Biomedical subjects
P C Sacks
Publications and source records attributed to P C Sacks.
Hematometra associated with estrogen replacement therapy.
We have described two cases of hematometra occurring after initiation of estrogen replacement therapy. In both cases, cervical stenosis had developed during a prolonged period of hypoestrogenism. After initiation of sequential estrogen/progestin therapy, the stenosis prevented menstrual flow, and sonography revealed an asymptomatic hematometra in both cases. Based on these cases, we recommend doing a baseline evaluation of cervical patency before initiating estrogen replacement therapy in women who have been menopausal for a substantial length of time.
Disseminated intravascular coagulation, hemolytic anemia, and acute renal failure associated with extensive multiple myomectomy.
Disseminated intravascular coagulation (DIC) and acute renal failure are uncommon complications of multiple myomectomy. We report a case of DIC, microangiopathic hemolytic anemia, myoglobinemia, and acute renal failure following the removal of 52 uterine fibroids. We postulate that extensive myometrial dissection and the administration of hetastarch favored the development of DIC and microangiopathic hemolytic anemia. Acute renal failure ensued, necessitating hemodialysis. Proposed mechanisms and recommendations for future prevention are discussed.
Incidence of bacteremia at dilation and curettage.
The American Heart Association does not recommend prophylactic antibiotics for patients undergoing dilation and curettage (D & C) except in the case of septic abortion or the presence of prosthetic valves. This recommendation is based on a retrospective analysis of case reports of infectious complications of D & C. To date we are unaware of prospective studies that answer this question. At a community hospital we studied 20 patients undergoing D & C for noninfectious indications. Aerobic and anaerobic blood cultures were performed before and during the D & C. All baseline cultures were negative. In one patient we were able to isolate Lactobacillus after the D & C, thus finding a 5% incidence of bacteremia. That places D & C in the same risk category as other diagnostic procedures considered low risk in the pathogenesis of subacute bacterial endocarditis. Our study thus validated the recommendations made by the American Heart Association.
Telomeric association: another characteristic of cancer chromosomes?
Telomeric associations between single chromatids and double chromatids of nonhomologous normal human chromosomes and altered markers were observed in two morphologically distinct squamous-cell carcinoma lines derived from a surgical specimen. Chromosomes 2, 3, 5, and 16 were associated by their telomeric ends more frequently than other chromosomes.
Infectious complications of intrauterine insemination: a case report and literature review.
Intrauterine insemination is commonly performed in the treatment of infertility. Infectious complications associated with intrauterine insemination are frequently cited, though rarely reported. A review of the literature yields only five reported cases of pelvic infections subsequent to intrauterine insemination (IUI), and only two of these show firm evidence of infection, with none presenting bacteriologic confirmation. We report a case of Escherichia coli septicemia subsequent to an IUI performed on a patient with a large adenomyoma. Of 147 patients treated with IUI at Georgetown University from November 1987 through March 1990, this was the only infectious complication. The incidence of infectious complications in our series is thus 0.0068 (6.8 per 1,000 women). A review of infectious complications in 38 reported series on intrauterine inseminations reveals five infections in 3,129 patients. With the addition of our series to the literature, the prevalence of infectious complications is 1.83 per 1,000 women undergoing IUI. The rates were not significantly altered by semen washing with antibiotics, or the administration of prophylactic antibiotics to the woman (P = .81). We conclude that (1) the infection rate following IUI is small, (2) many of the infections subsequent to insemination were not associated with intrauterine insemination, (3) most reported cases of infection fail to show evidence for the actual presence of infection, and (4) the prevalence is unaltered by the administration of prophylactic antibiotics or washing the semen sample with antibiotics.