Biomedical subjects
Publications and source records attributed to D E Soper.
Postpartum endometritis (PPE) continues to be a leading cause of morbidity in the puerperium. The patient's endogenous cervicovaginal flora remains the source of the polymicrobial character of this infection. Patients in labor with ruptured membranes for more than three hours who undergo delivery by cesarean section have an increased risk of developing PPE.
Lichen planus is an uncommon cutaneous disease that can affect the vulva. Vulvar pruritus and pain are common symptoms in patients with genital involvement. Examination reveals an erythematous, friable vestibule with adherent exudate. Marked resorption of the labia minor and atrophy may occur in time. Diagnosis is based on associated clinical findings involving the oral mucosa and/or the skin and on vulvar biopsy.
A suspension of Neisseria gonorrhoeae was injected into rabbit uterine horns to induce pelvic adhesive disease. There was no statistical difference in the formation of adhesions between the rabbits that were given anti-inflammatory agents and those that received no therapy. This study suggests that anti-inflammatory agents will offer no benefit as adjunctive therapy for the prevention of infection-induced pelvic adhesive disease.
One hundred thirty-five patients undergoing vaginal hysterectomy were randomly assigned to one of three regimens of prophylactic antibiotics. There was no statistically significant difference among the three groups in the incidence of postoperative pelvic cellulitis, fever index, or duration of hospitalization. A single preoperative dose of cefazolin was as effective as three perioperative doses of cefazolin or a single dose of cefonicid in preventing postoperative infectious morbidity.
Standard antimicrobial therapy for postpartum endometritis usually consists of several days of intravenous antibiotics followed by up to ten days of oral therapy. In an effort to decrease the length of hospitalization and duration of antibiotic use, 54 patients were placed on an abbreviated antibiotic protocol. Therapy consisted of intravenous gentamicin and clindamycin until the patient's temperature remained lower than 99.5F for 24 hours, at which time intravenous antibiotics were discontinued and the patient was discharged immediately without oral medication. No morbidity secondary to the abbreviated regimen was observed. Further, the duration of hospitalization and antibiotic therapy of the study group were significantly shorter than similar data from a group of historic controls. These observations suggest that an abbreviated course of antibiotics, based upon the patient's "therapeutic response," may be a safe and cost-effective alternative to the currently practiced therapeutic regimen.
Although pneumonia complicating pregnancy remains an unusual occurrence, it can have serious consequences for both the mother and fetus. Although Streptococcus pneumoniae remains the most common bacterial pathogen, recent epidemics have emphasized the importance of considering Legionella pneumophila as the etiologic agent. Presented is the first case of Legionnaires disease to be diagnosed during pregnancy.
The relative frequency of pharyngeal gonococcal infection may be increased in certain prenatal populations. Therapy of penicillin-sensitive strains of Neisseria gonorrhoeae is associated with acceptable cure rates using aqueous procaine penicillin with probenecid. Infection of the oropharynx of pregnant women with penicillinase-producing strains is more problematic. The antibiotics normally used for the therapy of uncomplicated penicillinase-producing N gonorrhoeae infections, spectinomycin or cefoxitin, are not effective in the therapy of pharyngeal infection. Reported is the first case of penicillinase-producing N gonorrhoeae oropharyngeal infection during pregnancy. The patient was successfully treated with trimethoprim/sulfamethoxazole, and no maternal or neonatal morbidity was noted.
A case of clostridial episiotomy infection is reported and the literature reviewed. Early recognition of the severity of this disease along with aggressive operative therapy is necessary to improve outcome. Clostridium sordellii is now the most common Clostridia species to be isolated from patients with these serious infections.
Delayed hemolytic transfusion reaction, an uncommon complication of blood transfusion, can be the cause of late postoperative fever in the gynecologic patient. The triad of fever, anemia, and a history of recent blood transfusion is the hallmark of this diagnosis.
BACKGROUND: Several case-control studies suggest that the male condom protects women against some sexually transmitted diseases. The female condom is the first barrier device under the woman's control that may be effective in the prevention of sexually transmitted diseases. GOAL OF THIS STUDY: To determine if appropriate use of the female condom decreased the rate of recurrent vaginal trichomoniasis in previously diagnosed and treated women. STUDY DESIGN: One hundred and four sexually active women with vaginal trichomoniasis were treated with metronidazole and assigned to a group using the female condom or a control group during a 45-day period of continued sexual activity. Fifty women served as controls, and 54 women were assigned to use the female condom. RESULTS: Only 20 women used the female condom each time they had sexual intercourse. Reinfection with trichomonas occurred in 7/50 (14%) controls, in 5/34 (14.7%) noncompliant users, and in 0/20 compliant users of the female condom. CONCLUSION: The compliant use of the female condom is effective in preventing recurrent vaginal trichomoniasis.
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