Group A Streptococcus causing PID from an initial pharyngeal infection. A case report.

BACKGROUND: Pelvic inflammatory disease (PID) is a difficult diagnosis. Five billion dollars is spent on over 1 million women diagnosed each year. Atypical organisms and prior history of tubal ligation may complicate the diagnosis. CASE: A woman who had undergone tubal ligation and abstained from intercourse for over two years developed group A streptococcal salpingitis. It occurred following an upper respiratory infection with the same organism. CONCLUSION: PID is rare in a woman with prior tubal ligation who is not engaging in intercourse. In this case it followed an upper respiratory infection with group A Streptococcus. Low diagnostic suspicion must be maintained for uncommon pathogens in PID in women with prior tubal ligation who are not engaging in intercourse.

Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss.

OBJECTIVE: To determine effectiveness of transdermal progesterone cream for controlling vasomotor symptoms and preventing postmenopausal bone loss. METHODS: We randomly assigned 102 healthy women within 5 years of menopause to transdermal progesterone cream or placebo. Study subjects and investigators were masked until data analysis was completed. An initial evaluation included complete history, physical examination, bone mineral density determination, and serum studies (TSH, FSH, lipid profile, and chemistry profile). Subjects were instructed to apply a quarter teaspoon of cream (containing 20 mg progesterone or placebo) to the skin daily. Each woman received daily multivitamins and 1200 mg of calcium and were seen every 4 months for review of symptoms. Bone scans and serum chemistries were repeated after 1 year. RESULTS: Thirty of the 43 (69%) in the treatment group and 26 of the 47 (55%) in the placebo group complained initially of vasomotor symptoms. Improvement or resolution of vasomotor symptoms, as determined by review of weekly symptom diaries, was noted in 25 of 30 (83%) treatment subjects and five of 26 (19%) placebo subjects (P < .001). However, the number of women who showed gain in bone mineral density exceeding 1.2% did not differ (alpha = .05, power of 80%). CONCLUSION: Although we found no protective effect on bone density after 1 year, we did see a significant improvement in vasomotor symptoms in the treated group.

Shoulder dystocia: prevention and treatment.

Although shoulder dystocia is an infrequent event it has assumed a position of great clinical importance because of our litigious environment. Many cases are preventable by the proper identification of risk factors, especially glucose intolerance, macrosomia, obesity, and postdate pregnancies. The severity of the problem can be rapidly graded or determined by the response to a systematic treatment plan; such a plan is outlined.