Anaerobic bacteria are important pathogens in obstetric and gynecologic infections. As metronidazole has excellent in vitro activity against almost all clinically significant anaerobes, the newly available parenteral form of the drug was evaluated in a comparative study with clindamycin. Forty-seven patients with postpartum endomyometritis with or without wound infection, acute or chronic salpingo-oophoritis, tuboovarian abscess, postoperative pelvic cellulitis or wound infection, or other soft-tissue infection were included in the study. Initially 6 patients were treated with metronidazole, usually combined with tobramycin, in an open study. Subsequently, 41 patients were treated on a randomized schedule of either metronidazole or clindamycin, each combined with tobramycin. Anaerobic bacteria were isolated from 86% (37 of 43) of the patients who had positive cultures from sites cultured for aerobes and anaerobes. Anaerobic gram-negative rods and gram-positive cocci were the predominant isolates from infected tissues. Of the patients who received metronidazole, 96% (25 of 26) were considered clinically cured; the remaining patient initially responded but continued to have slight temperature elevations. There were no adverse reactions to this drug. Of the patients who received clindamycin, 100% were considered clinically cured. The excellent therapeutic response to intravenous metronidazole and the predominance of pathogenic anaerobes observed in these infections support its use in the treatment of infections of the female genital tract.

Anti-Bacterial Agents↗

PubMed1979

Fascia lata urethrovesical suspension for recurrent stress urinary incontinence.

Although the physiologic mechanisms of normal micturition in the female subject are not fully understood, it is generally believed that urinary continence is maintained by a competent urethrovesical neck. Unfortunately, the patient who has had multiple operations for recurrent stress urinary incontinence often has a urethra that is shortened and fixed in scar tissue. In such patients, anterior colporrhaphy with operative release of the periurethral fibrosis and plication of the endopelvic fascia to create a functionally more normal urethrovesical junction will increase the chances for good results. A fascia lata support of the proximal 1 to 2 cm of the urethra ensures continued elevation of the urethra and with stress the sling provides a pulling-up effect. Fifty patients with a suburethral sling procedure are presented in detail. Forty-seven of these patients had a total of 121 prior operative procedures for stress urinary incontinence. Urologic studies are outlined. Forty-two patients (84%) were continent postoperatively, five were improved, and three had failures. Operative technique and complications are discussed.

Adult↗

PubMed1979

The occurrence of adenocarcinoma in endometriosis of the rectovaginal septum during progestational therapy.

Explore the source record for details and available documents.

Adenocarcinoma↗

PubMed1976

Gonadotropin release in patients with androgen insensitivity. Testicular feminization syndrome.

Two siblings are presented, both with classic androgen-insensitivity syndrome (AIS). Endocrine testing was carried out and then gonadectomy was performed. Studies in these patients with AIS revealed low control serum FSH. In these patients serum FSH was not significantly suppressed by intravenous estrogen nor adequately stimulated by FSH-LH-releasing hormone but rose normally after castration. The various studies are interpreted in the light of the known kinetics of pituitary gonadotorpins and their modulation by gonadal steroids. A third sibling is also presented.

Adult↗

PubMedDate not supplied

Moxalactam therapy for obstetric and gynecologic infections.

Moxalactam, a new cephalosporin antibiotic with a broad spectrum of activity, was evaluated for safety and therapeutic efficacy in the treatment of genital tract infections in women. Fifty-three patients with postpartum endometritis or acute or chronic pelvic inflammatory disease were treated with 2 g of moxalactam iv every 8 hr, usually for five days or longer. Appropriate cultures of peripheral blood, endometrium, cul-de-sac aspirates, urine, wound, and endocervix (only for Neisseria gonorrhoeae) were performed. Overall, 90.6% (48 of 53) of the patients were successfully treated with moxalactam--86.2% (25 of 29) and 95.8% (23 of 24) of the patients with endometritis and pelvic inflammatory disease, respectively. Therapy failed in one of five bacteremic patients with endometritis. Of all the bacteria isolated from appropriate culture sites, 58% (224 of 383) were anaerobes, with anaerobic gram-negative rods--particularly Bacteroides bivius-and gram-positive cocci being predominant. Of 206 anaerobic strains tested with moxalactam by agar dilution techniques, 82% (169 of 206) were susceptible (minimal inhibitory concentration [MIC], less than or equal to 8 micrograms/ml), 11.6% (24 of 206) were moderately susceptible (MIC, 16-32 micrograms/ml), and 6.3% (13 of 206) were resistant (MIC, greater than or equal to 64 micrograms/ml). Among the aerobic isolates, enterococci were uniformly resistant. Thus, moxalactam performed well as a single agent in this open clinical trial for women with infections of the genital tract.

Anaerobiosis↗