Evaluation of the centrifuged and Gram-stained smear, urinalysis, and reagent strip testing to detect asymptomatic bacteriuria in obstetric patients.

OBJECTIVE: Our purpose was to compare the efficacy of the centrifuged and Gram-stained smear with the efficacy of both urinalysis and reagent strip testing for nitrites and leukocyte esterase in detecting asymptomatic bacteriuria in obstetric patients. STUDY DESIGN: A midstream urine specimen was evaluated in 528 patients either at the initial prenatal visit or at a visit because of possible preterm labor. Separate aliquots were tested by centrifugation (with a Cytospin Cytocentrifuge; Shandon, Inc, Pittsburgh, Pa) with Gram stain, by microscopic urinalysis for the presence of moderate to large numbers of bacteria or >10 leukocytes per high-power field, and by reagent strips for the presence of nitrites or leukocyte esterase activity. Results were compared with those of a quantitative urine culture obtained with blood and MacConkey agar plates. RESULTS: Thirty-six women (6.8%) had urine cultures showing 100,000 colony-forming units of a uropathogen per milliliter. The sensitivity and specificity of testing by centrifugation and Gram stain were 100% and 7.7%, respectively. Urinalysis and dipstick testing offered a sensitivity of 80.6% and 47.2%, respectively, with a specificity of 71.5% and 80.3%. No combination of tests, in series or in parallel, offered improved specificity over urinalysis alone. CONCLUSIONS: Centrifugation with Gram stain of a urine specimen offers excellent sensitivity but very poor specificity compared with microscopic urinalysis for the detection of asymptomatic bacteriuria and is not an acceptable screening test in an obstetric population. The false-negative rates of urinalysis (19.4%) and reagent strip testing (52.8%) preclude these from being excellent screening tests for asymptomatic bacteriuria. Given the potential sequelae of undiagnosed asymptomatic bacteriuria in an obstetric population, we conclude that urine cultures should be used for all pregnant patients to detect asymptomatic bacteriuria.

Long-term outcome of nonconservative surgery (hysterectomy) for endometriosis-associated pain in women <30 years old.

OBJECTIVE: This study was undertaken to evaluate the effect that a patient's age at the time of hysterectomy for endometriosis-associated pain has on long-term improvement in symptoms. STUDY DESIGN: An investigation of women who underwent hysterectomy for pelvic pain and endometriosis at <30 or >40 years of age was performed by means of medical records review and mailed questionnaires. Participants were asked to complete 2 standardized surveys, the Disruption of Functioning Index and the Beck Depression Inventory. RESULTS: Sixteen women in the study group (<30 years old) and 27 women in the control group returned completed questionnaires. Although similar proportions reported overall alleviation of pain, the study group was significantly more likely to report residual symptoms, such as dyspareunia and dysuria. This younger group also more often reported a sense of loss after hysterectomy and reported more overall disruption in different aspects of life. CONCLUSION: Women who undergo hysterectomy for pelvic pain and endometriosis at <30 years old are more likely than older women to have residual symptoms, to report a sense of loss, and to report more disruption from pain in different aspects of their lives.

Human immunodeficiency virus infection and women: a survey of missed opportunities for testing and diagnosis.

OBJECTIVE: Our purpose was to describe factors that prompted testing of women infected with the human immunodeficiency virus and health encounters in which missed opportunities for diagnosis occurred. STUDY DESIGN: An observational investigation of 81 human immunodeficiency virus-infected women in the Chicago area was performed by means of an interviewer-administered survey. Patient demographic data, health history, and health care contacts were elicited. RESULTS: Sixty-five women (80%) had at least one documented missed opportunity during the 12 months before their diagnosis. Seventy-eight percent of those women with missed opportunities had them occur at reproductive health encounters. Of 25 pregnant women pregnant in the year before their eventual diagnosis, 12 failed to be diagnosed during that pregnancy. CONCLUSION: Despite visits to reproductive health care providers, the presence of symptoms suspicious for human immunodeficiency virus disease, high-risk behaviors, and even specific requests for testing by many of the women, numerous opportunities for the earlier diagnosis of human immunodeficiency virus infection were missed.

Castleman disease presenting as a pelvic mass.

BACKGROUND: To our knowledge, giant lymph node hyperplasia (Castleman disease) may present as a pelvic mass on magnetic resonance imaging (MRI). CASE: A postmenopausal woman with rapidly enlarging leiomyoma uteri was found to have a suspicious left adnexal mass mimicking an ovarian neoplasm on preoperative MRI. At laparotomy, the suspected uterus and normal ovaries were extirpated. In addition, a firm, 4 x 8-cm solid mass within the sigmoid colon mesentery was found and resected. The final histologic diagnosis was Castleman disease. CONCLUSION: Entities such as Castleman disease should be considered when assessing a pelvic mass. Characterization of the origin of pelvic masses can often be difficult, despite sophisticated diagnostic imaging studies such as MRI.