PubMed Health⌕ Search

Biomedical subjects

W J Ledger

Publications and source records attributed to W J Ledger.

At least 109 records · Page 6Linked to original sources
PubMed1978

Amniotic fluid analysis. Its role in maternal neonatal infection.

Indirect evidence suggests that amnionitis, in the absence of maternal symptoms, contributes to neonatal morbidity. The incidence is unknown because diagnostic techniques are not available. A quantitative amniotic fluid analysis of bacteria, white blood cells, and lactic dehydrogenase levels was performed during labor among 28 patients considered to be a risk for infection. Thirteen of 16 patients with bacterial colony counts greater than 10(3)/ml subsequently developed maternal infection had a premature delivery, neonatal sepsis, or a combination of these factors. Maternal fever was a late sign in clinical infection and was frequently absent in cases of premature delivery associated with microbiologic evidence of amnionitis. Amniotic fluid analysis may be of value in diagnosing unrecognized amnionitis among patients delivering prematurely and those requiring nonelective cesarean section.

Amnion↗
PubMed1977

Unilateral tuboovarian abscess: a distinct entity.

In a 30 month interval at the Los Angeles County-University of Southern California Medical Center, 85 patients had tuboovarian abscesses removed that were unrelated to complications of pregnancy. Thirty-seven patients (44 per cent) of the 85 had unilateral abscesses. Twenty patients (54 per cent) of the 37 patients with a unilateral abscess were using an intrauterine contraceptive device (IUD). In 13 (65 per cent) of the 20 women using an IUD, the foreign body was a Dalkon Shield. Unilateral pelvic abscesses can occur with or without the presence of an IUD.

Abscess↗
PubMed1977

Comparison of clindamycin and chloramphenicol in treatment of serious infections of the female genital tract.

A study was performed of 102 obstetric-gynecologic patients who were thought to have sepsis or a pelvic abscess. Fifty-three of these women received chloramphenicol and 49 received clindamycin. In addition, all patients received penicillin or a similar antibiotic and an aminoglycoside. Similar clinical results were observed with the two treatment regimens. In eight of the 49 patients who received clindamycin and in three of 52 patients who received chloramphenicol, use of the drug was discontinued because of side effects. These combinations of antibiotics did not eliminate the necessity for major operative drainage, which was required in 40 patients. Resistant organisms were recovered from only two patients. Although sepsis and shock were most frequently associated with gram-negative aerobic bacteremia, they occurred in two patients in whom only anaerobes were recovered from blood cultures. Because the clinical results with the two regimens were equivalent, a decision to use either clindamycin or chloramphenicol should be based on the individual physician's assessment of the toxicity of these agents.

Abscess↗
PubMed1977

Infections in elderly women.

The topic of infections in elderly women is reviewed. In this age group consideration must be given to possible underlying disease and to the patient's age when antibiotic therapy is to be utilized. Preventive measures are stressed in the care of elderly women with infections.

Abscess↗
PubMed1977

Vaginal hysterectomy.

The role of antibiotic prophylaxis in women undergoing vaginal hysterectomy is reviewed. Although there has been a wide range in the reported incidence of postoperative infection and a wide variation in the definition of infectious morbidity, all of the reported studies to date have shown a decrease in the number of infections with this regimen. Currently, a short perioperative course with the cephalosporins is recommended for patients not allergic to penicillin, and this continues to be effective. A short alternative regimen for the penicillin-allergic patient has not been studied as yet.

Abscess↗
PubMed1977

Necrotizing fasciitis in postpartum patients. A report of four cases.

Necrotizing fascitis is a rare but rapidly progressive soft tissue infection not previously reported in an obstetric patient. Since cure is dependent on rapid recognition and early surgical intervention, 4 cases are reported herein, the bacteriology discussed, and the literature reviewed.

Adolescent↗
PubMed1977

A fever index evaluation of chloramphenicol or clindamycin in patients with serious pelvic infections.

The fever index measured the responses of 102 women with serious pelvic infections who had received either chloramphenicol or clindamycin, in combination with other antibiotics. There was no statistical difference in the number of degree hours in the two populations. Patients with salpingo-oophoritis had significantly more fever than those with a septic abortion. Bacteremia did not delineate a group of women with a markedly elevated febrile response. Within the populaton with salpingo-oophoritis, neither black women nor women with an intrauterine device in place had significantly more fever, but patients requiring operation had more fever while those with an endocervical culture positive for the gonococcus at the time of admission had the most favorable clinical response. The significance of these findings is discussed.

Abortion, Septic↗
PubMed1977

Unrecognized amnionitis and prematurity: a preliminary report.

Quantitative amniotic fluid cultures were performed on 12 patients delivered of premature infants (10-premature labor, 2-premature rupture of membranes). Specimens from patients in premature labor were obtained at the time of amniotomy via transcervical needle aspiration or intrauterine catheter. Of the seven patients with colony counts greater than 1,000 per ml, two mothers and four neonates had clinical evidence of infection. Blood cultures from two infants and one mother and cerebrospinal fluid cultures from one newborn infant were positive for the same organism isolated from amniotic fluid. Anearobic bacteria were the predominant isolates in four specimens and included Bacteriodes species in two. In contrast, the five mothers and infants associated with counts of less than 1,000 per ml exhibited no infectious morbidity. Three had no bacterial growth from amniotic fluid, and factors commonly associated with prematurity were recognized in four. These clinical and microbiologic observations suggest that current methods of evaluating patients with premature labor and delivery are incomplete, and the role of unrecognized amnionitis should be reevaluated.

Amnion↗
PubMed1976

A new approach to patients with suspected anaerobic postpartum pelvic infections. Transabdominal uterine aspiration for culture and metronidazole for treatment.

Oral metronidazole was given as therapy in 25 women with the clinical diagnosis of a postpartum anaerobic soft tissue pelvic infection following a vaginal delivery. There was a good clinical response in 80 per cent of these women. No anaerobic organisms resistant to metronidazole were recovered in the treatment failures. Different specimen collection techniques were evaluated, with anaerobes recovered in 4 per cent of the blood cultures, 26.3 per cent of the transabdominal endometrial aspirations, and 88 per cent of the transcervical endometrial samples. The aerobic recovery of organisms was 4 per cent from blood cultures, 15.8 per cent from transabdominal endometrial aspirations, and 96 per cent from the transcervical approach. The significance of these findings is discussed.

Abdomen↗
PubMed1976

The relationship of hospital-acquired infection to invasive intrapartum monitoring techniques.

A 6 month survey of hospital-acquired uterine infection was done on the obstetric service of the Los Angeles County-University of Southern California (LAS-USC) Medical Center to determine the impact of the duration of monitoring upon the incidence of maternal infection. There were significantly more infections among the population monitored and in women undergoing cesarean section. In diminishing order, the incidence of infection was: cesarean section monitored, 90 of 223 (40.4 per cent); cesarean section not monitored, 56 of 271 (20.4 per cent); elective repeat cesarean section, 1 of 21 (5 per cent); vaginal delivery monitored, 33 of 1,236 (2.7 per cent); and vaginal delivery not monitored, 49 of 3,445 (1.4 per cent). In comparing those patients with infection and those free of infection following equivalent routes of delivery, there was no statistical difference in the duration of monitoring. These results suggest that the interval of monitoring alone is not a significant clinical factor in the development of maternal soft-tissue pelvic infection in a high-risk obstetric population.

California↗
PubMed1976

The use of pr-reduced media and a portable jar for the collection of anaerobic organisms for clinical sites of infection.

A system for the isolation of anaerobic organisms from clinical specimens was evaluated at the LAC-USC Medical Center. Clinicians were provided with a Gas Pak with a broth tube and two prereduced blood plates for direct inoculation of specimens. In the first 50 patients evaluated, 74 separate anaerobic isolates were recovered in 36 patients, 72 per cent of the total. Bacteroides fragilis was the most common organism recovered. The impact of this system upon clinical management is discussed.

Anaerobiosis↗