Spontaneous heterotopic triplets - A review of literature.

OBJECTIVE: Spontaneous heterotopic triplets, a tubal ectopic pregnancy and a twin pregnancy, are rare disorders. The study aimed to examine all available evidence regarding signs and symptoms, imaging findings, management and newborn outcome of spontaneous heterotopic triplets. DESIGN: A literature search in Medline and EMBASE databases from 2000 to 2016 was conducted. The following key words were employed: 'spontaneous heterotopic pregnancy', OR 'heterotopic triplets'. Only cases of spontaneous heterotopic triplets without assisted reproduction techniques were included. RESULTS: Six cases were identified and included in the present review. All cases presented with abdominal pain and one case presented in shock. Hemoperitoneum was present in five cases. Laterouterine mass with adnexal gestational sac is not systematically described (3 cases/6), but was a good ultrasonographic sign of heterotopic pregnancy. All patients had tubal rupture, but anyone had vaginal bleeding. The surgical treatment was made by salpingectomy in five cases to ensure successful treatment. The mean and median gestational age at delivery were 29.9 and 37.54 weeks, respectively (range 6-41 weeks). The neonatal outcome was good for 6 newborns. CONCLUSION: Spontaneous heterotopic triplets are rare. Early surgical intervention is the key to successful treatment of heterotopic triplet pregnancy and allows good neonatal outcome.

A survey of drug prescribing practices of dentists.

A survey of drug prescribing habits of 357 dentists practicing in five counties in Western New York was conducted in 1986. Respondents represented both general practitioners and specialists who were graduates of 25 different dental schools. From this study it can be concluded that dentists prescribe a wide range of drugs representing over 13 drug categories. The most frequently prescribed drug categories were antibiotics, narcotic analgesics, non-steroidal inflammatory agents, non-narcotic analgesics, and fluorides. The most frequent prescribers of drugs were oral surgeons, endodontists and periodontists.

Inhibition of serum bactericidal reaction by lipopolysaccharide.

An Rc-mutant of Escherichia coli that lacks UDPgalactose 4-epimerase grows normally without galactose but makes lipopolysaccharide lacking most of its carbohydrate. Exogenous galactose overrides the mutation and results in the formation of a complete lipopolysaccharide, thereby producing a smooth phenocopy. The smooth phenocopy was much more resistant to the bactericidal activity of normal human serum than was the rough phenotype. More complement was utilized by the rough mutant in the bactericidal process than by the smooth phenocopy. An antiserum was prepared in rabbits to a specific outer membrane protein in the mutant bacterium, the lambda receptor, whose expression could be suppressed by the addition of 10 mM maltose. The effect of the O-antigen in the lipopolysaccharide produced by the smooth phenocopy on the binding of antibody to the lambda receptor was determined. The smooth phenocopy exhibited significantly less binding of antibody than did the rough phenocopy. In addition, expression of the lambda receptor had little effect on the binding of antibody to the lambda receptor in the smooth phenocopy but caused significantly increased binding in the rough mutant. The results suggest that the increased resistance to the lethal action of normal human serum shown by the smooth phenocopy may be due to the blocking of antibody binding sites by the O-antigen of lipopolysaccharide, thereby preventing activation of the classical pathway of complement.

Potentiation of antibiotic bactericidal activity by normal human serum.

Combinations of certain antibiotics and normal human serum at concentrations at which there was no killing by the agents when used alone were found to be bactericidal for Escherichia coli K-12 cells. This effect was observed with tetracycline, streptomycin (SM), trimethoprim, and ampicillin, but not with chloramphenicol or nalidixic acid. Synergy between SM and human serum was also observed against four of nine smooth strains of E. coli. A plasmid-bearing strain of E. coli K-12 was also killed by combinations of tetracycline or SM plus serum, even though the plasmid conferred resistance to tetracycline and SM. Evidence is presented that the synergy between antibiotics and serum is due to a complement-mediated effect on the bacterial cells that makes the cells more susceptible to the bactericidal effects of the antibiotics.

Effects of antibiotic resistance plasmids on the bactericidal activity of normal rabbit serum.

The ability of normal rabbit serum to kill Escherichia coli J6-2 was measured. With the concentration of serum adjusted so that approximately 2% of the cells survived after 2 h of incubation, there was no killing of the same strain bearing the F-like plasmid R100. Other F-like plasmids also provided the host strain with resistance to serum bactericidal activity, whereas none of the I-like plasmids used provided the host strain with resistance. When E. coli J6-2 bore both R100 and an I-like plasmid, there was some resistance to serum but less than with R100 alone. The effects of lysozyme on E. coli J6-2, which had been treated with tris(hydroxymethyl)aminomethane and ethylenediaminetetraacetate, were not altered by the presence of R100. The plasmids from 16 clinical E. coli isolates were transferred to J6-2N, a nalidixic acid-resistant mutant of J6-2. Four of the 16 plasmids provided J6-2N with resistance to normal rabbit serum.

Decreased conjugation efficiency by Fla-mutants of Escherichia coli K-12 bearing F-like plasmids.

Fla-, Pil-mutants of Escherichia coli K-12 were found to have decreased transfer efficiency of F-like resistance plasmids as compared to the parent strains. This was accompanied by decreased production of conjugation pili and decreased resistance level to some, but not all, of the antibiotics to which resistance was conferred. There was no reduction in pilus production or transfer efficiency in any of the mutants when the plasmid was F'gal. This host-mediated influence on conjugation pilus production is discussed with reference to a possible loss of cell envelope integrity which causes the simultaneous loss of all cellular appendage structures.

Effect of entry exclusion on mating aggregates and transconjugants.

Mating aggregates during conjugation directed by an F-like R factor in Escherichia coli were measured as the number of Lac+-Lac- sectored colonies present in a mating mixture. There is a high degree of correlation between the concentration of transconjugants produced in a mating mixture and the concentration of mating aggregates observed at several different concentrations of donor and recipient cells. The mating aggregates are sex pilus specific as demonstrated by the ability of donor-specific ribonucleic acid phage MS-2 to decrease both mating aggregates and transconjugants in a mating mixture. During entry exclusion by either a derepressed or a repressed F-like R factor, isogenic to the superinfecting R factor except for a resistance determinant, the number of transconjugants was markedly reduced, but the number of mating aggregates was not decreased. Entry exclusion by F-Gal toward the donor HfrH resembled that of the F-like R factor in that there was a reduction in the number of recombinants but no significant decrease in mating aggregates. These results suggest that entry exclusion inhibits conjugation at a stage after the formation of mating aggregates.

Plasmid-mediated resistance to the bactericidal effects of normal rabbit serum.

An Escherichia coli K-12 strain bearing the plasmids R1 or R100 was more resistant to the bactericidal activity of normal rabbit serum than was the same strain without a plasmid. When the plasmid R100 was transferred to several K-12 strains, the strains acquired resistance to serum bactericidal activity.

Tetracycline resistance in Escherichia coli isolates from hospital patients.

Hospital isolates of Escherichia coli resistant to tetracycline (TC) were studied to identify mechanisms which regulate TC resistance levels and ability to transfer TC resistance. Antibiotic resistance patterns, resistance levels to TC, and ability to transfer TC resistance were determined for the isolates. Similar data were obtained for the transferable plasmids after transfer to several new host strains of E. coli. Of the 110 isolates, 50% were able to transfer TC resistance by conjugation. There was a nearly linear relationship between the minimum inhibitory concentration (MIC) of TC for the hospital strains and the percentage of strains at a given MIC that could transfer TC resistance. The strains that were simultaneously resistant to tetracycline, streptomycin, and ampicillin had relatively high MICs of TC and high ability to transfer TC resistance. These results and surveys of TC-resistant E. coli by others suggest that TC resistance levels and transmissibility may be influenced by other resistance markers. The isolates which did not transfer TC resistance by conjugation were tested for the presence of TC resistance plasmids by mobilization or by transformation with deoxyribonucleic acid from the isolates. Evidence for plasmid-mediated TC resistance was found in 92 (84%) of the 110 hospital strains.

Uptake of 3H-Tetracycline by resistant and sensitive Escherichia coli.

The uptakes of (3)H-tetracycline by 12 tetracycline-sensitive and 24 tetracycline-resistant Escherichia coli hospital cultures were found to be 270 and 75 nmoles of tetracycline per milliliter of cell water per 20 min, respectively. This confirms reports by other investigators who, by using only one or two cultures, suggested a relationship between tetracycline uptake and tetracycline resistance. However, minimum inhibitory concentrations of tetracycline for the cultures bore no relation to the tetracycline uptake values, suggesting that loss of tetracycline uptake may not be the primary cause of resistance. In addition there were three resistant cultures with uptake values greater than 140 and two sensitive cultures with uptakes lower than 180, raising the question of how these tetracycline-resistant cultures could grow with tetracycline at concentrations nearly as high as those found to inhibit growth of sensitive organisms. Of the tetracycline-resistant cultures, 15 were able to transfer tetracycline resistance to a recipient organism and 9 were not. Two of the cultures transferred TC-resistance to a recipient with no modification-restriction system (E. coli C) but did not transfer resistance to a recipient with a known modification-restriction system (E. coli K-12).