SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A review of inflammatory subcutaneous disease revealed that lymphoid follicles are observed frequently in lupus panniculitis. They are found rarely in other lymphocytic inflammatory diseases involving the panniculus, such as morphea, erythema nodosum, and erythema induratum. The lymphoid follicle may be an indication of immunoreactive and connective tissue disease, and cases should be evaluated with this in mind.
Five patients with pelvic inflammatory disease (PID) had thin polyethylene catheters introduced percutaneously through the abdominal wall into the pouch of Douglas for sampling of peritoneal fluid. At hourly intervals specimens were aspirated, simultaneously with the sampling of finger tip capillary blood. In both the concentration of amoxycillin was determined by the micromethod of Jalling et al. (1972). One hour after the oral ingestion of 0.5 grams of amoxycillin, a therapeutic level was recorded in blood plasma, the peak level being achieved in 2 hours. The concentration of amoxycillin in the peritoneal fluid showed some delay, mainly in the cases with a thick purulent exsudate, but the peak levels were similar to those in blood plasma. After a single dose of 0.5 gram of amoxycillin, a therapeutic level was maintained in blood and in peritoneal fluid for 7-8 hours. The drug was well tolerated and showed an excellent clinical effect.
The antibody response to the capsular polysaccharide of Bacteroides fragilis subspecies fragilis in women with acute pelvic inflammatory disease was quantitated using a sensitive radioactive antigen-binding assay. Antibody detected by this technique correlated highly with antibody measured by quantitative precipitin analysis (r = 0.99). Paired acute- and convalescent-phase sera obtained from women from whom B. fragilis subspecies fragilis was isolated by culdocentesis showed significantly greater changes in antibody concentration than corresponding sera obtained from women with gonococcal or nongonococcal pelvic inflammatory disease when B. fragilis subspecies fragilis was not isolated from the cul-de-sac. These data indicate that the steady state of immunity to this capsular antigen is perturbed in patients with acute nongonococcal pelvic inflammatory disease from whom this organism can be cultured. This finding may indicate that B. fragilis can play a significant role in acute pelvic inflammatory disease and can be involved early in the infectious process.
To study the bacterial pathogenesis of acute pelvic inflammatory disease, peritoneal fluid was obtained by culdocentesis in 133 of 344 women with this disease. In 104 of the specimens bacteria were identified both in the gram-stained smear and culture. Neisseria gonorrhoeae was isolated from the lower genital tract in over half of these women, and there were 3 patterns of bacterial recovery from peritoneal fluid: N gonorrhoeae alone (22%), N gonorrhoeae and other organisms (32%), and nongonococcal organisms alone (46%). In women without cervical gonorrhea only nongonococcal organisms were identified from peritoneal fluid. In both groups of women a similar number of nongonococcal organisms were isolated. The results of this study supported those reported prior to availability of antimicrobials and suggest that N gonorrhoeae initiates most cases of pelvic inflammatory disease. A significant number of these women have superinfection with nongonococcal organisms which may preclude recovery of gonococci.
A presumptive diagnosis of pelvic inflammatory disease (PID) is usually made in our gynecologic clinics when obscure, acute lower abdominal pain is accompained by fever and abnormal vaginal discharge, urinary and rectal discomfort, marked tenderness of the pelvic organs to palpation, or pelvic masses. In the present study, during a 2-year period, 223 women underwent laparoscopy to confirm this diagnosis. PID was confirmed in 103 (46.2%) of the cases; other serious conditions were diagnosed in 69 (30.9%) of the cases; and no evidence of disease was found in 51 (22.9%) of the cases. The authors conclude that laparoscopy is a valuable tool in the diagnosis of PID.
Inflammatory disease of the brain, particularly of pyogenic etiology, may be most accurately assessed by the use of computed tomography and contrast enhancement. Examples of cerebritis, evolving and mature intracerebral abcesses, and inflammatory extracerebral collections are presented and discussed, particularly with reference to differential diagnosis and the problem of infectious versus neoplastic etiology. Ancillary studies, particulary selective arteriography, are reviewed where appropriate. The residual changes of inflammatory disease of the brain after medical and/or surgical therapy are illustrated, and the value of serial examinations is emphasized. The rural indigent patient population (American Indian) served by the University of New Mexico Medical Center is a source of case material providing several examples of severe and untreated intracerebral infectious processes heretofore not described in the literature.
To evaluate guidelines for outpatient treatment of acute pelvic inflammatory disease recommended by the Center for Disease Control we studied 197 afflicted women. The women were treated either with tetracycline or with procaine penicillin and ampicillin, and 92% were subsequently seen at least once to assess efficacy of clinical and microbiologic treatment. Neisseria gonorrhoeae was isolated from the lower genital tract in 68% of these women, and although they had a quicker symptomatic response than those with nongonococcal infection (P less than 0.01), the two regimens were equally effective in producing clinical cure. However, subsequent identification of a pelvic abscess was 10 times more common in women from whom N. gonorrhoeae was not isolated. Therapy for pelvic inflammatory disease must be empirical since it is impossible to distinguish clinically between gonococcal and nongonococcal infection, and our data indicate that both regimens recommended by the Center for Disease Control are effective.
To study the vascular changes in inflammatory diseases of the cornea 22 patients with various corneal inflammations were examined by means of anterior segment fluorescein angiography. Simple avascular central and marginal corneal ulcers stained with fluorescein in the late phase of angiography. An inflamed limbus and an early microscopic pannus adjacent to the ulcer were seeen in simple corneal ulcers. Progressive pannus with pronounced fluorescein leakage was observed in chronic corneal ulcer, disciform keratitis, Mooren's ulcer, and complicated acute keratoconus. In sclerokeratouveitis and in gutter associated with rheumatoid arthritis the corneal vessels showed less leakage. The iris vessels showed fluorescein leakage as a sign of irritative iritis during the active stage of simple and chronic corneal ulcers, in disciform keratitis, Mooren's ulcer, and in graft rejection. It is concluded that anterior segment fluorescein angiography gives valuable information of the vascular architecture, flow and leakage in inflammatory diseases of the cornea.
Minimum inhibitory concentrations (MICs) of six penicillins against 95 strains of Neisseria gonorrhoeae from patients with uncomplicated anogenital infections and 22 strains from women with pelvic inflammatory disease were determined by an agar plate dilution method, using an inocula replicator. Against all 117 strains, the order of activity observed was: BL-P1654 > penicillin X > penicillin G > ampicillin > amoxicillin = carbenicillin. MICs against strains isolated from women with gonococcal pelvic inflammatory disease were significantly higher than those against isolates from uncomplicated infections: BL-P1654, P < 0.001; penicillin X, P < 0.001; penicillin G, P < 0.001; ampicillin, P < 0.001; and amoxicillin, P < 0.05. MICs of penicillin G were >/=0.125 mug/ml against 33 (36%) of the 92 strains from patients with uncomplicated infections, as contrasted with 15 (68%) of the 22 isolates from women with pelvic inflammatory disease (P < 0.01). The means of the MICs of penicillin G were 0.06 mug/ml for the former and 0.14 mug/ml for the latter.
The role of Chlamydia trachomatis in pelvic inflammatory disease (PID) diagnosed without laparoscopy was assessed by measuring antichlamydial antibodies in the patient's serum and by comparing the results with those in patients with uncomplicated non-specific genital infection (NSGI) and gonorrhoea and in non-infected controls. A modified microimmunofluorescence test was used. Patients with severe PID had significantly more positive antichlamydial IgG and IgM results than did control subjects, patients with gonorrhoea, and patients with NSGI. Less severe PID was associated with significantly raised levels of antichlamydial IgG antibodies compared with NSGI and controls and with raised levels of IgM antibodies compared with controls. Two patients with PID had lower genital tract gonorrhoea, one of whom had raised antichlamydial antibody levels. These findings may indicate a mixed infection and therapy should be reviewed in such patients. A serological diagnosis of chlamydial infection is relatively easy and cheap and enables a rapid diagnosis of chlamydial infection to be made.
Using a retrospective case control design on 101 women with a first episode of acute pelvic inflammatory disease (PID), it was found that 15% were wearing an intrauterine device, as compared to 7% out of a control group of 101 women matched for age, marital status, and interval since their last pregnancy termination. No statistically significant correlation between IUD usage and PID was demonstrated. A significant correlation (P less than 0.01) between previous induced abortion and subsequent PID was found. In the PID group, a significantly higher proportion of previous abdominal and pelvic operations (P less than 0.005) was found as compared to the control group, but the numbers were small. In the absence of a higher frequency of IUD wearers among PID patients as compared with matched controls, we do not believe that there is an increased risk of pelvic inflammatory disease.
Inflammatory diseases of the colon can be differentiated by means of their chymotrypsin A excretion in the stool. In proctosigmoiditis and a group of comparable gastroenterological cases, the mean excretion level is between 170 and 200 mug per gram of stool. The chymotrypsin A level in proctocolitis, on the other hand, is significantly higher in all stages and increases with increasing activity of the disease. This brings a further diagnostic criterion to the clinical and endoscopic differences between proctosigmoiditis and proctocolitis (colitis ulcerosa). The fundamentally different behavior in the excretion of chymotrypsin A in the stool supports the hypothesis of two diseases differing from each other.
A case of massive exudative hemorrhagic ascites occurring as a serious complication of chronic pelvic inflammatory disease (PID) is presented. The clinical manifestations, simulating diffuse carcinomatosis in a young female patient, are described.
The influence of different contraceptive techniques on the incidence of pelvic inflammatory disease (PID) in 672 patients with gonorrhoea have been studied. The lowest frequency of PID was found in patients using hormonal contraceptives (Group A), 8.8 per cent compared to 23.5 per cent in patients using intrauterine devices (Group B) and 15.1 per cent in patients using neither technique (Group C). In comparable control groups no significant differences in background factors, such as age, marital status and sexual activity were demonstrated. It is therefore concluded that the significantly lower incidence of PID in patients using hormonal contraceptives compared to the other groups and the high incidence of PID in patients using intrauterine devices is related to the contraceptive technique per se.
Gc globulin and prealbumin serum levels were determined in a coded serum panel from the National Cancer Institute-Mayo Clinic. Serum samples came from 100 patients with cancer (lung, prostate gland, or gastrointestinal tract), from 50 patients with benign inflammatory diseases from the same organs as those of the cancer patients, and from 50 clinically healthy smokers. No differences were observed among groups in the Gc globulin (vitamin D carrier) serum concentrations; however, prealbumin (vitamin A carrier) serum levels were decreased for patients with benign inflammatory diseases and for cancer patients; the cancer group showed the greatest decrease.
Diamine oxidase (DAO, histaminase), according to Schayer, is an essential enzyme in histamine metabolism. It metabolises also a variety of diamines such as putrescine and cadaverine and is generally accepted to be identical with histaminase. Lipoproteinlipase (LL) is assumed to play an essential role in lipid metabolism. In vertebrates, parenterally applied heparin causes a marked dose-dependent rise of the plasma level of both enzymes mainly due to the release from the enzyme containing organs. The plasmatic level changes of DAO and LL after heparin application (200 U/kg b.wt., i.v.) have been studied in 30 patients suffering from 20 different, predominantly inflammatory diseases. In all cases the release of postheparin diamine oxidase (PHD) and of post-heparin lipoproteinlipase (PHLA) was found to be markedly decreased. There existed a highly significant correlation between the degree of the release of both enzymes (r=0.843, p less than 0.0005). In all patients normal levels of plasma insulin were detected. No correlation was found between PHLA and plasma triglycerides levels. Decrease of PHD respectively PHLA was a more sensitive biochemical parameter than were changes of serum glutamic pyruvic transaminase in acute hepatitis and of C reactive protein (CRP) in chronic inflammatory kidney diseases. This finding is most likely a general phenomenon in inflammatory diseases. Besides hormonal regulation inflammation-dependent effects on PHLA have to be discussed.
One hundred emergency department charts on cases of suspected pelvic inflammatory disease (PID) were reviewed to determine method of diagnosis and treatment. Seventy-three gonococcus smears, 60 gonococcus cultures, and 53 VDRL tests for syphilis were done. Of these, 20 smears, 19 cultures, and 1 VDRL were positive. All 100 patients were treated for gonorrhea with either spectinomycin, tetracycline, ampicillin or penicillin. The author concludes there is no need to procure VDRL tests on all patients with suspected gonorrhea, nor do gonococcus cultures on all patients with suspected PID. Also, since only 39% of patients had a positive gonococcus smear or culture, penicillin may not always be the appropriate treatment.
Thorough epidemiologic assessment by trained personnel is important in the management of all cases of pelvic inflammatory disease (PID) due to Neisseria gonorrhoeae. Results of interviewing and an intensive epidemiologic follow-up study of 58 cases of gonococcal PID are presented. A total of 34 (49%) of the 69 male contacts examined were infected with N. gonorrhoeae. Twenty-three (68%) of the 34 were symptomatic, and 11 (32%) were asymptomatic. The interviews with the 58 patients who had PID clearly revealed their lack of comprehension of the nature of their infection. Nineteen (33%) of the 58 admitted reexposure after treatment to one of their contacts before he was examined. Intensive epidemiologic follow-up efforts and comprehensive education must be included in the routine management of patients with gonococcal PID; cooperative efforts by hospitals and local or state health departments are necessary components of treatment and prevention.