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Biomedical subjects

L Weström

Publications and source records attributed to L Weström.

At least 19 recordsLinked to original sources
PubMed2003

Diagnosis of pelvic inflammatory disease: time for a rethink.

OBJECTIVES: To critically evaluate the available evidence base concerned with the diagnosis of pelvic inflammatory disease (PID) based on clinical presentation, and to investigate the relation between signs and symptoms and the presence of laparoscopically diagnosed PID using the largest available dataset. METHODS: The evidence base was critically evaluated and data collected by Lund University between 1960 and 1969 were used to compare clinical presentation with the results of laparoscopic investigation. Three techniques were used in this investigation-sensitivity and specificity, likelihood ratios, and discriminant analysis. RESULTS: None of the variables (abnormal vaginal discharge, fever >38 degrees C, vomiting, menstrual irregularity, ongoing bleeding, symptoms of urethritis, rectal temperature >38 degrees C, marked tenderness of pelvic organs on bimanual examination, adnexal mass, and erythrocyte sedimentation rate >or=15 mm in the first hour) had both high specificity and sensitivity-most had low specificity and sensitivity. There was little variation in either the likelihood ratios or the post-test probabilities between the variables. The lowest likelihood ratio (0.97) produced a post-test probability of 78% (95% CI: 74% to 81%) whereas the highest (1.73) had a post-test probability of 84% (95% CI: 81% to 87%). The pretest probability of having PID based on the presence of lower abdominal pain was 79% (95% CI: 76% to 82%). The discriminant analysis indicated that three variables significantly influenced the prediction of the presence of PID: erythrocyte sedimentation rate (p<0.0001), fever (p<0.0001), and adnexal tenderness (p<0.0001). These variables correctly classified 65% of patients with laparoscopically diagnosed PID (95% CI: 61% to 69%). CONCLUSION: There is insufficient evidence to support existing diagnostic criteria, which have been based on a combination of empirical data and expert opinion. A new evidence base is urgently needed but this will require either a new investigation of the association between clinical presentation and PID based on a laparoscopic "gold standard" or the development of new diagnostic techniques.

Blood Sedimentation↗
PubMed1991

Treatment of candidal vaginitis. A prospective randomized investigator-blind multicenter study comparing topically applied econazole with oral fluconazole.

Two hundred and thirty-five women with clinically and microbiologically proven candidal vaginitis were randomly allocated for treatment with either one topically applied vaginal tablet of 150 mg econazole (114 women) or one orally administered capsule of 150 mg fluconazole (121 women). The women returned for follow-up visits 7-10, 28-35, and 80-100 days after the recruitment visit. Women with clinical and/or mycological failures and/or a recurrence were successively excluded from the follow-up. At the 28-35-day follow-up visit, the women treated with fluconazole had a significantly higher clinical/microbiological cure rate than those given econazole (P = 0.022; Fisher's exact 2-tail test). No significant such differences were observed at the 7-10 and the 80-100-day follow-up visits, although fluconazole tended to be more efficacious. Nine women administered fluconazole, and 2 women given econazole reported minor systemic side effects of the treatment. Three women out of 4 preferred oral to local therapy of candidal vaginitis.

Administration, Intravaginal↗
PubMed1989

Reduced rate of postoperative infections in emergency cesarean section after two doses of cefuroxim perioperatively. A placebo-controlled study.

The rate of postoperative infections after cesarean section was studied in a prospective double-blind randomized study to compare cefuroxim with a placebo. Intravenous bolus injections were given at the beginning of, and 12h after the operation. Eighty patients received cefuroxim and 80 received placebo. Endometritis or wound infection, or both, was diagnosed in 2/80 (2.5%) patients receiving cefuroxim and in 23/80 (29%) patients receiving placebo. No side effects were demonstrated or reported by the patients. Thus, two bolus injections of 1.5 g of cefuroxim given perioperatively significantly reduced postoperative infectious morbidity after emergency cesarean section.

Adolescent↗
PubMed1988

Decrease in incidence of women treated in hospital for acute salpingitis in Sweden.

Numbers of women discharged from hospital after being treated for acute salpingitis decreased by 40% in Sweden between 1974 and 1984. Several factors argue that this decrease was real, rather than a shift from inpatient to outpatient treatment. (Outpatients here include those treated by general practitioners as well as at hospital outpatient clinics). The decrease was nation wide and included all age groups. Repeat episodes of the disease decreased more than first episodes. The main reason for the decrease seems to be more strict attitudes to sexual relationships, especially in young people. Public and professional awareness of genital chlamydial infections was probably a contributing factor.

Acute Disease↗
PubMed1987

Pelvic inflammatory disease: bacteriology and sequelae.

Pelvic inflammatory disease (PID) is defined as the acute clinical syndrome associated with ascending spread of micro-organisms from the lower to the upper female genital tract. The causative organisms can be divided into exogenous (mostly sexually transmittable) and endogenous agents. During the past three decades' epidemic of sexually transmitted diseases (STDs), STD agents have accounted for 60-80% of PIDs in women below the age of 25. After PID a total of 17.4% of the women become infertile because of post-PID tubal damage. Multiple infections, increasing age at the first infection, and severe infections are followed by a more unfavourable fertility prognosis. The risk of an ectopic pregnancy increases 7-10-fold after PID. In areas with high prevalence of STDs, use of IUDs among women in the high risk age group for PID (15-24 years) seems to increase the risk of acquiring the disease but has no influence on the clinical course of the infection. Use of combined oral contraceptive pills decreases both the risk of acquiring PID and the risk of infertility after the infection.

Bacteria↗