Serum gentamicin levels in postcesarean endomyometritis.
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Cesarean Section↗
Biomedical subjects
S Faro
Publications and source records attributed to S Faro.
Acute bacterial endocarditis in pregnancy. A report of three cases.
Acute bacterial endocarditis, a fulminating disorder most often caused by Staphylococcus aureus, is uncommon in pregnancy. However, the frequency of this disease may be increasing due to the prevalence of intravenous drug abuse. Three cases occurred during pregnancy at Charity Hospital, New Orleans; all three patients were intravenous drug abusers. One patient had polymicrobial disease.
Acute Disease↗
Piperacillin v Carbenicillin in the therapy for serious infections.
One hundred seven patients were treated with either piperacillin (56) or carbenicillin (51) in an open randomized trial of hospitalized patients with pleuropulmonary (40), urinary tract (26), gynecologic (21), skin and soft-tissue (eight), joint (five), bone (three), and miscellaneous other infections (four). Patients with urinary tract infections were given 150 mg/kg/day of piperacillin sodium or 200 mg/kg/day or carbenicillin sodium in divided doses every six hours intravenously. Patients with other infections were given 250 mg/kg/day of piperacillin sodium and 450 mg/kg/day of carbenicillin sodium; 53/56 (95%) patients treated with piperacillin and 45/51 (88%) patients treated with carbenicillin were cured clinically. In general, the drugs were well tolerated. There were, however, more adverse experiences in the groups taking carbenicillin. Of special interest was the finding of liver function test abnormalities in 17/78 (21%) carbenicillin recipients (evaluative and nonevaluative cases). We concluded that piperacillin was effective and safe. It has potential for use in a great variety of infections.
Adult↗
Phosphatidylglycerol and fetal lung maturity.
The lecithin/sphingomyelin (L/S) ratio has been reported to be inadequate as a predictor of fetal surfactant maturity in many complicated obstetric cases, particularly in patients with diabetes. L/S ratios are also unreliable when the sample contains blood or meconium. Phosphatidylglycerol (PG) is present only in amniotic fluid and respiratory tract effluent. PG may characterize surfactant maturity in samples of amniotic fluid contaminated with blood or meconium as well as specimens collected from the vagina in cases of premature rupture of membranes. Three hundred eleven samples of amniotic fluid collected from January, 1980, to June, 1981, were analyzed for L/S ratio and PG. This report analyses the ability of these tests to predict neonatal maturity in normal and complicated obstetric cases.
Amniotic Fluid↗
Haemophilus influenzae implicated in puerperal infection.
We have described two cases of Haemophilus influenzae isolation, one from a patient with chorioamnionitis and one from a patient with bacteremia and endomyometritis. The first patient responded to cefoxitin and delivery, while the second patient failed to improve satisfactorily with clindamycin and tobramycin therapy, but responded to ampicillin.
Adolescent↗
Moxalactam in the therapy of serious infections.
Sixty-seven patients were treated with moxalactam in a noncomparative trial of hospitalized patients; 32 had endometritis or chorioamnionitis, 12 had skin and soft tissue infections, 5 had osteomyelitis, 5 had pneumonia, 5 had urinary tract infections, 4 had arthritis, 2 had sepsis from an unknown source, 1 had endocarditis, and 1 had peritonitis. Bacteremia was present in 12 of these patients. Patients were given 3 to 12 g of moxalactam per day (mean, 6.24 g/day) in divided doses every 6 to 8 h. Seven patients were given intramuscular treatment for 3 to 20 days for part or all of their therapy. The rest were given intravenous treatment exclusively. Treatment was continued for 2 to 42 days (mean, 10 days). The dose and the duration of therapy were determined by the type of infection and the response of each patient. There were four treatment failures and one enterococcal-clostridial superinfection. Moxalactam was well tolerated. Allergic reactions led to the discontinuation of the antibiotic in three patients. Prolonged prothrombin and partial thromboplastin times were observed in 2 of 11 patients tested; in both instances in patients had severe underlying diseases, including malnutrition and alcoholism. Pain on intramuscular injection was noted in two patients receiving 1,500 mg, but not in five receiving a lower dose; in one case the pain forced the use of intravenous therapy after one dose, and in the other case the pain was mild and the patient was treated for 20 days. We concluded that moxalactam was effective in the treatment of the types of infections included in this study and produced few adverse reactions.
Bacterial Infections↗
Pulmonary ventilation during hemodialysis.
During hemodialysis a decrease in pulmonary ventilation has been reported. The elimination of CO2 across the dialyzer has been suggested as the cause of the pulmonary hypoventilation. Our purpose was to analyze the factors that could have influenced the pulmonary ventilation of 7 patients with chronic renal failure during hemodialysis, performed against an acetate dialysate with constant addition of CO2, bubbling into the dialysis bath. In spite of the large volume of CO2 mainly as bicarbonate, eliminated across the dialyzer there was no significant decrease of ventilation. The values of pH in the venous line were extremely low and the values of PvCO2 were artificially maintained around 35.0 mm Hg. Thus, the total CO2 delivered to the lungs, but mainly the levels of pH and PCO2 in the venous line play an important role in the control of pulmonary ventilation of these patients.
Bicarbonates↗
Use of single-agent antimicrobial therapy in the treatment of polymicrobial female pelvic infections.
One hundred twenty patients with either postpartum endomyometritis or postgynecologic surgical infections were treated either with ticarcillin, clindamycin, or chloramphenicol. One hundred nine (91%) responded successfully to single-agent antimicrobial therapy. Most of the infections were polymicrobial, involving both aerobic and anaerobic bacteria. Forty patients were treated with ticarcillin, with 90% responding successfully; 48 were treated with chloramphenicol, with 94% responding successfully; and 32 were treated with clindamycin, with 88% responding successfully. Single-agent antimicrobial therapy appears to be appropriate for treating polymicrobial obstetric and gynecologic soft tissue infections.
Adolescent↗
Pulmonary gas exchange and ventilation during hemodialysis.
Hemodialysis-induced hypoxemia has been explained by several mechanisms: pulmonary microembolization, decreased pulmonary diffusing capacity, fall in alveolar oxygen tension, hypoventilation and ventilation/perfusion abnormalities. The objective of this study was to analyze the factors influencing pulmonary ventilation and gas exchange of 20 patients with chronic renal failure during hemodialysis performed under the following conditions: Group 1 (9 patients) dialyzed against an acetate dialysate with a cuprophan membrane; Group 2 (7 patients) dialyzed against acetate bubbled with CO2 with a cuprophan membrane; Group 3 (4 patients) similar to Group 1, but using a polyacrylonitrile membrane. Arterial and venous blood samples were obtained from the respective lines during the predialysis period (zero), at 30, 60, 120 180 and 240 min of hemodialysis, and 60 min post dialysis (300 min) for the measurement of pH, PCO2, PO2, HCO-3 and total CO2. The minute expired volume (VE), expired fractions of O2 (FEO2) and CO2 (FECO2), O2 consumption (VO2), CO2 elimination through the lungs (VCO2) and dialyzer, respiratory exchange ratio (R), dead space to tidal volume ratio (VD/VT), alveolar ventilation (VA) and alveolar-arterial O2 difference (delta AaPO2) were measured and a leukocyte count was performed for each period of hemodialysis. The patients in Groups 1 and 3 showed a significant drop in ventilation and PaO2, a slight decrease in PAO2 and a significant increase in delta AaPO2. The patients in Groups 1 and 2 showed a significant leukopenia at 30 min of hemodialysis. The volume of CO2 eliminated across the dialyzer was very similar for the three groups of patients. Group 2 did not show any drop in ventilation or PaO2. For Group 2 venous line pH was very low and PCO2 was within the normal range, in contrast to the normal or high pH and low PCO2 shown by Groups 1 and 3. This study indicates that the drop in PaO2 was partially the consequence of a slight decrease in PAO2, but mainly due to the increase in delta AaPO2. Thus the most likely cause of the decrease in PaO2 was the VA/Q imbalance brought about by a drop in ventilation. The drop in ventilation was linked not only to the volume of CO2 eliminated across the dialyzer, but also to the amount of CO2 delivered to the lungs, and to the pH and PCO2 of the venous line.
Adult↗
Group B beta-hemolytic streptococci and puerperal infections.
Group B beta-hemolytic streptococci as a major cause of puerperal infection in 40 patients is described. Unique features of this bacterial infection are the development of an average peak oral temperature within 12 hours of delivery, tachycardia, distended abdomen, and endomyometritis or endomyoparametritis. Bacteremia occurred in 35% of these patients.
Adolescent↗
Amniotic fluid optical density: relationship to L:S ratio, phospholipid content, and desquamation of fetal cells.
The relationship between amniotic fluid optical density at 650 nm (OD650) and the lecithin:sphingomyelin (L:S) ratio was compared in 174 samples of amniotic fluid from 143 patients. An OD650 greater than 0.15 accurately predicted and L:S ratio greater than 2.0 with an overall reliability of 67.9%. There were 19.5% false-negative and 12.6% false-positive predictions. The OD650 was found to have close correlation with the number of fetal squames in suspension in amniotic fluid. Pure surfactant phospholipid standards were found to exhibit negligible absorbance at 650 mm. OD650 may be more closely related to fetal cutaneous maturity than to pulmonary surfactant content and bears only an indirect relationship with pulmonary preparedness for independent existence. The OD650 test does not appear to be sufficiently reliable and specific to replace phospholipid determination as a data phase upon which to make clinical decisions regarding fetal pulmonary surfactant maturity.
Amniotic Fluid↗
Group B streptococcus and puerperal sepsis.
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Adult↗
Amnionitis with intact amniotic membranes involving Streptobacillus moniliformis.
A 23-year-old black woman was admitted to the hospital in premature labor with intact amniotic membranes. The patient was afebrile and did not have any obvious signs of infection. Gram stain of the amniotic fluid, obtained via transabdominal amniocentesis, revealed the presence of gram-negative rods. The bacterium was identified as Streptobacillus moniliformis, the agent of rat-bite fever.
Adult↗
Sulbactam/ampicillin versus metronidazole/gentamicin in the treatment of post-cesarean section endometritis.
Sixty-seven patients diagnosed with post-cesarean-section endometritis were studied in a prospective comparative randomized trial of sulbactam/ampicillin, a new beta-lactamase inhibitor drug combination, versus treatment with metronidazole/gentamicin. The success rate was 91% for each antibiotic regimen. Mycoplasma spp. or Ureaplasma spp. were isolated from all treatment failures. Endometrial cultures revealed 2.3 aerobes as well as anaerobes per patient, with Enterococcus faecalis, Bacteroides bivius, and Escherichia coli the most frequently reported bacterial isolates in 64, 40, and 28% of all patients, respectively. Positive blood cultures were noted in 11 (15%) patients with Mycoplasma sp. the most commonly found isolate (45.5%). Sulbactam/ampicillin appears to be safe and equally effective as a metronidazole/aminoglycoside drug regimen in the treatment of postpartum endometritis.
Adult↗
Wound infections after cesarean section with Mycoplasma hominis and Ureaplasma urealyticum. A report of three cases.
Mycoplasma hominis and Ureaplasma urealyticum were isolated from the surgical wounds of three patients who developed endometritis and a wound infection after cesarean section. In all patients, aspiration of the incision yielded a cloudy serosanguinous exudate. Gram stain of the fluid revealed numerous white blood cells but no bacteria. All patients responded to antibiotic therapy and local wound care.
Adolescent↗
Imaging of pineal apoplexy.
The authors present 2 unusual cases of hemorrhagic pineal cysts. CT/MR imaging characteristics are shown.
Adolescent↗
Ticarcillin/clavulanate for treatment of postpartum endometritis.
Postpartum endometritis continues to be the leading cause of morbidity following cesarean section. This infection is commonly polymicrobial, involving aerobic, facultative, and obligate anaerobic gram-negative bacteria as well as gram-positive bacteria. The major risk factor for the development of post-cesarean section endometritis is duration of labor with ruptured amniotic membranes of greater than 6 hours. The most frequently utilized antibiotic regimen employed for treatment of postpartum endometritis is the combination of clindamycin and gentamicin. The combination ticarcillin/clavulanate has a spectrum of activity resembling that of clindamycin and gentamicin. In the data reported, cure rates among patients treated with ticarcillin/clavulanate were similar to the rates for those treated with clindamycin plus gentamicin as well as those for cefoxitin.
Cesarean Section↗
The polymicrobial etiology of acute pelvic inflammatory disease and treatment regimens.
Continued research on acute pelvic inflammatory disease (PID) has demonstrated that PID has a rather remarkably varied etiology, the pathogens responsible including Neisseria gonorrhoeae, Chlamydia trachomatis, aerobic and anaerobic gram-positive and gram-negative organisms, and possibly mycoplasmas. There is clearly no single antimicrobial agent that is effective against all of the organisms implicated in the etiology of acute PID. The aminoglycosides, generally in combination with an antibiotic such as clindamycin, are commonly used in the treatment of patients with acute PID. The combination of a new monocyclic beta-lactam antibiotic, aztreonam, and clindamycin may be less toxic and equally or more effective for the treatment of acute PID.
Anti-Bacterial Agents↗