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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, VanDam J, Wassef W, Wang KK. Medical device evaluation by the Food and Drug Administration (FDA). Gastrointest Endosc 2001; 53:880-4. [PMID: 11375624 DOI: 10.1016/s0016-5107(01)70312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
To assess the relationship between hemostatic factors and spontaneous abortion, 134 pregnant women presenting to the emergency department were recruited and followed through 22 weeks' gestation. Cases were women experiencing a spontaneous abortion and controls were women who maintained their pregnancy. Fibrinogen, factor VII antigen, activated protein C-sensitivity ratio (APC-SR), protein S, and plasmin-antiplasmin (PAP) were measured. Cases had lower mean levels of fibrinogen and factor VII antigen compared with controls (3.1 g/L vs. 3.7 g/L and 89% of normal vs. 109% of normal, respectively). Regression analyses found that women with fibrinogen levels below 3.0 g/L had a five-fold increased risk of spontaneous abortion (OR = 5.1, 95% CI: 1.8-14.4) and women with factor VII antigen levels below 94% of normal had a threefold increased risk of spontaneous abortion normal (OR = 3.3, 95% CI: 1.2-8.5). Similar mean levels of APC-SR, protein S, and PAP were found in the two groups.
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Nelson DB. Helicobacter eradication versus prompt endoscopy for dyspepsia. Gastroenterology 2001; 120:1298-9. [PMID: 11266397 DOI: 10.1016/s0016-5085(01)70290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Murphy TV, Gargiullo PM, Massoudi MS, Nelson DB, Jumaan AO, Okoro CA, Zanardi LR, Setia S, Fair E, LeBaron CW, Wharton M, Livengood JR, Livingood JR. Intussusception among infants given an oral rotavirus vaccine. N Engl J Med 2001; 344:564-72. [PMID: 11207352 DOI: 10.1056/nejm200102223440804] [Citation(s) in RCA: 640] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. Our investigation began on May 27, 1999, after nine cases of infants who had intussusception after receiving the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) were reported to the Vaccine Adverse Event Reporting System. METHODS In 19 states, we assessed the potential association between RRV-TV and intussusception among infants at least 1 but less than 12 months old. Infants hospitalized between November 1, 1998, and June 30, 1999, were identified by systematic reviews of medical and radiologic records. Each infant with intussusception was matched according to age with four healthy control infants who had been born at the same hospital as the infant with intussusception. Information on vaccinations was verified by the provider. RESULTS Data were analyzed for 429 infants with intussusception and 1763 matched controls in a case-control analysis as well as for 432 infants with intussusception in a case-series analysis. Seventy-four of the 429 infants with intussusception (17.2 percent) and 226 of the 1763 controls (12.8 percent) had received RRV-TV (P=0.02). An increased risk of intussusception 3 to 14 days after the first dose of RRV-TV was found in the case-control analysis (adjusted odds ratio, 21.7; 95 percent confidence interval, 9.6 to 48.9). In the case-series analysis, the incidence-rate ratio was 29.4 (95 percent confidence interval, 16.1 to 53.6) for days 3 through 14 after a first dose. There was also an increase in the risk of intussusception after the second dose of the vaccine, but it was smaller than the increase in risk after the first dose. Assuming full implementation of a national program of vaccination with RRV-TV, we estimated that 1 case of intussusception attributable to the vaccine would occur for every 4670 to 9474 infants vaccinated. CONCLUSIONS The strong association between vaccination with RRV-TV and intussusception among otherwise healthy infants supports the existence of a causal relation. Rotavirus vaccines with an improved safety profile are urgently needed.
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Nelson DB, Murdoch M, Sandozi IK, Dalmasso AP, Crabtree JE, Ho SB. Dyspepsia is associated with CagA-positive Helicobacter pylori. Am J Gastroenterol 2000; 95:3412-7. [PMID: 11151870 DOI: 10.1111/j.1572-0241.2000.03354.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The role of Helicobacter pylori in nonulcer dyspepsia is controversial. Speculation has arisen that only strains of H. pylori carrying the CagA virulence factor are important in the development of dyspepsia. The objective of this study was to determine whether nonulcer dyspepsia correlated with CagA-positive H. pylori infection. METHODS A total of 435 healthy blood donors and 102 general medicine clinic respondents completed the Bowel Disease Questionnaire and the PRIME-MD survey, a validated screen for common psychiatric disorders. Subjects were classified as cases of nonulcer dyspepsia if they reported pain in the upper abdomen more than six times in the previous year and denied a past or current history of peptic ulcer disease. Study participants were tested for IgG antibodies to H. pylori and the CagA protein. RESULTS Clinic respondents were more likely than healthy blood donors to meet the case definition for nonulcer dyspepsia (34% vs 13%, p < 0.001), to be seropositive for H. pylori (54% vs 18%, p < 0.001), and to be CagA seropositive (41% vs 10%, p = 0.01). Logistic regression identified CagA seropositivity (p = 0.03), race (p = 0.001), and positive screens for depression (p = 0.007) or somatization (p < 0.001) as variables independently associated with nonulcer dyspepsia. CONCLUSION Infection with a CagA-positive strain of H. pylori is associated with a clinical diagnosis of nonulcer dyspepsia. However, nonulcer dyspepsia was also strongly and independently associated with positive screens for depression or somatization disorder as well as with ethnicity. These potential sources of variance should be considered in the design of future studies evaluating nonulcer dyspepsia.
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Nelson DB. Colonoscopy versus double-contrast barium enema. Gastroenterology 2000; 119:1402-3. [PMID: 11054401 DOI: 10.1016/s0016-5085(00)70295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wang KK, Wassef WY. Technology status evaluation report: endoscopy simulators: May 1999. Gastrointest Endosc 2000; 51:790-2. [PMID: 10840337 DOI: 10.1053/ge.2000.v51.age516790] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, Wassef W, VanDam J, Wang KK. Technology status evaluation report: ultrathin endoscopes esophagogastroduodenoscopy: March 2000. Gastrointest Endosc 2000; 51:786-9. [PMID: 10840336 DOI: 10.1053/ge.2000.v51.age516786] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Nelson DB, Block KP, Bosco JJ, Burdick JS, Curtis WD, Faigel DO, Greenwald DA, Kelsey PB, Rajan E, Slivka A, Smith P, Wassef W, VanDam J, Wang KK, Barthel J, Affronti JP, Aliperti G, Etemad B, Kocab MA, Kozam ML, Rosen AM, Silverstein BD, Vakil N. Technology status evaluation report: computerized endoscopic medical record systems: November 1999. Gastrointest Endosc 2000; 51:793-6. [PMID: 10840338 DOI: 10.1053/ge.2000.v51.age516793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Fink HA, Lederle FA, Roth CS, Bowles CA, Nelson DB, Haas MA. The accuracy of physical examination to detect abdominal aortic aneurysm. ARCHIVES OF INTERNAL MEDICINE 2000; 160:833-6. [PMID: 10737283 DOI: 10.1001/archinte.160.6.833] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Abdominal palpation during physical examination is an important means of detecting abdominal aortic aneurysm (AAA), but limited information is available on its accuracy. METHODS Two hundred subjects (aged 51-88 years), 99 with and 101 without AAA as determined by previous ultrasound, each underwent physical examination of the abdomen by 2 internists who were blinded to each other's findings and to the ultrasound diagnosis. RESULTS The overall accuracy of abdominal palpation for detecting AAA was as follows: sensitivity, 68% (95% confidence interval [CI], 60%-76%); specificity, 75% (95% CI, 68%-82%); positive likelihood ratio, 2.7 (95% CI, 2.0-3.6); negative likelihood ratio 0.43 (95% CI, 0.33-0.56). Interobserver pair agreement for AAA vs no AAA between the first and second examinations was 77% (kappa = 0.53). Sensitivity increased with AAA diameter, from 61% for AAAs of 3.0 to 3.9 cm, to 69% for AAAs of 4.0 to 4.9 cm, 72% for AAAs of 4.0 cm or larger, and 82% for AAAs of 5.0 cm or larger. Sensitivity in subjects with an abdominal girth less than 100 cm (40-in waistline) was 91% vs 53% for girth of 100 cm or greater (P<.001). When girth was 100 cm or greater and the aorta was palpable, sensitivity was 82%. When girth was less than 100 cm and the AAA was 5.0 cm or larger, sensitivity was 100% (12 examinations). Factors independently associated with correct examination findings included AAA diameter (odds ratio [OR], 1.95 per centimeter increase; 95% CI, 1.06-3.58); abdominal girth (OR, 0.90 per centimeter increase; 95% CI, 0.87-0.94); and the examiner's assessment that the abdomen was not tight (OR, 2.68; 95% CI, 1.17-6.13). CONCLUSIONS Abdominal palpation has only moderate overall sensitivity for detecting AAA, but appears to be highly sensitive for diagnosis of AAAs large enough to warrant elective intervention in patients who do not have a large girth. Abdominal palpation has good sensitivity even in patients with a large girth if the aorta is palpable.
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Nelson DB, Freeman ML, Silvis SE, Cass OW, Yakshe PN, Vennes J, Stahnke LL, Herman M, Hodges J. A randomized, controlled trial of transcutaneous carbon dioxide monitoring during ERCP. Gastrointest Endosc 2000; 51:288-95. [PMID: 10699773 DOI: 10.1016/s0016-5107(00)70357-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pulse oximetry, used to monitor oxygen saturation during endoscopy, does not directly measure hypoventilation. Study goals were to determine whether transcutaneous carbon dioxide (PtcCO(2)) monitoring during endoscopic retrograde cholangiopancreatography (ERCP) prevents severe hypoventilation and to assess the accuracy of clinical observation and pulse oximetry in detecting hypoventilation. METHODS All patients received intensive clinical and electronic monitoring including pulse oximetry. Supplemental oxygen was administered for pulse oximetry < 90%. Patients were randomized to a treatment arm (group 1) where PtcCO(2) monitoring guided sedation or a control arm (group 2) where PtcCO(2) was recorded but unavailable for guiding sedation. RESULTS Group 1 had significantly fewer episodes of severe carbon dioxide retention (rise in PtcCO(2) >/=40 mm Hg above baseline) than group 2 (0 of 199 versus 5 of 196, respectively, p = 0.03), as well a shorter mean duration of procedure discomfort (8.3% of procedure duration rated as "uncomfortable" versus 11.5%, p = 0.04). Correlations between clinical observation and objective measures of ventilation were poor: level of sedation versus PtcCO(2) (R = 0.3) or pulse oximetry (R = 0.06); slowest respiratory rate versus PtcCO(2) (R = 0.4) or pulse oximetry (R = -0.4). PtcCO(2) rises of greater than 20 mm Hg occurred without oxygen desaturation in 10.7% of patients receiving supplemental oxygen. CONCLUSIONS Carbon dioxide retention during ERCP is not reliably detected by clinical observation or by pulse oximetry in patients receiving supplemental oxygen. The addition of PtcCO(2) monitoring prevents severe carbon dioxide retention more effectively than intensive clinical monitoring and pulse oximetry alone. The clinical relevancy of this observation needs to be determined in an appropriately designed outcome study.
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Berke SJ, Cohen AJ, Sturm RT, Caronia RM, Nelson DB. ENDOSCOPIC CYCLOPHOTOCOAGULATION (ECP) AND PHACOEMULSIFICATION IN THE TREATMENT OF MEDICALLY CONTROLLED PRIMARY OPEN-ANGLE GLAUCOMA. J Glaucoma 2000. [DOI: 10.1097/00061198-200002000-00072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Laing K, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. ASGE Technology status evaluation report. Automatic endoscope reprocessors. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:925-7. [PMID: 10644193 DOI: 10.1016/s0016-5107(99)70197-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. ASGE technology status evaluation report. Endoscopic retrieval devices. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:932-4. [PMID: 10644195 DOI: 10.1016/s0016-5107(99)70199-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wang KK, Wassef WY. ASGE technology evaluation report. Endoscopy simulators. May 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:935-7. [PMID: 10644196 DOI: 10.1016/s0016-5107(99)70200-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wang KK, Wassef WY. ASGE technology status evaluation report. Biliary stents. Update May 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:938-42. [PMID: 10644197 DOI: 10.1016/s0016-5107(99)70201-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. ASGE technology status evaluation report. Injection needles. February 1999. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 50:928-31. [PMID: 10644194 DOI: 10.1016/s0016-5107(99)70198-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Zagelbaum BM, Schwartz BH, Nelson DB. Accidental instillation of N-butyl cyanoacrylate into the anterior chamber. Br J Ophthalmol 1999; 83:884. [PMID: 10636674 PMCID: PMC1723097 DOI: 10.1136/bjo.83.7.878h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
A 53-yr-old man was admitted with new onset of abdominal pain and nonbloody diarrhea 1 month after exposure to the antifungal agent itraconazole. Flexible sigmoidoscopy demonstrated the presence of pseudomembranes, and subsequent evaluation excluded other causes of diarrhea. Disruption of the resident fungal flora of the colon by itraconazole is proposed as the mechanism by which this patient developed pseudomembranous colitis. This association has not previously been reported.
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Carr-Locke DL, Conn MI, Faigel DO, Laing K, Leung JW, Mills MR, Nelson DB, Tarnasky PR, Waxman I. Technology status evaluation: magnetic resonance cholangiopancreatography: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 49:858-61. [PMID: 10343251 DOI: 10.1016/s0016-5107(99)70318-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Carr-Locke DL, Conn MI, Faigel DO, Laing K, Leung JW, Mills MR, Nelson DB, Smith P, Tarnasky PR, Waxman I. Technology status evaluation: personal protective equipment: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 49:854-7. [PMID: 10343250 DOI: 10.1016/s0016-5107(99)70317-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Nelson DB, Bosco JJ, Curtis WD, Faigel DO, Kelsey PB, Leung JW, Mills MR, Smith P, Tarnasky PR, VanDam J, Wassef WY. Technology status evaluation: sheathed endoscopes: November 1998. From the ASGE. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1999; 49:862-4. [PMID: 10343252 DOI: 10.1016/s0016-5107(99)70319-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Freeman ML, Nelson DB, Sherman S, Haber GB, Fennerty MB, DiSario JA, Ryan ME, Kortan PP, Dorsher PJ, Shaw MJ, Herman ME, Cunningham JT, Moore JP, Silverman WB, Imperial JC, Mackie RD, Jamidar PA, Yakshe PN, Logan GM, Pheley AM. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group. Gastrointest Endosc 1999; 49:580-6. [PMID: 10228255 DOI: 10.1016/s0016-5107(99)70385-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Same-day discharge after endoscopic biliary sphincterotomy (ES) is a common clinical practice, but there have been few data to guide appropriate selection of patients. Using a prospective, multicenter database of complications, we examined outcomes after same-day discharge as it was practiced by a variety of endoscopists and evaluated the ability of a multivariate risk factor analysis to predict which patients would require readmission for complications. METHODS A 150-variable database was prospectively collected at time of ES, before discharge and again at 30 days in consecutive patients undergoing ES at 17 centers. Complications were defined by consensus criteria and included all specific adverse events directly or indirectly related to ES requiring more than 1 night of hospitalization. RESULTS Six hundred fourteen (26%) of 2347 patients undergoing ES were discharged on the same day as the procedure, ranging from none at 6 centers to about 50% at 2 centers. After initial observation and release, readmission to the hospital for complications occurred in 35 (5.7%) of 614 same-day discharge patients (20 pancreatitis and 15 other complications, 3 severe). Of the same-day discharge patients, readmission was required for 14 (12.2%) of 115 who had at least one independently significant multivariate risk factor for overall complications (suspected sphincter of Oddi dysfunction, cirrhosis, difficult bile duct cannulation, precut sphincterotomy, or combined percutaneous-endoscopic procedure) versus 21 (4.2%) of 499 without a risk factor (odds ratio 3.1: 95% confidence interval [1.6, 6.3], p < 0.001). Of complications presenting within 24 hours after ES, only 44% presented within the first 2 hours, but 79% presented within 6 hours. CONCLUSIONS Same-day discharge is widely utilized and relatively safe but results in a significant number of readmissions for complications. For patients at higher risk of complications, as indicated by the presence of at least one of five independent predictors, observation for 6 hours or overnight may reduce the need for readmission.
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Abstract
BACKGROUND Antibiotic prophylaxis has been recommended for selected patients undergoing esophageal stricture dilation because of a reported high rate of bacteremia. The aim of this study was to determine the rate of bacteremia after esophageal dilatation in a large series and the source of the organisms recovered. METHODS Blood cultures and oral temperatures were obtained before esophageal dilation and at 5 and 30 minutes after dilation. Dilators were cultured immediately before dilation. Procedural data collected included type of dilation, number of passes, and presence of malignancy. RESULTS Of 100 procedures in 86 patients undergoing esophageal dilation, 22 (22%) were associated with a positive post-dilation blood culture. Bacteremia was more frequent with dilation of malignant strictures compared with benign strictures (9 of 17 [52.9%] vs. 13 of 83 [15.7%], respectively, p = 0.002) and with passage of multiple dilators compared with passage of a single dilator (16 of 46 [34.8%] versus 6 of 54 [11.1%], respectively, p = 0.007). Bacterial isolates from 22 positive blood cultures matched those from a dilator in only one episode (4.5%). CONCLUSION The rate of bacteremia after esophageal dilation is 22% and is associated with dilation of malignant strictures or passage of multiple dilators. Organisms cultured from the blood are not transmitted from the dilator.
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Nelson DB, Ness RB, Peipert JF, Soper DE, Amortegui AJ, Gluck J, Wiesenfeld H, Rice PA. Factors predicting upper genital tract inflammation among women with lower genital tract infection. J Womens Health (Larchmt) 1998; 7:1033-40. [PMID: 9812300 DOI: 10.1089/jwh.1998.7.1033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We sought to identify factors that discriminate between women with a lower genital tract infection and women with a lower genital tract infection and endometritis. This study enrolled women at risk for or having a lower genital tract infection with Chlamydia trachomatis or Neisseria gonorrhoeae and measured behavioral and clinical factors. Women were identified through contact tracing of male partners, presentation with cervicitis, or presentation with symptoms of pelvic inflammatory disease and classified as (1) having a lower genital tract infection without endometritis, (2) having a lower genital tract infection with endometritis, (3) having no lower genital tract infection with endometritis, and (4) having neither a lower genital tract infection nor endometritis. The primary comparison was between women having a lower genital tract infection without endometritis to women having a lower genital tract infection and endometritis. Women with a lower genital tract infection and endometritis were older and reported a history of more sexually transmitted diseases (70.0% vs. 56.7%), abdominal pain (82.2% vs. 60.0%), and use of barrier methods of contraception (28.9% vs. 8.6%) than women with a lower genital tract infection alone. The regression model found that women with a lower genital tract infection and endometritis were 7.1 times (95% CI = 2.2-23.0) more likely to report abdominal pain and 4.6 times (95% CI = 1.5-14.9) more likely to use barrier methods of contraception than women with a lower genital tract infection alone. These results suggest that behavioral factors, in addition to symptoms, can be used to identify women with and without upper genital tract involvement.
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