Reduction of intrapartum antibiotic prophylaxis by combining risk factor assessment with a rapid bedside intrapartum polymerase chain reaction testing for group B streptococci.

OBJECTIVE: To investigate the impact of administering Intrapartum Antibiotic Prophylaxis (IAP) to laboring women with one or more risk factors for Early Onset Group B Streptococcal neonatal infection (EOGBS) based on the result of a rapid bedside test for Group B Streptococci (GBS). STUDY DESIGN: Quality assessment study. METHODS: Three-hundred-sixty-six laboring women admitted to our maternity ward, with one or more risk factors for EOGBS, were prospectively included. Rectovaginal swab-samples were examined bedside by the GenomEra® GBS Polymerase Chain Reaction (PCR) assay upon admission. Time from administration of IAP to delivery was registered. According to national guidelines, one-hundred-two women mandatorily received IAP independent of the PCR test result fulfilling one of the following three risk factors: prior infant with EOGBS, preterm labor before 35 gestational week, temperature ≥ 38 °C during labor. Women with GBS bacteriuria during current pregnancy, rupture of membranes ≥ 18 h IAP, and preterm labor between 35 and 37 gestational week, received IAP solely if the PCR test was positive. Predictive values were calculated for each risk factor. RESULTS: Previous GBS bacteriuria was strongly associated (PPV = 71%) with a positive GBS PCR test, whilst the corresponding positive percent of ROM > 18 h and of GA 35-37 was only PPV = 16% and 22%, respectively. Seventy-four women, 74/251 (31%), received IAP because they were GBS PCR positive. IAP was thus reduced by about two-thirds compared to the risk-based strategy of offering IAP to all women with one or more risk factors for EOGBS. Two women, 2/254 (0.8%), received inferior care, as they did not receive IAP within the recommended 4 h prior to delivery due to the extra time spend on the test procedure. CONCLUSION: Bedside intrapartum PCR testing of women with risk factors for EOGBS effectively diminishes use of IAP during labor compared to the present risk factor-based strategy alone. In this project, the extra time spend on the PCR test procedure did not lead to noticeable delay in IAP.

A comparison of GenomEra® GBS PCR and GeneXpert ® GBS PCR assays with culture of GBS performed with and without broth pre-enrichment.

This study was designed to compare the performance of GeneXpert® and GenomEra® group B streptococcus (GBS) PCR assays, held up against standard culture of GBS performed with and without broth pre-enrichment. In Denmark, the strategy for preventing early onset GBS infection (EOGBS) is risk factor based. Three hundred and sixty six women fulfilling one or more of the criteria for presence of risk factors for EOGBS were prospectively included. Rectovaginal swab samples were taken intrapartum and tested bed-site by the GenomEra® and the GeneXpert® GBS PCR assays and cultured at the microbiology laboratory using Granada agar plates with and without prior growth of sampling material in selective enrichment broth. Among 366 participants tested intrapartum, 99 were GBS-positive by culture, 95 by GenomEra, and 95 by GeneXpert. Compared with culture, the GenomEra and the GeneXpert performed with a sensitivity of 91.8% and 91.7% and a specificity of 98.1% and 97.3%, respectively. A combined reference standard was established by defining true positives as either culture-positive samples or culture-negative samples where both the GeneXpert and the GenomEra GBS PCR assays were positive. Using this, the sensitivity increased to 92.2% and the specificity to 99.6% for GenomEra and to 92.0% and 96.8% for GeneXpert. The use of selective broth enrichment found only three additional GBS culture-positive samples. The performance of the two PCR methods examined was very similar and close to the findings by culture, and both PCR assays are thus applicable as rapid intrapartum bed-site tests.

Axially vascularized bone substitutes: a systematic review of literature and presentation of a novel model.

INTRODUCTION: The creation of axially vascularized bone substitutes (AVBS) has been successfully demonstrated in several animal models. One prototypical indication is bone replacement in patients with previously irradiated defect sites, such as in the mandibular region. The downside of current clinical practice, when free fibular or scapular grafts are used, is the creation of significant donor site morbidity. METHODS: Based on our previous experiments, we extended the creation of an arterio-venous loop to generate vascularized bone substitutes to a new defect model in the goat mandibula. In this report, we review the literature regarding different models for axially vascularized bone substitutes and present a novel model demonstrating the feasibility of combining this model with synthetic porous scaffold materials and biological tissue adhesives to grow cells and tissue. RESULTS: We were able to show the principal possibility to generate axially vascularized bony substitutes in vivo in goat mandibular defects harnessing the regenerative capacity of the living organism and completely avoiding donor site morbidity. CONCLUSION: From our findings, we conclude that this novel model may well offer new perspectives for orthopedic and traumatic bone defects that might benefit from the reduction of donor site morbidity.

Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles.

OBJECTIVE: To identify prognostic factors influencing the outcome of infertility treatment using intrauterine insemination with donor semen (IUI-D). DESIGN: Retrospective study of all patients undergoing IUI-D between August 1st, 1990 and July 31st, 1998. SETTING: University-affiliated infertility clinic. PATIENTS: Three hundred and five couples undergoing 1131 IUI-D treatment cycles. MAIN OUTCOME MEASURES: Type of hormonal treatment, number of follicles, length of follicular phase, endometrial pattern, female age, infertility diagnosis and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. RESULTS: Throughout the nine year period the overall clinical pregnancy rate per cycle was 22.3%, with an increase from 12.9% in 1990 to 34.6% in 1998. The multiple birth rate was 20.6%. The birth rate per couple was 61.1% after a mean of 3.2 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the sixth treatment cycle. The following parameters were positively and significantly correlated to a successful outcome of IUI-D: i) the first treatment cycle - compared to the following up to six treatment cycles; ii) number of mature follicles - more than one - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies when more than 3 mature follicles were present; iii) time of insemination after the 12th day in the cycle; iv) insemination after ovulation has occurred and; v) female age under 30 years. CONCLUSIONS: IUI-D is a simple and inexpensive treatment giving acceptable pregnancy rates for up to six treatment cycles if at least 2 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, and ovulation has occurred at the time of insemination, which ought to take place after cycle day (cd) 12 with at least two million motile spermatozoa.

Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles.

OBJECTIVE: To identify prognostic factors influencing the outcome of infertility treatment using homologous intrauterine inseminations (IUI-H). DESIGN: Retrospective study of all patients undergoing IUI-H at the Fertility Clinic, Odense University Hospital from August 1st, 1990 to July 31st, 1998. SETTING: University-affiliated infertility clinic. PATIENTS: Eight hundred and ninety-three couples undergoing 2473 IUI-H treatment cycles. MAIN OUTCOME MEASURES: Infertility diagnosis, female age, number of follicles, type of hormonal treatment, length of follicular phase, endometrial pattern, and semen quality related to clinical pregnancy rate, cumulative birth rate and multiple gestations. RESULTS: Throughout the nine year period the overall clinical pregnancy rate per IUI-H cycle was 11.9% with a significant increase from 8.7% in 1990 to 14.8% in 1998. The multiple birth rate was 18.1%. The birth rate per couple was 27.2% after a mean of 2.8 treatment cycles. The pregnancy rate was highest in the first treatment cycle and the cumulative birth rate rose only slightly after the fourth treatment cycle. Of the main outcome measures the following were positively and significantly related to a successful outcome of IUI: i) The first treatment cycle - compared to the following up to six treatment cycles; ii) number of mature follicles up to five - at the time of insemination, however, with an unacceptable high rate of multiple pregnancies with more than 4 mature follicles; iii) use of CC/hMG-FSH as compared to CC only for ovarian stimulation; iv) number of motile sperms inseminated exceeding 5 million; v) time of insemination between the 13th and the 16th day in the cycle and vi) anovulatory or idiopathic infertility. CONCLUSIONS: IUI-H is a simple and inexpensive treatment giving acceptable pregnancy rates for up to four treatment cycles providing that at least 3 to 4 mature follicles have developed at the time of insemination, which implies that hormonal ovarian stimulation and induction of ovulation is used, that insemination occurs between cycle day 13 and 16 and that at least 5 million motile sperms are available for insemination. Our results indicate that in the presence of tubal pathology or less than 5 million motile sperms, the couples should be referred directly to IVF-treatment.

[Epidemiology of ovarian cancer and female sex hormones]. / Ovariecancer-epidemiologi og de kvindelige kønshormoner.

The etiology of ovarian cancer (CO) is multifactorial. Several factors have been consistently observed to modify the risk of CO; however, the role of many other factors remains inconclusive. The possible relationship between sex hormones and ovarian cancer has received increasing attention through the last 20 years as it has been documented that sex hormones can be linked to the development or promotion of CO. Parity, reproductive life and the use of oral contraceptives have been shown to influence the incidence of CO. Infertility treatment has been one of the most discussed subjects, but the short treatment period of ovulation-induction, which causes high gonadotropin concentrations in blood and the target organ, does not appear to increase the risk of development of CO. Identification of genetic markers and measurement of the level of steroids in follicular fluid and the ovarian epithelial microenvironment may influence future research in CO epidemiology. The article reviews the relationship between sex hormones and ovarian cancer as being the most consistent factors associated with decreased or increased risk of CO.

Micturition after gastrocystoplasty and gastric bladder replacement.

PURPOSE: We determine the function of gastric tissue as a reservoir for urine and driving force for urination. MATERIALS AND METHODS: A total of 12 men 15 to 45 years old underwent gastrocystoplasty (8) or gastric bladder replacement (4). In 1 patient bladder neck reconstruction was performed with augmentation using the same gastric segment. Ten patients were followed for 1 to 2 years, and evaluated subjectively and objectively, including a urodynamic study 6 months postoperatively. RESULTS: No patient had dysuria or hematuria, despite urinary pH of 5 or less. Mean bladder capacity after augmentation increased from 130 (range 60 to 150) to 420 ml. (range 400 to 470), and was 350 ml. (range 340 to 380) after gastric replacement. Uninhibited contractions occurred only when bladder filling reached 71 to 92% of ultimate capacity with a mean amplitude of 22 cm. water (range 5 to 38). Patients with a gastric neobladder demonstrated an interrupted biphasic flow pattern with a mean maximum flow rate of 12 ml. per second (range 11.5 to 12.8). Urine was evacuated mainly by contraction of the gastric bladder (74%) in stage 1 and by abdominal straining (80%) in stage 2 of voiding. CONCLUSIONS: Stomach seems to be an ideal source of material for bladder augmentation or replacement. The high capacity, low pressure reservoir provided by gastric tissue is probably due to the nature of the involuntary contractions, which occur only late in filling with a low amplitude. Also, the gastric neobladder is evacuated mainly by contraction of its musculature, supplemented with abdominal straining at the end of voiding.

[Malignant transformation of Recklinghausen disease in the small intestine]. / Malign transformation af mb. Recklinghausen i tyndtarmen.

Neurofibromatosis is a relatively common genetic disorder of the peripheral and central nervous systems. Benign or malignant tumours may occur in different organs. Visceral tumours arising in the neural plexus of the intestinal wall may cause ulceration, bleeding, obstruction, perforation and palpable abdominal masses. In this paper a case of chronic anaemia due to a chronically bleeding intestinal neurofibroma is presented in a woman who had undergone intestinal resection. Histopathological analysis showed a neurofibroma with malignant transformation and a liver metastasis.

Reconstruction of resected mandibles using a hydroxyapatite veterinary bone graft.

A newly developed bone equivalent hydroxyapatite was derived from veterinary bone (VHAP). Sections of 1 cm of six rabbit mandibles were equally replaced by this VHAP graft. Radiological studies by X-ray were performed pre-operatively, immediately, and 1, 2 and 3 months post-operatively. The graft host-bone interface was examined periodically by scanning electron microscopy (SEM). Accompanying structural changes of the graft 3 months post-operatively were compared with the pre-operative findings by infra-red (IR) spectroscopic analysis. Complete union of the biomaterial to the host bone after 3 months was evidenced radiologically. SEM proved complete graft integration. This was accompanied by a decrease in optical density of the IR analysis of post-operative VHAP, indicating some leaching of the ions. Clinically, the graft was completely incorporated in the mandible without any complications. We discuss the use of VHAP in humans to reconstruct post-surgical mandibular defects.