher number of abortions (p<0.01), and higher number of sexual partners (p<0.01). CONCLUSION: Using the tablet computer based self-survey, patients had a more positive tendency toward answering privacy sensitive items. Therefore, it might be more useful and effective in obtaining sensitive, private information from patients.
Abdominal Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Medical History Taking ; Pelvic Inflammatory Disease ; Privacy ; Registries ; Seoul ; Sexual Partners

PURPOSE: In the emergency department (ED), identification of the obstetrical and gynecologic history for diagnosis of child-bearing aged women who present with abdominal pain is very important. We compared the usefulness of self-registry using a tablet computer and a traditional paper registry for taking history of child-bearing aged women. METHODS: We reviewed the prospective registries of child-bearing aged women presenting with abdominal pain without underlying disease to the ED of the Seoul Metropolitan Boramae Medical Center. We used a paper version of this registry from April 2008 to April 2011. From May 2011 to October 2012, we used the Smart Medical Registry (SMR), where the patient used a tablet computer to record her own data. The registries of child-bearing aged women included information on the patient's basic information, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. We performed statistical analysis of the difference between the paper registry and SMR. RESULTS: A total of 1193 patients were registered. Among them, 835 patients were registered using the SMR. There were no statistically significant differences in the patients' basic information and diagnostic classification. However, the SMR group reported more recent history of pelvic inflammatory disease (p<0.01), higher number of abortions (p<0.01), and higher number of sexual partners (p<0.01). CONCLUSION: Using the tablet computer based self-survey, patients had a more positive tendency toward answering privacy sensitive items. Therefore, it might be more useful and effective in obtaining sensitive, private information from patients.
Abdominal Pain* ; Classification ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Female ; Humans ; Medical History Taking ; Pelvic Inflammatory Disease ; Privacy ; Registries ; Seoul ; Sexual Partners

BACKGROUND: Pelvic inflammatory disease (PID) is a microbial infection caused by the upward spread of infectious organisms through the cervical os. Early diagnosis and treatment of PID are essential for the prevention of sequelae such as ectopic pregnancies, infertility, and chronic pelvic pain. Although Chlamydia trachomatis and Neisseria gonorrhoeae are well-known causal agents of PID, there have been reports on some changes in PID-associated infection. The aim of this study was to investigate the infection patterns in patients with PID in Jeju. METHODS: Endocervical samples obtained from 65 patients with PID were tested for C. trachomatis, Mycoplasma genitalium, Mycoplasma hominis, N. gonorrhoeae, Trichomonas vaginalis, and Ureaplasma urealyticum using multiplex PCR. RESULTS: The samples were positive for C. trachomatis (63%), M. hominis (34%), U. urealyticum (20%), M. genitalium (17%), N. gonorrhoeae (9%), and T. vaginalis (6%). CONCLUSIONS: This study showed that C. trachomatis infection was prevalent and the incidence of M. hominis was higher than that of U. urealyticum.
Chlamydia trachomatis ; Early Diagnosis ; Female ; Humans ; Incidence ; Infertility ; Mycoplasma genitalium ; Mycoplasma hominis ; Neisseria gonorrhoeae ; Pelvic Inflammatory Disease ; Pelvic Pain ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy, Ectopic ; Trichomonas vaginalis ; Ureaplasma urealyticum

Acute pelvic pain is one of the most common complaints of woman presenting in the emergency department. When gynecologic disorders are suspected, ultrasonography (US) is the modality of choice, enabling rapid diagnosis and decision making with regard to appropriate management. Frequent gynecologic etiologies include a large or enlarging simple ovarian cyst, hemorrhagic ovarian cyst or rupture of an ovarian cyst, acute pelvic inflammatory disease, and ovarian torsion. Endometriosis, uterine leiomyoma, and peritoneal inclusion cyst can also present as acute pelvic pain. Gynecologic disorders that cause acute pelvic pain frequently show characteristic ultrasonographic findings that enable specific diagnosis. In this review, the authors review ultrasonographic findings of gynecologic causes of acute pelvic pain.
Decision Making ; Diagnosis ; Emergency Service, Hospital ; Endometriosis ; Female ; Gynecology ; Humans ; Leiomyoma ; Ovarian Cysts ; Pelvic Inflammatory Disease ; Pelvic Pain* ; Rupture ; Ultrasonography*

OBJECTIVETo compare the clinical efficacy on chronic pelvic inflammation between the acupoint embedding therapy and acupuncture, and to compare the efficacy of different patterns/syndroms in differentiation treated with acupoint embedding therapy.

METHODSTwo hundred and eighteen cases were randomized into an embedding therapy group (115 cases) and an acupuncture group (103 cases). In both groups, Shenshu (BL 23), Guanyuanshu (BL 26), Zigong (EX-CA 1), Yaoyangguan (GV 3), Guanyuan (CV 4) and Qihai (CV 6) were selected as the main points. For qi and blood stagnation pattern/syndrome, Zhongdu (LR 6), Diji (SP 8) and the others were added; for cold and damp stagnation pattern/syndrome, Diji (SP 8) and Sanyinjiao (SP 6) were added; for stasis and phlegm pattern/syndrome due to spleen deficiency, Sanyinjiao (SP 6) and Zusanli (ST 36) were added. In the embedding therapy group, the catgut was embedded at 7 - 13 acupoints each time, once every 10 days. In the acupuncture group, the conventional acupuncture therapy was applied, once a day. The symptom scores were assessed in the aspects of the lower abdominal pain severity and attack frequency, lumbosacral soreness and distention, abnormality of vaginal discharge and the others. The efficacy was compared between the two groups.

RESULTSThe total effective rate was 93.0% (107/115) in the embedding therapy group, which was better than 83.5% (86/103) in the acupuncture group (P < 0.05). The symptom scores were all reduced after treatment in the two groups (all P < 0.05). In the embedding therapy group, the efficacies were not significantly different among different patterns/syndromes (all P > 0.05).

CONCLUSIONThe acupoint embedding therapy achieves the definite efficacy on chronic pelvic inflammation and obtains the similar efficacies among the different differentiated patterns/syndromes of the disease.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Catgut ; utilization ; Chronic Disease ; therapy ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Pelvic Inflammatory Disease ; diagnosis ; therapy ; Prostheses and Implants ; Treatment Outcome ; Young Adult

OBJECTIVE: The study was designed to ascertain a proper method of early diagnosis and treatment of ectopic pregnancy by analyzing its clinical and epidemiological characteristics. METHODS: The medical records of patients who were diagnosed to ectopic pregnancy at Hallym medical center during the period from January 1, 2000 to December 31, 2007 have been reviewed. RESULTS: The incidence of ectopic pregnancy was 7.3% (1,067) out of 14,519 deliveries. The most frequent age group was 26~30 (29.5%). Risk factors they had were previous histories of abdominal or pelvic surgery (37.0%), artificial abortion (30.8%), pelvic inflammatory disease (12%), and tubal sterilization (9.6%). Most frequent clinical symptoms were amenorrhea (88.7%), lower abdominal pain (81.2%), and vaginal spotting (60.0%). Percentage of patients with hemoglobin level over 10.0 gm/dL was 79% and below 8.0 gm/dL 3.9%. The clinical symptoms of ectopic pregnancy most commonly occurred after 6~8 weeks from last menstrual period (47%). Ectopic gestation was implanted on the fallopian tube in 89%, cornus in 7.2%, ovary in 1.1% and the cervix in 2.7%. Laparosopic surgeries were performed in 755 cases (71.6%) and laparotomies in 273 cases (25.9%) and dilatation and curettages in 26 cases (2.5%). Salpingectomy was performed most frequently (82.4%). Methotrexate (MTX) treatment was successful in 13 cases (1.21%). CONCLUSION: The early diagnosis of ectopic pregnancy is most useful when serum beta-hCG and vaginal sonography are used together. Laparoscopy would be a preferred method because of its short hospitalization period and low complication rate compared with laparotomy in ectopic pregnancy treatment.
Abdominal Pain ; Amenorrhea ; Cervix Uteri ; Cornus ; Curettage ; Dilatation ; Early Diagnosis ; Fallopian Tubes ; Female ; Hemoglobins ; Hospitalization ; Humans ; Incidence ; Laparoscopy ; Laparotomy ; Medical Records ; Methotrexate ; Metrorrhagia ; Ovary ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Ectopic ; Risk Factors ; Salpingectomy ; Sterilization, Tubal

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.
Abscess ; Animals ; Anti-Bacterial Agents ; Appendicitis ; Diagnosis, Differential ; Endometritis ; Endometrium ; Female ; Gastroenteritis ; Genitalia ; Ovary ; Parametritis ; Pelvic Inflammatory Disease ; Peritoneum ; Pregnancy ; Pregnancy, Ectopic ; Salpingitis ; Vagina