Optimum Therapy for Acute Pelvic Inflammatory Disease

Neisseria gonorrhoeae is responsible for about one-third to one-half of cases of acute pelvic inflammatory disease (PID), although there is considerable geographical variation. Chlamydia trachomatis is also an important aetiological agent, and is currently isolated 4 times more commonly from the cervix than the gonococcus. However, it is now clear that acute PID is polymicrobial in aetiology. Even when N. gonorrhoeae and/or C. trachomatis are isolated from the endocervix, anaerobes such as Bacteroides fragilis, Peptococcus and Peptostreptococcus and aerobes, especially the Enterobacteriaceae such as E. coli, are also frequently isolated. Bacterial synergism, coinfection with the gonococcus and C. trachomatis and the involvement of multiple other micro-organisms including aerobes and anaerobes and antibiotic resistance make the selection of an optimal antibiotic regimen difficult. The Centers for Disease Control (CDC) recommendations first proposed in 1982 and revised in 1985 emphasise broad spectrum antimicrobial therapy including coverage of C. trachomaus. In September 1989, the CDC revised its recommendation for the treatment of acute PID. Current recommendations include the use of newer third generation cephalosporins such as ceftriaxone, ceftizoxime and cefotaxime which give excellent coverage of the gonococcus and the Enterobacteriaceae. It is still important to include doxycycline or a tetracycline to cover C. trachomatis. For patients with advanced disease or a tuboovarian abscess, clindamycin plus gentamicin has been the regimen of choice. Aztreonam, a new monobactam, has several advantages over gentamicin including less toxicity, more dependable blood levels and good coverage of N. gonorrhoeae and the Enterobacteriaceae

Clindamycin Therapy for Chlamydia Trachomatis in Women

The population for this study consisted of 4013 sexually active women seen for family planning. Culture for Chlamydia trachomatis yielded an isolation rate of 6.1%. Women aged 16 to 25 accounted for 81.7% of the C. trachomatis infections, while those younger than 16 or older than 35 accounted for only 2.4% of the infections. Of the 246 patients whose cultures were positive for C. trachomatis, 159 (65%) were asymptomatic. The incidence of C. trachomatis was 11.2% among those with symptoms but only 6.4% among the asymptomatic group. Among 63 patients with Neisseria gonorrhoeae (who were excluded from the study), 26 (41.3%) also were infected by C. trachomatis. There were no microbiologic drug failures with erythromycin or clindamycin. Of 56 patients who enrolled in the clindamycin arm of the protocol, 48 (85.7%) completed therapy and experienced microbiologic and clinical cures. In contrast, erythromycin therapy was completed by only 25 of 57 women (43.9%) enrolled. The number of side effect failures for erythromycin was 22 of 57 (38.6%). This was more than five times the number of side effect failures for clindamycin (4 of 56, or 7.1%)

Definition of Anatomical Planes for Use in Transvaginal Sonography

Planes frequently used to identify radiologic and abdominal ultrasono‐graphic images such as transverse, coronal, and sagittal are generally not anatomically correct when applied to transvaginal ultrasonographic planes and images. More appropriate terminology specific for the planes imaged during transvaginal ultra‐sonography, such as TRANS‐pelvic and AP‐pelvic planes, are suggested. A TRANS‐pelvic plane refers to a plane imaged when the sound beam is directed across or from side to side in the pelvis. An AP‐pelvic plane refers to an image obtained when the sound beam is directed anteriorly and posteriorly

The Vanishing Twin: Pathologic Confirmation of an Ultrasonographic Phenomenon

Although the phenomenon of the vanished twin has been noted repeatedly through the use of ultrasound, no confirmatory histologic evidence has been presented previously. This has raised questions concerning the validity of the vanishing twin syndrome. In the following case, a triplet intrauterine pregnancy was diagnosed ultrasonographically four weeks after in vitro fertilization, but only a single fetus and placenta were delivered at term. Careful examination of the placenta revealed histologic evidence of the vanished twin. This evidence consisted of a chorion-lined sac containing amorphous material, surrounded by degenerated chorionic villi juxtaposed against a normal amniochorionic membrane

Ova Recovery, and in Vivo and in Vitro Fertilization of Ova From ru486-Treated Pmsg/Hcg-Primed Mice

In this study, the effect of preovulatory treatment with RU486, for different lengths of time and combinations of days, was shown in terms of the ova recovery, in vitro fertilization of recovered ova, in vivo fertilization and quality of fertilized ova in PMSG/hCG-primed mice. Female mice were injected with PMSG followed 48 h later by hCG to induce superovulation. Mice received RU486 (20 mg kg-1 body wt) for 1, 2, 3 and 4 preovulatory days (in different combinations). Ovulation, as judged by the number of ova recovered at 14 to 14-5 h post-hCG, was depressed (P \u3c 0-001), and the total number of embryos recovered at 40 h post-hCG was low (P \u3c 0-001), in mice receiving a minimum of two consecutive days’ treatment (day before PMSG + day of PMSG; or day before hCG + day of hCG) of RU486 under study. Quality of ova recovered from RU486-treated animals was not affected as determined by their ability to become fertilized in vitro. In vivo fertilization, as determined by the recovery of 2-cell embryos, was suppressed significantly in mice treated with RU486 for four consecutive preovulatory days (P \u3c 0 001). A varied degree of premature compaction was observed in 2-cell embryos immediately upon retrieval from the oviduct of RU486-treated animals, the effect being most marked in mice receiving RU486 for a minimum of two consecutive preovulatory days under study. It is suggested that premature compaction of early embryos was under the continuous influence of the luminal environment of treated animals and might be the reason for their degeneration at later stages in the reproductive tract and for a low pregnancy rate as shown by other studies. Compacted embryos decompacted within 15-30 min in vitro and led to normal blastocyst formation in vitro in RU486-free culture medium

In Vitro Effect of RU 486 on Sperm-Egg Interaction in Mice

The effect of RU 486 at different concentrations (1, 5, 10, and 20 µg/ml) was studied on sperm-egg interaction in vitro in B6D2Ff mice. The in vitro fertilization rate of mouse ova decreased from 77.0% (control) to 50.0%, 28.7%, and 7.5% in the presence of RU 486 concentrations at 5, 10, and 20 µg/ml medium, respectively (p \u3c 0.001). A concentration of 1 µg/ml did not affect the fertilization rate. A progesterone concentration at equal to or double the concentration RU 486 did not reverse the inhibitory effect of RU 486 on in vitro fertilization, which suggests a progesterone-independent mechanism. Exposure of spermatozoa (for 90 minutes) or ova (for 60 minutes) to RU 486 (20 µg/ml) followed by washing with RU 486-free medium before coincubation did not affect the fertilization rate. The presence or absence of cumulus cells did not change the inhibitory effect of RU 466 (20 µg/ml) on in vitro fertilization. RU 486 at 5 to 20 µg/ml medium was associated with perivitelline polyspermy in nonfertilized ova and enhanced perivitelline polyspermy in fertilized oval

Survival and Cell Acquisition Rates After Preimplantation Embryo Biopsy: Use of Two Mechanical Techniques and Two Mouse Strains

Two strains of mouse embryos at the four- and eight-cell stages had biopsy specimens obtained by means of two different mechanical techniques: aspiration and displacement. Embryos and biopsy specimen cells were evaluated for survival and development. Blastomere acquisition rates were significantly higher with the displacement biopsy technique; however, no difference in survival or developmental rates was found in blastomere biopsy specimens removed from either four-cell or eight-cell embryos. A maximum of one blastomere can be removed from a four-cell embryo, whereas three blastomeres can be taken at biopsy from an eight-cell mouse embryo without significantly affecting embryo development, although mouse strain differences were noted. Intact, viable, biopsied blastomeres will develop in vitro when cocultured with morphologically intact embryos. Births of live offspring after embryo biopsy are reported

Cervical Cancer : Women Aged 35 and Younger Compared to Women Aged 36 and Older

Purpose Age has been evaluated as a prognostic factor in cervical cancer in both hospital- and population-based studies. Results regarding the relation of age and cervical cancer prognosis are conflicting. This study pursued a contemporary assessment of the association of extreme young age at the time of a cervical cancer diagnosis on survival. Methods Institutional review board approval was obtained, and retrospective data collection at 2 academic institutions was performed. Inclusion criteria involved women ≤35 years diagnosed with cervical cancer between 1990 and 2012. Data included demographic and prognostic information pertinent to survival and progression. Characteristics of very young (≤25 years) and young (\u3e25–35 years) women were compared. Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards modeling were used to assess the association of age, tumor histology, grade, stage, and parametrial involvement with progression-free survival (PFS) and overall survival (OS). Findings Incident cases (n = 126) of cervical cancer in patients ≤35 years of age were identified of which complete clinical information was available for 114 women. Fifteen percent (17 of 114) were ≤25 years, with the remaining 85% (97 of 114) being 26 to 35 years of age. Race, smoking status, and marital status were comparable between the 2 groups. Squamous histology dominated overall (77 of 114; 68%) with adenocarcinoma contributing ~25% (30 of 114; 26%) of cases. The majority (96 of 114, 84%) had either stage 1A (31 of 114, 27%) or 1B (65 of 114, 57%) disease. A log-rank test revealed no evidence to infer a difference in either PFS or OS among the age groups (P = 0.511 and P = 0.340). In a univariate analysis, grade and stage significantly affected OS (P \u3c 0.0001, P = 0.045), and stage significantly affected PFS (P \u3c 0.0001). In multivariate modeling, presence of parametrial involvement and histologic cancer type significantly affected both PFS (P = 0.002, P = 0.001) and OS (P = 0.001, P = 0.001). Implications Tumor histology, parametrial involvement, and stage continue to be strong prognosticators for PFS and OS. Progression and survival outcomes are age independent in women with cervical cancer ≤35 years of age. Further study of a larger young cohort may potentially yield different outcomes

Cervical Cancer : Women Aged 35 and Younger Compared to Women Aged 36 and Older

Purpose Age has been evaluated as a prognostic factor in cervical cancer in both hospital- and population-based studies. Results regarding the relation of age and cervical cancer prognosis are conflicting. This study pursued a contemporary assessment of the association of extreme young age at the time of a cervical cancer diagnosis on survival. Methods Institutional review board approval was obtained, and retrospective data collection at 2 academic institutions was performed. Inclusion criteria involved women ≤35 years diagnosed with cervical cancer between 1990 and 2012. Data included demographic and prognostic information pertinent to survival and progression. Characteristics of very young (≤25 years) and young (\u3e25–35 years) women were compared. Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards modeling were used to assess the association of age, tumor histology, grade, stage, and parametrial involvement with progression-free survival (PFS) and overall survival (OS). Findings Incident cases (n = 126) of cervical cancer in patients ≤35 years of age were identified of which complete clinical information was available for 114 women. Fifteen percent (17 of 114) were ≤25 years, with the remaining 85% (97 of 114) being 26 to 35 years of age. Race, smoking status, and marital status were comparable between the 2 groups. Squamous histology dominated overall (77 of 114; 68%) with adenocarcinoma contributing ~25% (30 of 114; 26%) of cases. The majority (96 of 114, 84%) had either stage 1A (31 of 114, 27%) or 1B (65 of 114, 57%) disease. A log-rank test revealed no evidence to infer a difference in either PFS or OS among the age groups (P = 0.511 and P = 0.340). In a univariate analysis, grade and stage significantly affected OS (P \u3c 0.0001, P = 0.045), and stage significantly affected PFS (P \u3c 0.0001). In multivariate modeling, presence of parametrial involvement and histologic cancer type significantly affected both PFS (P = 0.002, P = 0.001) and OS (P = 0.001, P = 0.001). Implications Tumor histology, parametrial involvement, and stage continue to be strong prognosticators for PFS and OS. Progression and survival outcomes are age independent in women with cervical cancer ≤35 years of age. Further study of a larger young cohort may potentially yield different outcomes