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Biomedical subjects

M R Spence

Publications and source records attributed to M R Spence.

At least 37 records · Page 2Linked to original sources
PubMed1988

Monoclonal-antibody-based enzyme-linked immunosorbent assay for Trichomonas vaginalis.

Trichomonas vaginalis is estimated to infect 4 million women per year in the United States. The diagnosis of trichomoniasis is predominantly achieved by direct microscopic examination of vaginal exudates. This subjective diagnostic procedure is reported to be 75% sensitive under ideal circumstances. We have developed an enzyme-linked immunosorbent assay (ELISA) for the detection of T. vaginalis directly from vaginal exudates. The ELISA employs a monoclonal antibody specific for a 65-kilodalton surface polypeptide of T. vaginalis as the capture antibody in a sandwich format. A polyclonal rabbit anti-T. vaginalis antibody labeled with horseradish peroxidase serves as the probe. An evaluation of vaginal specimens from women attending clinics revealed a sensitivity and specificity of the ELISA of 89 and 97%, respectively, versus the culture technique. These results indicate the usefulness of this ELISA as an alternative to microscopic and culture methods for the detection of T. vaginalis in vaginal exudates.

Animals↗
PubMed1987

Detection of Chlamydia trachomatis cervical infection: a comparison of Papanicolaou and immunofluorescent staining with cell culture.

We compared tissue culture with Papanicolaou-stained cervical smears, endocervical cytologic smears stained with immunofluorescent monoclonal antibody, and a direct immunofluorescent stain of cervical specimens (MicroTrak) for detection of Chlamydia trachomatis in cervical specimens. Fifty-one (21%) of 245 women had positive cultures for C. trachomatis, 14 (27%) of whom had clinical evidence of cervicitis. With the criteria of intracytoplasmic coccoid inclusion bodies within metaplastic cells, 45 (34%) of 130 Papanicolaou smears were read as suggestive for C. trachomatis. Seventeen of the 45 positive Papanicolaou smears were positive on culture and 28 were negative (sensitivity 54%, specificity 71%). In contrast, 48 of 51 women with positive cultures and one woman with a negative culture had positive immunofluorescent-stained cytologic smears (sensitivity 94%, specificity 99%, with positive predictive value of 98%). Similarly, 47 of 51 women with positive cultures also had positive results with MicroTrak direct immunofluorescent stain, with only one positive specimen in 196 women with negative cultures (sensitivity 92%, specificity 99%, with positive predictive value of 98%). This study demonstrates that immunofluorescent staining of cervical specimens or of cytologic smears is a more sensitive and specific method than routine Papanicolaou smear for detection of chlamydia infection in a high-prevalence population.

Adolescent↗
PubMed1986

Recurrent bilateral renal agenesis.

Bilateral renal agenesis is usually a sporadic occurrence; recurrence in the same family is rare. A case of recurrent bilateral renal agenesis is presented.

Adult↗
PubMed1986

A correlative study of Papanicolaou smear, fluorescent antibody, and culture for the diagnosis of Chlamydia trachomatis.

A prospective study of 300 patients undergoing therapeutic termination of pregnancy was conducted. A Papanicolaou smear was obtained and a clinical evaluation of the cervix was made. Specimens from the cervix were examined by both direct fluorescent antibody and culture techniques for the presence of Chlamydia trachomatis. The presence of inflammation on Papanicolaou smear could be correlated with C trachomatis isolation. Papanicolaou smear findings consistent with C trachomatis lacked both sensitivity and specificity when compared with direct fluorescent antibody and/or culture techniques. A correlation was found between the clinical diagnosis of cervicitis and C trachomatis. This interrelationship was absent when the component findings of cervicitis (ectopy, friability, and purulent mucus) were examined independently.

Adolescent↗
PubMed1986

Postabortal endometritis and isolation of Chlamydia trachomatis.

A prospective study of 505 unselected women presenting for induced abortion was undertaken to determine the prevalence of Chlamydia trachomatis and to determine if cervical isolation of C trachomatis before abortion increases the risk of postabortal endometritis. A comparison of direct fluorescent antibody (slide) test with tissue culture for diagnosing C trachomatis infection also was evaluated in this population. C trachomatis was identified by culture in 89 patients (17.6%) and by direct slide test in 85 patients (16.8%). Six of 17 patients with postabortal endometritis were culture positive for C trachomatis, with a significant correlation between C trachomatis infection and development of endometritis observed (P less than .05). These data suggest C trachomatis may play an important role in postabortal endometritis.

Abortion, Induced↗
PubMed1985

High failure rates in outpatient treatment of salpingitis with either tetracycline alone or penicillin/ampicillin combination.

Eight hundred twenty-five ambulatory women with a clinical diagnosis of salpingitis were randomized to a 10-day course of either penicillin/ampicillin or tetracycline. Forty-four percent of women had gonococcal salpingitis and 56% nongonococcal salpingitis. Overall, both regimens cured equal proportions of women: At 30 days, 81% were cured by penicillin/ampicillin and 82% by tetracycline. However, the proportion of women with gonococcal salpingitis cured by 30 days was significantly greater than that of women with nongonococcal salpingitis. By 30 days, 14% of women with gonococcal salpingitis and 21% of women with nongonococcal salpingitis were not cured by either regimen. These data suggest that both regimens were only marginally acceptable for women with gonococcal salpingitis and that neither regimen was acceptable for nongonococcal salpingitis.

Adolescent↗
PubMed1985

Geographic variation among isolates of Trichomonas vaginalis: demonstration of antigenic heterogeneity by using monoclonal antibodies and the indirect immunofluorescence technique.

Although Trichomonas vaginalis causes one of the most common sexually transmitted diseases, little is known about the antigenic variation of the parasite or about differences between strains in epidemiology or virulence. Variation among isolates of T. vaginalis was investigated by using a panel of monoclonal antibodies, each reactive with different antigens, to test 88 isolates from diverse geographic areas of North America. All isolates of T. vaginalis reacted with at least one of the nine monoclonal antibodies; the individual antibodies reacted with 22%-76% of the isolates. A pool of two broadly reactive antibodies identified all isolates in the study. Four of the most narrowly reactive, or "specific," antibodies demonstrated differences in the antigenic composition of trichomonads isolated from patients in Seattle, Baltimore, and Brooklyn, New York (P less than .005 by chi 2 test). Application of these and other monoclonal antibody probes may facilitate epidemiological studies and provide rapid, reliable methods for direct diagnosis of trichomonads in clinical specimens.

Animals↗
PubMed1984

Prevalence of six sexually transmitted disease agents among pregnant inner-city adolescents and pregnancy outcome.

115 pregnant girls aged 13-17 years were investigated during the third trimester for endocervical infection with six sexually transmissible microorganisms. Specimens from 21 patients destroyed the tissue cell monolayers for propagation of Chlamydia trachomatis, but 11 were no longer toxic when recultured after freezing or with additional antimicrobial agents; Trichomonas vaginalis was present in 76% of the toxic specimens. C trachomatis was recovered from 37% of 105 specimens. T vaginalis was recovered from 34% of the 115 subjects, candida from 38%, Mycoplasma hominis from 70%, and Ureaplasma urealyticum from 90%. Neisseria gonorrhoeae was cultured from 1 of 12 girls infected earlier in pregnancy. T vaginalis infection, alone or with C trachomatis or candida, was associated with low gestational age and low birthweight. C trachomatis and candida infections alone had no effect on pregnancy outcome.

Adolescent↗
PubMed1984

Diagnosis of Chlamydia trachomatis infections by direct immunofluorescence staining of genital secretions. A multicenter trial.

Because few clinicians have access to laboratories offering cell culture confirmation of suspected Chlamydia trachomatis genital infections, we evaluated a diagnostic method in which fluorescein-conjugated monoclonal antibodies were used to directly identify C. trachomatis elementary bodies in slides made from genital secretions. Compared with culture results, the direct smear had a sensitivity of 92% and a specificity of 96% in 576 men, most of whom had symptoms and signs of urethritis. Among 595 women attending the same clinics, sensitivity of the direct smear for cervical infection was 89% and specificity was 99%. In 225 pregnant women screened in a prenatal or abortion clinic, the sensitivity and specificity of the test were 86% and 99% respectively. Direct detection of elementary bodies in genital smears offers an alternative diagnostic approach for C. trachomatis infections.

Bacteriological Techniques↗
PubMed1984

Risk factors in the development of cesarean section infection.

Fifty consecutive patients undergoing cesarean section were evaluated prospectively. A data collection form was developed and 113 variables relating to demographic features, antepartum care, intrapartum events and postpartum course were evaluated. All of the patients were seen and evaluated within 24 hours of delivery and all forms were completed when the patients were discharged from the hospital. Twenty-five of the 50 patients had postpartum febrile morbidity develop. There were 14 instances of endometritis; five, wound infections; two, urinary tract infections; two, upper respiratory tract infections; three pulmonary infections; one patient with phlebitis, and two with febrile morbidity and no apparent source. Factors significantly associated with an increased risk of developing febrile morbidity included antepartum infections, resident staff as primary surgeon, extension of the uterine incision and positive endometrial culture at the time of the operation. Patients undergoing elective repeat cesarean section had less febrile morbidity than others (p less than 0.025). Statistically significant differences between the two groups were not found for the variables obesity, anemia, rupture of membranes, number of pelvic examinations, fetal monitoring, fetal tachycardia, general anesthesia and skin preparation. Operative blood loss was greater in the patients having febrile morbidity develop, but this difference was not statistically significant.

Adult↗
PubMed1984

Pathogenicity of Trichomonas vaginalis: cytopathologic and histopathologic changes of the cervical epithelium.

Virulence of 52 Trichomonas vaginalis isolates was estimated by the subcutaneous mouse assay. A positive linear relationship was found between the mean volumes of subcutaneous abscesses caused by the parasites in mice and severity of cervical epithelial abnormalities observed in the patients from whom these strains had been isolated. This relationship implies that virulence of the human urogenital trichomonad, as measured by the mouse assay, may be related to some factors associated with dysplastic changes in the cervical epithelium. No relationships appeared to exist between the results of the mouse assay and inflammation of the vagina and cervix as evaluated clinically or pathologically, although these data were not analyzed statistically; likewise, no relationships were found between the mouse assay and nonprotozoal microorganisms identified in donors of the trichomonad strains.

Abscess↗
PubMed1983

A prospective randomized study of doxycycline as a prophylactic antibiotic in patients undergoing radical hysterectomy.

A prospective randomized study was undertaken to evaluate doxycycline as a prophylactic antibiotic in patients undergoing radical abdominal hysterectomy and pelvic lymphadenectomy. Although 69 patients were initially randomized, 64 patients (34 study, 30 control) are the basis of this report: 5 patients were omitted because large pelvic lymph nodes positive for tumor were found at laparotomy and radical hysterectomy was abandoned. The two study groups were similar in both preoperative and operative risk factors. There was a statistically significant reduction in the 7- and 14- day febrile index in the doxycycline group. The rate of cuff and/or pelvic cellulitis was 2.3 times higher in the control group. Thus, single-dose doxycycline as a prophylactic antibiotic reduced both febrile morbidity and the rate of serious infections in the radical hysterectomy patient.

Adult↗
PubMed1983

Medical and psychosocial aspects of gonococcal infection in the adolescent patient: epidemiology, diagnosis, and treatment.

Gonorrhea has reached epidemic proportions and poses a significant health problem for teenagers. The attitudes and behavior of adolescents play a major role in the increase of gonococcal infection, interacting with characteristics of the disease and public health issues. Controlling gonorrhea among teenagers thus requires attending to the medical and psychosocial issues. Accurate diagnosis is dependent, in part, on eliciting a valid sexual history. Selection of a laboratory protocol should reflect not only the sensitivity and specificity of a test but its acceptability to teenagers. Similarly, there is no longer a single "drug of choice" for treatment. Patient acceptability, potential for noncompliance, toxicity, cost, jeopardy to other uses, and possible coexistent infection are factors to be considered in addition to efficacy. Finally, medication is only part of the treatment plan, which includes sexual abstinence, therapy for sexual partners, and returning for a test of cure. Compliance with the entire treatment plan can often be enhanced by maximizing communication and rapport with the adolescent.

Adolescent↗
PubMed1983

Gonorrhea.

The gonococcus has become an extremely important organism in obstetrics and gynecology. It is associated with a wide array of clinical syndromes that frequently confront the practitioner. The diagnostic modalities available are many and are rapidly increasing. Therapy likewise is becoming complex as we learn more about the infections associated with this microbe. The basic principles of care still include a high index of suspicion of infection; clinical evaluation of the potentially infected patients; laboratory support of the clinical diagnosis; specifically directed antimicrobial therapy of adequate dosage and duration; treatment of sexual partners; and follow-up test-of-cure evaluation in all patients.

Adolescent↗