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Biomedical subjects

J H Harger

Publications and source records attributed to J H Harger.

At least 37 records · Page 2Linked to original sources
PubMed1986

Surveillance for postoperative infections in outpatient gynecologic surgery.

Postoperative infection rates were determined for gynecologic outpatient surgical procedures performed in a traditional operating room environment and a separate, recently opened, surgicenter within the same hospital. Infections were self-reported by attending surgeons responding to computer-generated line listings of their recent surgical procedures. Responses were obtained on 97.9% (612/625) of women having surgery in the operating room and 99.5% (629/632) of women with surgicenter procedures. The overall infection rate for reported women was 0.9% (11/1,241). The difference between operating room and surgicenter rates was not statistically significant. Postoperative infections occurred in 2.5% (3/118) of diagnostic laparoscopies with tubal lavage and 1.4% (3/214) of voluntary abortions by dilatation and evacuation and curettage (D&E&C). The five other infections were scattered among the remaining 25 procedure categories. Ten of the 11 infections were limited to the "clean-contaminated" wounds. No serious or life-threatening infections were encountered. The computer-assisted surveillance system worked well and was easily incorporated into the existing infection surveillance system. The degree of ascertainment of postoperative wound infections is unknown due to reliance on physician self-reporting. However, no patients requiring readmission for infection went unreported by the attending surgeons.

Ambulatory Surgical Procedures↗
PubMed1986

Changes in the frequency of genital herpes recurrences as a function of time.

To obtain objective information regarding changes in the frequency of recurrent genital Herpes simplex infections, the data from two consecutive pregnancies in 22 women with culture-proved genital Herpes simplex infections were reviewed. The pregnancies studied were separated by a mean of 2.0 years. When only culture-proved recurrences were considered, nine women had fewer recurrences in their second pregnancy than in their first, four had more recurrences in their second than in their first, and nine had the same number of recurrences in both pregnancies. The mean interval between culture-proved recurrences was 58.5 +/- 36.1 (SD) days in first pregnancies and 51.7 +/- 28.6 days in second pregnancies. Mean duration of viral shedding during 14 recurrences in first pregnancies was 4.6 +/- 3.4 days, and 3.2 +/- 2.2 days in 14 recurrences in second pregnancies (differences not significant by Mann-Whitney). Cervical Herpes simplex shedding in asymptomatic women occurred in four of 200 (2.0%) of first pregnancy cultures and zero of 167 second pregnancy cultures (NS). During culture-positive recurrent vulvar infections, 18 of 55 (32.7%) cervical cultures in first pregnancies were positive compared with four of 50 (8%) cervical cultures in second pregnancies (P less than .025). Route of delivery was very similar in the first and second pregnancies with vaginal delivery in 63.6% of first pregnancies and 72.7% of second pregnancies. Overall there was no appreciable difference in the frequency or severity of recurrent genital Herpes simplex infections over time, but more data are needed.

Cervix Uteri↗
PubMed1986

Current understanding of the natural history of genital herpes simplex infections.

Considerable variations in the disease make an accurate portrayal of genital herpes simplex virus (HSV) infections quite difficult. Primary genital HSV infections classically produce ulcerated lesions lasting a mean of 16-21 days in men and 10-16 days in women. HSV shedding has been documented for a mean of 9.1-11.6 days in men and 8.0-14.7 days in women. Probably many adults have a less severe initial genital infection, however, and it may be so mild as to be misdiagnosed or undetected. Studies of recurrent genital HSV infections are often misleading because they overestimate the frequency and severity of recurrences. By necessity, these studies have recruited and evaluated those adults with the worst and most frequent recurrences. Data from these studies show even greater variations than do data on initial episodes of genital HSV infection. The frequency and clinical importance of asymptomatic genital HSV shedding are being recognized and documented only now. Further studies of this phenomenon and of the natural history of all genital HSV infections are needed urgently.

Cervix Uteri↗
PubMed1985

HLA sharing and spontaneous abortion in humans.

Twenty-one Caucasian couples with two or more idiopathic fetal losses and with either no live-born children or with only one live-born child were typed for HLA-A, B, and DR antigens, and mixed lymphocyte responses of the maternal lymphocytes to stimulation by paternal lymphocytes were studied. The mixed lymphocyte response results showed that women who experienced habitual fetal loss had normal immune responses, thereby lending less credence to the idea that a defective immunologic response is involved in problem pregnancies. The data were pooled and analyzed with those of similar reports, and there was a strong indication that aborting couples shared a greater portion of the chromosome that contains the major histocompatibility complex (MHC) than would be expected in random matings.

Abortion, Habitual↗
PubMed1984

A cluster of neonatal herpes simplex infections without mucocutaneous manifestations.

Three cases of neonatal disseminated herpes simplex virus (HSV) infection are reported. They were all due to different strains of HSV-1, according to restriction endonuclease studies, and they represent the first cluster of neonatal-HSV infection at Magee-Womens Hospital. The neonatal symptoms occurred early, suggesting intrauterine infection. None of the babies had mucocutaneous lesions, and the mothers were asymptomatic and had no history of previous genital HSV infection.

Cross Infection↗
PubMed1984

Septic dermatitis of the neonatal scalp and maternal endomyometritis with intrapartum internal fetal monitoring.

During a 3-month period, 1,062 mother-infant pairs were studied for infections following internal fetal monitoring during labor. Six infants (0.56%) developed septic scalp dermatitis at the site of the spiral electrode application. Factors associated with septic scalp dermatitis included the number of vaginal examinations, the use of an intrauterine pressure catheter or of more than one spiral electrode, and fetal scalp blood sampling. Maternal diabetes and endomyometritis were also associated with an increased risk of scalp infection. The duration of spiral electrode use and duration of ruptured membranes were not significant risk factors. Endomyometritis was documented in 41 mothers, an overall incidence of 3.9%. In women whose babies were delivered by cesarean section, the incidence of endomyometritis was 28/117 (23.9%). Using multivariate analysis by logistic regression, endomyometritis was associated with the number of vaginal examinations during labor but not with the duration of internal monitoring, duration of labor, or duration of ruptured membranes.

Adult↗
PubMed1983

Characteristics and management of pregnancy in women with genital herpes simplex virus infection.

The natural history of genital herpes simplex virus (HSV) infections was investigated in 83 pregnancies in 78 women, and the information was used to determine the need for cesarean section in these women. We studied 163 recurrent episodes with HSV cultures from the cervix and from vulvar lesions every 1 to 3 days. Cervical HSV cultures were obtained weekly from asymptomatic women beginning at 32 weeks' gestation, and 14/462 (3.03%) of these cultures were positive. Cervical cultures obtained during culture-positive vulvar recurrences demonstrated concomitant cervical HSV shedding in 25/165 (15.2%) cultures. Mean duration of 26 genital HSV recurrences was 4.6 +/- 2.8 days with a range of 1 to 13 days. The mean interval between culture-positive HSV recurrences was 59.2 +/- 42.1 days, but many (14/76 = 18%) intervals were less than 21 days. Viral cultures were already positive in 92.3% of cases after 4 days' incubation, so they could be used effectively to determine route of delivery. Following a cautious set of criteria for vaginal delivery in these women, 69.1% were delivered of their infants vaginally and no neonatal morbidity caused by HSV was encountered. Information about the natural history of genital HSV infections obtained from frequent third-trimester viral cultures can be used to manage pregnancy and will reduce the need for cesarean section while avoiding neonatal HSV morbidity.

Cervix Uteri↗
PubMed1983

Etiology of recurrent pregnancy losses and outcome of subsequent pregnancies.

Prospective evaluation of 155 couples with two or more consecutive pregnancy losses disclosed uterine morphologic abnormalities in 27%, chromosomal abnormalities in 21 individuals (7.7%, or 15.4% of the couples), and at least one abnormal diagnostic test suggestive of a cause for recurrent pregnancy losses in 106 (68%). A positive test for antinuclear antibody was found in 7.5% of the women, whereas the expected rate in a population of this age is less than 2%. Cervical cultures for Ureaplasma urealyticum (T-strain mycoplasma) were positive in 48% of the women, and 28% of these women had a genetic or uterine abnormality to explain their pregnancy losses. Thyroid function profiles and cervical cultures for Mycoplasma hominis provided no significant information in the evaluation in these couples. With the exception of women with a positive antinuclear antibody, the overall prognosis for later pregnancies was quite good whether the diagnostic evaluation of the couple was normal (77% subsequent live births) or abnormal (71% subsequent live births). The significance of the positive antinuclear antibody in these women is unclear, but further studies and long-term evaluation are necessary to determine the relationship between recurrent pregnancy losses and later development of collagen-vascular diseases.

Abortion, Habitual↗
PubMed1982

Bromocriptine treatment of women with suspected pituitary prolactin-secreting microadenomas.

The present study was designed to investigate the efficacy of bromocriptine in reducing serum prolactin (PRL) levels and in decreasing the size of PRL-secreting microadenomas. Bromocriptine, 5.0 mg, was administered daily for 2 years of 17 women who had galactorrhea, hyperprolactinemia, and hypocycloidal polytomographic evidence suggestive of a pituitary microadenoma. Serum PRL levels were normalized in 16 of 17 women during therapy. Associated with this was resumption of regular menses in 15 of 16 women with menstrual dysfunction and cessation of galactorrhea in 16 of the 17 women. Improvement in the roentgenographic appearance of the sella turcica occurred in two women. No progression in tumor size was found during the course of therapy. Side effects attributed to bromocriptine were minimal, transient, and usually well tolerated. These data suggest that bromocriptine is an appropriate therapeutic modality for PRL-secreting pituitary microadenomas.

Adenoma↗
PubMed1982

Achondroplasia and pregnancy.

Five cases and a review of the literature concerning achondroplasia and pregnancy are described. Cephalopelvic disproportion secondary to marked pelvic contracture is the most consistent feature. Preeclampsia is more frequent but usually did not become a major problem regarding obstetric management. Polyhydramnios may indicate a poor prognosis for the fetus. Dyspnea on exertion and at rest is quite variable and may be related to associated vertebral column deformities. Fetal wastage and neonatal death are increased.

Achondroplasia↗
PubMed1981

Selection of patients for antibiotic prophylaxis in cesarean sections.

We conducted a prospective, double-blind, randomized, placebo-controlled study of cefoxitin perioperative prophylaxis in 386 women having cesarean sections after labor or rupture of membranes. Private patients constituted 70% of subjects. Cefoxitin was chosen for its low toxicity and its broad spectrum against common obstetric pathogens including Bacteroides fragilis. Cefoxitin-treated women received 2 mg of drug intravenously at umbilical cord clamping and at 6 and 12 hours after surgery. Demographic and obstetric variables did not differ between the 190 placebo-treated women and the 196 cefoxitin-treated women. The morbidity rate from infection was significantly reduced by cefoxitin prophylaxis. Seven factors were significantly correlated with increased risk of infection after cesarean section: maternal age, socioeconomic status, race, gestational age, duration of internal fetal monitoring, use of intrauterine pressure catheter, and obesity. Cefoxitin prophylaxis resulted in significant decreases in infection incidence in women with one, two, and three risk factors, respectively, but the reduction was not significant in women with no risk factors. Length of hospital stay was not significantly reduced by cefoxitin prophylaxis but antibiotic use was decreased 24%.

Adult↗
PubMed1981

Validity of hypothalamic-pituitary testing in hyperprolactinemia: prolactin responses to insulin hypoglycemia and arginine.

The release of prolactin (PRL) following insulin tolerance testing (ITT) and arginine infusion was studied in four groups of women: normal volunteers, amenorrheic women with normal PRL levels, and hyperprolactinemic women with and without roentgenographic evidence of pituitary adenoma. Women with normal serum PRL concentrations were found to have an increase in peripheral PRL and both testing modalities. Hyperprolactinemic women, whether or not there was evidence of a pituitary adenoma, did not appear to have a PRL response to either of these tests. Based on the percent change of PRL over basal values, there was a significant difference between the euprolactinemic and hyperprolactinemic groups (p less than 0.01 for insulin and p less than 0.05 for arginine). Our data indicate that in women with hyperprolactinemia neither ITT- nor arginine-induced PRL release can be utilized to discriminate between the presence and absence of an adenoma. This poor PRL response to ITT and arginine in the hyperprolactinemic patients could be the result of hypothalamic dysfunction.

Adenoma↗
PubMed1981

Increased amnionic fluid alpha-fetoprotein due to a holoacardium amorphous twin.

Amnionic fluid alpha-fetoprotein measurement was employed as a screening test for neural tube defects in a pregnancy only at risk due to advanced maternal age. The alpha-fetoprotein concentration was elevated more than 10 standard deviations above the mean and was found to be caused by a holoacardium amorphous twin. A normal female fetus was also present. Various causes of elevated alpha-fetoprotein concentration in amnionic fluid are discussed.

Abnormalities, Severe Teratoid↗
PubMed1981

Management of pelvic endometriosis with low-dose danazol.

Thirty-eight women with pelvic endometriosis diagnosed by laparotomy or laparoscopy were enrolled in a double-blind study utilizing danazol. Danazol was administered for 6 months in four doses schedules: 600, 400, 200, and 100 mg/day. At the completion of 6 months of therapy, repeat laparoscopy was performed and 71% of the women were found to have improvement of pelvic endometriosis. Minimal and moderate pelvic endometriosis appeared to respond well to doses of danazol of less than 400 mg/day, whereas severe endometriosis appeared to be best treated with danazol doses of greater than 400 mg/day. Symptomatic relief of pain, dysmenorrhea, and dyspareunia occurred in 89% of the women. The over-all pregnancy rate in women attempting conception was 28% (8 of 28). Fifty-four per cent of the women had recurrence of symptoms within 1 year of discontinuation of danazol.

Adult↗