Benign cystic teratoma manifested as an umbilical hernia.
We have reported a case of dermoid tumor manifested as an umbilical hernia. Resection led to complete recovery.
Adult↗
Biomedical subjects
J G Pastorek
Publications and source records attributed to J G Pastorek.
Demographic and behavioral predictors of Trichomonas vaginalis infection among pregnant women. The Vaginal Infections and Prematurity Study Group.
There is little available information on the demographic and behavioral factors associated with Trichomonas vaginalis in pregnant women. Among 13,816 women from six urban clinic centers, the prevalence rate by culture at mid-pregnancy was 12.6%. Women colonized with T vaginalis were significantly more likely to be black, cigarette smokers, unmarried, and less educated (all P less than .01). Several behavioral factors associated with T vaginalis included greater numbers of sexual partners both lifetime and in the last year, 5 years or more of sexual activity, and a history of gonorrhea (all P less than .01). Trichomonas vaginalis-colonized women were less sexually active in the preceding month compared with uncolonized women (P less than .01). Women using either barrier or oral contraception in the 6 months before becoming pregnant were far less likely to be colonized (P less than .01). Other factors such as age, gravidity, income level, age at first coitus, and use of antibiotics, alcohol, or douche during pregnancy were not independently associated with T vaginalis colonization. Because many of the factors predictive of increased risk of colonization have also been shown to be associated with adverse pregnancy outcome, they should be considered in assessing the association of T vaginalis with adverse pregnancy outcome.
Adult↗
Fetal blood sampling from the intrahepatic vein: analysis of safety and clinical experience with 214 procedures.
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Blood Specimen Collection↗
Temporary gastrostomy tubes in major gynecologic surgery.
Prophylactic, temporary tube gastrostomy was done in 39 patients having major gynecologic surgery. Patients who were thought to be at high risk for postoperative ileus had a Foley catheter inserted intraoperatively through the greater curvature of the stomach. The procedure was found to be technically easy, well tolerated by the patients, and clinically useful, since postsurgical ileus was prevented or treated without the local and respiratory ill effects of the commonly used nasogastric tube.
Adolescent↗
Antibiotic therapy for pelvic inflammatory disease.
Pelvic inflammatory disease (PID) is a serious illness with important medical and economic consequences, especially for young women. To make a significant impact on the acute and chronic morbidity associated with PID, experts currently recommend aggressive hospitalization and parenteral antimicrobial therapy. Antibiotic therapy, in the 1989 recommendations of the Centers for Disease Control, includes broad-spectrum cephalosporins active against penicillinase-producing Neisseria gonorrhoeae and the mixed aerobic and anaerobic genital flora, with concomitant administration of doxycycline for possible or proven infection with Chlamydia trachomatis. An alternative regimen consists of the "gold standard" combination of clindamycin plus an aminoglycoside. However, with the availability of beta-lactam/beta-lactamase-inhibitor combinations, such as ticarcillin/clavulanate and ampicillin/sulbactam, which have modest to very good activity against all these classes of bacteria, the gynecologist has the capability to utilize single-agent antibiotic regimens to adequately treat this potentially devastating sexually transmitted disease.
Amoxicillin↗
Chlamydia trachomatis and premature contractions.
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Antibodies, Bacterial↗
Listeriosis as an obstetric complication in an immunocompromised patient.
We have reported a case of maternal death associated with Listeria monocytogenes septicemia in a woman who was being treated with immunosuppressive drugs for lupus nephritis. This report, coupled with a previous case of L monocytogenes sepsis in a pregnant patient with AIDS, emphasizes that L monocytogenes infection may be an important, unrecognized pathogen in pregnant women with impaired immunity.
Adult↗
Pelvic inflammatory disease and tubo-ovarian abscess.
Pelvic inflammatory disease is a disease that has reached nearly epidemic proportions in the United States. The gold standard of diagnosis remains laparoscopy, and treatment is usually with broad-spectrum antibiotics and surgery.
Abscess↗
Hepatitis B.
Hepatitis B virus is an important sexually transmitted organism that causes not only disease in sexual partners but important perinatal illness as well. The obstetrician-gynecologist must be aware of the epidemiology and the pathophysiology of HBV infections, as well as strategies for treatment and prevention. Physicians must first realize that their profession places them in a high-risk group by definition; therefore pre-exposure prophylaxis (that is, vaccination) is a logical step to take early in a medical career. Moreover, familiarity with guidelines for global HBsAg screening of pregnant women to prevent the serious pediatric hepatic morbidity that results from perinatal transmission of the virus is of paramount importance.
Acute Disease↗
Comparative effectiveness and safety of cefotetan and cefoxitin as prophylactic agents in patients undergoing abdominal or vaginal hysterectomy.
In a multicenter, randomized clinical trial, 282 women who underwent abdominal or vaginal hysterectomy were given a single preoperative 2 g dose of cefotetan (171 evaluable patients) or three perioperative 2 g doses of cefoxitin (84 evaluable patients) as antibiotic prophylaxis. A successful clinical response occurred in 92 percent of those receiving cefotetan and 90 percent of those receiving cefoxitin who underwent abdominal hysterectomy, and in 94 percent of those receiving cefotetan and 93 percent of those receiving cefoxitin who underwent vaginal hysterectomy. The incidence of vaginal cuff cellulitis was 3.4 percent and 5 percent for cefotetan and cefoxitin patients, respectively, who underwent abdominal hysterectomy, and 4.8 percent and 4.5 percent, respectively, for those who underwent vaginal hysterectomy. The incidence of major wound infection was 3.4 percent and 2.5 percent for cefotetan and cefoxitin, respectively, in the abdominal hysterectomy group. Postoperative changes in oral body temperature, duration of hospitalization, and postoperative grading of surgical wounds were similar. Both drugs were well tolerated. These results suggest that a single dose of cefotetan is equally effective and as safe as multiple-dose cefoxitin for prophylaxis in patients undergoing hysterectomy.
Adult↗
The effect of hepatitis B antigenemia on pregnancy outcome.
Sixty patients documented to have hepatitis B antigenemia during pregnancy were identified retrospectively and compared with an equal number of matched control patients. Maternal and newborn infant parameters were examined. No statistically significant differences were noted between the two groups, except for an increase in infant birth weight in the group showing antigen-positive test results, specifically in infants born to Oriental mothers. It is concluded that infants born to women testing positive for hepatitis B surface antigen represent normal infants eminently suitable for peripartal preventive immunotherapy.
Adult↗
Ultrasonographic identification of the macrosomic fetus.
Ultrasonographically determined biparietal diameter, femur length, abdominal circumference, and estimated fetal weight were analyzed with regard to their ability to predict the macrosomic newborn. Receiver operating characteristic curves were plotted for each of these variables. Estimated fetal weight was superior to biparietal diameter or femur length measurements in the identification of the overgrown fetus. Because of limitations of positive predictive values and sensitivities, application of these observations varies with the clinical setting in which they are used.
Abdomen↗
Production of a phosphatidylglycerol-like substance by genital flora bacteria.
Bacteria contaminating amniotic fluid have anecdotally been shown to produce a phosphatidylglycerol-like substance, thus giving false positive tests for phosphatidylglycerol in vaginal pool fluid from patients with premature rupture of the membranes. Isolates of Escherichia coli, Proteus mirabilis, Acinetobacter calcoaceticus, Klebsiella pneumoniae, Staphylococcus aureus, coagulase-negative Staphylococcus, Streptococcus faecalis, and Streptococcus agalactiae (group B streptococcus) were grown in broth and analyzed for the presence of phosphatidylglycerol-like material by one-dimensional thin-layer chromatography and also by a polyclonal, immunologic slide agglutination test (Amniostat-FLM). All species demonstrated a positive test result for phosphatidylglycerol by either thin-layer chromatography, slide agglutination, or both. The material migrated separately from cardiolipin and phosphatidylethanolamine as determined by chromatography, but identically with the phosphatidylglycerol control. Gram-negative species were more strongly positive than gram-positive organisms. Colony counts on the order of 10(8) colony-forming units per milliliter were necessary to give positive test results for phosphatidylglycerol. The possible clinical implications of these findings are discussed.
Acinetobacter↗
Fine-tuning the fluorescent antibody test for chlamydial infections in pregnancy.
Endocervical specimens from 168 asymptomatic women in the second trimester of pregnancy were screened for Chlamydia trachomatis infection with both standard tissue culture methods and a direct fluorescein-conjugated monoclonal antibody assay (MicroTrak). Based on tissue culture results, the prevalence of Chlamydia trachomatis was 26.2% in this population. Compared with tissue culture, the monoclonal antibody assay's sensitivity, specificity, and positive predictive value varied depending upon how many elementary bodies were used to define a positive test. Specifically, if a cutoff of ten elementary bodies was used (as per the manufacturer's instructions), the sensitivity, specificity, and positive predictive value of this test were 86.3, 98.4, and 95.0%, respectively. At the other extreme, a cutoff of one elementary body produced a more sensitive but less specific test, with parameters of 93.2, 89.5, and 75.9%, respectively. Based on these data and operating characteristic analysis, the cutoff value defining a positive test was appropriately set at two or more elementary bodies, at least for this study population. This resulted in a sensitivity, specificity, and positive predictive value of 93.2, 95.2, and 87.2%, respectively. This monoclonal antibody assay appears to be a reasonable substitute for cell culture for Chlamydia trachomatis. However, because of varying magnitudes and implications of false-positive and false-negative tests, clinicians are urged to determine the appropriate breakpoint for their individual laboratories and patient populations before substituting the direct fluorescent antibody test for tissue culture.
Antibodies, Monoclonal↗
Fetal overgrowth. Diabetic versus nondiabetic.
Term, large for gestational aged newborns were retrospectively evaluated. The fetal parameter of relative growth, was measured using the ratio of fetal length to abdominal circumference (FL/AC). This measurement was not different between diabetic and nondiabetic gravidas who delivered LGA infants when ultrasound was obtained within 1 week of delivery.
Anthropometry↗
Single-dose antimicrobial prophylaxis at abdominal hysterectomy. Cefamandole vs. cefotaxime.
Two hundred twenty-three women were given a single, 1-g, intravenous dose of cefamandole or cefotaxime at elective abdominal hysterectomy in a multicenter, prospective, randomized, blind clinical trial of efficacy and safety. The demographic, surgical, efficacy and safety variables were statistically similar. Prior to discharge from the hospital, 12 women (5.3%) developed major postoperative pelvic infections that required parenteral antimicrobial therapy; no wound infections occurred. There was no correlation between a depressed antimicrobial development of significant postoperative infection. An expanded spectrum of antibacterial activity and a longer serum half-life did not improve clinical efficacy, and single-dose intravenous cephalosporin prophylaxis before abdominal hysterectomy was associated with a low incidence of pelvic infection.
Adult↗
Surgical sterilization at the time of cesarean delivery.
The cesarean section operation has been recognized for more than a century as an ideal time for the obstetrician to effect sterilization, usually with minimal morbidity, by way of one of the methods of tubal ligation. The physician must choose between simple, quick methods such as the Pomeroy or Parkland, with their slightly higher but acceptable failure rates, or the more elaborate and foolproof methods that involve burial of the tubal ends, such as the Irving or Uchida, which are technically more difficult and time consuming. The authors stress that whichever procedure is utilized, the surgeon must resist the desire to elaborate on proven techniques; otherwise, higher than published failure rates may result. It is important for the patient to understand the risks, both of immediate morbidity and remote failure, and to give her informed consent. Attentive presterilization counseling may identify the patient who will regret the loss of her fertility.
Cesarean Section↗
Ticarcillin disodium and clavulanate potassium in the treatment of post-cesarean-section endomyometritis.
The combination of ticarcillin disodium/clavulanate potassium is a potent, irreversible inhibitor of beta-lactamase that is active against a broad spectrum of gram-positive and -negative bacteria, which often are found in the polymicrobial infection of postcesarean endomyometritis. Eighty-four randomly chosen women with postcesarean endomyometritis received 3 g ticarcillin disodium plus 100 mg clavulanate potassium intravenously every six hours. The drug was discontinued after patients were afebrile and asymptomatic for 72 hours. The mean duration of therapy was 4.7 days. A clinical cure was achieved in 56 of the 70 evaluable patients (80%); 14 were clinical failures. Six of the 70 patients (9%) were bacteremic. One hundred eighty-five aerobic bacteria and 109 anaerobic bacteria were isolated. Of the 96 aerobic isolates tested, 75 (78%) were beta-lactamase positive, as were 68 of the 78 anaerobic isolates (87%).
Adult↗