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Abstract
This review describes the microbiology and management of female genital tract infections in adolescents. These infections include vulvovaginitis, vulvovaginal pyogenic infections (abscesses of Bartholin's and Skene's glands, infected labial inclusion cysts, labial abscesses, furunculosis, and hidradenitis), endometritis, pyometritis, salpingitis, pelvic inflammatory disease, and tubo-ovarian and pelvic abscess. Anaerobes can be cultured in 50% to 90% of females with a variety of genital infections and are the exclusive isolates in 20% to 50%. Obligate anaerobes are particularly common in closed-space infections, such as tubo-ovarian and vulvovaginal abscesses. The most common anaerobes found in these infections are gram-negative bacilli (especially P. bivia and P. disiens) and anaerobic cocci. Anaerobes generally are not the only pathogens found, but are usually mixed with aerobes. The most common aerobic pathogens are members of the Enterobacteriaceae family, especially E. coli, and aerobic or microaerophilic streptococci. Sexually acquired infections include Neisseria gonorrhoeae, Gardnerella vaginalis, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex, and Condyloma accuminata. Treatment regimens must provide antimicrobial coverage for N gonorrhoeae, C trachomatis, anaerobes, streptococci, and gram-negative facultative bacteria.
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152
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Hong S, Xin C, Qianhong Y, Yanan W, Wenyan X, Peeling RW, Mabey D. Pelvic inflammatory disease in the People's Republic of China: aetiology and management. Int J STD AIDS 2002; 13:568-72. [PMID: 12194742 DOI: 10.1258/095646202760159710] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the causes of pelvic inflammatory disease (PID) in Shenyang, Northeastern China, and to assess the efficacy of the syndromic management flowchart for PID recommended by World Health Organization (WHO). METHODS 200 outpatients with PID attending Gynaecologic Clinic of No. 1 and No. 2 hospital of China Medical University in Shenyang, and 155 control women without symptoms underwent pelvic examination, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma hominis (MH), bacterial vaginosis (BV), Candida albicans (CA) and Trichomonas vaginalis (TV). RESULTS In PID patients, the prevalence of MH was 26%, of BV 26%, of CT 16%, of CA 11%, of TV 4% and of NG 2.5%. In the control population, prevalences were 5.2%, 8.4%, 0%, 5.2%, 0.7%, 0% respectively. MH, BV and CT were significantly more common in PID patients than in controls (P<0.01). One hundred and thirty-seven of the 200 patients with PID (68.5%) returned for follow-up. Symptoms had resolved completely in 64 (47%), and had improved in 68 (50%). There was no improvement in five (4%). CONCLUSIONS The management protocol for female lower abdominal pain recommended by WHO is effective in this setting.
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153
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Cogan SL, Robinson JC. Uterine gas vs. vessel calcification. A case report. THE JOURNAL OF REPRODUCTIVE MEDICINE 2002; 47:588-90. [PMID: 12170539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Pelvic ultrasound plays a significant role in the diagnosis of uterine abnormalities; however, occasionally the radiologic findings may be misleading. CASE A case of suspected uterine vessel calcification was detected on ultrasound in a patient hospitalized with pelvic inflammatory disease that was originally interpreted as uterine gas. The lack of change over serial ultrasound scans in conjunction with the patient's benign clinical course led to reassessment of the initial impression; the findings were then attributed to uterine vessel calcification. CONCLUSION Uterine vessel calcification in a polysubstance abuser may be a manifestation of the known atherosclerotic cardiovascular complications of cocaine. Although ultrasound findings may be misleading, clinical judgment is essential to rule out clostridial endomyometritis.
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154
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Diankova T. [Inflammatory disease of the pelvis]. AKUSHERSTVO I GINEKOLOGIIA 2002; 41 Suppl 4:18-9. [PMID: 11519315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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155
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Levenson D. Outpatient pelvic inflammatory disease treatment as effective as inpatient care, study finds. REPORT ON MEDICAL GUIDELINES & OUTCOMES RESEARCH 2002; 13:9-10, 12. [PMID: 12498174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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156
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Ross J. Pelvic inflammatory disease. CLINICAL EVIDENCE 2002:1452-7. [PMID: 12230761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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157
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Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002; 186:929-37. [PMID: 12015517 DOI: 10.1067/mob.2002.121625] [Citation(s) in RCA: 299] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as outpatients, the effectiveness of this strategy remains unproven. STUDY DESIGN We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy. RESULTS Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy. CONCLUSION Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment.
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158
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Kuchimanchi U, McClean H. A multidistrict audit of the management of chlamydial PID in genitourinary medicine clinics in Yorkshire. Int J STD AIDS 2002; 13:264-7. [PMID: 11886612 DOI: 10.1258/0956462021924910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In response to recent reviews of practice of pelvic inflammatory disease (PID) management, a multidistrict audit involving eight genitourinary clinics within the Yorkshire region was carried out. This audit reports the referral patterns of patients, physical signs and microscopy findings at the first genitourinary medicine (GUM) clinic attendance, antibiotic treatment and follow-up data as well as health adviser involvement and partner participation for 68 patients diagnosed with chlamydial PID. Twenty-eight (41.2%) patients presented with symptoms of less than or equal to four weeks duration, partner notification was recorded as being carried out for all patients and at least one partner was documented as having been treated in 57 (83.8%) patients. There is, however, a wide variation in the antibiotic regimens used for treatment and their duration.
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159
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Risser WL, Risser JMH, Cromwell PF. Pelvic inflammatory disease in adolescents: a review. Tex Med 2002; 98:36-40. [PMID: 11862890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Pelvic inflammatory disease is relatively common in sexually active adolescents. Most cases are only mildly symptomatic, and criteria for diagnosis should not be stringent. Although chlamydial or gonorrheal infections or both are common in pelvic inflammatory disease, other aerobic and anaerobic organisms are often also present and may be the only causative agents. Commonly used initial therapy, e.g., ceftriaxone and doxycycline, treats some but not all of these organisms. Patients should be seen within 48 to 72 hours after initiating therapy; lack of improvement suggests noncompliance with antibiotic therapy, the need for broader-spectrum antibiotic coverage, a tubo-ovarian abscess, or a mistake in diagnosis. Important preventive measures include screening of sexually active, asymptomatic adolescents for gonorrheal and chlamydial infections, not only in clinics for sexually transmitted diseases and family planning but also in primary care settings. Urine tests that amplify chlamydial and gonococcal nucleic acid are noninvasive and very accurate.
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160
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161
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Ross JD. European guideline for the management of pelvic inflammatory disease and perihepatitis. Int J STD AIDS 2001; 12 Suppl 3:84-7. [PMID: 11589804 DOI: 10.1258/0956462011924001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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163
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Leiva A, Shaw M, Paine K, Manneh K, McAdam K, Mayaud P. Management of sexually transmitted diseases in urban pharmacies in The Gambia. Int J STD AIDS 2001; 12:444-52. [PMID: 11394980 DOI: 10.1258/0956462011923471] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to describe the quality and costs of sexually transmitted disease (STD) case management in urban pharmacies in The Gambia, and explore pharmacy workers' (PWs) willingness to improve the STD care they provide. PWs from 24 registered pharmacies were interviewed in order to collect information on their knowledge and practices regarding management of STDs. The same pharmacies were visited by a male 'simulated client' (SC) to ascertain how urethral discharge syndrome (UDS) cases were managed in practice. Fifteen (63%) pharmacies were equipped for treatment of UDS, pelvic inflammatory disease (PID) and genital ulcer syndrome (GUS), according to national guidelines. Appropriate syndromic management for UDS was mentioned by 11% of PWs but actually given to 4.4% of the SC visits. None of the PID or GUS cases would be treated correctly. Forty-two per cent of PWs advised on partner notification, 38% on safe sex and 29% on treatment compliance in the SC visits. The reported costs for treatment of UDS, PID and GUS ranged from $2.5-$15.0. The cost of treatment actually purchased by the SC averaged $3.5 (range $1.5-$9.6) for UDS. Excluding the pharmacy sector from interventions will limit the impact of STD control measures. Regular training in syndromic management and rational drug use, with a concise manual for reference are recommended. Strategies to lower the cost of drugs should be explored.
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164
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Kamiński K, Fiegler P, Marr J, Moore C. [Treatment of endometriosis with dienogest: preliminary report]. Ginekol Pol 2001; 72:299-304. [PMID: 11526761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
AIM OF THE STUDY Influence of two hormonal therapies (GnRH agonist--leuprolein acetate and a new progestin--dienogest) on symptoms of endometriosis in patients with different clinical grade of disease. MATERIAL AND METHODS 34 women with endometriosis confirmed by laparoscopy and histology were included into the study. Patients were randomized and divided into two therapeutic groups. One group was treated with dienogest and the second with leuprolein acetate during 6 month of study. The intensification of pain was assessed with Visual Analog Scale (VAS) and pelvic symptoms scale before, during (3 month) and after therapy. Dyspareunia was assessed with pelvic symptoms scale before, during (3 month) and after therapy. Frequency of adverse effects was assessed in 1, 3 and 6 month of therapy. Emotional state, bone density and basic serum parameters were assessed before and after therapy. RESULTS AND CONCLUSIONS Dienogest as well as leuprolein acetate decreased pelvic pain and dyspareunia. There were no differences between these influences. Dienogest did not reveal androgenic activity (did not reveal activity nor intense seborrheic lesions, nor hirsutism, nor voice tone). Dienogest did not reveal hot flashes. Bleeding (caused by dienogest therapy) did not influence hematologic indices nor affected the patients' decision on preterm end of treatment.
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165
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Palatyński A, Gruszczyńska J. [Decapeptyl (triptorelin) in the treatment of endometriosis genitalis externa]. Ginekol Pol 2001; 72:290-5. [PMID: 11526759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
The study involved 69 patients in whom endometriosis was diagnosed. The patients were divided into three groups randomly. In each of the groups, a different method of treatment was applied. In group A thermocoagulation was used, in group B triptorelin was used and in group C the above monitored methods of treatment were applied. Combined therapy involving the use of both thermocoagulation and triptorelin seen to be the most effective.
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166
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Child TJ, Thomas J, Rees M, MacKenzie IZ. Morbidity of first trimester aspiration termination and the seniority of the surgeon. Hum Reprod 2001; 16:875-8. [PMID: 11331632 DOI: 10.1093/humrep/16.5.875] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vacuum aspiration is a safe, acceptable, and efficacious method of first trimester pregnancy termination. The success and complication rates are thought to be partially dependent on operator experience and gestation. We examined this further by studying the outcome of 828 consecutive surgical abortions up to 13 weeks gestation in our hospital. The following outcomes were measured: surgical curettage for presumed retained products of conception; continuing pregnancy; uterine perforation; pelvic sepsis requiring intravenous antibiotics; and blood transfusion required. The complete abortion rate was 94.6% and the rate of continuing pregnancy 0.24%. There was a significant relationship between efficacy and seniority of the surgeon; consultants, senior registrars, registrars, and senior house officers had complete abortion rates of 97.8, 92.8, 94.7, and 88.4% respectively (P = 0.039). Parity did not affect efficacy. Terminations at 12-13 weeks gestation were associated with a significantly lower complete abortion rate. The rates of uterine perforation, blood transfusion, pelvic sepsis requiring intravenous antibiotics, and overnight hospital admission were 0.24, 0, 0.97, and 1.69% respectively. Thus, the only significant factors affecting outcome of surgical abortion are grade of operating surgeon or terminations performed at later gestations of 12-13 weeks. It is vital that physicians performing surgical terminations are adequately trained.
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167
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Palatyński A, Gruszczyńska J, Sobkiewicz S. [Nafarelin acetate (Synarel) and thermocoagulation in the treatment of endometriosis]. Ginekol Pol 2001; 72:284-9. [PMID: 11526758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
We evaluated the results of united treatment (thermocoagulation and nafarelin acetate) of the node type of endometriosis) among women with pain syndrome in pelvis minoris. During the treatment we observed withdrawal of pain in lower abdomen among 60% of patients and assuagement in remaining cases. During the treatment by Synarel the menses were absent together with complaints connected with menstruation. The efficacy of the drug together with surgical intervention was many times higher then that of thermocoagulation alone.
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168
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Kamiński P, Grzechocińska B, Gadomska H, Barcz E, Marianowski L. [The results of GnRH analog treatment of endometriosis]. Ginekol Pol 2001; 72:278-83. [PMID: 11526757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Our study consisted of 146 patients with endometriosis diagnosed during laparoscopy. The age of those women varied from 19 to 43. Pathological changes were classified according to Revised American Fertility Society scale. Numeric scale was also used to evaluate clinical symptoms characteristic to this disease. During the initial laparoscopy biopsies were taken, endometrial implants were coagulated, pelvic adhesions deliberated and endometriomas were enucleated or their wall cut out and coagulated. When endometriosis was histopathologically confirmed the hormonal treatment was undertaken during a period of time from 3 to 6 months depending on the severity of the disease. The patients were treated with 3.6 mg gosereline and 3.75 mg triptorelin monthly or with 400 mcg of naphareline daily. The hormonal therapy was monitored by the concentration of estradiol in blood serum. After full cycle of GnRH analogues treatment laparoscopy was repeated. The mean of The Symptom Severity Scores decreased from 7.1 to 2.1 after the treatment which is a 70% decrease. In the group of women with pain complains 96% of patients noticed improvement, in the group suffering from infertility there were 26.3% of patients who got pregnant. GnRH analogues were good tolerated by patients during the treatment.
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169
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Bowden FJ, Jacups S, Huffman S, Savage J, O'Brien M. Azithromycin and pelvic inflammatory disease in the Northern Territory. Med J Aust 2001; 174:366-7. [PMID: 11346115 DOI: 10.5694/j.1326-5377.2001.tb143320.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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171
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Johnson RA. Diagnosis and treatment of common sexually transmitted diseases in women. CLINICAL CORNERSTONE 2001; 3:1-11. [PMID: 11061063 DOI: 10.1016/s1098-3597(00)90017-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae are 2 very common sexually transmitted organisms, whose clinical manifestations in women can range from an asymptomatic carrier state to active pelvic inflammatory disease with known serious sequelae, including chronic pelvic pain, infertility, and ectopic pregnancy. The economic and clinical burden of these 2 infectious organisms are significant in the sexually active population. New developments in diagnosis and treatment of these infections raise great hope that substantial reduction in morbidity and disease prevalence rates can be achieved. Herpes simplex virus is probably better publicized and more feared in the sexually active population, and is far more prevalent than previously recognized; fortunately, however, it is not generally associated with significant morbidity. This article will review the current diagnoses and treatments of these conditions and consider some of the issues surrounding the impact of screening asymptomatic sexually active individuals. The treatment guidelines will emphasize the 1998 Guidelines for Treatment of Sexually Transmitted Diseases from the Centers for Disease Control and Prevention.
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172
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Ross JD. Outpatient antibiotics for pelvic inflammatory disease. BMJ (CLINICAL RESEARCH ED.) 2001; 322:251-2. [PMID: 11157512 PMCID: PMC1119512 DOI: 10.1136/bmj.322.7281.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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173
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Andersson K. The levonorgestrel intrauterine system: more than a contraceptive. EUR J CONTRACEP REPR 2001; 6 Suppl 1:15-22. [PMID: 11336429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Levonorgestrel can be released directly into the uterine cavity, where it causes pronounced endometrial suppression, although the dose of hormone is so low that the effect on ovarian function is negligible. The levonorgestrel-releasing intrauterine system (LNG-IUS) consists of a plain Nova-T device with a silastic reservoir attached to the vertical arm. The silastic reservoir is impregnated with levonorgestrel and is covered with a rate-limiting silastic membrane. The release rate oflevonorgestrel is approximately 20 microg/24 h for at least 5 years. The contraceptive efficacy of the LNG-IUS has been studied in a randomized, comparative trial over 5 years. A total of 1,821 women were fitted with the LNG-IUS and were compared with 937 women who were using the copper-releasing device, Nova-T. The continuation rates were 46.9 for the LNG-IUS and 44.5 for the Nova-T. The cumulative gross pregnancy rates were 0.5 for the LNG-IUS and 5.9 for the Nova-T. The Pearl index after 5 years was 0.09/100 woman-years for the LNG-IUS and the ectopic pregnancy rate was 0.02/100 woman-years. There were less withdrawals because of bleeding problems and pelvic inflammatory disease in the LNG-IUS group compared with the Nova-T group, but there were more withdrawals because of hormonal side-effects and absence of bleeding. There were no differences in the return of fertility after removal of the LNG-IUS and the Nova-T. All women will notice a change in their bleeding pattern after the LNG-IUS has been inserted and some will initially experience many days of spotting. It is extremely important to counsel women about the changes in bleeding pattern that will occur with the LNG-IUS before the system is fitted. One of the advantages of the LNG-IUS is that menstrual blood loss will decrease (and therefore hemoglobin levels will increase), which means that the LNG-IUS is one of the most effective reversible long-term treatments of idiopathic menorrhagia. The LNG-IUS can be used successfully throughout the reproductive period for effective contraception and treatment of menorrhagia. In addition, this system provides endometrial protection. Women who suffer from climacteric symptoms while they are using the LNG-IUS can be given estrogen to relieve their symptoms.
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174
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Lee YC, Min D, Holcomb K, Buhl A, DiMaio T, Abulafia O. Computed tomography guided core needle biopsy diagnosis of pelvic actinomycosis. Gynecol Oncol 2000; 79:318-23. [PMID: 11063665 DOI: 10.1006/gyno.2000.5994] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pelvic actinomycosis is a chronic suppurative inflammatory disease caused by the anaerobic Gram-positive bacilli Actinomyces israelii. The propensity of this disease to simulate gynecological malignancies has been described previously. The great majority of these patients were diagnosed with actinomycotic diseases during or after exploratory laparotomy, but rarely preoperatively. We reviewed the literature pertaining the management of pelvic actinomycosis. CASE A nulliparous woman with a long history of intrauterine contraceptive device (IUD) and recent Papanicolaou smear findings consistent with the presence of actinomyces presented with chronic vague lower abdominal pain, weight loss, poor appetite, and recent increase in abdominal girth associated with a large immobile pelvic mass. Transcutaneous computed tomography guided core needle biopsy established the diagnosis of pelvic actinomycosis obviating immediate surgical intervention. Intravenous and subsequent long-term oral penicillin therapy was constituted and resulted in a significant decrease in the size of the pelvic mass. CONCLUSION In patients presenting with pelvic masses and a history of IUD placement, actinomycotic infection should be considered and diagnosis attempted by imaging guided needle biopsy. Furthermore, this case suggested that correct nonsurgical diagnosis of pelvic actinomycosis followed by prolonged antibiotic therapy might eliminate the need for extensive extirpative surgery and assist in maintaining future fertility.
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175
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Abstract
Pelvic inflammatory disease (PID) refers to infection of the uterus (endometritis), fallopian tubes (salpingitis) and adjacent pelvic structures (tubo-ovarain complex, pelvic peritonitis). PID causes major medical, social, and economic problems. Long-term sequelae, especially tubal factor infertility and extra uterine pregnancy are common and their management is extremely costly. Medical treatment of PID should be immediate because sequelae are more frequent if the treatment is delayed or inadequate.
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176
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Marks C, Tideman RL, Estcourt CS, Smart S, Page J, Wagner K, Mindel A. Diagnosing PID--getting the balance right. Int J STD AIDS 2000; 11:545-7. [PMID: 10990340 DOI: 10.1258/0956462001916290] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to determine the clinical manifestations and diagnostic criteria used to diagnose presumptive pelvic inflammatory disease (PID) at the Sydney Sexual Health Centre (SSHC). The study was a retrospective, case-note review of all women diagnosed with presumptive PID between April 1991 and December 1997. Seven hundred and thirteen women were included. The commonest recorded symptoms were vaginal discharge (68%), lower abdominal pain (65%) and dyspareunia (57%), while adnexal tenderness (83%), cervical motion tenderness (75%) and cervicitis (56%) were the most frequently recorded examination findings. Sixty-two per cent were prescribed doxycycline and metronidazole. The recording of signs and symptoms in women with presumptive PID was poor and only 22% met the current Centers for Disease Control (CDC) diagnostic criteria. It is likely that PID is over diagnosed in this group of women. This may lead to under diagnosis of other conditions causing pelvic pain and may be detrimental to reproductive health.
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177
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[Oral hormone contraception]. ACTA MEDICA PORT 2000; 13:231-6. [PMID: 11189436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The authors focus on the main goals of hormonal contraception with special attention to its benefits regarding some pathological situations. Post coital, post partum and adolescent hormonal contraception are reviewed in detail. The authors also point out the contraindications to its prescription.
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Abstract
The goals in the management of pelvic inflammatory disease (PID) are not only treatment of the infection and prevention of immediate complications, but also prevention of its long-term consequences. There are criteria for hospitalization, but patients who do not meet them can be safely treated as outpatients. A variety of sexually transmitted and other microorganisms can cause this infection, but the most important are Chlamydia trachomatis and Neisseria gonorrhoeae. Regimens with activity against gonococci, chlamydiae, streptococci, gram-negative bacteria, and anaerobes should be administered. Several such antimicrobial regimens have shown very good clinical and microbiologic efficacy. However, their efficacy in preventing long-term complications, such as infertility, has not been established. Close follow-up is an important part of management. Evaluation of male sexual partners is imperative to prevent reinfection. Better diagnostic techniques and treatment modalities for PID must be developed to prevent its long-term consequences.
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179
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Kurz R, Amon K, Laqua D, Fischbach F, Buck J, Heinkelein J. [Actinomycosis of the pelvis with an indwelling IUD]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2000; 38:375-9. [PMID: 10875147 DOI: 10.1055/s-2000-14880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Infection with actinomycosis israeli (an anaerobic, gram-positive bacterium) presents as chronic inflammation with tendency to fibrosis and suppuration with formation of external sinuses. Cervicofacial, thoracic and abdominal forms of the disease made up 95% of cases of actinomycosis. A 53-year-old woman was admitted to the hospital because of a pelvic mass which was thought to be malignant. A laparotomy was performed and the histologic examination showed actinomycosis. The patient first received penicillin followed by tetracyclin and the pelvic mass shrunk. One year later no more mass was detectable. We think that the IUP in place over years is the source for this infection.
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180
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Stitely ML, Gherman RB. Successful pregnancy outcome following first trimester pelvic inflammatory disease. Aust N Z J Obstet Gynaecol 2000; 40:200-2. [PMID: 10925910 DOI: 10.1111/j.1479-828x.2000.tb01147.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pelvic inflammatory disease rarely complicates pregnancy. Although few in number, most of the previously reported cases have resulted in spontaneous abortion or intrauterine fetal demise. At 5 weeks gestation, a 20 year old gravida 2 para 1 underwent uterine curettage and diagnostic laparoscopy for a suspected ectopic gestation. Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness. After 84 hours of intravenous cefazolin, gentamycin, and clindamycin, the patient had resolution of all symptoms. She then completed 14 days of outpatient antibiotic therapy with oral cephalexin. At 39 weeks gestation, she delivered a 3611 g male fetus via spontaneous vaginal delivery. Successful pregnancy outcome can occur after first trimester pelvic inflammatory disease.
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181
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Bossens M. [Salpingitis and pelvic peritonitis]. REVUE MEDICALE DE BRUXELLES 2000; 21:A115-7. [PMID: 10829608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Reyal F, Grynberg H, Sibony O, Molinié V, Galeazzi G, Barge J, Engelmann P. [Pelvic actinomycosis]. Presse Med 1999; 28:2113-6. [PMID: 10613202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
UNLABELLED AN UNUSUAL INFECTION: Actinomycosis, uncommon in a pelvic localization, is a severe condition not well known to gynecologists. It is caused by Actinomyces israeli and is closely associated with long-term use of an intrauterine device. In the pelvic localization, the disease generally presents as a pseudoneoplastic formation. DIFFICULT DIAGNOSIS: Diagnosis is generally not established clinically. Pathology provides positive diagnosis. The germ cannot be isolated easily as it does not survive standard bacteriology sampling. Monoclonal antibodies may be helpful. MEDICAL TREATMENT Intravenous penicillin G followed by at least 6 months oral penicillin is generally successful in eradicating the infection. Indications for surgery should be limited to diagnostic procedures (pathology specimen), drainage in case of abscess formation, and removal of an obstacle compressing the digestive or urinary tract.
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183
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Giamarellou H. Fourth generation cephalosporins in the antimicrobial chemotherapy of surgical infections. J Chemother 1999; 11:486-93. [PMID: 10678790 DOI: 10.1179/joc.1999.11.6.486] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Surgical infections include a variety of entities such as secondary peritonitis, intra-abdominal abscesses, obstetric and gynecological infections as well as bone-joint and soft-tissue infections. By definition the term "surgical infection" implies that surgery itself plays the major role in therapy, while antimicrobial chemotherapy is only supplementary. Broad-spectrum empirical regimens employed include the combination of a 1st or 2nd generation cephalosporin plus clindamycin or metronidazole +/- aminoglycoside (depending on the severity of the condition). Cefepime and cefpirome are new 4th generation parenteral cephalosporins with a spectrum of activity which makes them suitable for the treatment of infections caused by a wide variety of bacteria. They are active against both gram-positive and gram-negative organisms, including Staphylococcus aureus and Pseudomonas aeruginosa with activity comparable to or greater than that of cefotaxime or ceftazidime respectively. Cefepime in particular is also very active against strains of Enterobacter and Pseudomonas spp resistant to these two agents. In comparison with 3rd generation cephalosporins, cefepime appears to be less likely to induce resistance, due to a lower rate of hydrolysis by beta-lactamases, a low affinity for these enzymes and more rapid permeation into the cell. Despite the fact that a 4th generation cephalosporin is well-suited for the treatment of polymicrobial infections, the following should be kept in mind: (I) MRSA strains and Bacteroides fragilis group are not included in their spectrum of activity. (II) Cefpirome is the only cephalosporin with in vitro activity against Enterococci. (III) Severe surgical infections of nosocomial origin, and particularly in settings where Enterobacter spp predominate, represent the major indication for empirical use of a 4th generation cephalosporin in combination with a nitroimidazole.
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184
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Atad J, Hallak M, Sharon A, Kitzes R, Kelner Y, Abramovici H. Pelvic actinomycosis. Is long-term antibiotic therapy necessary? THE JOURNAL OF REPRODUCTIVE MEDICINE 1999; 44:939-44. [PMID: 10589404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To describe 11 cases of actinomycosis and analyze whether long-term antibiotic use in necessary. STUDY DESIGN Analysis of 11 cases of pelvic actinomycosis diagnosed and treated during the last nine years. Four patients had an intrauterine device (IUD) for 6-20 years, three patients had an IUD for 3-5 years, and four patients had no known etiology. In most patients the symptoms lasted from several days to one month. The actinomycotic lesions involved one or both ovaries in all 11 cases. In five patients the lesion extended to other areas, such as the uterus, omentum, parametrium, pelvic walls, colon, bladder, cul-de-sac and gallbladder. RESULTS All patients underwent surgery that included removal of the lesions with the ipsilateral or both adnexa and, in specific cases, with extension of the lesions, hysterectomy, omentectomy, hemicolectomy and cholecystectomy. Confirmation of the diagnosis of actinomycosis was done by histology in all cases, and antibiotic treatment usually began 1-14 days after surgery. The drug of choice was penicillin. The duration of treatment was 12 months in 6 patients, 6 months in 3 and < or = 3 months in two. All patients were alive and well after two to nine years of follow-up. CONCLUSION In contrast to actinomycosis at other sites, where the literature recommends antibiotic therapy for 6-12 months, pelvic actinomycosis could be a limited disease. We propose that in cases of pelvic actinomycosis where the abscess can be completely removed surgically, a shorter period of antibiotic therapy can be effective.
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185
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Tikhonovskaia OA, Petrova MS, Logvinov SV, Evtushenko ID, Nevostruev SA. [Effect of ultraphonophoresis of eplir on the fibrous-sclerotic and adhesive changes in uterine adnexa]. BIULLETEN' EKSPERIMENTAL'NOI BIOLOGII I MEDITSINY 1999; 128:582-5. [PMID: 10640253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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186
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Woodward C, Fisher MA. Drug treatment of common STDs: Part II. Vaginal infections, pelvic inflammatory disease and genital warts. Am Fam Physician 1999; 60:1716-22. [PMID: 10537386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The Centers for Disease Control and Prevention (CDC) released new guidelines for the treatment of sexually transmitted diseases (STDs) in 1998. Several treatment advances have been made since the previous guidelines were published. Part II of this two-part series on STDs describes recommendations for the treatment of diseases characterized by vaginal discharge, pelvic inflammatory disease, epididymitis, human papillomavirus infection, proctitis, proctocolitis, enteritis and ectoparasitic diseases. Single-dose therapies are recommended for the treatment of several of these diseases. A single 1-g dose of oral azithromycin is as effective as a seven-day course of oral doxycycline, 100 mg twice a day, for the treatment of chlamydial infection. Erythromycin and ofloxacin are alternative agents. Four single-dose therapies are now recommended for the management of uncomplicated gonococcal infections, including 400 mg of cefixime, 500 mg of ciprofloxacin, 125 mg of ceftriaxone or 400 mg of ofloxacin. Advances in the treatment of bacterial vaginosis also have been made. A seven-day course of oral metronidazole is still recommended for the treatment of bacterial vaginosis in pregnant women, but intravaginal clindamycin cream and metronidazole gel are now recommended in nonpregnant women. Single-dose therapy with 150 mg of oral fluconazole is a recommended treatment for vulvovaginal candidiasis. Two new topical treatments, podofilox and imiquimod, are available for patient self-administration to treat human papillomavirus infection. Permethrin cream is now the preferred agent for the treatment of pediculosis pubis and scabies.
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187
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Drugs for sexually transmitted infections. THE MEDICAL LETTER ON DRUGS AND THERAPEUTICS 1999; 41:85-90. [PMID: 10906932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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188
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Gorisek B, Rebersek-Gorisek H, Kavalar R, Krajnc I, Zavrsnik S. Pelvic actinomycosis. Wien Klin Wochenschr 1999; 111:603-7. [PMID: 10483675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Pelvic actinomycosis is a rare chronic infection caused by bacteria of the family Actinomycetaceae. Prolonged use of an intrauterine contraceptive device (IUD) is a well known risk factor. We report six patients with pelvic actinomycosis, all of whom had an IUD inserted for over six years. Diagnostic problems necessitated a laparotomy in all patients. The pathohistological diagnosis was based on the characteristic microscopic image and specific staining. The patients were treated with penicillin and amoxycillin for several months.
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189
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Abstract
The abiding principles of antibiotic use in the surgical patient vary in the complicated pelvic surgery setting only in that some microbes likely to be encountered warrant minor variation in drug choice. Very early antibiotic administration, relatively large doses, and prompt association when the reason for therapy has been accomplished, are the keystones for treatment. Tissue levels of antimicrobial activity are the uniform therapeutic goal. We also prefer consistent selection of drugs known to be safe and believe that continuous infusion may enhance the overall protective effect. Preservation of normal host defenses enhances the action of all antibiotics.
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190
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National guideline for the management of pelvic infection and perihepatitis. Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the Study of Venereal Diseases). Sex Transm Infect 1999; 75 Suppl 1:S54-6. [PMID: 10616386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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191
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Abstract
Pelvic inflammatory disease is the most significant consequence of sexually transmitted infections. Statistics suggest that adolescents have a significantly higher rate of PID than does any other age group. Even asymptomatic and minimally symptomatic PID can lead to adhesions, infertility, and ectopic pregnancy, so clinicians should maintain a high index of suspicion when evaluating female adolescents with lower abdominal pain. Empiric treatment, including appropriate partner notification and treatment, should be initiated early.
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192
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Chimura T, Kaneko N, Hayashi Y, Funayama T, Numazaki M, Oda T, Murayama K, Morisaki N, Hirayama T, Sato F, Akatsuka K. [Clinical studies of faropenem in the field of obstetrics and gynecology]. THE JAPANESE JOURNAL OF ANTIBIOTICS 1999; 52:504-10. [PMID: 10516930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The clinical effect of faropenem was evaluated in 165 ambulatory patients with various infections in the field of obstetrics and gynecology at 10 institutions in Yamagata Prefecture. The results obtained are summarized below. 1. The rate of efficacy, as determined from the clinical effect following 3- to 7-day repeated administration at a dose of 600 mg/day, was 97.9% (46/47) for intrauterine infections, 92.0% (23/25) for adnexitis, 93.8% (15/16) for external genital infections, 88.9% (8/9) for mastitis, 94.0% (63/67) for cystitis, and 100% (1/1) for cervicitis. The overall efficacy rate was estimated to be 94.5% (156/165). 2. The rate of clinical efficacy, as classified by isolate, was high, 95.1% for Gram-positive bacteria, 100% for Gram-negative bacteria, and 100% for anaerobes. As for bacteriological response classified by isolate, the eradication rate was high, 91.4% (74/81) for Gram-positive bacteria, 98.4% (62/63) for Gram-negative bacteria, 89.5% (17/19) for anaerobes, and 93.9% (153/163) in all. 3. No adverse reactions or laboratory abnormalities were observed in any patient. The results presented suggest that faropenem is a highly safe and effective antibiotic for the treatment of obstetric or gynecological infections of various kinds in an ambulatory setting.
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193
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Tikhonovskaia OA, Petrova MS, Logvinov SV, Shustov LP, Titkova IN. [An experimental validation of the use of the ultraphonophoresis of the mud preparation Eplir in inflammation of the uterine adnexa]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 1999:32-4. [PMID: 10513470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Eplir ultraphonophoresis started on day 5 of experimental inflammation of the uterine appendages in the presence of antibacterial therapy reduces the severity of exudative processes, hemodynamic disorders, leukocytic infiltration, follicular atresia, prevents growth of connective tissue stroma.
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194
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Brown CE, Stettler RW, Twickler D, Cunningham FG. Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol 1999; 181:143-8. [PMID: 10411810 DOI: 10.1016/s0002-9378(99)70450-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Before the availability of modern imaging studies the diagnosis of septic pelvic thrombophlebitis causing prolonged puerperal fever was difficult to confirm without surgical exploration. With the use of computed tomography infection-related pelvic phlebitis can now be confirmed, and this study was designed to determine its incidence after delivery. We also designed a randomized clinical trial to evaluate the efficacy of heparin added to antimicrobial therapy for treatment of women with septic phlebitis. STUDY DESIGN We studied women who had pelvic infection and fever that persisted after 5 days despite adequate antimicrobial therapy with clindamycin, gentamicin, and ampicillin. After giving consent study participants underwent abdominopelvic computed tomographic imaging. Women with pelvic thrombophlebitis were randomly assigned to 1 of 2 management schemes that included continuation of antimicrobial therapy, either alone or with the addition of heparin, until the temperature was </=37.5 degrees C for 48 hours. RESULTS During the 3-year study period 44,922 women were delivered at Parkland Hospital; among these 8535 (19%) were delivered by the cesarean route. There were 69 women who met criteria for prolonged infection, and 15 (22%) of these were found to have septic pelvic thrombophlebitis. Four had infection after vaginal delivery and 11 had been delivered by the cesarean route. Of 14 women randomly assigned to therapy, 8 were assigned to receive continued antimicrobial therapy without the addition of heparin and the other 6 were assigned to receive heparin therapy in addition to the antimicrobial agents. According to an intent-to-treat analysis there was no significant difference between the responses of women with pelvic infection who were and were not given heparin therapy. Specifically, women not given heparin were febrile for 140 +/- 39 hours compared with 134 +/- 65 hours for women who received heparin (P =.83). Duration of hospitalization was also similar between the 2 groups at 10.6 +/- 1.9 days for those with thrombosis who were given antimicrobial agents alone and 11.3 +/- 1.2 days for women who also received heparin (P >.5). The 54 women with persistent fever but without computed tomographic evidence of septic pelvic thrombophlebitis were hospitalized for a mean of 12.0 +/- 4.1 days, compared with 10.9 +/- 2.9 days for women in whom thrombosis was diagnosed (P =.14). These women were followed up for >/=3 months post partum and none showed evidence of reinfection, embolic episodes, or postphlebitic syndrome. CONCLUSIONS The overall incidence of septic pelvic thrombophlebitis was 1:3000 deliveries. The incidence was about 1:9000 after vaginal delivery and 1:800 after cesarean section. Women given heparin in addition to antimicrobial therapy for septic thrombophlebitis did not have better outcomes than did those for whom antimicrobial therapy alone was continued. These results also do not support the common empiric practice of heparin treatment for women with persistent postpartum infection.
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195
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Ou MC, Ng HT, Tzeng CR. Sonographically guided intralesional antibiotic injection for treatment of a recalcitrant pelvic abscess: a case report. J Obstet Gynaecol Res 1999; 25:205-7. [PMID: 10467794 DOI: 10.1111/j.1447-0756.1999.tb01148.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it.
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196
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French JI, McGregor JA, Draper D, Parker R, McFee J. Gestational bleeding, bacterial vaginosis, and common reproductive tract infections: risk for preterm birth and benefit of treatment. Obstet Gynecol 1999; 93:715-24. [PMID: 10912974 DOI: 10.1016/s0029-7844(98)00557-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine associations between bacterial vaginosis and other prevalent lower genital tract infections and clinically recognized first-trimester bleeding; possible independent and joint effects of gestational bleeding and bacterial vaginosis or other prevalent infections on preterm birth and premature rupture of membranes; and effects of antimicrobial treatment on reducing risks of preterm birth among these women. METHODS A secondary analysis was conducted of 1100 pregnant women enrolled in a prospective observational study that examined the effects of standardized diagnosis and treatment of lower genital tract infections to prevent preterm birth. RESULTS Sixty percent of women with first-trimester bleeding had one or more study infections detected at the initial examination. First-trimester bleeding was associated independently with the presence of bacterial vaginosis (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0, 2.3), Trichomonas vaginalis (OR 2.3, 95% CI 1.3, 4.2), and Chlamydia trachomatis (OR 2.7, 95% CI 1.4, 5.1). Preterm birth was increased among women with first-trimester bleeding and bacterial vaginosis (relative risk [RR] 4.4, 95% CI 2.0, 9.5) and bacterial vaginosis and T vaginalis (RR 3.0, 95% CI 1.0, 8.8). Systemic antimicrobial treatment reduced the rate of preterm birth among women with bacterial vaginosis without first-trimester bleeding (RR 0.37, 95% CI 0.16, 0.88). Treatment of women with both first-trimester bleeding and bacterial vaginosis reduced preterm birth (RR 0.52, 95% CI 0.18, 1.55), but not significantly. CONCLUSION First-trimester bleeding was increased among women with bacterial vaginosis, T vaginalis, C trachomatis, and combinations of these infections. Women with bacterial vaginosis who also experienced first-trimester bleeding were at heightened risk for preterm birth. Treatment of studied infections reduced significantly the risks of preterm birth among women without first-trimester bleeding.
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MESH Headings
- Adolescent
- Adult
- Anti-Infective Agents/therapeutic use
- Female
- Fetal Membranes, Premature Rupture/etiology
- Fetal Membranes, Premature Rupture/prevention & control
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Obstetric Labor, Premature/etiology
- Obstetric Labor, Premature/prevention & control
- Pelvic Inflammatory Disease/diagnosis
- Pelvic Inflammatory Disease/drug therapy
- Pelvic Inflammatory Disease/etiology
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/drug therapy
- Pregnancy Complications, Cardiovascular/etiology
- Pregnancy Trimester, First
- Pregnancy, High-Risk
- Prospective Studies
- Treatment Outcome
- Uterine Hemorrhage/diagnosis
- Uterine Hemorrhage/drug therapy
- Uterine Hemorrhage/etiology
- Vaginosis, Bacterial/diagnosis
- Vaginosis, Bacterial/drug therapy
- Vaginosis, Bacterial/etiology
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197
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van den Brûle F. [Vaginal infections and sexually transmitted diseases]. REVUE MEDICALE DE LIEGE 1999; 54:296-302. [PMID: 10389473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
The diagnosis and treatment of vaginal and sexually transmitted infections constitute an important part of the activity of the gynaecologist and of the general practitioner. In this review article, we will describe various clinical entities, including bacterial vaginosis, vulvovaginal Candidiasis, trichomoniasis, gonorrhea, syphilis, genital herpes, Chlamydial infection, and pelvic inflammatory disease. The acquired immunodeficiency syndrome will not be described here.
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198
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Judlin P. [Treatment of sexually transmitted diseases and pelvic infections in gynecology]. CONTRACEPTION, FERTILITE, SEXUALITE (1992) 1999; 27:263-8. [PMID: 10349767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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199
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French RA, Cole C. An "enigmatic" cause of back pain following regional anaesthesia for caesarean section: septic pelvic thrombophlebitis. Anaesth Intensive Care 1999; 27:209-12. [PMID: 10212723 DOI: 10.1177/0310057x9902700216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A case of septic pelvic thrombophlebitis is reported. This presented as back pain and leg weakness 18 days after regional anaesthesia for caesarean section. The patient was referred to the Department of Anaesthesia. Obstetric review of the patient at the request of the anaesthetist led to a CT scan that demonstrated the diagnosis. This condition may lead to fatal "on-table" pulmonary embolus if the thrombosed vein is handled during an exploratory laparotomy. Treatment should be conservative with antibiotics and anticoagulation. This case illustrates the need for awareness amongst anaesthetists of possible surgical causes for morbidity that may initially appear anaesthetic-related.
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200
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Abstract
OBJECTIVE To review the pharmacology, microbiology, chemistry, pharmacokinetics, efficacy, safety, tolerability, dosage, administration, and economic issues of intravenous azithromycin. DATA SOURCES A MEDLINE search from 1978 to May 1998 of the English-language literature and an extensive review of journals and meeting abstracts was conducted. Due to the lack of published literature concerning the efficacy, safety, and pharmacokinetics of the intravenous formulation of azithromycin, the manufacturer was also contacted and requested to supply information concerning intravenous azithromycin. DATA EXTRACTION In vitro and preclinical studies were included, as well as data from Phase II and III clinical trials. Efficacy, pharmacokinetic, safety, and tolerability data were also supplemented with information from the manufacturer, due to the lack of published reports. DATA SYNTHESIS Azithromycin, an azalide subclass of the macrolide antibiotics, is now available as an intravenous formulation. The intravenous form is approved for the treatment of community-acquired pneumonia caused by Chlamydia pneumoniae, Haemophilus influenzae. Legionella pneumophila, Moraxella catarrhalis, Mycoplasma pneumoniae, Staphylococcus aureus (methicillin-sensitive), and Streptococcus pneumoniae, and for the treatment of pelvic inflammatory disease caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma hominis in situations in which intravenous therapy is required. Its spectrum of activity, unique pharmacokinetics, and high and sustained tissue penetration allow for once-daily dosing with monotherapy in many cases. Clinical and bacteriologic response rates as well as the adverse event profile have been similar to or better than comparative agents. CONCLUSIONS Azithromycin offers advantages over other agents due to its unique pharmacokinetics, high and sustained tissue penetration, and spectrum of activity. This allows for monotherapy and once-daily intravenous dosing for mild-to-moderate community-acquired pneumonia or pelvic inflammatory disease in many instances. Future research should focus on total duration of antibiotic therapy and the need, or lack thereof, for extensive oral antibiotic follow-up.
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