Hospital morbidity due to post-operative infections in obstetrics & gynecology.

OBJECTIVE: To study the incidence and risk factors for postoperative infection following cesarean sections and major gynecological surgery. METHODS: Postoperative infection was documented in the specified registers in all patients following cesarean sections and major gynecological surgery from January 1997 to December 1998. This study was a part of the prospective analysis of hospital-based morbidity and mortality in the Department of Obstetrics and Gynecology. RESULTS: There were a total of 89 cases of postoperative infections amongst 4,032 patients undergoing major operations giving an overall infection rate of 2.2%. The morbidity due to infections was 3.3% in cesarean sections and 0.9% in major gynecological surgery. Abdominal hysterectomies had a higher infection rate than vaginal surgery. The most common causative organisms isolated were Enterococcus, Staphylococcus and Klebsiella species. CONCLUSION: It was found that vaginal flora was a significant source of contamination during surgery, which could be minimised by local sterilisation methods. The high infective morbidity in abdominal hysterectomies needs further analysis of the risk factors. Infection surveillance with a regular review of antibiotic protocols is recommended.

Clinical utility of serum thyroglobulin in metastatic disease.

We examined the usefulness of serum thyroglobulin (Tg) levels in 196 patients with metastatic disease. Of these, 51 patients had a thyroidal primary (40 differentiated, 7 medullary and 4 undifferentiated), 35 patients had a nonthyroidal primary and in 110 patients the primary site was not known. Serum Tg was raised in 74.5 per cent (38 of 51) patients with carcinoma of the thyroid and in 92.5 per cent (37 of 40) patients with differentiated thyroid carcinoma (DTC). Twelve (34.3%) patients with proved nonthyroidal malignancies and 34 (30.9%) patients with unknown primary origin had elevated serum Tg levels. Of the 110 patients with unknown primary site thyroidal primary in 10 patients (all with elevated serum Tg levels) and nonthyroidal primary in 38 patients (7 had raised serum Tg levels) could be established. The sensitivity (for DTC) and the specificity (for nonthyroidal primary) of serum Tg estimation were 94.0 per cent (47 of 50) and 74.0 per cent (54 of 73) respectively and for patients with distant metastases were 100 (29 of 29) and 85.1 per cent (40 of 47) respectively. The positive and the negative predictive values of serum Tg were 71.2 (47 of 66) and 94.7 per cent (54 of 57) respectively and for patients with distant metastases were 80.6 (29 of 36) and 100 per cent (40 of 40) respectively. Our findings suggest that for patients presenting with metastases (particularly distant metastases) of an unknown primary site, serum Tg estimation is of great value to identify or rule out the involvement of the thyroid as the primary organ.

Significance of antithyroglobulin autoantibodies in differentiated thyroid carcinoma.

The incidence of antithyroglobulin autoantibodies (ATA) was 17.7% in 963 patients (who attended the clinic from 1981 to 1990) with differentiated thyroid carcinoma (DTC). Another 12 patients developed ATA for a transient period after the treatment with radioiodine. The prevalence of ATA in females (21.5%, 123/572) was significantly higher (p < 0.001) than that seen in males (12.0%, 47/391). Age-dependent occurrence of ATA was not seen for the various age decades. The ATA was more prevalent (p < 0.01) with the papillary type of tumor (118/564) as compared to the follicular variety (51/398). ATA did not influence the metastatic spread of the tumor at the initial presentation (105/170 for the ATA-positive group and 445/793 for the ATA-negative group). However, within the group with metastases, 82.9% (87/105) of patients had local spread into the neck in the presence of ATA, which was significantly higher (p < 0.01) than that seen for patients without ATA (63.8%, 284/445). For assessment of the influence of ATA on the outcome of the disease, the data from 222 patients (46 positive and 176 negative for ATA), with a minimum follow-up of 5 years (mean follow-up of 7.4 years), was considered suitable for analysis. The outcome of the disease was comparable in the presence and the absence of ATA (38/46 and 137/176 patients became disease-free in ATA-positive and -negative groups, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Malic enzyme activity in the developing rat brain in relation to thyroid status.

Malic enzyme activity in the soluble fraction of neonate brains from mothers fed with propylthiouracil (0.015% w/v) in drinking water from day 12 of the gestation period was significantly lowered (P less than 0.01) as compared to the offspring of normal mothers. Supplementation of triiodothyronine to the neonates from experimental mothers restored the malic enzyme activity to normal levels. However, administration of triiodothyronine to adult control rats did not influence malic enzyme activity in the brains of these animals. Our data suggest that during the initial critical period of brain maturation, malic enzyme is under the control of thyroid hormones. The response of malic enzyme towards thyroid hormones is lost once the brain has matured.

Malic enzyme response to triiodothyronine in the brain of neonatal rats.

Malic enzyme activity in the soluble fraction of the neonatal brain of hypothyroid rats was observed to be lowered as compared to that of the control animals (p less than 0.01). Administration of triiodothyronine to the neonates of control animals resulted in significant enhancement (p less than 0.001) in the activity of the Malic enzyme. Our studies show that brain malic enzyme which is involved in lipogenesis and hence in myelination responds to triiodothyronine in the early stage of life.