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Treatment of hopitalized patients with acute pelvic inflammatory disease: Comparison of cefotetan plus doxycycline and cefoxitin plus doxycycline
94
Citationsfrom the Literature
A suburethral sling procedure with polytetrafluoroethyleae for the treatment of genuine stress incontinence in patients with low urethral closure pressure Horbach NS; Blanc0 JS; Ostergard DR; et al Division of Gynecologic Urology, Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA OBSTET. GYNECOL.; 7114 (648-652)/1988/ One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressure (20 cm H,O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.
Surgical treatment of stress urinary incontinence: A comparison of the Kelly pllcation, Marshall-Mar&et&Krantz, and Pereyra procedures Park GS; Miller EJ Jr Department of Obstetrics and Gynecology, Fitzsimons Army Medical Center, Aurora. CO, USA OBSTET. GYNECOL.; 7114 (57%579)/1988/ Six hundred eighty patients surgically treated for stress urinary incontinence were observed annually for up to ten years to compare the efficacy and complications of three types of repair procedures. Although Marshall-Marchetti-Krantz procedures yielded the most effective repair in the immediate postoperative period, Kelly plications were equally corrective more than three years after surgery (69 and 668’0, respectively). Both were superior to the original Pereyra urethropexies at all times. Repeat operations were more likely to fail than primary repairs. The efficacy of the Pereyra procedure was increased with the use of permanent suture. Marshall-Marchetti-Krantz procedures were not affected by suture selection. Pereyra procedures had more complications, many related to intravesical suture. Success rates of all procedures declined steadily with lengthening periods of observation. We conclude that Kelly plications and Marshall-Marchetti-Krantz procedures have similar long-term efficacy and complication rates. The use of intraoperative cystoscopy and permanent suture with the Pereyra procedure might make it competitive.
Bladder training after surgery for stress urinary incontinence: Is it necessary?
Bergman A; Matthews L; Ballard CA Division of Gyneoclogy/Urology, Women’s Hospital, University of Southern California Medical Center, Los Angeles, CA 90033, USA OBSTET. GYNECOL.; 70/6 (909-912)/1987/ Int J Gynecol Obstet 28
Eight-nine consecutive patients with a clinically and urodynamically proved diagnosis of genuine stress urinary incontinence entered this study. Forty women had a revised Pereyra procedure and 49 had a Burch retropubic urethropexy. All had a suprapubic Bormano catheter for postoperative bladder drainage. Postoperatively, patients were randomly allocated to ‘bladder training’ (N = 44) or ‘nonbladder training’ (N = 45) protocols. ‘Bladder training’ consisted of scheduled clamping and unclamping of the catheter, whereas the ‘nonbladder training’ patients had continuous bladder drainage throughout their postoperative period. Postvoiding residual urine volume was measured twice daily after the patient had voided with a symptomatically full bladder. The catheter was removed once residual volume was 50 ml or less. The bladder training protocol had no effect on resumption of spontaneous voiding after surgery. There was no significant change in length of postoperative bladder catheterization or in urinary tract infection rate among women with or without bladder training.
Perineal hernia repair using human dura Delmore JE; Turner DA; Gershenson DM; Horbelt DV Department of Gynecology, The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, Houston, TX, USA OBSTET. GYNECOL; 70/3 PART II (507-508)/1988/ A patient developed a large perineal hernia and prolapse of a myocutaneous neovagina 13 months after total pelvic exenteration for recurrent squamous cell cancer of the cervix and gracilis myocutaneous vaginal reconstruction. The neovagina was removed and the pelvic floor defect was repaired with preserved human dura. Twelve months postoperatively, the patient remained asymptomatic. Current and potential uses for human dura allografts are discussed.
Treatment of hopitalized patients with acute pelvic inflammatory disease: Comparison of cefotetan plus doxycycline and cefoxitin plus doxycycllne Sweet RL; Schachter J; Landers DV; et al Department of Obstetrics, University of California. San Francisco, CA, USA AM. J. OBSTET. GYNECOL.; 158/3 II SUPPL. (736-743)/ 1988/ Acute pelvic inflammatory disease remains the major medical and economic consequence of sexuality transmitted diseases among young women. The polymicrobial origins of pelvic inflammatory disease have been well documented and the major organisms recovered from the upper genital tract in patients with pelvic inflammatory disease include Chlamydia trachomatis, Neisseria gonorrhoeae, and mixed anaerobic and aerobic bacteria. This study was undertaken to compare the efficacy and safety of cefotetan plus doxycycline with that of cefoxitin plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 68 hospitalized patients with acute pelvic inflammatory disease were entered and randomized into two treatment groups: cefot-
Citations from the Literature etan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic an aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94Vo) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks. respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.
95
GYNECOL. ONCOL.; 29/3 (290-304)/1988/ Although the clinical and pathological features of sarcoma botryoides of the vagina in infancy are well documented in the literature, only occasional cases of a histologically similar tumor of the uterine cervix have been described, mostly as individual case reports. We have reviewed 13 cases sarcoma botryoides of the cervix. The patients range in age from 12 to 26 years, with a mean of 18 years. All presented with vaginal bleeding, ‘something’ protruding from the introitus, or both. On gross examination the tumors were polypoid, smooth, glistening, and focally hemorrhagic. Microscopic examination revealed the presence of a cambium layer and cells showing the features of rhabdomyoblasts in all the cases. Sii of the 13 tumors (45%) contained foci of mature cartilage. All the patients were alive and well 1 to 8 years (average 3.5 years) postoperatively except for one who died of the tumor after 1 year. Although most of the patients had a radical operation, sometimes followed by chemotherapy, three had excellent results after polypectomy or cervicectomy. The findings indicate that, unlike its counterpart in the vagina, which has a poor prognosis, sarcoma botryoides of the cervix in young women has a favorable outlook.
ONCOLOGY Presorgieal prognostic factors in carcinoma of the cervix, stages IB and IIA
O’Brien DM; Carmichael JA Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Queen’s University, Kingston, Ont., Canada AM. J. OBSTET. GYNECOL.; 158/2 (250-254)/1988/ Possible prognostic factors in early stage cervical cancer include patient age, tumor size. cell type, differentiation, and channel invasion. In this study each of these factors was evahtated based only on the findings available before surgery, and the observations are compared with patient survival and incidence of node metastases. One hundred consecutive patients with stage IB or HA cervical cancer treated by primary radical surgery and followed by at least 2 years are reported. Diseasefree survival was 9OVoat 2 years and 85% at 5 years; 19% had node metastases. Of the factors studied, only age >50 years was associated with poor prognosis (p < 0.02 versus age < 50 years). Only large tumor size was associated with increased node metastases (p < 0.001 versus medium and small size). Tumor cell type, differentiation, and channel involvement had no bearing on survival or node metastases. Because older age and large tumors appear to be factors of poor prognosis for surgery, and yet it is not clear that these patients fare better with radiotherapy, we suggest a prospective trial of radiotherapy versus surgery for this group.
Sarcoma botryoides of the uterine cervix in young women: A clinkopnthological study of 13 cases
Daya DA; Scully RE Department of Pathology, Henderson Hamilton, On t. Lg V 1C3, Canada
General Hospital,
Continuous iafusion fluoropyrimidiues as salvage therapy for patients wltb advanced ovarian carcinoma
Goodman HM; Dottino PR; Kredenster D; et a.I Division of Gynecologic Oncology, The Department of Obstetrics, Gynecologv and Reproductive Science, The Mount Sinai School of Medicine, New York, NY 10029, USA GYNECOL. ONCOL.; 29/3 (348-355)/1988/ A major challenge facing those caring for patients with ovarian carcinoma is inducing remission following the failure of first-line treatment. Toward this end, we have examined the efficacy of continuous infusion fluoropyrimidines. During a 2year period, nine patients with recurrent ovarian carcinoma received treatment with continuous infusion S-fluorouracil (5FU) or 5-fluorouracil-deoxyribose as single agents or in combination with other drugs. Eight patients were evaluable, with responses obtained with each treatment regimen. Myelotoxicity was mild, with only 3 episodes of grade 4 toxicity out of 70 total cycles of chemotherapy. Mucositis was moderate to severe, tending to be the dose-limiting adverse effect. Continuous infusion 5-FU in these combinations appears to be active with every acceptable toxicity in heavily pretreated patients.
Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma
Patsner B; Mann WJ; Cohen H; Loesch M Division of Gynecologic Oncologv, Department of Obstetrics and Gynecology, School of Medicine, State University of New York, Stony Brook, NY 11794-8091, USA AM. J. OBSTET. GYNECOL.; 158/2 (399-402)/1988/ Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrird carcinoma before definitive surgical stagInt / Gynecol Obstet 28
Citationsfrom the Literature
A suburethral sling procedure with polytetrafluoroethyleae for the treatment of genuine stress incontinence in patients with low urethral closure pressure Horbach NS; Blanc0 JS; Ostergard DR; et al Division of Gynecologic Urology, Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA OBSTET. GYNECOL.; 7114 (648-652)/1988/ One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressure (20 cm H,O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.
Surgical treatment of stress urinary incontinence: A comparison of the Kelly pllcation, Marshall-Mar&et&Krantz, and Pereyra procedures Park GS; Miller EJ Jr Department of Obstetrics and Gynecology, Fitzsimons Army Medical Center, Aurora. CO, USA OBSTET. GYNECOL.; 7114 (57%579)/1988/ Six hundred eighty patients surgically treated for stress urinary incontinence were observed annually for up to ten years to compare the efficacy and complications of three types of repair procedures. Although Marshall-Marchetti-Krantz procedures yielded the most effective repair in the immediate postoperative period, Kelly plications were equally corrective more than three years after surgery (69 and 668’0, respectively). Both were superior to the original Pereyra urethropexies at all times. Repeat operations were more likely to fail than primary repairs. The efficacy of the Pereyra procedure was increased with the use of permanent suture. Marshall-Marchetti-Krantz procedures were not affected by suture selection. Pereyra procedures had more complications, many related to intravesical suture. Success rates of all procedures declined steadily with lengthening periods of observation. We conclude that Kelly plications and Marshall-Marchetti-Krantz procedures have similar long-term efficacy and complication rates. The use of intraoperative cystoscopy and permanent suture with the Pereyra procedure might make it competitive.
Bladder training after surgery for stress urinary incontinence: Is it necessary?
Bergman A; Matthews L; Ballard CA Division of Gyneoclogy/Urology, Women’s Hospital, University of Southern California Medical Center, Los Angeles, CA 90033, USA OBSTET. GYNECOL.; 70/6 (909-912)/1987/ Int J Gynecol Obstet 28
Eight-nine consecutive patients with a clinically and urodynamically proved diagnosis of genuine stress urinary incontinence entered this study. Forty women had a revised Pereyra procedure and 49 had a Burch retropubic urethropexy. All had a suprapubic Bormano catheter for postoperative bladder drainage. Postoperatively, patients were randomly allocated to ‘bladder training’ (N = 44) or ‘nonbladder training’ (N = 45) protocols. ‘Bladder training’ consisted of scheduled clamping and unclamping of the catheter, whereas the ‘nonbladder training’ patients had continuous bladder drainage throughout their postoperative period. Postvoiding residual urine volume was measured twice daily after the patient had voided with a symptomatically full bladder. The catheter was removed once residual volume was 50 ml or less. The bladder training protocol had no effect on resumption of spontaneous voiding after surgery. There was no significant change in length of postoperative bladder catheterization or in urinary tract infection rate among women with or without bladder training.
Perineal hernia repair using human dura Delmore JE; Turner DA; Gershenson DM; Horbelt DV Department of Gynecology, The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, Houston, TX, USA OBSTET. GYNECOL; 70/3 PART II (507-508)/1988/ A patient developed a large perineal hernia and prolapse of a myocutaneous neovagina 13 months after total pelvic exenteration for recurrent squamous cell cancer of the cervix and gracilis myocutaneous vaginal reconstruction. The neovagina was removed and the pelvic floor defect was repaired with preserved human dura. Twelve months postoperatively, the patient remained asymptomatic. Current and potential uses for human dura allografts are discussed.
Treatment of hopitalized patients with acute pelvic inflammatory disease: Comparison of cefotetan plus doxycycline and cefoxitin plus doxycycllne Sweet RL; Schachter J; Landers DV; et al Department of Obstetrics, University of California. San Francisco, CA, USA AM. J. OBSTET. GYNECOL.; 158/3 II SUPPL. (736-743)/ 1988/ Acute pelvic inflammatory disease remains the major medical and economic consequence of sexuality transmitted diseases among young women. The polymicrobial origins of pelvic inflammatory disease have been well documented and the major organisms recovered from the upper genital tract in patients with pelvic inflammatory disease include Chlamydia trachomatis, Neisseria gonorrhoeae, and mixed anaerobic and aerobic bacteria. This study was undertaken to compare the efficacy and safety of cefotetan plus doxycycline with that of cefoxitin plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 68 hospitalized patients with acute pelvic inflammatory disease were entered and randomized into two treatment groups: cefot-
Citations from the Literature etan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic an aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94Vo) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks. respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.
95
GYNECOL. ONCOL.; 29/3 (290-304)/1988/ Although the clinical and pathological features of sarcoma botryoides of the vagina in infancy are well documented in the literature, only occasional cases of a histologically similar tumor of the uterine cervix have been described, mostly as individual case reports. We have reviewed 13 cases sarcoma botryoides of the cervix. The patients range in age from 12 to 26 years, with a mean of 18 years. All presented with vaginal bleeding, ‘something’ protruding from the introitus, or both. On gross examination the tumors were polypoid, smooth, glistening, and focally hemorrhagic. Microscopic examination revealed the presence of a cambium layer and cells showing the features of rhabdomyoblasts in all the cases. Sii of the 13 tumors (45%) contained foci of mature cartilage. All the patients were alive and well 1 to 8 years (average 3.5 years) postoperatively except for one who died of the tumor after 1 year. Although most of the patients had a radical operation, sometimes followed by chemotherapy, three had excellent results after polypectomy or cervicectomy. The findings indicate that, unlike its counterpart in the vagina, which has a poor prognosis, sarcoma botryoides of the cervix in young women has a favorable outlook.
ONCOLOGY Presorgieal prognostic factors in carcinoma of the cervix, stages IB and IIA
O’Brien DM; Carmichael JA Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Queen’s University, Kingston, Ont., Canada AM. J. OBSTET. GYNECOL.; 158/2 (250-254)/1988/ Possible prognostic factors in early stage cervical cancer include patient age, tumor size. cell type, differentiation, and channel invasion. In this study each of these factors was evahtated based only on the findings available before surgery, and the observations are compared with patient survival and incidence of node metastases. One hundred consecutive patients with stage IB or HA cervical cancer treated by primary radical surgery and followed by at least 2 years are reported. Diseasefree survival was 9OVoat 2 years and 85% at 5 years; 19% had node metastases. Of the factors studied, only age >50 years was associated with poor prognosis (p < 0.02 versus age < 50 years). Only large tumor size was associated with increased node metastases (p < 0.001 versus medium and small size). Tumor cell type, differentiation, and channel involvement had no bearing on survival or node metastases. Because older age and large tumors appear to be factors of poor prognosis for surgery, and yet it is not clear that these patients fare better with radiotherapy, we suggest a prospective trial of radiotherapy versus surgery for this group.
Sarcoma botryoides of the uterine cervix in young women: A clinkopnthological study of 13 cases
Daya DA; Scully RE Department of Pathology, Henderson Hamilton, On t. Lg V 1C3, Canada
General Hospital,
Continuous iafusion fluoropyrimidiues as salvage therapy for patients wltb advanced ovarian carcinoma
Goodman HM; Dottino PR; Kredenster D; et a.I Division of Gynecologic Oncology, The Department of Obstetrics, Gynecologv and Reproductive Science, The Mount Sinai School of Medicine, New York, NY 10029, USA GYNECOL. ONCOL.; 29/3 (348-355)/1988/ A major challenge facing those caring for patients with ovarian carcinoma is inducing remission following the failure of first-line treatment. Toward this end, we have examined the efficacy of continuous infusion fluoropyrimidines. During a 2year period, nine patients with recurrent ovarian carcinoma received treatment with continuous infusion S-fluorouracil (5FU) or 5-fluorouracil-deoxyribose as single agents or in combination with other drugs. Eight patients were evaluable, with responses obtained with each treatment regimen. Myelotoxicity was mild, with only 3 episodes of grade 4 toxicity out of 70 total cycles of chemotherapy. Mucositis was moderate to severe, tending to be the dose-limiting adverse effect. Continuous infusion 5-FU in these combinations appears to be active with every acceptable toxicity in heavily pretreated patients.
Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma
Patsner B; Mann WJ; Cohen H; Loesch M Division of Gynecologic Oncologv, Department of Obstetrics and Gynecology, School of Medicine, State University of New York, Stony Brook, NY 11794-8091, USA AM. J. OBSTET. GYNECOL.; 158/2 (399-402)/1988/ Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrird carcinoma before definitive surgical stagInt / Gynecol Obstet 28