Antibiotic prophylaxis to prevent post-abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial.

OBJECTIVE: To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis. DESIGN: Randomised double-blind placebo-controlled trial. SETTING: Two teaching hospitals and one district general hospital. SAMPLE: Two hundred and seventy-three women with bacterial vaginosis undergoing termination of pregnancy. METHODS: Women with bacterial vaginosis, diagnosed using modified Spiegel's criteria, were individually randomised to receive either a 2 g metronidazole suppository or identical placebo per-operatively. Participants, doctors and investigators were blinded to treatment allocation. Participants were asked to complete a questionnaire about post-operative symptoms, visits to the general practitioner, antibiotic treatment, readmission to hospital, contraception and emotional response after one month. RESULTS: The prevalence of bacterial vaginosis was 29.3% (326/1,111). Intention-to-treat analysis showed that post-operative upper genital tract infection developed in 12/142 (8.5%) women allocated to metronidazole and 21/131 (16.0%) women randomised to placebo, a difference of 7.6% (95% confidence intervals -15.4 to +0.2%; relative risk 0.53. 0.27 to 1.03, P = 0.055). The effect of prophylaxis was similar when the analysis was restricted to women receiving the allocated treatment and with complete follow up. There was no difference in the risk of readmission to hospital and the frequencies of self reported symptoms in the two groups were similar. CONCLUSION: This randomised placebo-controlled trial among women with bacterial vaginosis provides weak evidence that metronidazole decreases the risk of upper genital tract infection after first trimester suction termination of pregnancy but a chance finding could not confidently be excluded. Large well-conducted randomised trials with long term outcome measures are now needed to determine the most effective antibiotic combinations and strategy for prevention of post-abortal pelvic infection.

Expression of the Aspergillus niger glucose oxidase gene in A. niger, A. nidulans and Saccharomyces cerevisiae.

We report the cloning of the Aspergillus niger glucose oxidase gene and its use to elevate glucose oxidase productivity in A. niger by increasing the gene dosage. In addition, the gene has been introduced into A. nidulans where it provides the novel capacity to produce glucose oxidase. A plasmid, in which DNA encoding the mature form of glucose oxidase was preceded by a Saccharomyces cerevisiae secretion signal, effected high-level production of extracellular glucose oxidase in this yeast.

A comparison of the responses of staphylococci and streptococci to teicoplanin and vancomycin.

Continuous turbidimetric monitoring of cultures of staphylococci and streptococci exposed to teicoplanin or vancomycin revealed considerable inhibitory activity at concentrations below the conventionally-determined minimum inhibitory concentration. Teicoplanin was more active than vancomycin against low inocula, but exhibited a larger inoculum effect. A modest decline in susceptibility to teicoplanin and vancomycin could be induced by sequential exposure to the drugs. Such variants gradually reverted to susceptibility on passage in antibiotic-free broth. The morphological consequences of exposure to the two antibiotics were similar as judged by scanning electron microscopy.

A randomized control study of oxytocin augmentation of labour. 1. Obstetric outcome.

Sixty women who were progressing slowly in spontaneous labour were assigned at random to three management protocols. Group 1 were observed without the use of oxytocin for 8 h while groups 2 and 3 were managed with a low-dose and high-dose oxytocin protocol respectively. The caesarean section rates were not significantly different between the three groups: 45%, 35% and 26% respectively. Cervical dilatation rate increased significantly after oxytocin infusion in both treatment groups compared with controls. The 'delay-to-delivery' interval and second stage duration were significantly shorter in the high-dose group than in the control group. There were no measurable differences in the condition of the newborn infants between the three groups.

A randomized control study of oxytocin augmentation of labour. 2. Uterine activity.

Uterine activity was measured in 60 women whose first labour was progressing slowly in the active phase. The mean level of active contraction area (uterine activity integral, UAI) before oxytocin augmentation was 898 (SD 458) kPas/15 min. UAI increased significantly with time, even in women not given oxytocin. UAI increased logarithmically with increasing oxytocin infusion rate. Levels of uterine activity before and after oxytocin infusion are correlated positively such that the higher the initial level of UAI the higher the UAI in response to oxytocin. However, the regression line approaches the line of identity such that even with high doses of oxytocin UAI would not be likely to exceed 2500 kPas/15 min. There is a positive correlation between uterine activity and cervical dilatation rate in unstimulated labour; however, this is less evident following oxytocin infusion. Increases in uterine activity below 1200 kPas/15 min result from both higher frequency and active pressure, whereas above 1200 kPas/15 min any increase is due mainly to a rise in frequency.

The clinicopathological features of metastatic superficial papillary bladder cancer.

A review of the records of more than 1,000 patients with bladder cancer has led to the identification of 9 with superficial papillary tumors and no evidence of muscle invasion in whom distant metastases developed. The majority of these patients had multiple recurrent tumors that were difficult to control by endoscopic means and failed to respond to intravesical chemotherapy, Helmstein's therapy or radiotherapy. Of the patients 4 had superficial tumors in the prostatic ducts but no stromal invasion. In 7 patients with well or moderately differentiated tumors the histological grade was the same in the metastases. The sites of metastases were bone in 5 patients, lung in 3 and liver in 1, which suggested hematogenous spread of tumor. Histological evidence of microvascular invasion was seen in 2 of the resected bladder tumors. We conclude that failure to control bladder tumors by local means should be an indication for early cystectomy, even in patients with no evidence of muscle invasion.

CO2 cystoscopy using a flexible fibreoptic endoscope.

Flexible carbon dioxide cystoscopy has been carried out in 65 patients using an Olympus BF type 1 TR endoscope (usually used for bronchoscopy). Good views were obtained and comparison with standard cystoscopy confirmed that no lesions were missed. The procedure was well tolerated under local anaesthesia. The flexible cystoscope was particularly useful in examining patients with diverticula, anterior bladder neck lesions or the post-radiation fibrotic pelvis.