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Mucopurulent Cervicitis—the Ignored Counterpart in Women of Urethritis in Men
150
ONCOLOGY AND CHEMOTHERAPY
acid (99mTc-DTPA), determination of renal excretion of B2 microglobin and immunofluorescence of antibody-coated bacteria were compared in 19 patients with acute pyelonephritis and 15 with lower urinary tract infection. All patients with acute pyelonephritis showed positive results of scintiphotography with 67 Ga and an increased excretion of B2 microglobulin, while all patients with lower urinary tract infection showed negative results of scintiphotography with 67Ga and a normal excretion of B2 microglobulin. Only 10 patients with acute pyelonephritis and 3 with lower urinary tract infection showed positive results of immunofluorescence of antibody-coated bacteria. In several patients with acute pyelonephritis an increased uptake of 67 Ga was accompanied by a decreased visualization of 99mTc-DTPA, which suggests diminished function of the inflamed kidney possibly owing to diminished renal blood flow. Scintiphotography with 67 Ga and determination of renal B2 microglobulin excretion are the most reliable noninvasive methods for the diagnosis of renal inflammation and ruling out lower urinary tract infection. Furthermore, followup determinations of urinary excretion of B2 microglobulin are useful to control the efficacy of treatment with antibiotics. F. T. A. 2 figures, 1 table, 25 references
Mucopurulent Cervicitis-the Ignored Counterpart in Women of Urethritis in Men R. C. BRUNHAM, J. PAAVONEN, C. E. STEVENS, N. KIVIAT, C.c. Kuo, C. w. CRITCHLOW AND K. K. HOLMES, Departments of Medicine, Pathology and Pathobiology, University of Washington School of Medicine, Pacific Medical Center, and Harborview Medical Center, Seattle, Washington New Engl. J. Med., 311: 1-6 (July 5) 1984 The authors investigated the etiology of cervicitis in 110 women attending a sexually transmitted disease clinic. A total of 100 nonmenstruating women had cervical cultures for Chlamydia trachomatis, Neisseria gonorrhoeae and herpes simplex virus. Endocervical secretions were inspected visually and subsequently examined microscopically. There was a high correlation between the presence of a characteristic yellow-colored endocervical mucopurulent secretion (mucopus) and positive cultures for C. trachomatis. A count of 10 or more polymorphonuclear leukocytes per high power field had a similar positive correlation with positive C. trachomatis cultures. Of the 19 women with positive C. trachomatis cultures 18 (95 per cent) had mucopus, or 10 or more polymorphonuclear leukocytes per high power field. Women infected with N. gonorrhoeae and herpes simplex virus lacked endocervical mucus and significant numbers of polymorphonuclear leukocytes in gram-stained smears of cervical mucus. Herpetic infections could be identified by the presence of typical cervical or vulvar ulcerations in 4 of 5 women with positive herpes cultures. C. trachomatis can be isolated in approximately a third of all heterosexual men with urethritis seen in a clinic for sexually transmitted disease. N. gonorrhoeae is found in an additional 10 per cent of such men. The authors stated that the prevalence of mucopurulent cervicitis in women approximates the combined prevalence of gonococcal and nongonococcal urethritis in heterosexual men. Therefore, mucopurulent cervicitis is believed to be the female counterpart of male urethritis. The diagnosis of this entity is established by the presence of either typical yellow mucopus or more than 10 polymorphonuclear leukocytes per high power field in satisfactorily gram-stained endocervical smears. When present, these findings suggest C.
trachomatis infection, which should be treated with 500 mg. tetracycline 4 times a day for 7 days as recommended by the Centers for Disease Control. Male sexual contacts of affected women should be treated with a similar regimen. G. F. S. 4 figures, 2 tables, 19 references
Evidence for Disordered Control of 1,25-Dihydroxyvitamin D Production in Absorptive Hypercfilciuria A. E. BROADUS, K. L. INSOGNA, R. LANG, A. F. ELLISON AND B. E. DREYER, Department of Internal Medicine, Yale University, New Haven, Connecticut
New Engl. J. Med., 311: 73-80 (July 12) 1984 Patients with absorptive hypercalciuria are defined by 3 criteria: 1) 24-hour urine calcium excretion more than 300 mg., 2) renal calciuric response more than 20 mg. calcium per dl. glomerular filtrate following oral calcium loading, and 3) normal or suppressed nephrogenous cyclic adenosine monophosphate and serum parathormone in the fasting state. Previous studies have indicated an increased plasma concentration of 1,25-dihydroxyvitamin D in these patients, which was believed to be secondary to an increased production rate. Contrary to predictions, the authors detected a significant decrease in plasma 1,25-dihydroxyvitamin D concentration following an acute calcium challenge in 15 patients with absorptive hypercalciuria. However, long-term (2 weeks) administration of a high calcium diet (1,000 mg. per day) resulted in a gradual increase in plasma 1,25-dihydroxyvitamin D concentration in these patients. Subjects without absorptive hypercalciuria had qualitatively similar changes in serum 1,25-dihydroxyvitamin D concentration but the absolute magnitude of change was not nearly as great. The circulating level of 1,25-dihydroxyvitamin D is variable and depends not only on calcium intake but also on the duration of a given calcium intake. The data do not support the hypothesis that elevated 1,25dihydroxyvitamin D levels are secondary to autonomous production in these patients. Clearly, they exhibit an appropriate decrease in 1,25-dihydroxyvitamin D concentration in response to an acute challenge. Continued calcium administration results in an increase to normal levels of 1,25-dihydroxyvitamin D but the explanation for this phenomenon is not apparent. G.F.S. 6 figures, 2 tables, 21 references
ONCOLOGY AND CHEMOTHERAPY Utility of the Abdominoinguinal Incision in the Resection of Lower Abdominal Tumors Department of Surgical Oncology, New York State Department of Health, Roswell Park Memorial Institute, Buffalo, New York
C. P. KARAKOUSIS,
J. Surg. Oncol., 26: 176-182 (July) 1984 Tumors located in the lower retroperitoneum often are adherent to the external iliac vessels and the wall of the pelvis. Often, these tumors, usually soft tissue sarcomas, are considered unresectable or hemipelvectomy is advised. The author presents a new surgical approach, the abdominal inguinal incision, which was used to remove all tumors successfully in 18 patients.
ONCOLOGY AND CHEMOTHERAPY
acid (99mTc-DTPA), determination of renal excretion of B2 microglobin and immunofluorescence of antibody-coated bacteria were compared in 19 patients with acute pyelonephritis and 15 with lower urinary tract infection. All patients with acute pyelonephritis showed positive results of scintiphotography with 67 Ga and an increased excretion of B2 microglobulin, while all patients with lower urinary tract infection showed negative results of scintiphotography with 67Ga and a normal excretion of B2 microglobulin. Only 10 patients with acute pyelonephritis and 3 with lower urinary tract infection showed positive results of immunofluorescence of antibody-coated bacteria. In several patients with acute pyelonephritis an increased uptake of 67 Ga was accompanied by a decreased visualization of 99mTc-DTPA, which suggests diminished function of the inflamed kidney possibly owing to diminished renal blood flow. Scintiphotography with 67 Ga and determination of renal B2 microglobulin excretion are the most reliable noninvasive methods for the diagnosis of renal inflammation and ruling out lower urinary tract infection. Furthermore, followup determinations of urinary excretion of B2 microglobulin are useful to control the efficacy of treatment with antibiotics. F. T. A. 2 figures, 1 table, 25 references
Mucopurulent Cervicitis-the Ignored Counterpart in Women of Urethritis in Men R. C. BRUNHAM, J. PAAVONEN, C. E. STEVENS, N. KIVIAT, C.c. Kuo, C. w. CRITCHLOW AND K. K. HOLMES, Departments of Medicine, Pathology and Pathobiology, University of Washington School of Medicine, Pacific Medical Center, and Harborview Medical Center, Seattle, Washington New Engl. J. Med., 311: 1-6 (July 5) 1984 The authors investigated the etiology of cervicitis in 110 women attending a sexually transmitted disease clinic. A total of 100 nonmenstruating women had cervical cultures for Chlamydia trachomatis, Neisseria gonorrhoeae and herpes simplex virus. Endocervical secretions were inspected visually and subsequently examined microscopically. There was a high correlation between the presence of a characteristic yellow-colored endocervical mucopurulent secretion (mucopus) and positive cultures for C. trachomatis. A count of 10 or more polymorphonuclear leukocytes per high power field had a similar positive correlation with positive C. trachomatis cultures. Of the 19 women with positive C. trachomatis cultures 18 (95 per cent) had mucopus, or 10 or more polymorphonuclear leukocytes per high power field. Women infected with N. gonorrhoeae and herpes simplex virus lacked endocervical mucus and significant numbers of polymorphonuclear leukocytes in gram-stained smears of cervical mucus. Herpetic infections could be identified by the presence of typical cervical or vulvar ulcerations in 4 of 5 women with positive herpes cultures. C. trachomatis can be isolated in approximately a third of all heterosexual men with urethritis seen in a clinic for sexually transmitted disease. N. gonorrhoeae is found in an additional 10 per cent of such men. The authors stated that the prevalence of mucopurulent cervicitis in women approximates the combined prevalence of gonococcal and nongonococcal urethritis in heterosexual men. Therefore, mucopurulent cervicitis is believed to be the female counterpart of male urethritis. The diagnosis of this entity is established by the presence of either typical yellow mucopus or more than 10 polymorphonuclear leukocytes per high power field in satisfactorily gram-stained endocervical smears. When present, these findings suggest C.
trachomatis infection, which should be treated with 500 mg. tetracycline 4 times a day for 7 days as recommended by the Centers for Disease Control. Male sexual contacts of affected women should be treated with a similar regimen. G. F. S. 4 figures, 2 tables, 19 references
Evidence for Disordered Control of 1,25-Dihydroxyvitamin D Production in Absorptive Hypercfilciuria A. E. BROADUS, K. L. INSOGNA, R. LANG, A. F. ELLISON AND B. E. DREYER, Department of Internal Medicine, Yale University, New Haven, Connecticut
New Engl. J. Med., 311: 73-80 (July 12) 1984 Patients with absorptive hypercalciuria are defined by 3 criteria: 1) 24-hour urine calcium excretion more than 300 mg., 2) renal calciuric response more than 20 mg. calcium per dl. glomerular filtrate following oral calcium loading, and 3) normal or suppressed nephrogenous cyclic adenosine monophosphate and serum parathormone in the fasting state. Previous studies have indicated an increased plasma concentration of 1,25-dihydroxyvitamin D in these patients, which was believed to be secondary to an increased production rate. Contrary to predictions, the authors detected a significant decrease in plasma 1,25-dihydroxyvitamin D concentration following an acute calcium challenge in 15 patients with absorptive hypercalciuria. However, long-term (2 weeks) administration of a high calcium diet (1,000 mg. per day) resulted in a gradual increase in plasma 1,25-dihydroxyvitamin D concentration in these patients. Subjects without absorptive hypercalciuria had qualitatively similar changes in serum 1,25-dihydroxyvitamin D concentration but the absolute magnitude of change was not nearly as great. The circulating level of 1,25-dihydroxyvitamin D is variable and depends not only on calcium intake but also on the duration of a given calcium intake. The data do not support the hypothesis that elevated 1,25dihydroxyvitamin D levels are secondary to autonomous production in these patients. Clearly, they exhibit an appropriate decrease in 1,25-dihydroxyvitamin D concentration in response to an acute challenge. Continued calcium administration results in an increase to normal levels of 1,25-dihydroxyvitamin D but the explanation for this phenomenon is not apparent. G.F.S. 6 figures, 2 tables, 21 references
ONCOLOGY AND CHEMOTHERAPY Utility of the Abdominoinguinal Incision in the Resection of Lower Abdominal Tumors Department of Surgical Oncology, New York State Department of Health, Roswell Park Memorial Institute, Buffalo, New York
C. P. KARAKOUSIS,
J. Surg. Oncol., 26: 176-182 (July) 1984 Tumors located in the lower retroperitoneum often are adherent to the external iliac vessels and the wall of the pelvis. Often, these tumors, usually soft tissue sarcomas, are considered unresectable or hemipelvectomy is advised. The author presents a new surgical approach, the abdominal inguinal incision, which was used to remove all tumors successfully in 18 patients.