Le métronidazole (Flagyl) reste la référence dans le traitement des infections anaérobies et des parasitoses comme la giardiase ou l’amibiase. Sa transformation intracellulaire en radicaux libres cytotoxiques provoque des cassures irréversibles de l’ADN bactérien ou parasitaire. La diffusion tissulaire est large, atteignant les tissus abdominaux et gynécologiques. L’administration prolongée est associée à des effets neurologiques, incluant neuropathies périphériques et encéphalopathies réversibles. L’association avec l’alcool déclenche une réaction de type antabuse. Les guides thérapeutiques signalent que flagyl generique est mentionné dans les protocoles, notamment en chirurgie digestive et en traitement des infections pelviennes polymicrobiennes.

Patient data collection form

QE II Research Institute for Mothers and Infants
Cecilia Ng
Department of Obstetrics, Gynaecology & Neonatology, USYD
30/01/2012
PATIENT DATA COLLECTION FORM
Royal Prince Alfred Hospital &
The University of Sydney
Attach Patient Label Here

Patient Study No.: QEII-12-_ _ _
Date of Surgery:
PECN-T/S _ _ _
_ _/_ _/_ _ _ _
FMB-_ _ _ NHKB-_ _ _ GD-_ _ _
PATIENT HISTORY
Day 1 of last menstrual period:

Menstrual cycle phase:
Early-

Obstetric Gynaecological History:
Gravida:

Symptoms: (Tick and fill details to all that apply)
Other (please specify):

Previous Diagnosis of Gynaecological Conditions: (Tick and fill details to all that apply)
Adenomyoma
Other (please specify):

Previous Gynaecological Surgery: (Tick and fill details to all that apply)
Nil
Ovarian cystectomy Other (please specify):

Medical Treatment: (Tick and fill details to all that apply)
Other (please specify):

Smoking/Alcohol: (Tick all that apply)
Smoking:
Alcohol:
PRESENT PATIENT SURGERY DETAILS
Surgery: (Tick and fill details to all that apply)
Hysterectomy
OGE Template - Patient Data Collection Form V5-2012.doc QE II Research Institute for Mothers and Infants
Cecilia Ng
Department of Obstetrics, Gynaecology & Neonatology, USYD
30/01/2012

PATIENT DIAGNOSIS PATHOLOGY DETAILS
Diagnosis: (Tick and fill details to all that apply)
· ENDOMETRIOSIS cases only: (Indicate on diagram type and location of endometriosis lesions)
Key to use:
OvCy = Ovarian cyst
PE = Peritoneal lesion
DIE = Deep-infiltrating lesion
RF = Red flare lesions
BN = Black nodules
WN = White nodules
Sc = Scarring
FA = Filmy adhesions
DA = Dense adhesions
FFCy = Fluid filled cysts
Other locations:
Endometriosis
Stage (rASRM):

· FIBROID/LEIOMYOMA:
Submucosal

· POLYPS:
Endometrial

· OTHER PATHOLOGIES:
Normal pelvic
Others (please specify):

Endometrial curetting/biopsy sent to RPAH Anatomical Pathology (circle): Yes / No
Endometriosis lesion(s) biopsy sample(s) sent to RPAH Anatomical Pathology (circle): Yes / No
Samples Collected for QEII Tissue Bank: (Number accordingly with roman numerals [exception for Blood,
Urine and Peritoneal Fluid] & Tick all that apply)
Endometrial
OGE Template - Patient Data Collection Form V5-2012.doc

Source: http://www.mjwcooper.com.au/attachments/article/58/OGE%20Template%20-%20Patient%20Data%20Collection%20Form%20V5-2012.pdf