A randomized, prospective study comparing once-daily gentamicin versus thrice-daily gentamicin in the treatment of puerperal infection.

OBJECTIVE: The efficacy, safety, and antibiotic-related charges for once-daily gentamicin with twice-daily clindamycin were compared with those of thrice-daily dosing of these antibiotics. STUDY DESIGN: Patients with puerperal endometritis or with chorioamnionitis in labor assessed to be at risk for endometritis were randomized to receive gentamicin 4 mg/kg intravenously every 24 hours with clindamycin 1200 mg intravenously every 12 hours (experimental arm) or gentamicin 1.33 mg/kg intravenously and clindamycin 800 mg intravenously every 8 hours (conventional dosing interval arm). Primary outcomes included cure rates, mean length of treatment, antibiotic-related charges, and nephrotoxicity. Multiple logistic regression analysis was used to control for confounding variables. RESULTS: There were 135 and 137 patients randomized to the experimental and conventional interval arms, respectively. Cures were obtained in 94.1% and 87.6% of patients in the experimental and conventional arms, respectively (p = 0.06). The experimental arm had mean antibiotic charges of $250.79 versus $442.49 in the conventional arm (p < 0.0001). There was no permanent nephrotoxicity in either group. CONCLUSIONS: Once-daily gentamicin dosing with twice-daily clindamycin dosing is as efficacious and safe as the thrice-daily dosing of gentamicin and clindamycin for peripartum uterine infection. The experimental regimen results in substantial cost savings. The incidence of nephrotoxicity is low.

First-trimester growth patterns of aneuploid fetuses.

First-trimester growth restriction has been reported in certain aneuploid pregnancies. The purpose of this study was to evaluate this association further by comparing the crown-rump lengths (CRLs) and growth rates from 196 chromosomally abnormal fetuses with a control population of 1929 euploid fetuses. The mean CRLs and growth rates were significantly reduced (P < 0.05) in the groups of fetuses with trisomy 18 (n = 49), trisomy 13 (n = 19), and triploidy (n = 8). Using a fifth percentile cut-off, growth rate was a better discriminator than a single CRL in identifying fetuses affected with these aneuploidies. These growth parameters were not significantly reduced in fetuses with trisomy 21 (n = 92), sex chromosome trisomies (n = 20), or 45,X (n = 8). We conclude that fetal growth restriction associated with an underlying chromosome abnormality can occur as early as the first trimester. This phenomenon results from intrinsic fetal factors and not delayed ovulation. Such information is important to establish as first-trimester serum screening evolves.

Programa de pesquisa del cáncer gástrico en el Estado Táchira, Venezuela

Por la alta incidencia de cáncer gástrico, similar a la de otros estados andinos de Venezuela, se ha establecido, a partir de 1980, un Programa Piloto de Pesquisa del Cancer Gástrico en el Estado Táchira (PCG) y cuya secuencia ha consistido en planificación, motivación, radiología indirecta, segunda exploración (con fibrogastroscopia y radiología directa) histopatología, tratamiento y registro-seguimiento. Se presentan los resultados obtenidos en 429 casos avanzados y 129 precoces, observándose en los últimos años una moderada reducción en la mortalidad global.

Spontaneous bilateral quadriceps tendon rupture in a patient on hemodialysis.

Since the initiation of maintenance dialysis and renal transplantation, the course of patients with chronic renal disease has been altered. One of the frequent complications found in such patients is the development of secondary hyperparathyroidism, which is commonly associated with metastatic calcification and a variety of bone lesions collectively referred to as renal osteodystrophy. Bilateral rupture of the quadriceps tendon is a rare complication and previous reports have prescribed surgical correction of the ruptured tendon. The present case is that of a patient on chronic hemodialysis with secondary hyperparathyroidism and bilateral spontaneous rupture of the quadriceps tendon who was treated successfully without surgery.

Post-fracture avascular necrosis of the femoral head: correlation of experimental and clinical studies.

Both extraosseous and intraosseous blood supply of the femoral head are susceptible to injury in patients with femoral neck fractures. The injury to the extraosseous vessels is proportional to the amount of displacement at the time of fracture. The major intraosseous vessels are damaged if the fracture extends through the superior lateral portion of the neck or head. There is no apparent significant age difference in adults who develop avascular necrosis following a femoral neck fracture that unites compared with those who do not develop avascular necrosis. The difference in reported incidence of avascular necrosis following femoral neck fracture is probably due to several factors. Impacted and nondisplaced fractures should be reported separately from displaced fractures. Avascular necrosis should be reported following united fractures to avoid the confusion in diagnosis when associated with nonunion. At least two years of follow-up are necessary to diagnose 80% of patients who develop avascular necrosis. The type of internal fixation used does not significantly alter the incidence of avascular necrosis. The amount of vascular damage produced at the time of fracture predetermines which patient will develop avascular necrosis. Additional vascular damage may be produced at the time of internal fixation, especially malrotation of the head. The arthritic changes seen in some patients three or more years after femoral neck fracture seem to be initiated by collapse and fragmentation of small areas of avascular necrosis in or near the weight-bearing portion of the head. The various methods currently available for predicting the vascularity of the head at the time of fracture are not sufficiently quantitative to be used on a routine clinical basis. Biologic factors may explain the difference in the incidence of avascular necrosis in the adult femoral head epiphysis compared with that in the metaphysis and explain why the area of revascularization and reossification of avascular bone is so limited.