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Transcervical uterine cultures with a new endometrial suction curette: A comparison of three sampling methods in postpartum endometritis
206
Citations from the Literature
than the best correlation found with the cystometric measurements. The values for sensitivity and specificity of cystometry for the detection of an abnormality associated with urgency were 58% and 92% respectively, and the corresponding values for a positive BNEC test (as defined by a maximum deflection at rest > 13 pA) were 100% and 77%. Randomized treatment of mucopurulent cycllne or amoxkillin
cervicitls with doxy-
Paavonen J; Roberts PL; Stevens CE; Wolner-Hanssen P; Brunham RC; Hillier S; Stamm WE; Kuo C-C; DeRouen T; Holmes KK; Eschenbach DA Department of Medicine, University of Washington, Seattle, WA; USA American Journal of Obstetrics and Gynecology/l61/1 (128135)/1989/ A randomized trial of doxycycline versus amoxicillin was performed to treat mucopurulent cervicitis. Chlamydia trachomatis, the most common single agent associated with mucopurulent cervicitis, was isolated from 30 (47%) and Neisseria gonorrhoeae from five (8%) of 64 patients. Patients were followed up for 3 months, and the effect of treatment was assessed by clinical (presence of endocervical mucopus, cervicitis severity score, and number of polymorphonuclear luekocytes on Gram-stained smears of endocervical secretions) and microbiologic criteria. Doxycycline and amoxicillin were equally effective for treating chlamydial and nonchlamydial cervicitis. However, endocervical mucopus was still present in 18% of the patients in both treatment groups after 2 months and in 23% of the doxycycline group and 33% of the amoxicillin group after 3 months of therapy. The cause of persistent/ recurrent mucopus after antimicrobial treatment was not explained by relapse or reinfection with Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, or Gardnerella vaginalis, but persistence was associated with the degree of cervical ectopy. Technique and complications floor with polyglactin mesh
of reconstruction
Traascervical uterine cultures with a new endometrial suction curette: A comparison of three sampling methods in postpartum eadometrltls
Martens MG; Faro S; Hammill HA; Riddle GD; Smith D Section of Infectious Diseases, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030; USA Obstetrics and Gynecology/74/2 (273-276)/1989/ The potential for cervicovaginal contamination has precluded direct sampling of the endometrial cavity and has led to the development of multi-lumen protected catheter systems, among other techniques. The extent of this presumed contamination was examined using three different techniques in 55 postpartum women with the diagnosis of endometritis. Each woman had the endometrium sampled with an unprotected cotton-tipped swab, a double-lumen cathether with brush, and a flexible endometrial suction curette. A statistically larger number of bacterial species was recovered with the cotton swab (2.4) than with double-lumen catheter (1.3) or the suction curette (1.7) (P < 0.001). A difference was also noted between the double-lumen catheter and the suction curette (P = 0.006); however, this represented less than one-third of a single bacterial species. The larger number of bacterial species recovered by the unprotected methods was found to result not from cervicovaginal contamination, as suspected, but from a significant increase in the recovery of bacteria commonly regarded as potential pathogens, such as Bacteroides bivius, Streptococcus faecalis, Proteus mirabilis, and Bacteroides melaninogeni-
ONCOLOGY
of the pelvic
Sener SF; Imperato JP; Blum MD; Ignatoff JM; Soper TG; Winchester DP; Meiselman M Division of General Surgery, Department of Surgery, Evanston Hospital, IL 60201; USA Surgery Gynecology & Obstetrics/l68/6 (475-480)/1989/ A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. Int J Gynecol Obstet 31
The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further.
Intestinal surgery in gynecologic oncology
Rubin SC; Benjamin I; Hoskins WJ; Pierce VK; Lewis JL Jr Gynecologic Service, Department of Surgery, Memorial SloanKettering Cancer Center, New York, NY 10021; USA Gynecologic Oncology13411 (30-33)/1989/ Intestinal surgery is frequently required in the management of patients with gynecologic malignancies. During a recent 3year period 10.4% of all laparotomies performed on the Gynecology Service at Memorial Sloan-Kettering Cancer Center included major intestinal surgery. A total of 215 separate intestinal procedures were performed during 171 operations on 158 patients. The majority of operations were performed in patients with ovarian (42.7%), cervical (2407o),and endometrial (12.3%) malignancies. Seventy-nine of 171 (46.2%) of operations were intestinal obstruction (43.2%) and intestinal fistula (21%). Procedures performed included 87 intestinal resections, 26 intestinal bypasses, 82 colostomies, and 20 intestinal conduit urinary diversions. Hand suturing was used in 7l@/oof anastomoses; automatic stapling instruments were used in 29%. There was a single surgical mortality. Complications
Citations from the Literature
than the best correlation found with the cystometric measurements. The values for sensitivity and specificity of cystometry for the detection of an abnormality associated with urgency were 58% and 92% respectively, and the corresponding values for a positive BNEC test (as defined by a maximum deflection at rest > 13 pA) were 100% and 77%. Randomized treatment of mucopurulent cycllne or amoxkillin
cervicitls with doxy-
Paavonen J; Roberts PL; Stevens CE; Wolner-Hanssen P; Brunham RC; Hillier S; Stamm WE; Kuo C-C; DeRouen T; Holmes KK; Eschenbach DA Department of Medicine, University of Washington, Seattle, WA; USA American Journal of Obstetrics and Gynecology/l61/1 (128135)/1989/ A randomized trial of doxycycline versus amoxicillin was performed to treat mucopurulent cervicitis. Chlamydia trachomatis, the most common single agent associated with mucopurulent cervicitis, was isolated from 30 (47%) and Neisseria gonorrhoeae from five (8%) of 64 patients. Patients were followed up for 3 months, and the effect of treatment was assessed by clinical (presence of endocervical mucopus, cervicitis severity score, and number of polymorphonuclear luekocytes on Gram-stained smears of endocervical secretions) and microbiologic criteria. Doxycycline and amoxicillin were equally effective for treating chlamydial and nonchlamydial cervicitis. However, endocervical mucopus was still present in 18% of the patients in both treatment groups after 2 months and in 23% of the doxycycline group and 33% of the amoxicillin group after 3 months of therapy. The cause of persistent/ recurrent mucopus after antimicrobial treatment was not explained by relapse or reinfection with Chlamydia trachomatis, Neisseria gonorrhoeae, genital mycoplasmas, or Gardnerella vaginalis, but persistence was associated with the degree of cervical ectopy. Technique and complications floor with polyglactin mesh
of reconstruction
Traascervical uterine cultures with a new endometrial suction curette: A comparison of three sampling methods in postpartum eadometrltls
Martens MG; Faro S; Hammill HA; Riddle GD; Smith D Section of Infectious Diseases, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030; USA Obstetrics and Gynecology/74/2 (273-276)/1989/ The potential for cervicovaginal contamination has precluded direct sampling of the endometrial cavity and has led to the development of multi-lumen protected catheter systems, among other techniques. The extent of this presumed contamination was examined using three different techniques in 55 postpartum women with the diagnosis of endometritis. Each woman had the endometrium sampled with an unprotected cotton-tipped swab, a double-lumen cathether with brush, and a flexible endometrial suction curette. A statistically larger number of bacterial species was recovered with the cotton swab (2.4) than with double-lumen catheter (1.3) or the suction curette (1.7) (P < 0.001). A difference was also noted between the double-lumen catheter and the suction curette (P = 0.006); however, this represented less than one-third of a single bacterial species. The larger number of bacterial species recovered by the unprotected methods was found to result not from cervicovaginal contamination, as suspected, but from a significant increase in the recovery of bacteria commonly regarded as potential pathogens, such as Bacteroides bivius, Streptococcus faecalis, Proteus mirabilis, and Bacteroides melaninogeni-
ONCOLOGY
of the pelvic
Sener SF; Imperato JP; Blum MD; Ignatoff JM; Soper TG; Winchester DP; Meiselman M Division of General Surgery, Department of Surgery, Evanston Hospital, IL 60201; USA Surgery Gynecology & Obstetrics/l68/6 (475-480)/1989/ A polyglactin mesh sling was used to reconstruct the pelvis in eight patients after colorectal or urologic resections in preparation for postoperative radiation therapy. There were three perioperative complications a pelvic abscess requiring percutaneous drainage, a wound dehiscence and a herniation of the small intestine between the pelvic sidewall and mesh requiring small intestinal resection. There were two delayed complications, both partial small intestinal obstructions. One occurred just after the conclusion of radiation treatment and the other occurred five months after the conclusion of radiation therapy. Both obstructions responded to conservative management. None of the common acute radiation effects occurred during radiotherapy. One patient with delayed partial small intestinal obstruction had possible late radiation effects. Int J Gynecol Obstet 31
The median follow-up period after radiation therapy was 12.5 months. Despite the complications described in this report, the use of a polyglactin mesh sling as an adjunct to resection of carcinoma of the pelvis has merit and should be studied further.
Intestinal surgery in gynecologic oncology
Rubin SC; Benjamin I; Hoskins WJ; Pierce VK; Lewis JL Jr Gynecologic Service, Department of Surgery, Memorial SloanKettering Cancer Center, New York, NY 10021; USA Gynecologic Oncology13411 (30-33)/1989/ Intestinal surgery is frequently required in the management of patients with gynecologic malignancies. During a recent 3year period 10.4% of all laparotomies performed on the Gynecology Service at Memorial Sloan-Kettering Cancer Center included major intestinal surgery. A total of 215 separate intestinal procedures were performed during 171 operations on 158 patients. The majority of operations were performed in patients with ovarian (42.7%), cervical (2407o),and endometrial (12.3%) malignancies. Seventy-nine of 171 (46.2%) of operations were intestinal obstruction (43.2%) and intestinal fistula (21%). Procedures performed included 87 intestinal resections, 26 intestinal bypasses, 82 colostomies, and 20 intestinal conduit urinary diversions. Hand suturing was used in 7l@/oof anastomoses; automatic stapling instruments were used in 29%. There was a single surgical mortality. Complications