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Revision of uterine cavity as prophylaxis against puerperal infection
SELECTED
449
ABSTRACTS
Simultaneously 0.01 to 0.015 Gm. of morphine hydrochloride is injected intramuscularly. In extreme instances, the morphine may be administered intravenously In cases of in a different vein from that being used for papaverine injection. lesser intensity, the papaverine is injected slowly and in the above dosage, but the least possible quantity of morphine (0.005 Gm.) is given, to avoid excessive depression of the respiratory center. In the mildest cases: 0.02 to 0.04 Gm. of papaverine is given intravenously without morphine. These dosages are rigidly followed, but varied according to individual indications. The highest dose of papaverine used by the authors was 0.20 Gm. on one occasion. Other authors have reported using even higher doses, but they have not found this necessary. In most cases, even those with most severe symptoms, a favorable effect is produced by intravenous injection. As soon as vasodilatation occurs, the symptoms cease, the patient shows improvement and the injection can be stopped. Symptoms may recur with less intensity after several hours, when the injection is repeated. Even when symptoms do not recur, a second injection may be given A space as an adjuvant in the treatment of the pulmonary infarct which follows. of four hours has been arbitrarily set by some, but the authors believe the second dose should be administered according to the individual requirements of the patient. Treatment of postembolie pulmonary infarct is similar to that for any acute pulmonary disease. Rest must be complete and prolonged and proper use of sulfonamides may prevent development of later sequelae. Inhalations of carbon dioxide are contraindicated unless too high dosage of morphine has depressed the respiratory center. Oxygen inhalations are valuable in treatment. J. P. GREENHILL. Ferreira, Jorge, Cid. : Early Rising After Delivery and the Service Assistance in the Home, Rev. de ginec. e d’obst. 37: 288-291, 1943.
of Obstetric
The author states that the two are interdependent. Mother and child are sent home from the hospital between the third and seventh days and there they are attended and followed up by the service until complete recovery. To be allowed up early, primiparas and multiparas must fulfill the following conditions: normal birth without traumatic or surgical lacerations, axillary temperature not over 36.8’ C., normal loehia, firm uterine involution under 11 em. from the pubic symphysis, normal urinary and digestive functions, regular milk function and good general condition. About I in 10 usually fulfill these conditions. Besides being beneficial, early rising increases the useful output of each maternity bed. J. P. GREENHILL. Da Costa, Luiz Alfred0 Co&a: Revision of Uterine Against Puerperal Infection, Rev. de ginec. e d’obst.
Cavity as Prophylaxis 37: 295300, 1943.
The author has used the method of Gheorghiu in 54 cases: 86 normal labors and deliveries except for retention of membranes, 5 normal labors followed by hemorrhage and manual extraction of placenta, 9 surgical births with retention of membranes and 4 surgical births with hemorrhage and manual extraction of placenta. In the group of 36 eases, puerperal infection occurred in 2.7 per cent. Puerperal infection was listed when the temperature reached at least 38” C. twice in 24 hours. In the other 18 cases, there were six infections; howover, they occurred in severely ill cases: fever during labor in two, vaginal tamponing in two (one with perforation of uterus), forced dilatation with rupture of cervix in one and version after various trials of forceps in one.
450
AMERICBN
There conclusions. of In of it not
were
JOURNAL
no deaths,
but
OF
the
OBSTETRICS
limited
number
AND
GY SI%OLOGT
of cases
does
not
allow
general
The interesting cases are those of revision for simple retention of -Fragments membrane, with an infection rate of 2.7 per cent, which e,ould even be reduced. 100 similar cases under expectant observation sometimes helped by small doses oxytocics, the incidence of puerperal intertion was S pw cent. Conueqnently, is advantageous to revise the uterine t::rvity after birth when the membranes are completely expelled, or when there ih 11onbt about the iuicgrity ot’ the plaeent:~,.
Gheorghiu’s method is as follows: ‘l’he patient is anesthetized with ethyl chloride and, using all asept.ic and antiseptic precautions the hand is introduced one or several times into the uterine caYit,v until I1 is complrtrly tlearrr~l of ;nly remnants of membrane. Then the uterlnc: cavity is washetl wif.h ided water, using a Budin No. 30 sound and aiming only at. a slight mechanical cleansing effect. The current of water must ha\-;r Juw pressure and be stopped before the sound is removed, so that all water runs oul, first. Thr vagina is also washed out under low pressure. With this method: the morhii(itv rate in the author ‘o clinic has fallen from 20 to 25 per rent. in 1913, to 2 to :I per cwnl. at present.
Vagina3 Infections Dub04 med.
P.: An Wehnschr.
Ef%ctive Treatnmnt 74: 1944, 1944.
of Trichomonas
Vaginal4
Vaginit4
Sehweie.
The trichomonas vaginalis belongs to the family of protozoa1 porasit,es in man and certain ones such as Plasmodizc,m malariae and Lamb& intestinaWs can he destroyed by quinine. By analogy, Dubois of the Lausanne Woman’s Clinic reasoned trichomonas vaginitis should respond to quinine. He therefore esperimented with many chemical agents and drugs, and found that in reality, quinine immobilized Trichomonm vaginalis more quickly than the other agents he employed. He therefore prepared vaginal suppositories CorxE~aini@g quinine and used them in 25 women who had trichomonas vaginalis vaginitis. Only 10 women re turned for regular treatments but the results were good. Relief was obtained after the use of two suppositories daily for S to 10 days.
Coutts, W. EL, Brieva, Vae;ina ad Uterine
Virus Infections J., Darner, J., and Said IX.: Cervix, Obst. y giene. latino-am. 2: 9-21, 1944.
of the
Vulva,
The authors examined a large series of prostitutes in Santiago, Chile, and found a number who had virus infection. A characteristic of such infections may be found in material obtained by biopsy. This consists of the presence of inelusion bodies found in the cytoplasm or nucleus, or in both, and their presence also in the intercellular spaces. Special staining methods have enabled the authors to study the chemical composition of these inclusion bodies a.nd to make the correct diagnosis. J.
Rieper, 8:
J. P.: 2574’67,
Treatment
of Trichomooos
Vaginal4
Vaginitis,
An.
P.
GREENHILL
brasil.
de ginec.
1943.
The author reports a series of 16 women treated for trichomonas vaginalis vaginitia by means of negatol. In this series el per cent were owed clinically but only 37.5 per cent were freed of the trichomonas organisms. Negatol produces a superficial necrosis which sterilizes the vagina, but reinfection takes
449
ABSTRACTS
Simultaneously 0.01 to 0.015 Gm. of morphine hydrochloride is injected intramuscularly. In extreme instances, the morphine may be administered intravenously In cases of in a different vein from that being used for papaverine injection. lesser intensity, the papaverine is injected slowly and in the above dosage, but the least possible quantity of morphine (0.005 Gm.) is given, to avoid excessive depression of the respiratory center. In the mildest cases: 0.02 to 0.04 Gm. of papaverine is given intravenously without morphine. These dosages are rigidly followed, but varied according to individual indications. The highest dose of papaverine used by the authors was 0.20 Gm. on one occasion. Other authors have reported using even higher doses, but they have not found this necessary. In most cases, even those with most severe symptoms, a favorable effect is produced by intravenous injection. As soon as vasodilatation occurs, the symptoms cease, the patient shows improvement and the injection can be stopped. Symptoms may recur with less intensity after several hours, when the injection is repeated. Even when symptoms do not recur, a second injection may be given A space as an adjuvant in the treatment of the pulmonary infarct which follows. of four hours has been arbitrarily set by some, but the authors believe the second dose should be administered according to the individual requirements of the patient. Treatment of postembolie pulmonary infarct is similar to that for any acute pulmonary disease. Rest must be complete and prolonged and proper use of sulfonamides may prevent development of later sequelae. Inhalations of carbon dioxide are contraindicated unless too high dosage of morphine has depressed the respiratory center. Oxygen inhalations are valuable in treatment. J. P. GREENHILL. Ferreira, Jorge, Cid. : Early Rising After Delivery and the Service Assistance in the Home, Rev. de ginec. e d’obst. 37: 288-291, 1943.
of Obstetric
The author states that the two are interdependent. Mother and child are sent home from the hospital between the third and seventh days and there they are attended and followed up by the service until complete recovery. To be allowed up early, primiparas and multiparas must fulfill the following conditions: normal birth without traumatic or surgical lacerations, axillary temperature not over 36.8’ C., normal loehia, firm uterine involution under 11 em. from the pubic symphysis, normal urinary and digestive functions, regular milk function and good general condition. About I in 10 usually fulfill these conditions. Besides being beneficial, early rising increases the useful output of each maternity bed. J. P. GREENHILL. Da Costa, Luiz Alfred0 Co&a: Revision of Uterine Against Puerperal Infection, Rev. de ginec. e d’obst.
Cavity as Prophylaxis 37: 295300, 1943.
The author has used the method of Gheorghiu in 54 cases: 86 normal labors and deliveries except for retention of membranes, 5 normal labors followed by hemorrhage and manual extraction of placenta, 9 surgical births with retention of membranes and 4 surgical births with hemorrhage and manual extraction of placenta. In the group of 36 eases, puerperal infection occurred in 2.7 per cent. Puerperal infection was listed when the temperature reached at least 38” C. twice in 24 hours. In the other 18 cases, there were six infections; howover, they occurred in severely ill cases: fever during labor in two, vaginal tamponing in two (one with perforation of uterus), forced dilatation with rupture of cervix in one and version after various trials of forceps in one.
450
AMERICBN
There conclusions. of In of it not
were
JOURNAL
no deaths,
but
OF
the
OBSTETRICS
limited
number
AND
GY SI%OLOGT
of cases
does
not
allow
general
The interesting cases are those of revision for simple retention of -Fragments membrane, with an infection rate of 2.7 per cent, which e,ould even be reduced. 100 similar cases under expectant observation sometimes helped by small doses oxytocics, the incidence of puerperal intertion was S pw cent. Conueqnently, is advantageous to revise the uterine t::rvity after birth when the membranes are completely expelled, or when there ih 11onbt about the iuicgrity ot’ the plaeent:~,.
Gheorghiu’s method is as follows: ‘l’he patient is anesthetized with ethyl chloride and, using all asept.ic and antiseptic precautions the hand is introduced one or several times into the uterine caYit,v until I1 is complrtrly tlearrr~l of ;nly remnants of membrane. Then the uterlnc: cavity is washetl wif.h ided water, using a Budin No. 30 sound and aiming only at. a slight mechanical cleansing effect. The current of water must ha\-;r Juw pressure and be stopped before the sound is removed, so that all water runs oul, first. Thr vagina is also washed out under low pressure. With this method: the morhii(itv rate in the author ‘o clinic has fallen from 20 to 25 per rent. in 1913, to 2 to :I per cwnl. at present.
Vagina3 Infections Dub04 med.
P.: An Wehnschr.
Ef%ctive Treatnmnt 74: 1944, 1944.
of Trichomonas
Vaginal4
Vaginit4
Sehweie.
The trichomonas vaginalis belongs to the family of protozoa1 porasit,es in man and certain ones such as Plasmodizc,m malariae and Lamb& intestinaWs can he destroyed by quinine. By analogy, Dubois of the Lausanne Woman’s Clinic reasoned trichomonas vaginitis should respond to quinine. He therefore esperimented with many chemical agents and drugs, and found that in reality, quinine immobilized Trichomonm vaginalis more quickly than the other agents he employed. He therefore prepared vaginal suppositories CorxE~aini@g quinine and used them in 25 women who had trichomonas vaginalis vaginitis. Only 10 women re turned for regular treatments but the results were good. Relief was obtained after the use of two suppositories daily for S to 10 days.
Coutts, W. EL, Brieva, Vae;ina ad Uterine
Virus Infections J., Darner, J., and Said IX.: Cervix, Obst. y giene. latino-am. 2: 9-21, 1944.
of the
Vulva,
The authors examined a large series of prostitutes in Santiago, Chile, and found a number who had virus infection. A characteristic of such infections may be found in material obtained by biopsy. This consists of the presence of inelusion bodies found in the cytoplasm or nucleus, or in both, and their presence also in the intercellular spaces. Special staining methods have enabled the authors to study the chemical composition of these inclusion bodies a.nd to make the correct diagnosis. J.
Rieper, 8:
J. P.: 2574’67,
Treatment
of Trichomooos
Vaginal4
Vaginitis,
An.
P.
GREENHILL
brasil.
de ginec.
1943.
The author reports a series of 16 women treated for trichomonas vaginalis vaginitia by means of negatol. In this series el per cent were owed clinically but only 37.5 per cent were freed of the trichomonas organisms. Negatol produces a superficial necrosis which sterilizes the vagina, but reinfection takes