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Biomedical subjects

P Duff

Publications and source records attributed to P Duff.

At least 127 records · Page 7Linked to original sources
PubMed1983

Acute intraamniotic infection due to Streptococcus pneumoniae.

In isolated instances, Streptococcus pneumoniae has been reported to be the cause of genital tract infection. In such cases, pelvic infection usually has occurred in association with a primary infection in the respiratory tract and a subsequent bacteremia. The authors describe 2 cases of acute intraamniotic infection due to the pneumococcus. Both cases occurred in the absence of any other site of infection. The potential serious complications of pneumococcal infection are emphasized.

Adult↗
PubMed1983

Serum gentamicin levels in patients with post-cesarean endomyometritis.

Serum gentamicin levels were measured by agar diffusion bioassay in 38 patients undergoing treatment with clindamycin-gentamicin for post-cesarean endomyometritis. Patients received intravenous gentamicin in a dose of 1 mg/kg actual body weight every eight hours. All trough levels were less than 1 microgram/ml. The mean 30-minute postinfusion level was 5.78 +/- 2.43 micrograms/ml (mean +/- SD). The range of postinfusion concentrations was 1 to 12 micrograms/ml. Postinfusion concentrations were less than 5 micrograms/ml in 13 patients, but none of these individuals experienced a clinical failure of antimicrobial therapy. There were no statistically significant differences in mean age, weight, hematocrit, serum creatinine, estimated creatinine clearance, or administered dose in patients with therapeutic gentamicin levels and patients with apparent subtherapeutic levels. The authors conclude that postinfusion gentamicin concentrations fluctuate widely in obstetric patients receiving 1 mg/kg/dose and that apparent subtherapeutic postinfusion levels still may be clinically efficacious, depending upon the antimicrobial susceptibility of the infecting microorganisms.

Adult↗
PubMed1982

A comparative study of two antibiotic regimens for the treatment of operative site infections.

This prospective study was designed to compare the relative efficacy of two antibiotic regimens for the treatment of operative site infections subsequent to pelvic operations. Patients with endomyoparametritis after delivery or pelvic cellulitis subsequent to hysterectomy were randomized to treatment with the combination of penicillin-gentamicin or the single agent cefoxitin. Seventeen of the 26 patients (65%) with endomyoparametritis who were treated with penicillin-gentamicin were cured by antibiotic therapy alone, in comparison to 15 of 23 (65%) patients treated with cefoxitin. Fifty-eight percent of the patients with pelvic cellulitis who were treated with penicillin-gentamicin responded favorably, in comparison to 50% of the patients treated with cefoxitin. None of these differences was statistically significant. In this study, neither antibiotic regimen provided satisfactory initial treatment for surgically induced soft tissue pelvic infection. Moreover, 11 of the 28 patients with treatment failures (40%) developed serious sequelae of their primary infection.

Bacterial Infections↗
PubMed1982

Antibiotic prophylaxis for abdominal hysterectomy.

Ninety-one patients were enrolled in a prospective randomized double-blind study evaluating the efficacy of systemic antibiotic prophylaxis in reducing the incidence of operative site infection after abdominal hysterectomy. Forty-five patients received a 2-dose course of cefoxitin; 46 patients received a placebo. Although patients in the antibiotic group had a lower fever index, there were no statistically significant differences between groups with respect to incidence of pelvic cellulitis, urinary tract infection, wound infection, need for therapeutic antibiotics, or duration of hospitalization. It is concluded that, in this patient population, the theoretic risks of widespread use of systemic antibiotics for prophylaxis outweigh the observed benefits.

Adult↗
PubMed1982

Antibiotic prophylaxis in low-risk cesarean section.

This prospective study was undertaken in an effort to evaluate the role of systemic antibiotic prophylaxis in elective abdominal delivery. Eighty-two patients undergoing elective cesarean section who were not in labor and who did not have ruptured membranes were assigned on a randomized, double-blind basis to receive a three-dose perioperative course of either placebo or ampicillin. Postoperatively, patients were evaluated for the development of infection-related complications. Patients in the antibiotic group experienced less febrile morbidity, had lower fever indices and developed fewer operative-site infections than did patients in the control group. No patient in either group, however, developed a potentially life-threatening infection, and all infected patients responded promptly to parenteral antibiotic therapy. Because of the limited morbidity associated with elective cesarean section in this patient population, it is concluded that the theoretical risks of antibiotic prophylaxis outweigh the expected benefits.

Ampicillin↗
PubMed1982

The pharmacokinetics of prophylactic antibiotics administered by intraoperative irrigation at the time of cesarean section.

Thirty patients at term undergoing cesarean section received intraoperative irrigation with either cefamandole, cephalothin, or ampicillin to prevent postoperative infection. Serum drug levels were measured at 15, 60 and 120 minutes after completion of irrigation. Serum levels at each sampling interval were highest for cefamandole and lowest for cephalothin. Les than 2% of the total drug dose was excreted in the urine during the first 2 postoperative hours. In most patients, maximum serum antibiotic concentrations exceeded minimal inhibitory concentrations for several recognized pelvic pathogens. It is concluded that the mechanism of action of intraoperative irrigation may in part be due to systemic absorption of antibiotic and not simply to a local effect on the endometrium. Moreover, the degree of systemic absorption may be sufficient to cause allergic drug reactions and to exert selective pressures for the emergence of drug-resistant microorganisms.

Adult↗
PubMed1981

Localized amniotic fluid embolism presenting as ovarian vein thrombosis and refractory postoperative fever.

Amniotic fluid embolism is a rare, usually fatal obstetric emergency. This is a case of a documented puerperal embolization presenting as an isolated thrombosis of the right ovarian vein. Neither the classic cardiopulmonary decompensation nor the defibrinogenation syndrome developed in our subject. To our knowledge, this is the first reported case of an isolated amniotic fluid embolism precipitating ovarian vein thrombosis. Differentiation from septic pelvic thrombophlebitis without histologic examination of an excised surgical specimen is impossible. Whereas surgical intervention is usually not required in most cases of septic pelvic vein thrombophlebitis, ovarian vein resection and unilateral adnexectomy were necessary in our patient.

Adult↗
PubMed1981

Diagnosis and management of face presentation.

Face presentation is an unusual complication of pregnancy; it occurs once in every 500 to 600 deliveries. Prematurity, fetal macrosomia, anencephaly, and cephalopelvic disproportion (CPD) are the major obstetric factors that predispose the fetus to face presentation. Although the mechanisms of labor in face presentation are different from those of simple vertex presentation, there is no consistent alteration in the duration of labor in the absence of underlying CPD. When disproportion does not exist and gross anomalies are not present, the prognosis for spontaneous vaginal delivery is excellent. The majority of perinatal losses reported in face presentation have resulted from traumatic operative vaginal deliveries, specifically version and extraction and midforceps rotations. Recent experience at this institution with a limited series of face presentations demonstrates that, with careful intrapartum surveillance, delivery can be accomplished with no increase in risk to either mother or fetus.

Delivery, Obstetric↗
PubMed1981

Mondor disease in pregnancy.

Mondor disease, or superficial thrombophlebitis of the breast, is an uncommon disorder that occurs only rarely in pregnant women. One such case is presented here followed by a review of the clinicopathologic features of the disease. Accurate diagnosis of Mondor disease is based almost entirely on careful physical examination of the breast, and no specific treatment is required. Its major clinical significance lies in the need to distinguish it from malignancy of the breast.

Adolescent↗
PubMed1980

Antibiotic prophylaxis in vaginal hysterectomy: a review.

Recent experimental studies in laboratory animals have elucidated the pathogenesis of operative site infections and have defined the mechanism by which prophylactic antibiotics enhance host defenses against infection. On the basis of these experimental observations, several investigators have conducted well-designed studies to evaluate the effectiveness of prophylactic antibiotics in reducing the risk of infection associated with vaginal hysterectomy. Without exception, these studies have demonstrated a dramatic decrease in the incidence of pelvic infections when antimicrobial agents are administered for a limited time in the perioperative period. To date, short courses of prophylactic antibiotics have not been shown to create selective pressures for the emergence of drug-resistant organisms or to lead to the development of more serious superinfections.

Animals↗
PubMed1980

Pathophysiology and management of septic shock.

Septic shock is an acute medical and surgical emergency with a devastating mortality rate. It may occur in both debilitated, immunosuppressed patients and young, healthy patients undergoing genitourinary instrumentation. This paper reviews the intricate pathophysiology of septic shock and presents a comprehensive plan for the management of this life-threatening illness.

Anti-Bacterial Agents↗