Metronidazole for bacterial vaginosis. A comparison of vaginal gel vs. oral therapy.

OBJECTIVE: To compare the efficacy and safety of 0.75% metronidazole vaginal gel with oral metronidazole for the treatment of bacterial vaginosis (BV). STUDY DESIGN: Nonpregnant women with BV were enrolled in a multicenter, randomized, investigator-blind treatment trial. Patients were randomly assigned to either 0.75% metronidazole vaginal gel (5 g twice daily for five days) or oral metronidazole (500 mg twice daily for seven days). Follow-up visits occurred approximately two and five weeks after initiation of therapy. RESULTS: BV was clinically eliminated at the first follow-up visit in 83.7% (36/43, 95% CI 72.3-95.1%) of the intravaginal group and 85.1% (40/47, 95% CI 74.6-95.6%) of the oral group. At the final visit, BV was eliminated in 70.7% (29/41, 95% CI 56.3-85.1%) of the intravaginal group and 71.1% (32/45, 95% CI 57.4-84.8%) of the oral group. Significantly more patients in the oral treatment group (51.8%) reported gastrointestinal complaints as compared to the intravaginal treatment group (32.7%, P = .04). CONCLUSION: The efficacy of 0.75% metronidazole vaginal gel twice daily for five days in treating BV was similar to that of standard oral metronidazole treatment and was associated with fewer gastrointestinal complaints.

Analysis of inter-fragmentary movement as a function of musculoskeletal loading conditions in sheep.

It is well accepted that inter-fragmentary movement influences the fracture healing process. Small axial movement can stimulate callus formation whereas larger shear movement delays the healing process. It is, therefore, essential for optimal fracture healing to minimize shear and to control axial movement. Unfortunately, the complex gap movements are mostly unknown under the large variety of clinical as well as experimental conditions of fracture fixation. To further understand the complex interactions of musculoskeletal loading and inter-fragmentary movements in bones and to reduce the need for animal experiments, a three-dimensional (3D) musculoskeletal model of the left hind limb of a sheep was developed. From 3D ground reaction forces and inverse dynamics, resultant joint loading was determined over a gait cycle. Muscle and joint contact forces were derived from an optimization routine and internal loads in the tibia and metatarsus from beam theory. Finally, inter-fragmentary movements were calculated from the bony loading condition and experimentally determined stiffness matrices of monolateral AISF external fixator constructs. Both the joint contact forces at the hip and gap movement of a mid-shaft tibial fracture agree with in vivo data reported in the literature. The bones proved to be mainly axially loaded with slightly increasing shear forces toward their ends. The results suggest that inter-fragmentary movement of metatarsal fractures is fairly independent of the fracture location whereas the movement increases in proximal tibial fractures compared to those in the distal and diaphyseal tibia. Considerable shear movement was found for all locations and external fixator mountings. However, shear movement could be minimized with a cranio-lateral rather than a cranio-medial shift from the cranial fixator plane.

Results of noncomparative studies of cefotetan in the treatment of obstetric and gynecologic infections.

In a multicenter trial involving 11 centers, 160 women were enrolled to evaluate the safety and effectiveness of 1 or 2 gm of cefotetan administered every 12 hours in the treatment of obstetric and gynecologic infections. The 133 evaluable patients generally were under 25 years of age, were nonwhite, and had hospital-acquired endometritis or pelvic inflammatory disease caused by both aerobic and anaerobic bacteria. Escherichia coli, Neisseria gonorrhoeae, group D streptococci, Bacteroides sp., and Peptococcus sp. were among the most frequently isolated pathogens. The patients were treated for a mean of 5.6 +/- 1.6 days and received a total dose of 19.27 gm. The signs and symptoms of infection were cleared or improved in 93% of the 133 patients evaluable for clinical response. Of the 116 evaluated bacteriologically, 95% had a satisfactory or presumed satisfactory response; only six patients (5%) were considered to be bacteriologic failures. Differences in the results of several clinical laboratory tests performed before and after treatment were statistically, but not clinically, significant (p less than 0.05). Safety was evaluated in the 158 patients who received cefotetan, and only four (3%) had adverse reactions considered related to the drug. Cefotetan was clearly effective and produced no untoward reactions in these women with obstetric and gynecologic infections caused by both aerobic and anaerobic organisms when administered at 1 or 2 gm every 12 hours.

Adolescent contraception.

Many adolescents are at risk for unplanned pregnancy. Health professionals who care for adolescents should be familiar with the various contraceptive methods and their suitability for teenagers. Each method, with its pros and cons, is described in this article. Ultimately, the health care provider is advised to tailor contraception to fit the needs of the individual patient.

Histochemical examination of glycoconjugates of epithelial cells in the human fallopian tube.

In human fallopian tubes, secretory cells made up about 70% and ciliated cells most of the remainder of the epithelium. At the light microscopic level, lectin-peroxidase conjugates and other methods demonstrated on secretory cells a surface glycocalyx containing glycoconjugates with fucose residues, terminal sialic acid-beta-galactose disaccharides, and sulfate esters. Secretory cells also expressed ABO blood group antigens, on their surface, staining for terminal alpha-N-acetylgalactosamine and alpha-galactose in blood group A and B subjects, respectively. The glycocalyx coating the cilia of all ciliated cells contained an acidic glycoconjugate with terminal sialic acid-beta-galactose disaccharides. Ciliated cells ranged from strongly positive to negative in staining for blood group ABO antigens, fucose, and terminal beta-galactose. The glycocalyx on the surface of cilia differed from that on the secretory cell surface in lacking sulfate esters and possessing terminal sialic acid-beta-galactose disaccharides cytochemically unlike those on secretory cells. Cytoplasmic granules, presumably secretory in nature, stained for blood group antigen in secretory cells of some specimens. Two lectin conjugates with affinity for the core region of N-glycosidically linked oligosaccharides revealed bodies interpreted as lysosomes in ciliated and secretory cells of most specimens. The latter lectins also stained mast cells intensely, presumably because of affinity for N-acetylglucosamine. The luminal surface of endothelial cells stained heavily for fucose and for a terminal sialic acid-beta-galactose disaccharide like that on the surface of cilia. The staining for carbohydrate did not vary qualitatively, and the ratio of secretory to ciliated cells did not differ with the phase of the menstrual cycle. The salpingeal epithelium in two patients with inactive endometrium did not differ from the others. The epithelium in a specimen from a patient with uterine fibroids showed foci of mucous metaplasia, containing a nonsulfated sialylated glycoconjugate. At the electron microscopic level, fucosylated glycoconjugate was visualized with a specific lectin conjugate on the surface of the secretory cells but not on the surface of ciliated and endothelial cells. Infrequent cytoplasmic granules containing mucosubstance apparently provided the cell mechanism in secretory cells for collecting and transporting material from biosynthetic sites to the glycocalyx.(ABSTRACT TRUNCATED AT 400 WORDS)

Papillary adenocarcinoma of minor salivary gland origin in a child.

A papillary adenocarcinoma with metastasis occurred in a 5-year-old child. The neoplasm arose on the anterolateral sublingual aspect of the tongue and metastasized to a submandibular lymph node. Histologically, the tumor contained broad glandular papillary projections. The tumor cells were cuboidal and had vesicular, "ground glass" nuclei. Colloidlike material was found within the stroma and lumen of the glands. To determine whether the papillary adenocarcinoma was of minor salivary gland or ectopic thyroid in origin, ultrastructural, histochemical, and immunohistochemical techniques were applied to make this clinically important distinction. Ultrastructural and immunohistochemical studies did not indicate the site of origin. Histochemical methods, however, demonstrated the colloidlike material to be sulfated mucopolysaccharide, which was nonreducible by ferric ferrocyanide. These histochemical properties and the anterolateral location identified the tumor as salivary gland in origin.

Another cause of nipple discharge. Mammary duct ectasia with periductal mastitis.

Mammary duct ectasia with periductal mastitis is a distinct, benign form of breast pathology that is different from fibrocystic disease of the breast. There are no known increased risk factors for developing breast cancer from this entity. The treatment is local surgical excision which relieves symptoms and does not significantly alter the appearance of the breast.

Giardiasis in pregnancy.

Giardiasis in pregnancy can be a debilitating disease with threatens the well-being of mother and fetus, as illustrated by three cases. The usual therapeutic agents are contraindicated in pregnancy. Paromomycin, an oral, poorly absorbed aminoglycoside, is an alternate, potentially less toxic agent for treatment of symptomatic giardiasis in pregnancy. The pharmacologic actions of paromomycin in human beings and its antiprotozoan efficacy are discussed.

Adolescent contraception.

PIP: Many adolescents in the United States remain at risk for an unplanned pregnancy despite advances in contraceptive technology and increased availability of birth control methods. Physicians who care for adolescents need to be familiar with the various contraceptive measures and their appropriateness for adolescents. A health professional must also be prepared to participate in sex education and to counsel or refer individual teenage patients when sexual problems occur. Attention in this discussion of adolescent contraception is directed to the following: reasons for nonuse of contraception, postcoital contraception, oral contraception (contraindications, side effects, guidelines for use in adolescents, and the mini-pill (progestogen only), IUDs, diaphragms, vaginal chemical contraceptives, condoms, withdrawal or rhythm, intervention techniques, and selection of the proper method. The average adolescent is exposed to unprotected intercourse for a year or longer before requesting contraception. Available evidence suggests that teenagers today may be using contraceptives more than ever before, yet a significant number fail to use a method for a variety of reasons. Most reasons reflect lack of knowledge; some reflect nonavailability. The reasons include ignorance of fertile periods, a belief that their age is protective, infrequent or unanticipated intercourse, and strong guilt feelings evoked by the idea of being prepared for the possibility of sexual intercourse. Many adolescents are hesitant to ask for contraceptive advice or prescriptions from private physicians because they fear lectures on morality and refusal of their requests. There is evidence in at least 1 study that locating the family planning clinic within the school is effective in lowering pregnancy rates and ensuring high continuation rates after 36 months of followup. Intervention techniques that might be effective include providing a method immediately following an event (abortion, birth, rape) when motivation is highest and tailoring the method to the individual life style and preference. If no contraindications exist, the teenager should be given the method preferred and a method that is geared to frequency of intercourse. A backup method should also be provided if the preferred method is not tolerated or never started. To maximize continuation rates, frequent followup is essential.^ieng

Menstrual extraction in the adolescent.

Menstrual extraction or suction aspiration of the uterus with a flexible cannula within 2 weeks of a missed menstrual period is infrequently used in the adolescent. Eighty-two adolescents (39 private and 43 clinic patients) underwent 90 menstrual extractions at the Medical University of South Carolina from January 1977 through March 1979. The clinic population consisted of a higher percentage of blacks and more individuals who had previously been pregnant and carried pregnancies to term. Major complications occurred in only two patients. One pregnancy continued to term. This could have been prevented if vigorous attempts had been made to encourage all patients to return for follow-up exam. The patients' shift to the use of pills and IUDs after the procedure suggests that menstrual extraction may serve as an introduction to effective birth control methods. Results of menstrual extraction in the adolescent compare favorably with those reported in adults.

Conjunctival lesion caused by Rhinosporidium seeberi.

We have described the first known reported case of rhinosporidiosis from the state of South Carolina and possibly the ninth reported conjunctival infection in the United States. Differential diagnosis of focal lesions on the conjunctiva, eyelid, or sclera includes cystic inclusions or adenoma of the various glandular structures, pterygium, pedunculated granuloma due to retained foreign body, or end-stage chalazion. Histopathologic differential diagnosis includes spherules of Coccidioides immitis.

Granular cell myoblastoma.

The experience at this university between 1954 and 1978 included 96 granular cell myoblastomas in 67 patients. The unusual locations of the tumors were the breast, bronchus, vocal cord, stomach and rectus sheath. An extremely rare invasive squamous carcinoma developed from a lesion of the larynx with pseudoepitheliomatous hyperplasia of the overlying dpithelium. Two patients with malignant granular cell myoblastoma have been encountered.

Sparganosis: clinical and pathologic observations in ten cases.

Sparganosis is an infection, usually of subcutaneous tissues, caused by the larva of a tapeworm of the genus Spirometra. Approximately 55 cases have been reported in this country, almost exclusively from the Southeastern states. We report an additional ten cases, all of which presented as a single subcutaneous mass. Questionnaires sent to the involved patients support the concept that the most likely route of infection in man is through the drinking of impure water. The primary significance of this organism is that infestation results in a subcutaneous mass which is clinically confused with neoplastic disease.

Gastrointestinal complications of modern intrauterine devices.

Two cases of gastrointestinal tract injury associated with extrauterine intrauterine devices (IUDs) are reported and compared with the 6 previously reported cases. Puerperal insertion was a factor in 6 cases, but 5 of these patients developed gastrointestinal symptoms only after a subsequent labor and delivery. Significant morbidity was present in most patients, and the diagnosis was often delayed and difficult to establish. Laparotomy was required in 7 cases. An extrauterine device should be removed promptly to minimize the risk of developing serious gastrointestinal complications.