Biomedical subjects
Publications and source records attributed to S Faro.
A 32-year-old black woman presented in the emergency room with vaginal bleeding. Physical examination revealed a granulomatous lesion on the thigh and a breast abscess. Histopathologic examination and culture of an endometrial biopsy revealed Blastomyces dermatitidis. The breast abscess and thigh lesion were found to contain B. dermatitidis as well.
The efficacy of mezlocillin versus cefoxitin versus clindamycin plus gentamicin was evaluated in 152 patients with postpartum endometritis. There were no statistically significant differences in rate of cure among the three groups (87% with mezlocillin, 82% with cefoxitin, and 92% with clindamycin-gentamicin). There were no severe adverse reactions observed in any of the three treatment regimens. Mezlocillin is as safe and effective as cefoxitin and clindamycin-gentamicin for treatment of postpartum endometritis.
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Forty-two patients with acute pelvic inflammatory disease were treated using aztreonam, a monobactam, and clindamycin. Sixty-four percent of protocol patients were culture positive for Neisseria gonorrhoeae, and 26% had positive endometrial cultures for other organisms. Fifty-one percent of patients had ultrasound findings consistent with a pelvic abscess. One patient with a tuboovarian abscess palpable to the umbilicus became afebrile and improved on treatment, but ultimately was treated surgically. All other protocol patients responded rapidly to the aztreonam-clindamycin regime, giving a 97.7% cure rate.
One hundred duplicate endocervical specimens from obstetrical and gynecological patients were cultured for Mycoplasma spp. and Ureaplasma urealyticum. Rates of recovery of these organisms from commercially prepared A7 medium and the Mycotrim-GU system were compared. We detected 14 (93%) of the total 15 isolates of Mycoplasma spp. on A7 plates and 11 (73%) in the Mycotrim-GU system. We detected 34 (89%) of the total 38 isolates of U. urealyticum on A7 plates and 32 (84%) in the Mycotrim-GU system. The times of detection for both types of organism were similar in the two systems. We conclude that cultivation on A7 medium as described is a more cost-effective method of recovery of Mycoplasma spp. and U. urealyticum than the Mycotrim-GU system.
A randomized, double-blind, multicenter trial was initiated to compare the safety and efficacy of piperacillin, cephalothin and cefoxitin in the prophylactic treatment of patients undergoing vaginal hysterectomy. The total dose of each antibiotic was 6 grams given in three equally divided doses. A satisfactory prophylactic response was obtained in 143 of 151 (95 per cent) patients treated with piperacillin, in 82 of 87 (94 per cent) patients treated with cephalothin and in 57 of 60 (95 per cent) patients treated with cefoxitin. The pooled data indicated that the piperacillin treatment group did not differ from the combined cephalosporin treatment groups with respect to prophylactic response, presence of febrile morbidity, fever index, duration of postoperative hospitalization and incidence of reported adverse experiences.
Four cases of amnionitis due to Lactobacillus sp and three cases of bacteremia are reported. Postpartum endometritis developed in all four cases. Lactobacillus bacteremia occurred in two infants. A review of the literature on serious infections due to Lactobacillus sp is also presented. The importance of considering the clinical role of any microorganism isolated in pure culture from symptomatic patients is discussed.
Disseminated herpes simplex virus infection in a pregnant woman was successfully treated with acyclovir. Similar reported cases have suggested that acyclovir may be suitable for the treatment of disseminated or severe primary herpes in pregnant women.
Ninety-three female patients with post-cesarean endometritis, post-hysterectomy pelvic cellulitis, and other miscellaneous moderately severe pelvic soft-tissue infections were treated in a randomized fashion with either ticarcillin plus clavulanic acid or cefoxitin. Of the 47 patients treated with ticarcillin plus clavulanic acid, 38 had clinical cures, four showed improvement, therapy failed in three, and two were nonevaluable, for a failure rate of 6.7 percent. Of the 46 patients treated with cefoxitin, 33 had clinical cures, five showed improvement, therapy failed in seven, and one was nonevaluable, for a failure rate of 15.6 percent. Bacteriologically, the addition of clavulanic acid to ticarcillin was found to broaden the antibacterial spectrum to include some Escherichia coli, most Klebsiella, many coagulase-negative staphylococci, and all isolates of Staphylococcus aureus. Adverse reactions were few, with only one patient having therapy with cefoxitin discontinued because of side effects. It is concluded that ticarcillin plus clavulanic acid is quite suitable for antibiotic therapy of female pelvic soft-tissue infection, based on the (expanded) coverage of both aerobic and anaerobic bacterial species.
Soft tissue female pelvic infections, that is, postpartum endomyometritis, pelvic cellulitis, and salpingitis, are frequently polymicrobial, involving aerobic and anaerobic bacteria. The most common antibiotic regimen employed for the treatment of these patients is clindamycin and an aminoglycoside. Single-agent therapy, utilizing the newer beta-lactams, is more economical, potentially less toxic, and as effective.
A total of 442 specimens from various anatomic sites was cultured for herpes simplex virus during the past 2 years. Most specimens were obtained from the respiratory tracts and cutaneous lesions of immunocompromised hosts (232 specimens) or the female genital tract (138 specimens). Two tubes containing human newborn foreskin fibroblasts and two Ortho Cultureset tubes containing Vero cells were inoculated with each specimen. The 384 inoculated specimens were stained with Cultureset peroxidase-antiperoxidase reagents within 48 h and again at 3, 4, or 5 days if initially negative. Fibroblasts were inspected for cytopathic effect for 7 days. Of these 384 specimens, Cultureset detected 57 of 62 positive specimens within 48 h; fibroblasts detected 58 positive specimens by 7 days. The calculated sensitivity and specificity for Cultureset at 48 h were 91.9 and 100%, respectively. However, when all results were considered, including those that became positive in Cultureset after 48 h, the calculated sensitivity and specificity for Cultureset were 98.8 and 100%, respectively. We conclude that Cultureset is a reliable method for detection of herpes simplex virus when two tubes are inoculated and stained as described.
The elimination of CO2 across the dialyzer has been reported as the cause of pulmonary hypoventilation during hemodialysis. There are some evidences that the venous line blood composition could influence the central venous blood and this one the pulmonary ventilation. Our purpose was to analyze (1) the influence of the changes in composition of the venous line blood on the central venous blood and (2) the possible role of the central venous blood composition on the pulmonary ventilation of 10 chronic renal failure patients during hemodialysis performed twice in the same patients in two different conditions: acetate dialysate without (condition I) and with (condition II) constant addition of 100% CO2 bubbling into the dialysis bath. During condition I the venous line blood pH was kept in a normal range, and the PCO2 was low, whereas during condition II the pH was very low and the PCO2 extremely high. The patients during condition I decreased their pulmonary ventilation and lost CO2 across the dialyzer as the central venous blood pH and HCO3- increased, and PCO2 did not change. The same patients during condition II increased their pulmonary ventilation and absorbed CO2 across the dialyser as the central venous blood pH decreased and PCO2 increased. Thus, the venous line blood has influence on the central venous blood composition, and this plays a role on the control of pulmonary ventilation of these patients.
The incidence of G6PD deficiency in red blood cells of 241 Sicilian cataractous patients (138 males and 103 females) and in the lens of 32 subjects (15 males and 17 females) of the same group was evaluated. The incidence of G6PD deficiency was significantly higher than expected (p less than 0.001), both in RBCs and in lens. The results suggest that G6PD deficiency is a risk factor for cataract both in hemizygous males and heterozygous females.
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Chlamydia trachomatis is found worldwide and is probably the most common sexually transmitted disease, infecting both females and males, adults as well as children. The organism is responsible for a variety of infections in women--urethral syndrome, cervicitis, endometritis and salpingitis. C. trachomatis may colonize the lower genital tract and result in asymptomatic infection, ultimately resulting in sterility. In addition, infection of the female genital tract during pregnancy may result in spontaneous abortion, premature labor, postpartum endometritis, neonatal conjunctivitis or pneumonia.
A short-term course of an intravenous cephalosporin (cefuroxime) was used as therapy in 24 cases of pyelonephritis due to susceptible organisms in 23 pregnant women. Clinical cure was achieved in 96% of patients, and there were no adverse reactions to the drug. Bacteriologic cure was documented in 52% of those clinical cures, whereas 26% were considered to have bacterial colonization. However, 50% of those patients with bacteriologic cure subsequently had bacteriuria or pyelonephritis caused by other organisms. We conclude that women who have pyelonephritis in pregnancy are at high risk for subsequent urinary tract disease, even if adequately treated for their index infection. Short-term parenteral antibiotic therapy, followed by long-term oral suppressive therapy, is probably the treatment of choice for pyelonephritis complicating pregnancy.
MICs were determined for 218 clinical isolates of Bacteroides by a broth microdilution method. Imipenem was the most active antibiotic tested. Azlocillin, mezlocillin, and cefoxitin had comparable activities, with resistance among members of the B. fragilis group and B. capillosus. Ceftizoxime was the most active cephalosporin tested. Members of the B. fragilis group showed high levels of resistance to cefotetan and ceftazidime. Resistance to penicillin G varied from 0 to 14%.
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