Abortion procedures and abortifacients.

PIP: This article provides a brief history of women's efforts to control their reproductive lives through access to abortion in the 20th century. The first section presents a world overview that traces the development of anti-abortion laws and the subsequent liberalization of these laws. Section 2 reviews the frequency of abortions and abortion fees in the US and pays special attention to patient characteristics. The third section delineates the new type of counseling developed for abortion patients; and section 4 describes procedures for first trimester abortion (the history and advantages of vacuum aspiration, the proper setting, the format, complications, and procedural variations. Section 5 examines the practice of menstrual extraction as it occurred in the US from 1970-75 and occurs in Bangladesh. The next two sections cover abortions at 8-14 weeks and dilation and evacuation at 14-20 weeks. Section 8 looks at late mid-trimester abortion techniques and considers issues related to fetal personhood. Section 9 covers the history, current use, and multiple insertions of laminaria tents. Section 10 explains methods of postcoital contraception, and section 11 discusses currently available abortifacients. The next two sections argue that abortion is far safer than childbirth and explore the psychological impact of abortion. The article ends with three sections on recent legal changes, current problems in the delivery of abortion services in the US, and the prognosis for the future.^ieng

Clavulanic acid biosynthesis in Streptomyces clavuligerus: gene cloning and characterization.

Seven classes of Streptomyces clavuligerus mutants defective in clavulanic acid (CLA) biosynthesis have been identified and used to clone the chromosomal DNA encoding eight CLA biosynthetic genes. The complete sequences of three and the partial sequences of two of these biosynthetic genes are reported, together with their known or predicted functions.

Cloning and sequence analysis of blaBIL-1, a plasmid-mediated class C beta-lactamase gene in Escherichia coli BS.

The extended-spectrum, plasmid-borne beta-lactamase gene blaBIL-1, which was discovered in Escherichia coli, has been cloned. Unusually for a plasmid-borne beta-lactamase, blaBIL-1 encodes a novel class C enzyme and appears to have originated from the chromosomal ampC gene of Citrobacter freundii.

Molecular characterization of the gene encoding high-level mupirocin resistance in Staphylococcus aureus J2870.

The nucleotide sequence of the ileS gene conferring high-level resistance to mupirocin in Staphylococcus aureus J2870 has been determined. The gene sequence is substantially different from that of the native ileS gene of S. aureus, indicating that high-level resistance to mupirocin results from the acquisition of a novel ileS gene.

Analysis and toxic overexpression in Escherichia coli of a staphylococcal gene encoding isoleucyl-tRNA synthetase.

We have cloned and sequenced the Staphylococcus aureus Oxford ileS gene which encodes isoleucyl-tRNA synthetase (Ile-RS), the target for the antibiotic mupirocin. The gene was identified by hybridisation to oligodeoxyribonucleotide probes derived from internal Ile-RS amino acid (aa) sequences. The 2754-bp open reading frame encodes a 918-aa protein of 105 kDa which is homologous to other known Ile-RS from Gram- bacteria, archaebacteria, yeast and protozoa. Motifs which have been implicated in the functioning of the active site are strongly conserved. The gene was engineered for high-level expression in Escherichia coli. Ile-RS overproduction was toxic to the E. coli host, the magnitude of its observed effects being strain-dependent.

The biosynthetic genes for clavulanic acid and cephamycin production occur as a 'super-cluster' in three Streptomyces.

The cosmid cloning vector pHC79 has been used to clone fragments of chromosomal DNA from the Streptomyces: S. clavuligerus, S. jumonjinensis and S. katsurahamanus. These strains all produce both the beta-lactam antibiotic, cephamycin and the beta-lactamase inhibitor, clavulanic acid. Although structurally related these two beta-lactams are known to be derived from different biosynthetic precursors. Hybridisation studies and restriction mapping have shown that the gene clusters encoding the two biosynthetic pathways are chromosomally adjacent in these strains, thus creating a 'super-cluster' of genes involved in both the production and enhancement of activity of a beta-lactam antibiotic.

Beta-lactam antibiotic biosynthetic genes have been conserved in clusters in prokaryotes and eukaryotes.

A cosmid clone containing closely linked beta-lactam antibiotic biosynthetic genes was isolated from a gene library of Flavobacterium sp. SC 12,154. The location within the cluster of the DNA thought to contain the gene for delta-(L-alpha-aminoadipyl)-L-cysteinyl-D-valine synthetase (ACVS), the first step in the beta-lactam antibiotic biosynthetic pathway, was identified by a novel method. This DNA facilitated the isolation, by cross-hybridization, of the corresponding DNA from Streptomyces clavuligerus ATCC 27064, Penicillium chrysogenum Oli13 and Aspergillus nidulans R153. Evidence was obtained which confirmed that the cross-hybridizing sequences contained the ACVS gene. In each case the ACVS gene was found to be closely linked to other beta-lactam biosynthetic genes and constituted part of a gene cluster.

Chlamydial infection in a Chinese gynecologic outpatient clinic.

In an attempt to detect the presence, if any, of cervical chlamydial infection, we obtained endocervical smears from 1000 female patients attending the outpatient gynecologic and family planning clinics at Women's Hospital, Zheijiang Medical University, Hangzhou, People's Republic of China. Using direct immunofluorescent monoclonal antibody staining technique, we identified elementary bodies typical of the Chlamydia trachomatis organism in ten of the 1000 slides (1%). The only characteristic of statistical significance in this small group of infected women was the complaint of infertility for more than two years' duration, noted in six of the ten cases.

Some physiological consequences of the rapid smoking treatment for cigarette addiction.

The effects of rapid smoking, casual smoking, and rapid breathing on heart rate, blood pressure, cardiac output, and rectal-forearm-finger temperatures were compared. Carboxyhemoglobin, end-tidal carbon monoxide, plasma nicotine, electrocardiogram, and subjective symptom data were also obtained during these conditions as an older subject group smoked low nicotine cigarettes and younger subject groups smoked either high or low nicotine cigarettes. The authors concluded that the physiological changes produced by rapid smoking are greater than those produced by casual smoking and are not an artifact of rapid breathing. The controversy concerning the hazard potential of rapid smoking for either young or older subjects, however, is not fully resolved.

Protocol for management of unsuccessful pregnancy.

PIP: Complications of unsuccessful pregnancy (including intrauterine fetal death, missed abortion, gross fetal abnormalities, and hydatidiform mole) and their successful management are reviewed as 21 such cases are reported retrospectively. In all cases of pregnancy complication, active management is recommended; such management is many times determined by the gestational week in which the pregnancy failed. Dilatation and evacuation are used for gestations from 12-18 weeks; and prostaglandin induction is indicated for pregnancies of greater than 18 weeks in size. In these 21 cases, 6 underwent dilatation and evacuation (using laminaria tents as well), 8 underwent laminaria insertion followed by extraamniotic prostaglandin F2 alpha and oxytocin augmentation, 4 patients were treated with prostaglandin E2 vaginal suppositories augmented by laminaria. Based on these results a preference is indicated for continuous extraamniotic infusion of PGF2 alpha vs. prostaglandin E2 suppositories. Also advocated is treatment as outpatient whenever possible.^ieng

Induction of midtrimester abortion by the combined method of continuous extravovular infusion of prostaglandin F2alpha and intracervical laminaria tents.

Midtrimester abortion was successfully induced in 55 of 60 patients with continuous extraovular infusion of prostaglandin F2alpha (PGF2alpha) following the insertion of intracervical laminaria tents. Intravenous oxytocin was also used in 38 (63%) of the 60 patients. The mean induction-abortion time (IAT) was 11.72 hours +/- 1.06 SD). Abortion was completed in 40% within 8 hours, 80% within 16 hours, and 93% within 24 hours. The mean total dose of PGF2alpha was 41.9 mg. There was no significant difference in IAT between the parous patients (13.40 hours +/- 1.90 SD) and the nulliparous patients (10.41 hours +/- 1.13 SD). There was no apparent correlation between IAT and the stages of gestation (12 to 22 weeks). The five patients who failed to abort within 24 to 36 hours underwent uterine evacuation, which was easily accomplished because there was a marked degree of cervical dilatation. Side effects and complications of the technique were few. Endometritis occurred in three patients, two of whom had had intrauterine devices in situ until just prior to the procedure. It appears that this method has a high success rate, an acceptable safety factor, good patient tolerance, and relatively few side effects.

Prophylactic use of tetracycline for first trimester abortions.

Because the efficacy of prophylactic antibiotic therapy has yet to be established and because numerous variables often hamper studies of such therapy, the results of prophylactic antibiotic therapy were studied in a homogeneous gynecologic population. The patients were 4000 women undergoing first trimester abortions. The surgical procedure, the gynecologists' skill, and the hospital environment were relatively uniform, as was the patient age range. Two groups of 1000 patients each received tetracycline; the other 2000 patients served as controls. The complications associated with abortion were then analyzed in those receiving tetracycline and in the 2000 controls. Complications were less frequent among patients receiving tetracycline. This finding supports the argument of those who favor the prophylactic use of antibiotics in the management of various high-risk surgical problems.

PIP: An evaluative study of the prophylactic use of tetracycline in 1st-trimester abortions is presented. 2 groups of 1000 patients received 1.5 gm of tetracycline hydrochloride, orally, 2-3 hours before the abortion procedure, followed by 500 mg every 6 hours for 4 days. 2 groups of 1000 patients served as controls. The patient population and operative conditions were relatively uniform. The total complication rates for the antibiotic groups were 3.4% and 2.9%, and 9.1% and 8.8% for the controls. 118 of the control group patients experienced major complications compared with 45 patients in the antibiotic group. The results tend to support the arguments for the use of antibiotics in managing high-risk surgical procedures.