Schistosoma mansoni of the ovary

Schistosoma mansoni of the ovary

COMMUNICATIONS IN BRIEF and left ovarian veins with the superior and inferior mesenteric veins, respectively.10 Valladores13 suggested that the prese...

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and left ovarian veins with the superior and inferior mesenteric veins, respectively.10 Valladores13 suggested that the presence of adhesions offers another explanation for this migration through the newly formed channels between the portal system of the omentum and the genitals. A short note of the life cycle of the Schistosoma is in order. The eggs of the Schistosoma hatch on reaching fresh water, releasing the meracidium which swims until it finds and penetrates the appropriate snail, where it undergoes two generations of development and multiplication to produce free-swimming circariae, the infecting stage for mammals. The circariae penetrate skin or mucosa and, carried by the blood or lymph,

Schistosoma mansom of the ovary CHARLES M. BAHARY, M.D. YORDANKA OVADIA, M.D. ALEXANDER NERI, M.D. Department of Obstetrics and Gynecology, Beilinson Medical Center, Tel-Aviv University Medical School, Tel-Aviv, Israel

B IL H A R z 1 A s 1 s ( Bilharz, 1851 ) is a general term which describes a group of disease entities produced in man and animal by three species of digenetic trimatodes belonging to the family schistosomatides, namely, S. mansoni, S. haematobium, and S. japonicum. They inhabit the circulatory system of man and animals in tropical and subtropical countries, affecting the colon and rectum, the bladder, the liver, the spleen, the genitals, and the peritoneum. In the past decades, a number of cases of genital schistosomiasis have been reported. 2 - 4 In Brasil, where this disease is endemic, more than 100 cases have been described. Migration of ova through the pelvic plexus has been emphasized localizing in the ovaries,S the Fallopian tubes, cervix, vulva, vagina, and the uterus. 1 The rich network of venous anastomosis between the bladder and the genitals offers an explanation for the high incidence of genital manifestation in S. haematobium. 7 • 9 However, less well understood is the migration of S. mansoni from the portal system to the genitals. Some authors believe that the eggs are transported through the bloodstream from the sites of oviposition, though migration of adult worms also occurs 3 through the anastomosis between the superior, middle, and inferior hemorrhoidal veins with hypogastric veins. The valvular system being rather imperfectly developed offers no obstacle for such migration from the portal veins to that of the inferior vena cava. Furthermore, studies of portocaval anastomosis by methylene blue injections demonstrated communication between the right

Fig. 1. Pseudotubercle with eosinophilic leukocytosis and central necrosis.


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Fig. 2. Schistosoma mansoni ova in the ovary.

reach the heart where they are distributed throughout the circulation. S. -mansoni lodges in the portal system almost exclusively. They mature into adult worms. After copulation, the female migrates against the blood flow and settles in the venous radicles, where eggs are laid and pass out through the feces. The following case report describes a coincidental finding of a genital schistosomiasis-a rarity-during the course of a vaginal repair operation. A 37-year-old multipara was admitted for vaginal repair operation. Her main complaint was mild incontinence. At operation (with the Halban procedure) white-yellow tubercle-like granules were discovered when the cul-de-sac was opened. Laparotomy was therefore undertaken and the pelvic viscera were found covered by these tubercles. The right ovary was triply enlarged. The uterus and the right adnexa were removed. Histologically, the pseudotubercles (Fig. 1) were composed of connective tissue with diffuse eosinophilic leukocytosis and central necrosis. In the ovary, S. mansoni ova were discovered (Fig. 2). Apart from a positive complement fixation test, all other available tests to trace the portal lesions were negative. Astiban* in 0.3 mg. daily doses for 5 days was administered. Adnexal schistosomiasis accounts for over 50 per cent of the genital lesions. In ovarian bilharziasis, some menstrual disturbances, due to theca cell luteinization, might occur, with endo*Antimony di Mercapto potassium Succinate, Roche of Switzerland.

metria! hyperplasia and which disappears after therapy. 3 Clinically, dysmenorrhea was present in most cases.l, 2 The admission diagnosis varied from twisted ovarian cyst to ruptured ectopic pregnancy or pelvoperitonitis. There was one case of genitalS. mansoni associated with ovarian carcinoma. 14 Although a causal relationship was demonstrated between S. haematobium a_11d bladder cancer, conclusive evidence has not been put forth in regard to S. mansoni and genital maiignancy. 1 Trivalent antimony compounds, such as tartar emetic, Stibophen, Anthiomaline, Astiban (TWSb), and Meracil (orally effective) have proved to be effective on S. mansoni. Astiban is 50 times less toxic than tartar emetic 6 with the highest cure rate (90 per cent) and has no significant cardiovascular effect.U• 12 Side effects are limited to vomiting, transitory skin rashes, and rheumatoid pain. REFERENCES

1. Arean, V. M.: AM. J. 0BST. & GYNEC. 72: 1038, 1956. 2. Armburst, A. de F.: Hospital Rio de Janeiro 38: 177, 1950. 3. Charlewood, G. P., Shippe1, S., and Renton, H.: J. Obst. & Gynaec. Brit. Emp. 56: 367, 1949. 4. Chaves, E., and Dios dos Santos, A.: Unpublished data. 5. Fernandes, M., and Lapa, R.: An. brasil. de ginec. 11: 427, 1941. 6. Friedham, EAH, da Silva, J. R., and Martins, A. V.: Am. J. Trop. Med. 3: 714, 1954.

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7. Gelfand, M.: Schistosomiasis in South Central Africa, Johannesburg and Cape Town, 1950 Juta and Company. 8. Gelfand, M.: Am. J. T rop. Med. 29: 945, 1949. 9. Gilbert, B.: J. Obst. & Gynaec. Brit. Emp. 50: 317, 1943. 10. Makar, N.: Xeme Congres Soc. Int. Chirurgie, Cairo 3: 561, 1935. 11. Honey, M .: Brit. Heart J. 22: 601, 1960. 12. Somers, K ., and Rosanelle, S. D.: Brit. Heart J 24: 187, 1962. 13. Valladores, C. de P.: Pub!. da Doc. de Gastroenterologica e Nutricaes de Sao Paulo, Brazil 1952, p. 53. 14. Werneck, J. E. F., and Jungueira, M. A.: Rev. de ginec. e obst. 2: 94, 1941. P. 0 . Box 85 Petah Tiqva, Israel

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J. Obst. & Gy nec.

Estimation of fetal weight in utero by simple external palpation VACLAV INSLER, M.D. DINU BERNSTEIN, M . D. MOSHE RIKOVER, M .D. THEA SEGAL, M .D . Department of Obstetrics and Gynecology, Go vernment Hospital "Zahalon," Jaffa, Israel

A c c u R A T E estimation of the fetal weight prior to or during delivery may be of considerable help in the management of labor. 5 Several authors p roposed m ethods for such estimation. Johnson and Toshach1 calculated the fetal weight from the distance between the symphysis pubis and uterine fundus and the station of the fetal head. They reported an accuracy of ± 240 grams in 50.5 p er cent of the 200 examined cases. Poulos

REIIL WE / (;J{T (f1)











...,e t vHT

~~------~----------~~~~~~--~~) 4100 ,000 2200 2600 sooo Fig. 1. Regression line and fiducial limits of the real fetal weight against the estimated weight. The method employed in the calculation ensures that the fiducial limits cover 92 to 95 per cent of the values of real fetal weight in a given population of data. (The statistical analysis was perfoffiied with an electronic computer by M r. J. Zahavi of the Office :M:ec-han1zation Center, Tel-Aviv.)