Biomedical subjects
Publications and source records attributed to L E Phillips.
Two patients with chorioamnionitis due to Gardnerella vaginalis are described. Institution of tocolytic therapy for preterm labor is associated with maternal complications of septic hypotension and pulmonary edema in one patient. Diagnostic modalities, specifically culturing techniques, are discussed, as well as suspected pathophysiologic mechanisms.
Explore the source record for details and available documents.
Vaginitis is a complex syndrome that is probably the most common outpatient disease seen by the gynaecologist. The specific aetiologies of vaginitis are many. One of the most common entities, however, is "non-specific vaginitis" which can be subdivided into: Gardnerella vaginitis, anaerobic vaginosis, and vaginitis of undetermined aetiology. The role of Gardnerella as a causative agent for vaginitis has been studied in depth but its specific role remains controversial. Anaerobic vaginosis can be diagnosed by noting on microscopic examination the presence of clue cells, free-floating bacteria and numerous white blood cells (WBC's). Culturing an aliquot of the vaginal discharge reveals a high number of anaerobes. In addition, this condition responds to antibiotics effective against anaerobes, e.g., metronidazole. Vaginitis of undetermined aetiology is more complex and is characterized by a purulent vaginal discharge, a pH of 4.0-4.6, numerous WBC's, and a high concentration of bacteria. The microbiology of this vaginitis includes many facultative Gram-negative rods and Gram-positive cocci. Anaerobes may be present but do not make up a large component of the endogenous microflora. This condition does not respond to the usual antibiotic therapies employed in treating bacterial vaginitis. Since this condition appears to be primarily an inflammatory reaction, it may be responsive to topical antiinflammatory agents such as benzydamine.
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.
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.
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.
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.
Seroreactivity of sera from 109 patients with first-infection primary syphilis was 98.2% in the fluorescent treponemal antibody absorption test, 92.7% in the rapid plasma reagin 18-mm circle card test, 72.5% in the microhemagglutination test (MHA-TP), and 72.5% in the Venereal Disease Research Laboratory test. Seroreactivity of sera from 18 patients with primary syphilis with documented previous infection(s) was 100% in the fluorescent treponemal antibody absorption test, the rapid plasma reagin 18-mm circle card test, and the MHA-TP test and 88.9% in the Venereal Disease Research Laboratory test. The MHA-TP test failed to confirm reactivity in 13 of 79 sera which were reactive in the Venereal Disease Research Laboratory test and in 24 of 101 sera which were reactive in the rapid plasma reagin 18-mm circle card test. Testing another production lot of MHA-TP reagents resulted in even poorer correlation. The reactivity of the MHA-TP test in primary syphilis appeared to vary with the sensitivity of the production lot of reagents.
The effects of cefamandole and cefoxitin on the assays of serum containing gentamicin, tobramycin, or amikacin by the BACTEC 460 (Johnston Laboratories, Cockeysville, Md.) were studied. The results were analyzed to determine whether the presence of the test substances, cefamandole or cefoxitin, caused a statistically different mean value of aminoglycoside or increase in variance as compared with serum assayed in their absence. The results were then considered in light of medical significance to see whether the difference observed would have any real effect on patient care. The results of each analyses dictate that serum of patients treated with both amikacin and cefamandole be tested in triplicate.
Explore the source record for details and available documents.
Serum tobramycin levels of synthetic and patient specimens were determined by the Bactec 460. The results were compared with those obtained from the same specimens by radioimmunoassay. These studies suggest that assays performed by either method should be run in duplicate or triplicate to achieve maximum accuracy. The studies also suggest that results obtained by the Bactec method are at least as reliable as those obtained by the radioimmunoassay method.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The rapid expansion of continuing education within the professions has evolved with little continuity and structure, a fact which impedes the professional's ability to develop a long-range plan of continued professional development. A major weakness stems from society's lack of uniform standards to measure and certify continuing education. A new unit of measure, the continuing education unit (CEU), has been developed as a voluntary national effort for a uniform unit of measure for noncredit continuing education, which will both quantify programs and ensure a reasonable degree of program quality. Effective implementation and use of the CEU requires consumers of continuing education to assume a greater role in program planning and development in conjunction with program producers. The CEU provides a valuable tool for the professions to effectively use continuing education; however, improved competency requires more than the mere accumulation of CEU.
Explore the source record for details and available documents.
A study of the temporal relationship between the appearance of phenoloxidase activity and the formation of fruiting bodies in Schizophyllum commune was undertaken. The results indicate that phenoloxidase activity increases in colonies subsequent to the formation of aggregate masses of hyphae, continues to increase until mature, sporulating fruiting structures are produced, and then declines significantly.