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Biomedical subjects

E Rees

Publications and source records attributed to E Rees.

At least 19 recordsLinked to original sources
PubMed1988

Screening for cervical dysplasia in department of genitourinary medicine.

In 632 patients attending a sexually transmitted disease (STD) clinic who were colposcoped because they were in certain high risk groups for cervical neoplasia, and irrespective of cytological findings, 13 out of 51 biopsied had false negative cytology results. Human papilloma virus (HPV) was the most important sexually transmitted agent associated with cervical intraepithelial neoplasia (CIN), but HPV was also present in most patients with false negative (11/13) and false positive (11/14) cytology results. Screening by colposcopy, as well as cervical cytology, is therefore mandatory and must be available for certain STD clinic patients.

Adult↗
PubMed1987

Early intravenous indomethacin prolongs respiratory support in very low birth weight infants.

Infants weighing 1500 g at birth requiring either intermittent positive pressure ventilation or continuous positive airway pressure by 12 hours of age were entered in a randomized double blind controlled trial to test the efficacy of early intravenous indomethacin therapy in preventing chronic pulmonary disease of prematurity. Of the 30 newborns enrolled, 15 were treated with indomethacin and 15 were treated with placebo at 12, 24 and 36 hours of age. The groups were similar for birth weight, gestational age, sex, hyaline membrane disease and intracranial hemorrhage. Infants in the placebo group were successfully weaned from intermittent positive pressure ventilation at an earlier age than infants in the indomethacin group (p less than 0.05). Furthermore, chronic pulmonary disease of prematurity was similar in the two groups despite a reduction in the incidence of patent ductus arteriosus in the indomethacin group.

Clinical Trials as Topic↗
PubMed1985

Chlamydial infections of the urethra in women.

Cervical and endourethral swabs from 360 untreated women attending a sexually transmitted disease (STD) clinic were cultured for Chlamydia trachomatis and other genitourinary pathogens. The patients included contacts of men with non-gonococcal urethritis, women with gonorrhoea, and those in whom symptoms suggestive of urinary tract infection were the main reasons for their attendance. Chlamydial infection of the urethra was less common than, and seldom occurred in the absence of, cervical chlamydial infection; it was frequently silent, producing no signs or symptoms of urethritis. Only 33/96 women with evidence of urethritis gave chlamydia positive urethral swabs, and 14 of them had other concurrent infections of the genitourinary tract. Chlamydia trachomatis thus does not appear to be a major cause of the signs and symptoms of urethritis commonly found in women attending STD clinics, and there seems to be no indication for taking routine urethral swabs to aid in the diagnosis of chlamydial infection in women.

Cervix Uteri↗
PubMed1984

Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Liverpool from 1977 to 1982.

After the 1976 outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) infections had been controlled, less than 1 per cent of cases of gonorrhoea in Liverpool in 1977 and 1978 were caused by PPNG. Thereafter the steady increase in PPNG infections to 5.6 per cent of all cases in 1982 was associated with marked changes in epidemiological pattern, plasmids and auxotypes. In 1976 nearly all PPNG infections were acquired by young black males living in the inner city from women frequenting clubs; the PPNG were all of the African 3.2 megadalton (MD) plasmid type and of arginine-requiring auxotype. Between 1977 and 1982 female patients were increasingly ship girl prostitutes associating with seamen who constituted more than 50 per cent of the male patients. These men and other travellers introduced PPNG into Liverpool from the Far East and West Africa. In 1978 PPNG of the Asian type with 4.4 MD plasmid with or without 24.5 MD transfer plasmids were isolated in Liverpool where in 1979 all PPNG carried 4.4 MD and 24.5 MD plasmids. In 1982 strains of the 'new' African type with 3.2 and 24.5 MD plasmids were isolated as were PPNG of the Asian type that had been acquired in West Africa. Auxotyping of the 1982 isolates showed that none were arginine-requiring but three other types were identified: proline-requiring: proline-arginine-requiring; non-requiring. For the control of PPNG, a strategy based on constant vigilance, appropriate diagnostic procedures, rapidly effective treatment and determined contact tracing is needed.

Adolescent↗
PubMed1984

Genital infections with Chlamydia trachomatis in women attending an antenatal clinic.

Cervical swabs for isolation of C. trachomatis and serum for anti-chlamydial antibodies were taken from 252 pregnant women on their first visit to an urban antenatal clinic. Chlamydial infection was found in 18 (7%) women, and antibody at titres greater than 1/32 in 48 (19%); of the 18 infected women only 10 (56%) showed antibody. The likelihood of infection could not have been predicted by urogenital symptoms, the social or medical history or serology. Hypertrophic cervical ectopy and mucopus were significantly more common in infected than in uninfected women but underestimate the true rate of infection. The consorts of 10 infected women had signs of non-gonococcal urethritis but were asymptomatic; C. trachomatis was isolated from the urethra of one man. The indications for routine screening of antenatal patients for chlamydial infections is discussed.

Adolescent↗
PubMed1983

Voluntary regionalization and associated trends in perinatal care: the Nova Scotia Reproductive Care Program.

The Nova Scotia Reproductive Care Program is a system of voluntary regionalization that involves the 37 hospitals in the province that provide obstetric care to a population of 850,000. Between 1971 and 1980, the perinatal mortality rate in the central tertiary care unit for nonreferred patients fell progressively from 12.5 per 1,000 total births to 5.16. For all cases, including high-risk referrals, this rate has fallen from 12.7 to 7.2. During the same interval, the perinatal mortality rate for the province's seven regional hospitals fell from 18.7 to 12.2, and that for the 28 community hospitals fell from 18.4 to 7.0. Analysis of these reductions by fitted trend lines demonstrates statistical significance. Further analysis demonstrates that, with regionalization of perinatal services, it is possible to reduce the perinatal mortality rate in small community hospitals to levels that approximate those of a sophisticated tertiary care hospital.

Female↗
PubMed1983

Topical acyclovir in the treatment of genital herpes: a comparison with systemic therapy.

Controlled trials of acyclovir cream were conducted in the treatment of initial and recurrent genital herpes. For 54 patients with the first episode of genital infection (initial disease) treated with acyclovir the duration of viral shedding, formation of new lesions, times to crusting and healing and duration of symptoms were significantly reduced compared with the results obtained in 47 placebo recipients. When applied early in the course of recurrent episodes in 44 patients, acyclovir cream significantly reduced viral shedding, a new lesion formation, time to healing and the duration of symptoms compared with the effects in 41 control patients. Topical therapy with acyclovir cream is well tolerated and compares quite favourably with systemic treatment, especially for recurrent genital herpes.

Acyclovir↗
PubMed1982

Effects of chloramphenicol on Chlamydia trachomatis infection in neonatal conjunctivitis and in McCoy cell cultures.

It was found that 26 of 127 infants with chlamydial conjunctivitis had previously received chloramphenicol eye drops. This treatment had delayed the onset and reduced the degree of oedema, congestion and discharge compared with infected infants with no 'first-line' chemotherapy, but eye swabs remained positive in 22 (85%) of the chloramphenicol treated infants. The problems of designing laboratory tests which might accurately forecast the clinical value, or lack of value of antibiotics in chlamydial infections were investigated. The minimum inhibitory concentration (MIC) of chloramphenicol, against Chlamydia trachomatis in McCoy cell cultures varied widely according to the antibiotic preparation used, the timing and duration of its exhibition in relation to the single step growth cycle of C. trachomatis, and, in particular, the method of examination of infected tissue cultures for residual chlamydial growth after incubation with chloramphenicol.

Chlamydia Infections↗
PubMed1982

Infant apnea syndrome. A prospective evaluation of etiologies.

The frequency of proposed causes for the infant apnea syndrome (IAS) or "near miss" sudden infant death is unknown. Using a protocol, we investigated a small series of 28 consecutive infants with IAS. This in-hospital evaluation included, for all patients, blood chemistries; x-rays of skull, lumbar puncture, chest, and barium swallow; electrocardiogram, echocardiogram, 24-hour Holter cardiac monitor; viral and bacterial cultures of blood, urine, stool, and CSF; EEG; and esophageal pH study for gastroesophageal reflux (GER). A probable cause was found in 17 of the 28 infants including GER 6, encephalitis 4, convulsive disorder 3, periventricular edema 1, Arnold-Chiari malformation 1, milk allergy 1, periodic breathing 1. Home apnea monitors were used only by three, all of whom had no diagnosis and only these three had repeat apneic episodes. There have been no deaths during follow-up of 12 to 24 months. It is our conclusion that detailed evaluation of IAS often yields a specific diagnosis. The most valuable investigations were lumbar puncture, EEG, and esophageal pH studies.

Apnea↗
PubMed1981

Persistence of chlamydial infection after treatment for neonatal conjunctivitis.

A high incidence of pharyngeal infection was found in babies with isolation-positive chlamydial conjunctivitis. Chlamydia trachomatis was isolated from the pharynx of 12 (52%) of 23 babies before treatment, and was reisolated from the eyes of 4 (12%) of 34 and from the pharynx of 14 (41%) of 34 after treatment. C trachomatis was reisolated significantly more often from babies treated only with topical tetracycline for 4 weeks (75%) than from those treated with both topical tetracycline and oral erythromycin for 2 weeks (32%). Reisolation from the eyes was associated with only minor clinical signs. Radiological signs of an inflammatory lesion in the chest were found in 2 of 8 babies examined because of persistent cough. These signs were not associated with high or rising titres of serum chlamydial antibody.

Chlamydia Infections↗
PubMed1980

The treatment of pelvic inflammatory disease.

The treatment of pelvic inflammatory disease depends upon the etiology of the condition. Pelvic infection (PI) after parturition and abortion, gynecologic surgery, and a variety of invasive procedures is commonly associated with the isolation of anaerobic and aerobic flora of the vagina. The factors which influence the choice of antimicrobial treatment and the role of Bacteroides fragilis and Escherichia coli are discussed. Sexually transmissible agents of importance are Neisseria gonorrhoeae and Chlamydia trachomatis. Pelvic infections associated with these pathogens require antibiotics which exert an optimum effect against them. Examination and treatment of the sexual partner(s) are important. The possible role of the anaerobic and aerobic vaginal flora as opportunistic secondary pathogens is discussed. Developments in the surgical treatment of the sequelae of PID are reviewed. The results of treatment of uncomplicated gonorrhea in 262 women are reported. C. trachomatis was isolated from 53% of women before treatment. After treatment, PI developed in 11 women who had been given penicillin and in one woman who had been given tetracycline (P = 0.0071). It is suggested that recognition and treatment of postgonococcal cervicitis in women treated for uncomplicated gonorrhea with penicillin might provide one form of preventive treatment for nongonococcal PI.

Anti-Bacterial Agents↗
PubMed1978

Epidemiology and treatment of gonorrhoea caused by penicillinase-producing strains in Liverpool.

The epidemiological features are described of an outbreak of gonorrhoea caused by penicillinase-producing strains of gonococci in 76 patients in Liverpool between February and November 1976. Initially infections were confined to a socially deprived inner city area with a large immigrant population, and subsequent spread of infection remained circumscribed. The characteristics of those patients acquiring these infections were similar to those infected by gonococci of diminished sensitivity to benzylpenicillin, and showed a strong association with adverse social factors. A comparison of the clinical features of patients harbouring sensitive, less sensitive, and penicillinase-producing strains showed severe symptoms and signs in men and a greater involvement of multiple sites in women infected with penicillinase-producing gonococci. Treatment with penicillins failed. Tetracycline was satisfactory in men but was less so in women in whom gonococci persisted in the rectum. Cefuroxime and spectinomycin were effective.

Black or African American↗
PubMed1978

Isolation of Chlamydia trachomatis from Bartholin's ducts.

Exudate from Bartholin's ducts from 30 selected patients was investigated for Chlamydia trachomatis and Neisseria gonorrhoeae. N. gonorrhoeae was isolated from the duct exudate in 24 patients and C. trachomatis in nine. Concurrent infection of the ducts was present in seven (29.2%); the remaining two patients were sexual contacts of men with non-specific urethritis. The duct exudate was mucopus in seven patients, cloudy mucus in one, and clear mucus in the other. Although contamination of the vulva by C. trachomatis derived from cervical or urethral infection cannot be excluded, three cases are described which suggest that a true infection of the duct occurs and may persist after gonococcal infection has been cured.

Adolescent↗