Lower segment uterine rupture related to early pregnancy by in vitro fertilization and embryo transfer after a previous cesarean delivery

A 31-year old woman with secondary infertility after a previous Cesarean delivery underwent in vitro fertilization and embryo transfer (IVF-ET). She was pregnant by IVF-ET. In the first trimester, however, she began to have genital bleeding and lower abdominal pain. This led to intrauterine fetal death, which was terminated by curettage of the uterine cavity. Later, magnetic resonance imaging (MRI) showed the uterine pregnancy on the lower segment scar and the rupture, which was abdominally repaired. It is very likely that the uterine rupture was associated with the implantation in the Cesarean section's scar in this case.

In vitro and in vivo antibacterial activities of AM-1155 in the fields of obstetrics and gynecology

AM-1155 is a new 8-methoxyquinolonecarboxylic acid with a broad spectrum of antibacterial activity. It inhibited more than 90% of clinical isolates of Streptococcus agalactiae, Escherichia coli, Peptostreptococcus magnus, Bacteroides fragilis and Prevotella bivia at the concentration of 3.13 mg/l. The antibacterial activity of AM-1155 was almost equal to that of sparfloxacin. The in vivo efficacy of AM-1155 was evaluated using a polymicrobial pyometra (E. coli and B. fragilis) model of rats. The accumulation of neutrophils to the uterus in the AM-1155-treated group was less marked than that of the nontreated group, as well as the bacteriological response. These results suggest that the new antimicrobial agent AM-1155 might be useful for the treatment of polymicrobial infections in the fields of obstetrics and gynecology.

In vitro bactericidal activities and morphologic changes in Escherichia coli and Bacteroides fragilis by cephalosporins

Polymicrobial infections with aerobes and anaerobes are common in pelvic inflammatory diseases. New parenteral cephalosporins have been widely used against those infections. We investigated in vitro morphologic changes and bactericidal activities on Escherichia coli and Bacteroides fragilis by cephalosporins; cefluprenam (CFLP), ceftazidime (CAZ) or cefotaxime (CTX). CFLP induced morphologic changes (filamentation) and bactericidal activities on E. coli and B. fragilis. Morphologic changes were observed by electron microscope. The filamentation induced by CFLP was time and concentration dependent. The bactericidal activity of CFLP against E. coli was almost equal to those of CAZ and CTX. The bactericidal activity of CTX against B. fragilis was superior to those of CFLP and CAZ. These results suggest that there are characteristic aspects in each cephalosporin.

In vitro and in vivo antibacterial activities of S-1090, a new oral cephalosporin, in the fields of obstetrics and gynecology

S-1090 is a new synthetic, nonesterified, oral cephalosporin with a broad spectrum of antibacterial activity. The activities of S-1090 against the causative organisms in the fields of obstetrics and gynecology are superior to those of the currently prescribed oral cephems, cefdinir, cefpodoxime, and cefaclor. The in vivo efficacy of S-1090 was evaluated using uterine endometritis of model rats. The accumulation of neutrophils in the uterus in the S-1090-treated group was milder than that in the nontreated group, and the same was true for the bacteriological response. S-1090 is a promising oral cephalosporin antibiotic for the treatment of infections in the fields of obstetrics and gynecology.

Therapeutic effects of cefozopran on polymicrobial infections associated with Enterococcus faecalis in a Rat pyometra model

Enterococcus faecalis plays an important role as a pathogen in polymicrobial infections. We evaluated the efficacy of cefozopran (CZOP) using polymicrobial pyometra rats. Rats were infected with a mixed intrauterine inoculation of E. faecalis plus either Bacteroides fragilis or Prevotella bivia (minimal inhibitory concentration of CZOP; E. faecalis: 6.25 micrograms/ml, B. fragilis: 12.5 micrograms/ml, P. bivia: 12.5 micrograms/ml). Immediately after inoculating 10(5) CFU of each organism/rat, CZOP (either 40 mg/kg, i.v., q.i.d., for 5 days or 80 mg/kg, i.v., b.i.d., for 5 days) was administered. The intrauterine inflammatory change and bacterial counts in the CZOP-treated group were compared with those in the nontreated control group. CZOP significantly (p < 0.01) decreased the bacterial counts except for B. fragilis in the regimen of 80 mg/kg b.i.d. However, the 40 mg/kg, q.i.d., regimen significantly (p < 0.05) reduced bacterial counts compared to 80 mg/kg, b.i.d. These results suggest that CZOP in a more divided dose is efficacious for the treatment of polymicrobial infections associated with E. faecalis in pyometra.

Therapeutic effects of an injectable new quinolone, pazufloxacin, against polymicrobial infections in the uterine endometritis model

Polymicrobial infections with aerobes and anaerobes are common in female genital tract infections. We evaluated the efficacy of an injectable new quinolon, pazufloxacin, using a uterine endometritis model. Rats were infected with a mixed inoculation of Escherichia coli plus Bacteriodes fragilis (MIC of pazufloxacin and ceftazidime: E. coli: 0.05 and 1.56 micrograms/ml, respectively, B. fragilis: 3.13 and 3.13 micrograms/ml, respectively). After inoculating 10(7) cfu/rat of each organism, pazufloxacin or ceftazidime (10 or 20 mg/kg, respectively, i.v., b.i.d., 3 days) was administered and compared with the nontreated group. The viable cell counts of the uterine corpus and uterine cervix in pazufloxacin-treated and ceftazidime-treated groups were decreased, compared with the nontreated group. The viable cell counts of the adnexa in the pazufloxacin-treated group were significantly decreased, compared with the ceftazidimetreated group. These results suggest that pazufloxacin would be useful for the treatment of polymicrobial infections, especially adnexitis.

In vitro and in vivo antibacterial activities of a new carbapenem BO-2727 for use in obstetrics and gynecology

The antibacterial activity of BO-2727 against 100 clinical isolates of Streptococcus agalactiae (20 strains), Escherichia coli (20 strains), Peptostreptococcus magnus (20 strains), Bacteroides fragilis (20 strains) and Prevotella bivia (20 strains) was compared with those of imipenem, panipenem, meropenem, biapenem and ceftazidime (CAZ). Minimal inhibitory concentrations (MICs) for 50% of tested strains (MIC50s) of BO-2727 against S. agalactiae, E. coli, P. magnus, B. fragilis and P. bivia were 0.05, 0.05, 0.1, 0.78 and 0.78 mg/l, respectively. MIC90s of BO-2727 against S. agalactiae, E. coli, P. magnus, B. fragilis and P. bivia were 0.05, 0.05, 0.1, 0.78 and 0.78 mg/l, respectively. The efficacy of BO-2727 was evaluated using a polymicrobial pyometra model (E. coli and B. fragilis) in rats. Both the inflammatory changes in the uterus, from the point of view of neutrophil accumulation, and the bacteriological response in the treated group were milder than those in either the nontreated group or the CAZ-treated group. These results indicate that BO-2727 may be useful for the treatment of polymicrobial infections in patients with pyometra.

Effects of long-term/low-dose clarithromycin on neutrophil count and interleukin-8 level in pyometra

We investigated the effects of clarithromycin (CAM) on clinical and endometrial immune responses in chronic intrauterine infection (pyometra). CAM was orally administered in a dose of 200 mg once a day for 4 months (long-term/low-dose treatment) in patients with pyometra. Lavage fluid of the uterine endometrial cavity was obtained from 5 healthy women (controls) and 5 patients with pyometra to investigate the levels of neutrophil and interleukin-8 (IL-8), which is a neutrophil chemotactic factor. All patients showed clinical improvement at the end of treatment. In the assessment of the immune responses, neutrophils were accumulated in the lavage fluid of the uterine endometrial cavity in pyometra (p < 0.001, versus controls) and decreased by CAM treatment (p < 0.001). The level of IL-8 was significantly higher in the lavage fluid of patients with uterine endometritis than in the controls (p < 0.001), and decreased by CAM treatment (p < 0.01). There was a close correlation (r = 0.982) between neutrophil count and IL-8 level in the endometrial lavage of patients with pyometra. The reduction of the uterine endometrial neutrophil migration in chronic inflammatory sites may partially be a direct effect of CAM.

Ovarian abscess caused by Peptostreptococcus magnus following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol

BACKGROUND

Transvaginal ultrasound-guided aspiration of ovarian endometrioma has been applied and emphasized as a safe and simple procedure.

CASE

Two 27-year-old infertile women, both gravida 0, para 0, underwent medical follow-up examinations for cases of ovarian endometrioma. Both had undergone transvaginal ultrasound-guided aspiration of ovarian endometrioma. Because both were continuously febrile and had abdominal pain and cysts with tenderness in spite of antibiotic therapies, both underwent laparotomies for treatment. In both cases, enucleation of the ovarian abscess revealed purulent and malodorous fluid that demonstrated Peptostreptococcus magnus in culture.

CONCLUSION

We theorize that following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol, anaerobic infection by P. magnus occurred, and a cyst formed in the abscess.

Studies on the pathogenicity of anaerobes, especially Prevotella bivia, in a rat pyometra model

OBJECTIVE

Prevotella bivia is one of the anaerobic bacteria that resides in the flora of the female genital tract. We studied the pathogenicity of P. bivia in a rat pyometra model.

METHODS

The experimental animal (rat) model of pyometra was developed to investigate the pathogenicity of P. bivia in a rat pyometra model.

RESULTS

In the groups inoculated with aerobes alone, the infection rate was 10% (1/10) in the Staphylococcus aureus- or Staphylococcus agalactiae-inoculated group and 20% (2/10) in the Escherichia coli-inoculated group. Infection was not established in the groups inoculated with anaerobes alone. High infection rates were observed in all the mixed-infection groups. In the S. agalactiae- and Bacteroides fragilis-, S. agalactiae- and P. bivia-, F. coli- and B. fragilis-, and E. coli- and P. bivia-inoculated groups, an infection rate of 100% (10/10) was demonstrated. The efficacy of antibiotics such as flomoxef (FMOX) could be determined using a rat pyometra model. In relation to the alteration of vaginal microbial flora during the menstrual cycle, estrogen increased the growth of P. bivia.

CONCLUSION

Mixture of aerobic bacteria and P. bivia increased the pathogenicity of P. bivia. Estrogen would be useful for raising up the inflammatory change of the uterus in experimental models of genital tract infection due to P. bivia.

Ovarian abscess caused by Peptostreptococcus magnus following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol

BACKGROUND

Transvaginal ultrasound-guided aspiration of ovarian endometrioma has been applied and emphasized as a safe and simple procedure.

CASE

Two 27-year-old infertile women, both gravida 0, para 0, underwent medical follow-up examinations for cases of ovarian endometrioma. Both had undergone transvaginal ultrasound-guided aspiration of ovarian endometrioma. Because both were continuously febrile and had abdominal pain and cysts with tenderness in spite of antibiotic therapies, both underwent laparotomies for treatment. In both cases, enucleation of the ovarian abscess revealed purulent and malodorous fluid that demonstrated Peptostreptococcus magnus in culture.

CONCLUSION

We theorize that following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol, anaerobic infection by P. magnus occurred, and a cyst formed in the abscess.

Therapeutic effects of a new quinolone, DU-6859a, on polymicrobial infections in a newly designed model of rat uterine endometritis

We evaluated the efficacy of a new quinolone, DU-6859a, using a new model of rat uterine endometritis. Rats were infected with mixed inocula of Escherichia coli and Bacteroides fragilis. The MICs of DU-6859a and levofloxacin against E. coli were 0.025 and 0.05 mg/L, respectively; those against B. fragilis were 0.20 and 0.39 mg/L, respectively. Immediately after inoculating 10(5) cfu/rat of each organism, DU-6859a or levofloxacin (20 mg/kg po bid or tid, respectively, for 3 days) was administered and compared with the untreated group. The viable cell counts of E. coli and B. fragilis in the DU-6859a- and levofloxacin-treated groups were significantly lower than those in the untreated group. These results suggest that DU-6859a would be useful for treating polymicrobial infections in uterine endometritis.

Studies on the pathogenicity of anaerobes, especially Prevotella bivia, in a rat pyometra model

OBJECTIVE

Prevotella bivia is one of the anaerobic bacteria that resides in the flora of the female genital tract. We studied the pathogenicity of P. bivia in a rat pyometra model.

METHODS

The experimental animal (rat) model of pyometra was developed to investigate the pathogenicity of P. bivia in a rat pyometra model.

RESULTS

In the groups inoculated with aerobes alone, the infection rate was 10% (1/10) in the Staphylococcus aureus- or Staphylococcus agalactiae-inoculated group and 20% (2/10) in the Escherichia coli-inoculated group. Infection was not established in the groups inoculated with anaerobes alone. High infection rates were observed in all the mixed-infection groups. In the S. agalactiae- and Bacteroides fragilis-, S. agalactiae- and P. bivia-, F. coli- and B. fragilis-, and E. coli- and P. bivia-inoculated groups, an infection rate of 100% (10/10) was demonstrated. The efficacy of antibiotics such as flomoxef (FMOX) could be determined using a rat pyometra model. In relation to the alteration of vaginal microbial flora during the menstrual cycle, estrogen increased the growth of P. bivia.

CONCLUSION

Mixture of aerobic bacteria and P. bivia increased the pathogenicity of P. bivia. Estrogen would be useful for raising up the inflammatory change of the uterus in experimental models of genital tract infection due to P. bivia.

Blood supply to the latissimus dorsi muscle and muscle performance during co- or counterpulsatile stimulation for circulatory assist

For the application of the latissimus dorsi muscle (LDM) to circulatory assist, the muscle is stimulated with co- or counterpulsation during the cardiac cycle. The purpose of this study was to evaluate the blood supply to the LDM and its muscular performance during each respective stimulation. The origin of the LDM was connected to a tension gauge, a potentiometer, and 1 kg of weight in series. The LDM was stimulated at a ratio of 1:1 of heart to muscle contraction for 10 min. Copulsatile stimulation made thoracodorsal arterial flow (TDF) predominant during cardiac diastole. In counterpulsatile stimulation, TDF occurred predominantly during cardiac systole. Between the 2 patterns of stimulation, no significant differences were observed in the mean TDF rate during 1 cardiac cycle. The maximal force, maximal contraction length, and power of the LDM also did not differ significantly. These results suggest that despite the difference of the TDF profile, LDM performance may be comparable between co- and counterpulsatile stimulation for the application of the LDM to circulatory assist.

Effects of long-term administration of roxithromycin on neutrophil count and interleukin-8 level in endometrial cavity subjected to pyometra

We investigated the effect of long-term administration of roxithromycin (RXM) on clinical responses and immune responses to chronic intrauterine infection, pyometra. One hundred and fifty milligrams of RXM were orally administered once a day for 3 months to patients with pyometra. Neutrophils and interleukin-8 (IL-8), which is a neutrophil chemotactic factor, in the lavage fluid of the uterine endometrial cavity obtained from 5 normal women and 18 patients with pyometra were investigated. Sixteen (88.9%) of the 18 patients showed a clinical improvement at the end of treatment. The immune responses occurred in the lavage fluid from the uterine endometrial cavity. Neutrophils accumulated in the lavage fluid of the uterine endometrial cavity before RXM treatment (p < 0.001 vs. normal subjects and decreased after RXM treatment (p < 0.001). The levels of IL-8 were significantly higher in the lavage fluid of pyometra patients than in normal women (p < 0.001), and tended to decrease after RXM treatment (p < 0.01). These results indicate that RXM decreases uterine endometrial cavity inflammation through reduction of neutrophil migration in inflammatory sites and is effective in treating chronic intrauterine infection.

Therapeutic effects of cefluprenam (CFLP) on polymicrobial infections associated with Enterococcus faecalis in rat pyometra model

Enterococcus faecalis plays an important role as one of the pathogens in polymicrobial infections. We evaluated the efficacy of cefluprenam (CFLP) using a polymicrobial pyometra of a model rat. Rats were infected with a mixed intrauterine inoculation of E. faecalis plus either Bacteroides fragilis or Prevotella bivia (minimal inhibitory concentration of CFLP: E. faecalis, 3.13 mug/ml; B. fragilis, 3.13 mug/ml; P. bivia, 3.13 mug/ml). Immediately after inoculating 10(5) cfu/rat of each organism, CFLP (either 40 mg/kg, i.v., q.i.d. for 5 days or 80 mg/kg, i.v., b.i.d. for 5 days) was administered. The intrauterine inflammatory change and bacterial count in the treated group were compared with those in the non-treated control group. CFLP significantly (P < 0.01) decreased the bacterial counts except for B. fragilis in the regimen of 80 mg/kg, b.i.d. However, the regimen of 40 mg/kg, q.i.d. significantly (P < 0.05) reduced the bacterial counts more than did that of 80 mg/kg, b.i.d. CFLP proved to demonstrate a good tissue concentration above 3 mug/g for 1 h. These results suggest that CFLP in a more divided dose is efficacious for the treatment of polymicrobial infections associated with E. faecalis in pyometra.

Comparative study on vaginal or oral treatment of bacterial vaginosis

The bacterial epidemiology of bacterial vaginosis (BV) and the efficacy of vaginal or oral treatment of BV with clindamycin (CLDM) were investigated. The epidemiology of BV was investigated in 100 symptomatic women before CLDM therapy. Two groups consisting of 50 patients each with the diagnosis of symptomatic BV were treated with either oral administration of 450 mg CLDM three times daily or 2% CLDM phosphate in vaginal cream (self-made) 5 g once a day, for 7 days. There was no significant differences in efficacy among vaginal and oral therapies with CLDM. Vulvovaginal irritation occurred in 3 patients orally treated and in 1 patient vaginally treated. Gastrointestinal disturbances were observed in 4 orally treated patients. A slight abnormal elevation of the glutamine-oxaloacetic transaminase level was also found in 1 patient orally treated. Since there were no statistically significant differences in efficacy rates between vaginal and oral CLDM treatments, we favor vaginal treatment of BV, based on less adverse effects.

Pharmacokinetics of miconazole in serum and exudate of pelvic retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy

Due to the increased number of compromised hosts with fungal infections, doctors have recently started prescribing antifungal agents. In the field of gynecology, however, the choice of which drug to use has been difficult. The efficacies of these drugs depend on their antifungal spectra, potencies and concentrations in tissues. The present study was designed to investigate the pharmacokinetics of miconazole in the exudate of the retroperitoneal space that is formed after radical hysterectomy and pelvic lymphadenectomy. A total of 600 mg of miconazole was administered to the patients for exactly 60 min using an automatic drip-infusion pump. The parameters of the formulas analyzed by the two-compartment model were determined using the least-squares method, and a simulation curve was made. The maximum drug concentration (Cmax) of miconazole in serum was 6.26 mg/l 1 h after drip infusion commencement and the t1/2 in serum was 8.86 h. The value of the area under the time-serum concentration curve (AUC) in serum was 19.13 mg/h per l. The Cmax of miconazole in the exudate of the retroperitoneal space was 0.13 mg/l 2.48 h after the drip infusion was started. The value of AUC in the exudate was 2.52 mg/h per l.

Bacteriological epidemiology and treatment of bacterial vaginosis

One hundred symptomatic women with clinical bacterial vaginosis (BV) were enrolled in this study. The bacteriological epidemiology of BV and efficacy of oral or vaginal administration of antimicrobial agents for treatment of BV were investigated. The epidemiology of BV was investigated before antimicrobial therapy. Fifty patients were treated with oral administration of metronidazole (MTN), 500 mg twice a day, and 50 patients with 2% clindamycin (CLDM) phosphate in a vaginal cream, 5 g once a day for 7 days. The major organisms occurring were Streptococcus agalactiae, Escherichia coli, Gardnerella vaginalis, Peptostreptococcus species, Bacteroides species, Prevotella species, and Mobiluncus species and opportunistic pathogens such as Staphylococcus epidermidis and Enterococcus faecalis. The therapeutic efficacy of CLDM cream on BV appeared to be preferable to oral MTN from clinical and bacteriological aspects. The clinical and bacteriological effectiveness of MTN and CLDM in the treatment of BV suggests that anaerobes might play a major role in causing the clinical symptoms in patients with BV.