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Biomedical subjects

S N Hajj

Publications and source records attributed to S N Hajj.

At least 19 recordsLinked to original sources
PubMed1990

Comparison of chemiluminescent DNA probe to cell culture for the screening of Chlamydia trachomatis in a gynecology clinic population.

Two hundred ninety-five endocervical swab specimens were obtained from patients presenting to a gynecology clinic in order to compare a nonradioactive chemiluminescent DNA probe with cell culture for detection of Chlamydia trachomatis. Discrepancies between cell culture and DNA probe were resolved by retesting and reculturing samples. In a population with a 10.8% prevalence, the corrected sensitivity, specificity, positive predictive value, and negative predictive value for the DNA probe were 80.6, 95.8, 71.4, and 97.3%, respectively. These results compare favorably to other non-culture methods such as direct fluorescent antibody and enzyme immunoassay tests for the detection of C trachomatis in populations with similar prevalence rates.

Cells, Cultured↗
PubMed1989

Unusual urethral diverticulum lined by colonic epithelium with Paneth cell metaplasia.

Diverticulum of the female urethra has an incidence of 1.4% to 4.7%. It is generally agreed that the majority of these are acquired lesions. There is, however, evidence that some are of congenital origin. Documented cases of diverticula with colon-type tissue are rare. A case of urethral diverticulum with colonic epithelium and features of Paneth cell metaplasia is presented. Causes, symptoms, diagnostic methods, and treatment are discussed.

Adult↗
PubMed1988

Abortion hysterectomy for gynecologic pathology.

Abortion hysterectomy has been discredited as the method of performing simultaneous pregnancy termination and elective sterilization for women with undesired pregnancies who simultaneously wish to end their child-bearing potential. The procedure continues to be advocated, however, for cases in which there is an underlying gynecologic pathologic condition. The morbidity of this procedure has not been directly compared with that for indicated hysterectomy in nonpregnant women. Between January 1976 and January 1987, 50 patients underwent abortion hysterectomy at The University of Chicago. The morbidity and mortality rates of these patients were compared with those of 50 premenopausal nonpregnant women undergoing abdominal hysterectomy for gynecologic pathologic status. There was no statistically significant different between the groups in the duration of surgery, estimated blood loss, or infectious morbidity. No operative site infections or other adverse sequelae were noted at the time of final postoperative examination. These data support the relative safety of abdominal abortion hysterectomy for women with undesired pregnancy in whom hysterectomy is indicated for an underlying gynecologic pathologic condition.

Abortion, Therapeutic↗
PubMed1988

Surgical approaches to pelvic infections in women.

Pelvic abscess is a complication of gynecologic disease or obstetric surgery. Tuboovarian complex is differentiated from abscesses because of the absence of a true abscess wall; treatment of a tuboovarian complex is conservative. The diagnosis of tuboovarian complex is made by history, pelvic examination and ultrasonography. Tuboovarian abscesses (TOAs) are sequelae of surgical procedures. Both conventional and novel surgical techniques can be used to manage them. Pelvic thrombophlebitis and ovarian vein thrombosis are late complications of pelvic infections that may be associated with significant morbidity and mortality.

Abscess↗
PubMed1988

Use of C-reactive protein to predict the outcome of medical management of tuboovarian abscesses.

Medical management of tuboovarian abscesses (TOAs) has been shown to be successful. However, the ability to predict which patients with TOA would respond to antibiotic therapy could shorten the hospital stay and decrease treatment costs. C-reactive protein (CRP), an acute-phase-reactant protein with a short half-life, was investigated as a possible predictor of response by TOA patients to medical therapy. Twenty-two patients with TOAs were admitted prospectively into this study, which included daily quantitative determinations of CRP. The patients had either resolution of the mass and symptoms (responders), increased evidence of systemic sepsis and acute peritonitis requiring surgery (failures) or continuation of the tender adnexal mass without evidence of peritoneal irritation (persisters). Twelve patients classified as responders showed a continued daily decrease in quantitative CRP levels of at least 20% per day below the previous day's value until the return to normal levels. The five failures showed a progressive rise in CRP levels as well as evidence of systemic sepsis. Persisters showed an initial decrease in the CRP level followed by a leveling off of the value to a decrease of less than 20% per day. The rate at which daily CRP determinations decline may be a useful predictor of the response to antibiotic therapy.

Abscess↗
PubMed1988

A comparison of cefonicid and cefoxitin for preventing infections after vaginal hysterectomy.

One hundred women who underwent vaginal hysterectomy were randomly and prospectively divided into two study groups, one to receive a single, 1-g preoperative dose of cefonicid and the other to receive 2 g of cefoxitin preoperatively and postoperatively for a total of four doses. There were no differences between the two groups in the rates of febrile morbidity, urinary tract infection, serious infection, noninfectious morbidity or duration of hospitalization. Both cefonicid and cefoxitin were equally effective in preventing postoperative infectious morbidity and demonstrated little difference in side effects. The single-dose regimen of cefonicid provides the advantages of decreased cost and prolonged therapeutic tissue levels when compared to cefoxitin. Perioperative antimicrobial prophylaxis with this single-dose cephalosporin provides a cost-effective regimen that is both safe and prophylactically effective.

Adult↗
PubMed1987

Urethral prolapse in the premenarcheal female.

Urethral prolapse in the premenarcheal female manifests as vaginal bleeding and a periurethral mass. In the past, the recommended management was surgical excision or cautery. However, conservative management has been shown to have excellent results. Five premenarcheal patients with urethral prolapse treated by conservative therapy are presented. Treatment regimen consisted of local hygiene with sitz baths, hexachlorophene soap, topical providone iodine and estrogen cream. There were no complications or recurrences. Surgery is not warranted in the treatment of urethral prolapse in the premenarcheal female. Medical management is equally effective and less traumatic in this age group.

Child↗
PubMed1987

Measurement of C-reactive protein to compare ceftizoxime versus cefoxitin/doxycycline therapy for septic pelvis: a preliminary report.

C-reactive protein (CRP), a biological marker of inflammation, may be a useful indicator of therapeutic response in patients with septic pelvis. In a study comparing ceftizoxime and cefoxitin/doxycycline in patients with septic pelvis, quantitative CRP levels were closely correlated with the responses and failures of therapy. The results of this study showed the two antibiotic regimens to be equally effective, with 23 of 25 patients in each treatment group achieving a satisfactory response. The fact that ceftizoxime was effective in four of five patients with Chlamydia trachomatis in cervical isolates suggests that intravenous therapy for the acute infection can be accomplished without the addition of an antichlamydial agent. Upon discharge from the hospital, patients can continue therapy with an oral drug that is specifically active against Chlamydia.

C-Reactive Protein↗
PubMed1987

Retrograde dissection of the adnexa in residual ovary syndrome.

Injuries to the ureter in the course of gynecologic procedures can occur frequently. The usual histologic signs and symptoms of peri-oophoritis, adhesion and distorted anatomy encountered with residual ovaries make their ablation hazardous to the surrounding structures and the ureter in particular. A method is described and illustrated to facilitate surgical extirpation and render the procedure safe.

Adnexa Uteri↗
PubMed1982

Medical treatment of urethral prolapse in children.

Urethral prolapse denotes the complete circular eversion of the urethral mucosa through the external meatus. Two different entities exist: premenarcheal and menopausal urethral prolapse. Premenarcheal prolapse is predominantly asymptomatic and is usually brought to medical attention by vaginal bleeding. Trauma and medical conditions predisposing a patient to increased abdominal pressure are associated with prolapse in children. The menopausal group seeks medical attention primary because of the severity of urinary symptoms, ie, nocturia, urgency, tenesmus, dysuria, and frequency. Therapy for both groups has been traditionally accomplished by surgical manipulation-excision, surgical ligation, cautery, fulguration, and cryosurgery. The authors treated 5 premenarcheal female children with antibiotics, estrogen cream, and sitz baths for 2 weeks. In all the patients prolapse was resolved. The results, with follow-up for 4 to 12 months without recurrence, suggest that urethral prolapse in children can be managed without surgical intervention.

Child↗
PubMed1982

A proposed scoring system for the management of female urinary incontinence.

The management of urinary incontinence is frequently ineffective. Inappropriate surgical intervention can convert medically treatable incontinence into a more serious and less remediable condition. To allow a more scientific approach to management, we have developed a scoring system for female incontinence based on three primary controlling factors: (1) the direction of the urethra, (2) the urethral vesical angle and (3) the urethral pressure profile. For each factor a score of 1 to 3 was assigned according to the deviation from normal anatomy or function. Scores ranged from 3 to 9. Patients scoring 6 to 9 were treated surgically, by ventral suspension of the bladder neck and urethra. Patients scoring 3 to 5 were treated medically and underwent surgery only if indicated for other pathology. Thirty-three patients were evaluated and treated with this approach, with a one- to two-year follow-up. This system appears to provide an objective method of choosing between surgical and medical therapy for urinary incontinence.

Adult↗
PubMed1980

C-reactive protein as a predictor of infectious morbidity with premature rupture of membranes.

The management of patients with premature rupture of membranes (PROM) poses one of the most serious dilemmas in obstetrics since PROM significantly increases the likelihood of prematurity and serious perinatal infection. Early infection is not reliably predicted nor detected by standard laboratory parameters. Serum C-reactive protein (CRP) levels were assayed along with white blood cell count, differential, and temperature course in patients with PROM and controls. Elevated CRP very accurately divided patients with evidence of infectious morbidity from those without such evidence (p < 0.001). In 109 patients there were 11 false negatives and no false positives. In 14 of 20 patients followed with serial comparisons who developed morbidity, CRP became elevated at least 12 hours prior to any other parameter measured. Changes in the other six patients were concurrent. The results suggest that CRP may be a reliable, early predictor of infectious morbidity and thus may be of benefit in the selective management of patients with PROM.

Adolescent↗
PubMed1980

Diverticula of the female urethra.

Urethral diverticula in women are more frequent than generally accepted and in some series are reported to occur in as many as 4.7% of women screened. Surgical excision remains the most common treatment, but a high indicence of complications has been reported with the standard surgical procedures. Because of the high morbidity, a new technique was developed to achieve better visualization and mobilization of the diseased urethra and thus permit better repair. The technique described herein has been developed and used in a small series with good results and without the often quoted complications of fistulas, strictures, and recurrences.

Adult↗
PubMed1980

Gunshot wounds of the pregnant uterus: report of two cases.

Two patients with gunshot wounds of the pregnant uterus are reported. Both were explored and delivered of stillborn infants by Cesarean section. Neither patient sustained a significant visceral injury. Expectant management with close observation is appropriate in pregnant when the entrance wound is below the level of the uterine fundus, the infant is dead, and the bullet is radiographically shown to be in the uterus.

Adolescent↗
PubMed1980

C-reactive protein in the evaluation of antibiotic therapy for pelvic infection.

C-reactive protein (CRP), an acute-phase reactant not found in normal serum, has previously been shown, by qualitative assay, to differentiate inflammatory from noninflammatory pelvic pathology. In this study, quantitative measures of serum CRP were obtained concomitantly with white blood counts (WBC) and erythrocyte sedimentation rates (ESR) in patients being treated for pelvic infection. CRP levels and their changes, which were not known to physicians treating the patients, accurately indicated those patients who would need supplementary antibiotics to achieve remission. WBC levels were misleading in over half the patients, and the ESR bore no relationship to the clinical situation. The data suggest that CRP may be used to assess the efficacy of antibiotic therapy in pelvic infection. Our successful use of single-agent therapy in most cases also suggests that the use of multiple antibiotics is unnecessary and that CRP levels can indicate when additional antibiotics are appropriate.

Anti-Bacterial Agents↗
PubMed1979

A simplified surgical technique for the treatment of the vault in vaginal hysterectomy.

The surgical steps in the various techniques to remove the uterus by vaginal hysterectomy are quite uniform; however, the handling of the vaginal cuff differs with each and all techniques reviewed. The technique here described is a simplified method that secures hemostasis, establishes drainage of the anterior vaginal wall, and creates a vaginal canal adequate for sexual function. Emphasis is placed on the inclination of the vagina, a step that brings the vaginal axis almost perpendicular to the body axis, obviating the constant bearing-down effect on the intra-abdominal pressure on the apex of the vagina. Prevention of subsequent enterocele formation is achieved by the occlusion of the weak spot between the ulterosacral ligaments, the site of the hernial sac formation.

Female↗
PubMed1979

The intrauterine device and ovarian pregnancy.

Within a 1-year period, three patients presenting to the University of Chicago, Chicago Lying-In Hospital with a complaint of lower abdominal pain were diagnosed at laparotomy to have ovarian pregnancies according to the criteria of Spiegelberg. All of the patients were at the time using the Copper-7 intrauterine device for contraception. There are now 50 known cases of ovarian pregnancies in patients using the intrauterine device (IUD). The characteristics of these patients do not differ markedly from those previously reported in studies on tubal pregnancies, with and without the IUD, but the presentation of patients tends to be more variable than in tubal pregnancies. The increasing incidence noted here, in a population already known to be particularly prone to pelvic inflammatory disease and therefore ectopic pregnancies in general, lends further credence to a questioning of the desirability of the IUD in such a population.

Adolescent↗