The necessity of both anorectal and vaginal cultures for group B streptococcus screening during pregnancy.

BACKGROUND: Group B streptococcus (GBS) sepsis affects approximately 2 of every 1000 newborns. In an effort to decrease the incidence of neonatal GBS infection, the Centers for Disease Control and Prevention have established guidelines for screening and treatment during pregnancy. One strategy includes obtaining both vaginal and anorectal GBS cultures, then treating patients whose cultures are positive. Many of our patients are reluctant to undergo anorectal cultures. We conducted a study to determine whether performing cultures of both the vagina and anorectum would change patient management. METHODS: We obtained vaginal and anorectal GBS cultures from 222 consecutive patients at 35 to 37 weeks' gestation. RESULTS: Fifty-four patients (24.3%) had positive GBS cultures. Of those women, 10 (18.5%) had negative vaginal but positive rectal cultures. Thus, nearly one fifth of the patients with GBS colonization would not have received intrapartum antibiotics if only vaginal cultures had been performed. CONCLUSIONS: Health care providers caring for pregnant patients should consider obtaining both vaginal and anorectal cultures when screening for Group B streptococcus.

Office management of Bartholin gland cysts and abscesses.

Bartholin gland cysts and abscesses are common problems in women of reproductive age. Although the cysts are usually asymptomatic, they may become enlarged or infected and cause significant pain. Often the clinician is tempted simply to lance the cyst or abscess, since this technique can be effective for other common abscesses. However, simple lancing of a Bartholin gland cyst or abscess may result in recurrence. More effective treatment methods include use of a Word catheter and marsupialization, both of which can be performed in the office.

Abdominal trauma in the pregnant patient.

Physicians who care for pregnant women must be prepared to evaluate and treat abdominal trauma during pregnancy. The evaluation and management of even minimal abdominal trauma in pregnancy is often problematic, and the use of laboratory tests, fetal monitoring, radiography and ultrasonography depends on the extent of the trauma and the viability of the fetus. Intervention ranges from reassurance to cardiopulmonary resuscitation and surgery. Common laboratory studies include a complete blood count, coagulation panel, urinalysis and blood type and screen. Ultrasonography is useful for evaluation of fetal weight and status of amniotic fluid, but tocodynamometry is more sensitive for diagnosis of placental abruption. Patients with minimal trauma and no bleeding, uterine contractions or abdominal pain can be safely discharged after four to six hours of monitoring, but patients with any of these findings should be admitted to the hospital for overnight observation with continuous fetal heart rate monitoring.

Sonohysterography for endometrial abnormalities: preliminary results.

In examinations where the etiology of an abnormal endometrial sonographic image is not clear, saline infusion through a fine flexible catheter during transvaginal sonography provides visual contrast and uterine expansion. In 39 women, polyps, myomata, synechiae, endometrial hyperplasia, and cancer were correctly described as verified at surgery. Hyperplasia and neoplasia are not distinguishable, but the approach for biopsy and therapy is established by this simple and well-tolerated technique, which is here called sonohysterography.

Preterm premature rupture of membranes: a randomized study of home versus hospital management.

OBJECTIVE: To compare length of latency period, gestational age at delivery, and safety in a carefully selected group of patients with preterm premature rupture of the membranes (PROM) randomized to home versus hospital management. METHODS: After meeting strict inclusion criteria, 67 patients with preterm PROM were randomized by sealed envelope to home versus hospital expectant management. The groups were managed similarly with pelvic and bed rest. Management included recording of temperature and pulse every 6 hours, daily charting of fetal movements, twice-weekly nonstress test and complete blood count, and weekly ultrasound and visual examination of the cervix. RESULTS: There was no significant difference in clinical characteristics or perinatal outcome between the groups. There was, however, a significant decrease in both the days of maternal hospitalization and maternal hospital expenses in the home group. CONCLUSION: Only a very small proportion of cases of preterm PROM (18%) could meet the strict safety criteria for inclusion used in the study. In the home-management group, length of the latency period and gestational age at delivery were not significantly different than in hospitalized patients.

Prevalencia del papillomavirus humano en lesiones benignas, premalignas y malignas del cervix uterino / HPV prevalence in benig, premalignant and malignant lesions of the cervix

Se informa la prevalencia de los papillomavirus humano tipos 6, 11, 16, 18 encontrada en una muestra de mujeres con patalogías premalignas y malignas del cervix uterino, así como en algunas muestras de lesiones benignas del mismo tejido. para el diagnóstico viral se empleó la técnica de hibridación de ácidos nucleicos "dot blot" con marcaje radioactivo. Se discuten las características de este método así como las ventajas y desventajas de los dos tipos de toma de muestra del cervis utilizados. raspado y biopsia. Se comenta el valor de prevalencia global encontrada, 86.3 %, así como el patrón de distribución de los 4 tipos virales, y se compara el diagnóstico de un grupo de muestras empleándo simultanemente en ellas el dot blot y el Southern blot, el cual permite además conocer el estado físico en que se encuentra el virus en el genóma humano infestado. Se analiza la relación entre diferentes variables (edad, edad de las primeras relaciones sexuales, número de parejas sexuales diferentes, tipos de contraceptivos usados, edad del primer parto, número de partos, histología de la lesión) con la infección viral en la muestra de mujeres estudiadas

An analysis of the reassembly of denatured creatine kinase from monkey brain.

Creatine kinase isolated from monkey brain was characterized with respect to denaturation/inactivation and renaturation/reactivation/reassociation in order to determine the mechanism of reassembly. Enzyme unfolded in 8 M urea exhibits several characteristics of denatured protein: complete loss of enzymatic activity, decrease in intrinsic fluorescence with a red shift in the emission maximum and loss of circular dichroism at 220 nm. The renatured protein reassembles to its apparently native condition as judged by these criteria, but small differences of uncertain origin persist. Dependence of activity and fluorescence on denaturant concentration indicate that inactivation is more sensitive to urea than is unfolding; spectral changes at the intermediate urea concentrations suggest formation of aggregated protein. Upon dilution, enzyme previously exposed to 8 M urea for 40 min regains 70-80% native activity, independent of protein concentration over the range of 0.56-160 nM. Reactivation kinetics, measured using the assay mixture with and without trypsin, are independent of protein concentration, and are adequately described by a single rate constant, 3.2 X 10(-3) s-1 and 4.2 X 10(-3) s-1, respectively. Reactivation is completed 20-30 min after initiation of renaturation. Fluorescence changes during refolding are at least biphasic, exhibiting a rapid increase, then a slow decrease completed at approximately 15-20 min after initiating refolding. Reassociation is measured by competitive hybridization between dimerizing B subunits and M subunits to form MB heterodimer. The time dependent decay in heterodimer formation during competitive dimerization shows that reassociation is completed between 60 and 90 min after initiation of reassembly. These results indicate that the brain isozyme of creatine kinase, like the muscle form, is composed of subunits which do not require association for expression of catalytic activity. Furthermore, a comparison of spectral data and susceptibility to trypsin inactivation between the muscle and brain isozymes supports previous suggestions that in the native state, the brain isozyme is a conformationally looser, more open protein.