Biomedical subjects
Publications and source records attributed to J L Thomason.
Diamond's medium modified, the commercially available version of the Klaas modification of Diamond's medium, was compared to Kupferberg medium and to direct wet-mount examination for detection of trichomonads in symptomatic patients. Diamond's medium was found to be superior to both Kupferberg medium (P less than 10(-4) and wet mount (P less than 10(-6].
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Although not life-threatening, trichomoniasis is a major health problem, especially in women. It is transmitted sexually and has a very high incidence worldwide. We argue that Trichomonas vaginalis is not a commensal. Attempts should be made to identify this pathogen in all suspicious cases. Although culturing remains the most sensitive method to detect T vaginalis, newer methodologies such as monoclonal antibody fluorescent and direct staining make it possible to diagnose an infection with high sensitivity and specificity and to treat the patient at the same visit. Treatment is effective, approaching a 100% success rate when sexual consorts are also treated. Only by aggressive attempts to diagnose and treat this disease can we stop its spread.
Bacterial vaginosis is a disease that results from massive overgrowth of vaginal bacterial flora. The exact etiology is unknown. The major components of the normal bacterial flora, peroxide-producing lactobacilli, are replaced by non-peroxide-producing lactobacilli, allowing overgrowth of anaerobic and gram-negative aerobic flora. Anaerobic bacteria produce enzymes, aminopeptidases, that degrade protein and decarboxylases that convert amino acids and other compounds to amines. Those amines contribute to the signs and symptoms associated with the syndrome, raising the vaginal pH and producing a discharge odor. The excessive amounts of bacteria characteristic of the syndrome attach to epithelial cell surfaces, resulting in "clue" cells. Nearly half the patients report no noticeable symptoms, but many develop a characteristic copious, malodorous discharge within six months if untreated. Serious infectious sequelae are associated with bacterial vaginosis, including salpingitis, abscesses, endometritis and pelvic inflammatory disease. There is also a danger to pregnant women because of premature rupture of the membranes and premature labor. Clindamycin and metronidazole are considered effective therapy for the disease. Treatment of sexual partners remains controversial since sexual transmission has not been proven unequivocally.
Terconazole is the first of a new class of antifungal agents, the triazoles. The results of numerous European studies have demonstrated the efficacy and safety of this agent in both cream and suppository form in the treatment of vulvovaginal candidiasis. Recently, results of short- and long-term analyses in the United States confirmed the efficacy and safety of 0.4% terconazole cream and 80-mg terconazole suppositories. In short-term evaluations (eight to ten days after therapy), 0.4% terconazole cream was as effective as 2.0% miconazole nitrate cream and significantly superior microbiologically in one study. The clinical cure rates with terconazole cream ranged from 87.3% to 95.5% and the microbiologic cure rates, from 76.9% to 91.1%. Thirty- to 35-day microbiologic relapse rates with terconazole cream ranged from 10.4% to 22.2%. In the short-term evaluations of vaginal suppositories the cure rates of 80-mg terconazole suppositories for three days were comparable to those of 100-mg miconazole nitrate suppositories for seven days. The clinical cure rates with 80-mg terconazole suppositories ranged from 90.0% to 92.2% and the microbiologic cure rates, from 80.4% to 85.0%. The 30- to 35-day microbiologic relapse rates of the 80-mg terconazole suppositories ranged from 20.0% to 28.1%. Terconazole cream and suppositories demonstrated an excellent safety profile in all the studies; no life-threatening side effects occurred with any of the regimens. The frequency of common side effects was similar with terconazole and miconazole nitrate formulations.
A study was undertaken to determine which fermentation products in vaginal secretions serve as the best markers for bacterial vaginosis. Three categories of markers had been previously identified, but due to cost considerations it was necessary to accurately determine if analysis for all three were necessary. With the use of vaginal secretions from well-defined patient populations, we applied gas-liquid chromatography to test for both volatile and nonvolatile acid fermentation products. It was found that only the detection of nonvolatile acids was necessary, because no additional patients with bacterial vaginosis were identified by subsequent analysis of volatile acids. Routine analysis of volatile acids to identify patients with bacterial vaginosis is labor intensive and costly and had no clinical diagnostic value.
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Four methods for the detection of Trichomonas vaginalis in vaginal secretions from 88 symptomatic patients were compared: wet-mount examination, Kupferberg liquid medium, Hirsch charcoal agar, and the Papanicolaou smear. Hirsch diphasic slants and Kupferberg medium did not significantly differ in sensitivity from direct examination of wet mounts. The Papanicolaou smear identification of trichomonads was found to be the least sensitive method evaluated.
A 32-year-old women with essential thrombocythemia and a history of bleeding completed a full-term pregnancy. During pregnancy, the platelet count declined markedly to near-normal levels, but returned to prepregnancy levels within two weeks after delivery. The clinical course was uneventful, except for two brief episodes of vaginal bleeding during the second trimester. Possible etiologic mechanisms for pregnancy-related reduction of platelet levels in thrombocythemia include increased platelet consumption or down-regulation of platelet production by a placental or fetal factor.
Two biochemical indicators of bacterial vaginosis, proline aminopeptidase activity and gas-liquid chromatographic analysis, were compared. Five hundred women had their vaginal secretions tested for pH, presence of a positive amine test, levels of volatile and nonvolatile short-chain organic acids, and proline aminopeptidase activity. In addition, direct microscopic and Gram stain examinations were performed. Of the 500 women, 349 (70%) had some form of vaginitis. One hundred sixteen were diagnosed as having bacterial vaginosis, and 69 of these (59%) had Mobiluncus sp on either direct microscopic or Gram stain examination. Two hundred thirty-three had either mixed or other forms of vaginitis. One hundred fifty-one patients were normal. The sensitivity of the proline aminopeptidase assay was 83 and 79%, respectively, in patients having bacterial vaginosis with and without Mobiluncus morphotypes. In contrast, gas-liquid chromatography of short-chain organic acids had sensitivities of 71 and 30%, respectively. Specificity of both assays was about 95%. The greater sensitivity of the proline aminopeptidase assay, especially in patients without Mobiluncus morphotypes, proves its superiority.
The specific activity of guaiacol peroxidase was measured daily in human cervical mucus, vaginal fluids, and saliva during 45 cycles in 31 women. Also determined were basal body temperatures and serum hormones (luteinizing hormone [LH], estradiol, progesterone). The guaiacol peroxidase was extracted with 0.5 M CaCl2 and thus may be a different peroxidase from that obtained by noncalcium extraction procedures. The guaiacol peroxidase specific activity did not vary in the saliva during the cycle but fell sharply in the cervical mucus and vaginal fluid four to five days before the ovulation time, estimated by the LH peak, and rose again one to two days after ovulation. Anovulatory cycles did not show the midcycle drop in guaiacol peroxidase. Growth curve analysis gave excellent fitting of the guaiacol peroxidase data to a polynominal model. These data suggest that cervicovaginal guaiacol peroxidase may be clinically useful in detecting the fertile period for population control and for infertility treatment.
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A single ultrasonic determination of fetal weight in utero was made in 270 singleton pregnancies. Infants were divided by birth weights into two groups, less than and greater than the 50th percentile. Ultrasonically determined fetal weight correlated with birth weight (R2 greater than or equal to 0.52) beyond 33 weeks' gestation. Mean fetal weights measured by ultrasound at various stages of gestation correlated well with published values.
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The vaginal secretions of 20 normal control subjects and 21 patients with motile, curved anaerobic rods were cultured for aerobic and anaerobic bacteria, Chlamydia trachomatis, herpes simplex virus, and Trichomonas vaginalis. Extensive histories and physical examinations of the patients and microscopic appearance and gas-liquid chromatography patterns of vaginal secretions were compared between the two groups. The patients who had motile rods in their vaginal secretions more frequently presented with a history of complaints about foul-smelling discharge (18 [86%] of 21); discharge noted during physical examination at their introitus (15 [71%] of 21); a vaginal pH greater than 4.5 (21 [100%] of 21); and a highly specific microscopic appearance of their secretions. The secretions were characterized by the absence of lactobacilli, the presence of highly motile, curved bacilli, and an increased number of background bacteria when compared with normal patients. Patients had more frequent anaerobic isolates than did controls (P less than .001), with increased numbers of Peptococcus, Peptostreptococcus, Propionibacterium, and Bacteroides species. All patients with motile bacteria in their secretions met the criteria of the syndrome of nonspecific vaginosis that has been previously described.
A selective and differential agar for optimal growth of the large curved motile anaerobic rods isolated from patients having non-specific vaginosis (NSV) was developed. A basal medium of Columbia CNA agar was used with colony growth found to be optimal by the addition of 7% fetal calf serum and 5% rabbit blood (CNARS). Beta-Haemolysis was found to be demonstrated most readily on a bilayer plate with a basal layer consisting of CNA agar with fetal calf serum, overlaid with a layer of CNA agar containing fetal calf serum and rabbit blood. Optimal growth was found by anaerobic incubation at 37 degrees C, after 5 days.
Six patients with placenta previa complicated by premature labor underwent tocolysis with terbutaline sulfate. The average prolongation of pregnancy was 3.5 weeks. Five patients were at 31 weeks' gestation or more at the initiation of tocolytic therapy and had infants who survived and were greater than 2,000 gm at birth. All patients received an average blood transfusion of 6.7 units of packed cells each.
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