bluuebunny/crossref_metadata_2025 huggingface dataset:
Preterm Labor and Maternal Hypoxia in Patients With Community-Acquired Pneumonia
Authors: Maccato Maurizio L. , Pinell Phillip , Martens Mark G. , Faro Sebastian
Published: March 2007

Objective:We sought to determine if preterm labor is associated with the degree of maternal hypoxia in pregnant women with community-acquired pneumonia but no other maternal diseases.

Methods:We retrospectively reviewed the medical records of all antepartum patients admitted with a diagnosis of community-acquired pneumonia to an inner-city university hospital between 1983 and 1987. Included in this review were only the patients with radiologically confirmed diagnose of pneumonia and documented arterial blood gases on room air at the time of admission, but no other maternal diseases.

Results:A total of 22 cases were identified. There was no maternal mortality, but there were 2 patients (9%) who developed respiratory failure requiring mechanical ventilation. Bacteremia withStreptococcus pneumoniaewas documented in 1 patient (5%). Preterm labor complicated 5 cases (23%) and led to preterm delivery in 3 patients (14%). Terbutaline tocolysis was instituted in 3 patients, but was discontinued in 1 patient who was allowed to deliver because of her worsening condition. Preterm labor was associated with the WBC count on admission, usually > 18,000/mm3, but no statistically significant correlation with the severity of maternal hypoxia was noted. Five patients (23%) were incorrectly diagnosed at the time of admission, 4 with an initial diagnosis of pyelonephritis and 1 with an initial diagnosis of cholecystitis.

Conclusions:Community-acquired pneumonia in the antepartum period is responsible for significant maternal and fetal complications even in the absence of other maternal diseases. Preterm labor and delivery remain frequent, and tocolysis should be used cautiously. At the time of admission, the diagnosis may be difficult. The degree of maternal hypoxia on admission does not correlate with the presence of preterm labor.
Vulvar Vestibulitis—A Complex Clinical Entity
Authors: Ledger William J. , Kessler Alan , Leonard Garrick H. , Witkin Steven S.
Published: March 2007

Objective: This study aims to determine the pathophysiology of vulvar vestibulitis and to evaluate
currently used treatment options.

Methods: Two hundred twenty women with vulvar vestibulitis were seen between October 1987
and March 1995. Every patient had vulvar pain when they attempted intercourse, 75% had excessive
vaginal discharge, 36.4% had constant or recurring vulvar burning, and 10.9% had symptoms
suggestive of cystitis. All were cultured for the presence of Candida albicans. One hundred sixty‐one
(73.2%) were also tested for vaginal IgE and prostaglandin E2 (PGE2); 72 (32.7%) had a vulvar biopsy performed as well.

Results: A wide range of variants were noted: 53 (24.1%) had a human papilloma virus (HPV)
infection, 25 (11.4%) had a Candida vulvovaginitis, 43 (19.5%) had a vaginal allergy, 15 (6.8%) had
vaginal PGE2 present, 14 (6.4%) had elevated urinary oxalate excretion, and 29 (13.2%) had a
variety of diagnosed variants. In 81 (36.8%) no underlying diagnosis was made. This understates
the numbers and varieties of vulvar vaginal diagnoses, for not all patients received a vaginal fluid
analysis, a vulvar biopsy, or a 24 h urine screen for oxalates. A variety of medical and operative
interventions was used. Symptoms were relieved in 65.9% of patients. The degree of sueeess varied.
Successful outcomes were achieved in 14.3% of patients using a low oxalate diet and calcium citrate
supplementation, 16% with anti‐Candida treatment, 48.1% with antihistamines, 77% with vulvar
injection of interferon, 83% with operative removal of inflamed vulvar tissue, and a posterior
colporrhaphy used to cover the cutaneous defect.

Conclusions: The diagnosis of vulvar vestibulitis is easy to make. An etiology for this chronic
condition will not be achieved in every patient. A majority of patients can get relief by a variety of
medical and operative interventions.
Screening for Human Immunodeficiency Virus in Inner City Females With Abnormal Cervical Cytology
Authors: Jennings T. Scott , Dottino Peter , Sperling Rhoda , Beddoe Ann Marie
Published: March 2007

Objective: This report evaluates the acceptance, results, and predictors of human immunodeficiency
virus (HIV) infection in inner city women referred to a colposcopy clinic for abnormal cervical
cytology.

Methods: HIV testing results of 1,908 inner city women referred for abnormal cervical cytology
were analyzed retrospectively with respect to acceptance, race, ethnicity, Pap smear results, sexually
transmitted diseases (STDs), HIV exposures, and final histologic findings.

Results: HIV testing was accepted by 50.4% of patients. Women who agreed to screening were
significantly more likely to admit exposure to HIV or to be Hispanic, foreign‐born, or have a history
of multiple STDs. Of those screened, 3.3% were found to be HIV seropositive. Although higher
grades of referral Pap smears were noted in the women found to be HIV seropositive, final histologic
findings were not different. The only predictors of unknown HIV seropositivity were admitted
HIV exposure and external condyloma.

Conclusions: Fifty percent of inner city women of unknown HIV status referred for abnormal
cervical cytology will accept HIV serotesting and 3.3% are found to be positive. Most HIV‐seropositive
women can be detected based on either a history of exposure to HIV or the presence
of external condyloma.
Immunohistochemical Characterization of Leukocytic Subpopulations in Chronic Endometritis
Authors: Tawfik Ossama , Venuti Susan , Brown Sharla , Collins Julie
Published: March 2007

Objective: We analyzed the histologic and immunohistochemical changes in the endometrial leukocytic
subpopulations to determine which of them are characteristic of chronic endometritis.

Results: Endometrial biopsies from 25 cases of chronic endometritis and 35 controls were studied.
Characteristic morphologic findings included the presence of a plasma cell infiltrate, and a prominent,
albeit non‐specific, lymphocytic infiltrate in all patients with endometritis. A neutrophilic
infiltrate was also noted in 90% of the patients. Other non‐specific histologic findings included
occasional prominent lymphoid aggregates, stromal edema, hemorrhage, and necrosis and cystic
dilation of some glands in endometria of patients with chronic endometritis. Endometrial immune
cells were investigated immunohistochemically using antibodies to CD3 (pan‐T), CD20 (pan‐B,
L26), and Ham‐56 (macrophage). In control patients, endometrial immune cells were predominantly
composed of CD3 and Ham‐56 positive cells. CD20 positive cells comprised <2% of immune
cells in control patients [mean: <2 cells/high power field (HPF)]. Large numbers of CD20 and CD3
lymphocytes were seen in endometria of patients with chronic endometritis. A semiquantitative
analysis showed that the numbers of CD20 and CD3 positive cells in patients with chronic endometritis
were increased 50‐ and 3‐fold, respectively, when compared to those of control patients
(mean B cells: 49 vs. 2 cells/HPF; mean T cells: 149 vs. 45 cells/HPF). CD20 positive cells were
predominantly seen in subepithelial and periglandular aggregates. CD3 positive cells had a predominant
stromal distribution and an occasional intra‐ or subepithelial localization. There was no
difference in the number and distribution of Ham‐56 positive cells in patients with or without
endometritis.

Conclusions: These findings suggest that CD20 cells may have a significant role in the pathogenesis
of chronic endometritis and that immunostaining for B and T lymphocytes could be used in
confirming the diagnosis of endometritis or in diagnosing subclinical or progressing endometritis in
which plasma cells could not be detected or are rarely identified.
Randomized Clinical Trial of Azithromycin vs. Erythromycin for the Treatment of Chlamydia Cervicitis in Pregnancy
Authors: Edwards M. S. , Newman R. B. , Carter S. G. , LeBoeuf F. W. , Menard M. K. , Rainwater K. P.
Published: March 2007

Objective:The purpose of this study was to prospectively test the null hypothesis that there is no difference in the clinical effectiveness of azithromycin and erythromycin for the treatment of chlamydia cervicitis in pregnancy.

Methods:All antepartum obstetrical patients underwent routine screening for chlamydia cervicitis using a DNA probe assay (Gen-Probe Pace, San Diego, CA). Women who tested positive for chlamydia cervicitis were prospectively randomized to receive either azithromycin 1 g orally at enrollment, or erythromycin 500 mg orally 4 times a day for 7 days. Sexual partners were referred to the county health department for evaluation and treatment. A test of cure was repeated in 2 weeks. Results were analyzed by chi-square analysis and Fisher's exact test when indicated.

Results:One hundred forty women tested positive for chlamydia cervicitis and agreed to randomization. There were 4 (6.2%) treatment failures in the azithromycin group and 18 (27.7%) in the erythromycin group (P= 0.005). Gastrointestinal side effects were reported by 42 (65.5%) of the women taking erythromycin, but only 12 (19.4%) of those taking azithromycin (P< 0.002). Gastrointestinal side effects and resultant noncompliance were significantly related to treatment failure with erythromycin.

Conclusions:The findings of this study support the conclusion that a single dose of azithromycin is a significantly more effective and better tolerated treatment regimen for chlamydia cervicitis in pregnancy than erythromycin which is currently recommended.
Retrospective Analysis of the Serologic Response to the Treatment of Syphilis During Pregnancy
Authors: Galan Henry L. , Montalvo Juan F. , Deaver John
Published: March 2007

Objective: The purpose of this study was to assess the effect of several maternal variables on the serologic response following the treatment of syphilis in pregnancy.

Methods: A 5‐year chart review identified 95 patients coded with syphilis at Hermann Hospital. Inclusion criteria were 1) serologically confirmed syphilis infection during the index pregnancy, 2) complete treatment during the index pregnancy, and 3) minimum of one follow‐up rapid plasma reagin (RPR) titer. Forty‐nine of 95 patients met the inclusion criteria. Treatment response was evaluated by comparing each post‐treatment titer of a patient to her pretreatment titer. Each comparison was considered an “observation.” Each observation was classified as either a positive response (≥4‐fold titer decline) or a negative response (<4‐fold titer decline). Maternal variables assessed included 1) prior history of syphilis untreated or incompletely treated prior to the index pregnancy, 2) gestational age, 3) titer level, 4) unknown duration, 5) positive response at 1 month, 6) positive response at 2 months, 7) positive response at >3 months, and 8) race.

Results: A positive response following treatment was significantly more likely if there was no prior history of syphilis or if there was a high initial RPR titer (>32). Only 33/54 (61%) observations at or greater than 3 months had a positive response.

Conclusions: Our study suggests that an absence of a history of syphilis and an initial high RPR titer are predictive of a positive response following appropriate treatment. Given the low percentage of observations with a positive response at 3 months, we speculate that we may be undertreating our pregnant patients with syphilis infection.
Cesarean Delivery in Women With Genital Herpes in Washington State, 1989–1991
Authors: Marrazzo Jeanne M. , John Grace C. , Krohn Marijane A. , Corey Lawrence
Published: March 2007

Objective: The purpose of this study was to determine whether the proportion of cesarean deliveries in pregnant women with a history of genital herpes and no active lesions at birth is higher than that in women with no history of genital herpes, and to determine whether this risk was modified by birth facilities′ underlying prevalence of cesarean delivery.

Methods: This was a retrospective survey. Women who gave birth in Washington state from 1989 to 1991 were identified from the state birth records and were classified as having clinical genital herpes during pregnancy (N = 1,094) or history of genital herpes only (N = 4,163) at delivery. Women without genital herpes (N = 5,257) were randomly selected from remaining births.

Results: The main outcome measure was primary cesarean delivery, excluding those performed for indications other than genital herpes. Prevalence of primary cesarean delivery was 59.5% in women with clinical herpes during pregnancy and 12.5% in women with history of herpes, both significantly different from prevalence of 11.2% in unexposed women. Age‐adjusted risk for cesarean delivery among women with a history of herpes was 1.13 [95% confidence interval (CI): 0.93, 1.37]. When baseline cesarean delivery prevalence was above 20%, this risk was 1.2 (95% CI: 1.0, 1.4; P = 0.058), compared to 1.1 (95% CI: 0.9, 1.3; P = 0.186) where cesarean delivery prevalence was below 20%.

Conclusions: Women with history of genital herpes appear to have a slightly elevated risk of cesarean delivery, particularly in hospital settings with baseline prevalence of primary cesarean delivery above 20%. This rate is somewhat lower than that noted in a previous survey, suggesting that practitioners are following standard guidelines. Evaluations of cesarean delivery for genital herpes in other states should be performed.
Infection After Hysterectomy
Authors: Hemsell David L.
Published: March 2007

Antibiotic prophylaxis and advances in technology have reduced operative site infections after hysterectomy to a minimum. Pelvic infections are the most common infection type and respond promptly to a variety of parenteral single-agent and combination antibiotic regimens. Oral antibiotic regimens following parenteral therapy are unnecessary. Abdominal incision infections are less common than pelvic infections, less common than seromas or hematomas, and usually do not require antimicrobial therapy. Abscesses or infected hematomas require parenteral antimicrobial therapy, and drainage of those located above the cuff will predictably shorten therapy time. With early discharge from the hospital, many infections will not become evident until after the patient is home. For that reason, it is important that the patient's discharge instructions outline symptoms and signs associated with these infections so she can present for care at the earliest possible time.
Ethical Dimensions of Human Immunodeficiency Virus Infection During Pregnancy
Authors: Chervenak Frank A. , McCullough Laurence B. , Ledger William J.
Published: March 2007

Physicians encounter complex and sensitive ethical challenges in the medical care of pregnant women with human immunodeficiency virus (HIV) infection. This paper identifies those ethical challenges and provides concrete clinical guidance for how they should be addressed in obstetric care. The paper begins with a brief historical review, to highlight and to call into question the civil rights model of the ethics of HIV infection that has dominated the literature, clinical practice, and public policy. The authors propose an alternative ethical framework. This framework begins by underscoring the public health obligations of both physicians and pregnant women with HIV infection. The framework is based on a clinical ethics that appeals to both beneficence-based and autonomy-based obligations of the physician to the pregnant woman and the beneficence-based obligations of both the physician and the pregnant woman to the fetal patient. This framework is then deployed in a clinical ethical analysis of termination of pregnancy and contraception, partner notification, disclosure and confidentiality of her serostatus by the patient to the health care team, disclosure and confidentiality of her serostatus to other health care professionals, prevention of vertical transmission, and advance directives.
Ex Vivo Human Placental Transfer of Anti‐Human Immunodeficiency Virus Compounds
Authors: Bawdon Roger E.
Published: March 2007

Objective: The transfer of anti‐human immunodeficiency virus (HIV) drugs has been studied in the ex vivo human placental model. There is a paucity of information on the placental transfer of these drugs because of ethical considerations and the expense involved in the use of the non‐human primate model.

Methods: The standardized ex vivo human placental model was used in these studies and the clearance index in relationship to antipyrine was used to determine the role of transfer of non‐nucleosides, nucleosides, and a protease inhibitor. Several of the nucleosides and ritonavir were combined with zidovudine (AZT) to determine the effect of the combinations.

Results: All non‐nucleosides, nucleosides, and the protease inhibitor were found to cross the human placenta by simple diffusion, although at variable rates. Ritonavir did not diffuse as rapidly as the nucleosides, but some diffusion was noted at peak concentrations.

Conclusions: Ex vivo perfusion studies agree with those determined in the non‐human primate model and with data from existing clinical trials.
Ampicillin/Sulbactam Vs. Cefoxitin for the Treatment of Pelvic Inflammatory Disease
Authors: Jemsek Joseph G. , Harrison Frank
Published: March 2007

Objective:The safety and efficacy of ampicillin plus sulbactam were compared with those of cefoxitin in the treatment of women with pelvic inflammatory disease (PID).

Methods:This single-site, randomized, prospective, third-party-blinded, comparative, parallel-treatment study enrolled 93 women with a diagnosis of PID. Patients were treated with either ampicillin/sulbactam (2 g/1 g, administered intravenously [IV], every 6 h) or cefoxitin (2 g, administered IV, every 6 h) for a minimum of 12 doses. Patients with cultures positive forChlamydia trachomatisalso received concurrent oral or IV doxycycline (100 mg twice daily). Patients with cultures negative forC. trachomatisreceived prophylactic oral doxycycline (100 mg twice daily) for 10–14 days after treatment with either ampicillin/sulbactam or cefoxitin was completed.

Results:Ninety-three patients were entered in the study: 47 in the ampicillin/sulbactam arm and 46 in the cefoxitin arm. All 93 patients were evaluable for safety; 61 (66%) were evaluable for efficacy. Demographic characteristics were similar for the groups. Of the 27 evaluable ampicillin/sulbactam-treated patients, 67% experienced clinical cure, 30% improved, and 4% failed treatment. Respective values for the 34 cefoxitin-treated patients were 68%, 24%, and 9% (P= 0.67). Pathogens were eradicated in 70% of the women given ampicillin/sulbactam vs. 56% of those who received cefoxitin (P= 0.64).

Conclusions:Overall, ampicillin/sulbactam demonstrated clinical and bacteriologic efficacy at least equivalent to that of cefoxitin in the treatment of women with acute PID. The use of ampicillin/sulbactam for this indication may avoid the complex dosing regimens associated with other treatments.
Randomized, Placebo-Controlled Trial of Transplacental Antibiotic Prophylaxis of Neonatal Group B Streptococcal Colonization and Bacteremia in Rabbits
Authors: Lembet Arda , McDuffie Robert S. , Gibbs Ronald S.
Published: March 2007

Objective:We evaluated the effect of maternal administration of ampicillin/sulbactam on colonization and bacteremia in newborn rabbits after intracervical inoculation of mothers with group B streptococci (GBS).

Methods:New Zealand white rabbits on day 30 of a 31-day gestation were inoculated intracervically with104−105colony forming units (cfu) GBS. Two hours after inoculation mothers received ampicillin/sulbactam (50 mg/kg) or saline (control) intramuscularly as a single dose, in a randomized double-blinded manner. We induced labor 4 h later with intramuscular oxytocin. At delivery, cultures for GBS were taken from neonatal oropharynx. Thereafter, cultures were taken from neonatal oropharynx and anorectum daily and from neonatal heart at death or after 96 h. Sample size analysis showed a need for 17 pups in each group.

Results:In the control group, induction failed in one animal that was excluded from analysis. At birth, 0 of 39 pups of treated does had positive oropharyngeal cultures compared to 26 of 27 (96%) pups of saline-treated does (P< 0.0001). Pups treated with antibiotic in utero were also significantly less likely to have positive oropharyngeal cultures at 24, 48, and 72 h after birth compared to controls (24 h, 0% vs. 100%,P< 0.0001; 48 h, 8% vs. 100%,P< 0.0001; 72 h, 16% vs. 100%,P< 0.0001). Treated pups were significantly less likely to have positive anorectal cultures at 24, 48, and 72 h after birth compared to control animals (24 h, 0% vs. 100%,P< 0.0001; 48 h, 0% vs. 95%,P< 0.0001; 72 h, 0% vs. 92%,P< 0.0001). Treated pups were significantly less likely to have positive heart cultures at 72 h after birth compared to controls (11% vs. 92%,P< 0.0002). Cumulative neonatal survival was higher in treated pups compared to controls at 72 and 96 h after birth (72 h, 32% vs. 0%,P= 0.0003; 96 h, 26% vs. 0%,P= 0.015).

Conclusions:Single dose transplacental prophylaxis given 4 h before delivery resulted in decreased neonatal GBS colonization and bacteremia and improved neonatal survival in rabbits.
Cervical Ripening With Prostaglandin Gel andHygroscopic Dilators
Authors: Hibbard J. U. , Shashoua A. , Adamczyk C. , Ismail M.
Published: March 2007

Objective: To study the effectiveness and morbidity of adding hygroscopic cervical dilators to prostaglandin
gel for cervical ripening and labor induction.

Study design: Patients of at least 34 weeks’ gestation with a medical indication for induction of
labor and with a modified Bishop score of 5 or less were randomized to receive either prostaglandin
gel or prostaglandin gel with hygroscopic cervical dilators. Primary outcomes were time to delivery,
change in cervical score, and infection. Secondary outcomes included cesarean delivery rate and
deliveries before 24 hours of induction. Continuous variables were analyzed by Wilcoxon sum rank
test and categorical data by chi‐square or Fisher exact test, with P < 0.05 being significant.

Results: Seventeen patients were randomized to intracervical prostaglandin alone and 23 patients
received intracervical prostaglandin plus hygroscopic dilators. No demographic differences were
noted between the groups. After six hours of ripening, the combined group achieved a greater
change in Bishop score (3.6 vs. 2.1, P = 0.007) and tended to have a shorter induction time (21.7 vs. 26.4 hours, P = 0.085). The combined therapy group had a higher infection rate than the prostaglandin‐only group (59% vs. 12%, P = 0.003).

Conclusion: Combining cervical dilators with prostaglandin gel provides more effective cervical
ripening and a more rapid induction to delivery interval than prostaglandin alone but with a significant
and prohibitive rate of infection.
Compliance With Universal Precautions: Knowledgeand Behavior of Residents and Students in aDepartment of Obstetrics and Gynecology
Authors: Helfgott A. W. , Taylor-Burton J. , Garcini F. J. , Eriksen N. L. , Grimes R.
Published: March 2007

Objectives: To assess the knowledge of universal precautions for the delivery and operating rooms
by residents and students and to evaluate their use of universal precautions.

Study Design: Obstetrics and gynecology (ob/gyn) residents (n = 30) and students (n = 31) from
an inner‐city, teaching hospital were polled by anonymous questionnaire to assess their knowledge
of the appropriate barrier equipment for certain ob/gyn procedures. To determine actual compliance
with universal precautions, 459 0b/gyn procedures were observed. We noted the use of appropriate
barrier equipment for each procedure: gloves for pelvic exam and face shields, gowns,
gloves, and booties for vaginal delivery, cesarean delivery, and dilation and curettage. The True
Epistat statistical software program was used to perform simple regression analysis.

Results: Thirty residents (100%) knew the appropriate barrier equipment required for each type
of procedure performed. One student (<1%) did not know that booties were appropriate for the
surgical procedures. Rationale for lack of compliance with universal precautions elicited by the
questionnaire included time constraints (64%), inconvenience (52%), and presumption that patient
was not infected (34%).

The observed rate of compliance with universal precautions by participants indicates that individual
compliance was inversely related to the years of experience (overall compliance rate of
students was 96%; for first‐year residents, 92%, second‐year residents, 89%, third‐year residents,
84%, fourth‐year residents, 78%; r = ‐0.9918, P = 0.0009).

Conclusions: Knowledge regarding universal precautions was nearly 100%, while overall observed
compliance was only 89%. Compliance with universal precautions was better among students
(96%) than among residents (88%). Compliance with universal precautions was inversely
related to years of experience.
The Effects of Escherichia coli STa (Heat Stable) Toxinon the Contractility of Isolated Human MyometriumIn Vitro
Authors: de Carrera A. Leal , Carrera-Leal B. , Pierdant-Perez G. , Deleon F. D. , Mcfadden T. M.
Published: March 2007

Objective: The purpose of the study was to assess the effects of Escherichia coli STa (heat stable)
toxin on isolated human myometrial response to oxytocin.

Methods: One hundred and sixteen muscle strips were obtained from the lower uterine segment
of 42 women undergoing cesarean section at term. Amniotic membranes and decidua were excluded.
Uterine contractility in response to cumulative doses of E. coli STa toxin was recorded, as
well as uterine response to cumulative doses of oxytocin before and after incubation with STa toxin
or vehicle. The 50th percentile effective oxytocin concentration (EC50) of muscle strips with and
without spontaneous activity before and after the incubation with STa toxin or vehicle was calculated.
A paired t test was used for comparison.

Results: Muscle strips with and without spontaneous activity responded to cumulative doses of
oxytocin before and after the incubation with STa toxin or vehicle. No differences in contraction
force, duration, or frequency were noted between the groups (P > 0.05). Furthermore, this toxin
was not able to induce uterine contractility when tested alone.

Conclusions: The inability of this toxin to affect myometrial response to oxytocin in this study may
be due to the absence of amnion cells, chorion, or decidua. Other possible explanations for the lack
of response are discussed.
The Role of Bacterial Vaginosis in Infection After Major Gynecologic Surgery
Authors: Lin L. , Song J. , Kimber N. , Shott S. , Tangora J. , Aroutcheva A. , Mazees M. B. , Wells A. , Cohen A. , Faro S.
Published: March 2007

Purpose:Previous studies have reported an association between bacterial vaginosis (BV) and postoperative fever and infection. This prospective study investigated whether the intermediate or definite stages of BV are risk factors for postoperative infection after major gynecologic surgery.

Methods:Vaginal cultures were obtained preoperatively from 175 women undergoing gynecologic surgery. The diagnostic criteria for BV were based on Nugent's standardized method of Gram stain interpretation. Postoperative fever was defined as at least one temperature equal to 101.0℉ or greater, or two or more temperatures more than 6 hours apart equal to 100.4℉ or greater.

Results:Thirty-six percent of the positive-BV group developed a postoperative fever, compared with 20% of theLactobacillus-predominant group and 12% of the intermediate-BV group (P= 0.017). The differences between the positive-BV group and theLactobacillus-predominant group, and between the positive-BV group and the intermediate-BV group, with respect to postoperative fever, were statistically significant (P= 0.045 andP= 0.007, respectively). The difference between the intermediate-BV group and theLactobacillus-predominant group was not statistically significant (P= o.28).

Conclusions:Although the association between BV and postoperative febrile morbidity could be a spurious result of confounding with other variables, it may be prudent for the surgeon to identify patients with BV and treat them preoperatively. Infect. Dis. Obstet. Gynecol. 7:169–174, 1999.
Lymphogranuloma Venereum Presenting as a Rectovaginal Fistula
Authors: Lynch C. M. , Felder T. L. , Schwandt R. A. , Shashy R. G.
Published: March 2007

Lymphogranuloma venereum (LGV) is a rare form of the sexually transmitted disease caused by Chlamydia trachomatis. In the United States, there are fewer than 350 cases per year. In a review of the world’s literature, there has not been a case reported in the last thirty years of a case ofLGV presenting as a rectovaginal fistula. We present a case of an otherwise healthy American woman who presented with a rectovaginal fistula. Although uncommon, LGV does occur in developed countries and may have devastating tissue destruction if not recognized and treated before the tertiary stage. Infect. Dis. Obstet. Gynecol. 7:199–201, 1999.
Do Antepartum Herpes Simplex Virus Cultures Predict Intrapartum Shedding for Pregnant Women With Recurrent Disease?
Authors: Garland S. M. , Lee T. N. , Sacks S.
Published: March 2007

Objective: To examine antenatal screening as a predictor of intrapartum shedding of herpes simplex virus (HSV) and to determine its usefulness in guiding the appropriate route of delivery for patients with recurrent HSV in pregnancy.

Methods: A population of 198 pregnant women with a history of recurrent genital HSV were cultured in the last weeks of their pregnancy by specially‐trained personnel and intrapartum by their delivering attendants.

Results: Of cultures from a total of 906 antenatal visits, 17% were culture positive, with an asymptomatic shedding rate of 3.4%. Asymptomatic shedding occurred in 12.6% of women. Over the 8‐week antepartum period, viral culture‐positivity rates for each visit ranged from 11% to 19.5%. This provided an expected delivery culture‐positivity rate of 15.3%. However, actual intrapartum viral culture positivity occurred in only three of 191 women (1.5%; P < 0.001). Because previous studies have suggested antepartum culture positivity fails to predict intrapartum viral shedding, evaluations, including cultures, as well as predictive values for subsequent culture positivities, were determined under the supervision of an infectious disease specialist. Under these conditions, positive predictive values were 59% when the interval between visits was 2 days, but only 19% when days between visits were >2 (P < 0.0001). No cases of neonatal herpes were seen in this population, although cesarean deliveries were performed in 31% of the patient population, with genital herpes as the indication for 56% of those.

Conclusions: Antepartum serial screening by viral culture is not predictive of an infant′s risk of intrapartum viral exposure when conducted at weekly intervals. However, more frequent assessments of patients can be predictive of an infant′s exposure risk to HSV; for patients with frequent recurrent disease near term or primary infection in pregnancy, frequent late antepartum screening may be appropriate. Infect. Dis. Obstet. Gynecol. 7:230–236, 1999.
Puerperal and Intrapartum Group A Streptococcal Infection
Authors: Anteby Eyal Y. , Yagel Simcha , Hanoch Josef , Shapiro Mervyn , Moses Allon E.
Published: March 2007

Objective: To determine the demographic and clinical variables characteristic of non‐epidemic intrapartum or puerperal group A streptococcal (GAS) infection.

Methods: The records of 47 patients diagnosed with intrapartum or puerperal GAS infection over a 6 1/2 year period at Hadassah‐University Hospital‐Mt. Scopus, Jerusalem were reviewed. Data regarding 25,811 women, the general population of women that delivered during that period, were obtained from their computerized medical records. Frequency distributions, t‐test, chi‐square, and Spearman′s Rank Correlation were used, as appropriate, to analyze and compare demographic and clinical variables associated with development of GAS infection, its clinical course and subsequent
development of septic shock.

Results: Mean age of mothers with GAS infection was higher than that of our general pregnant population (30.4 versus 27.4 years, P = 0.0019), and a higher proportion of GAS infected patients (30% versus 12%, P < 0.005) experienced PROM. Thirty‐one (66%) women had fever as their sole presenting symptom, eight (17%) had fever and abdominal pain, seven (15%) had fever and abnormal vaginal bleeding, and one patient (2%) presented with a rash. Three patients (6%) developed a septic shock. Two of these patients presented with symptoms more than 14 days after delivery.

Conclusions: We describe the characteristics of non‐epidemic intrapartum or puerperal GAS infection. Data from our study and review of the literature suggest that some patients who develop septic shock may present later in the puerperium than patients with an uncomplicated GAS infection. Infect. Dis. Obstet. Gynecol. 7:276–282; 1999.
Chitotriosidase Activity in the Serum of Patients with Sarcoidosis and Pulmonary Tuberculosis
Authors: Bargagli Elena , Margollicci Maria , Nikiforakis Nikolaos , Luddi Alice , Perrone Anna , Grosso Salvatore , Rottoli Paola
Published: March 2007

Background: Human chitotriosidase is a chitinase selectively expressed by activated macrophages. An increase in chitotriosidase activity was previously described by us in the serum and bronchoalveolar lavage of sarcoidosis patients. Objective: The aim of the present study was to analyze serum chitotriosidase activity in a larger number of sarcoidosis patients to verify the reported increase with respect to controls and to compare serum chitotriosidase levels in patients with sarcoidosis and tuberculosis, two granulomatous disorders of different etiology. Methods: Chitotriosidase activity was measured in the serum of 96 sarcoidosis patients, 15 pulmonary tuberculosis patients and 30 healthy controls. Results: We found significantly higher serum chitotriosidase activity in sarcoidosis patients than controls (p < 0.01) and in sarcoidosis patients than tuberculosis patients (p < 0.01), confirming a striking elevation of chitotriosidase activity (>10 times greater than normal) in pulmonary sarcoidosis patients. This is the first time that chitotriosidase activity has been analyzed in the serum of patients with pulmonary tuberculosis; it was found to be significantly lower than in sarcoidosis patients and not significantly greater than in controls. Conclusion: Although the mechanisms leading to the increase in chitotriosidase activity in sarcoidosis are still unknown, this enzyme may be specifically involved in the pathogenesis of the disease. Further studies with a greater number of patients are needed to confirm these results and to determine whether chitotriosidase could be a marker with diagnostic or prognostic value in sarcoidosis.
Autonomic Neuropathy Increases the Risk of Obstructive Sleep Apnea in Obese Diabetics
Authors: Bottini Paolo , Redolfi Stefania , Dottorini Marco L. , Tantucci Claudio
Published: March 2007

Background: Nonobese diabetics with diabetic autonomic neuropathy (DAN) show an elevated prevalence of obstructive sleep apnea-hypopnea (OSAH). Objective: It was the aim of this study to assess if the presence of DAN could further increase the risk of developing OSAH in obese diabetics. Methods: Eighteen obese diabetic patients, 8 with DAN [age 57 ± 5 years, body mass index (BMI) 35 ± 4] and 10 without DAN (age 56 ± 8 years, BMI 37 ± 5), were recruited. Ten age-matched obese subjects were studied as controls (age 53 ± 12 years, BMI 34 ± 3). All subjects underwent a cardiorespiratory sleep study in the in-hospital sleep laboratory to obtain the apnea-hypopnea index (AHI) and oxygen desaturation indices. Results: Diabetics with DAN (Ob-DAN+) had a higher AHI than diabetics without DAN (Ob-DAN–) and controls, amounting to 39.5 ± 13 versus 15.8 ± 12 (p < 0.01) and 19.3 ± 21 (p < 0.05), respectively. A moderate-to-severe OSAH (AHI ≧15) occurred in all Ob-DAN+ and only in 4 Ob-DAN– and 4 control patients. Moreover, the indices reflecting the impairment of oxygen saturation (SaO2) during sleep such as the mean lowest SaO2 and sleep time with a SaO2 <90% were more severely affected in Ob-DAN+ patients compared with the other groups and were associated with longer obstructive respiratory events. Conclusions: Apneas-hypopneas are more frequent and last longer in Ob-DAN+ than in other obese subjects, with or without diabetes.
Foaming of Synthetic and Natural Biodegradable Polymers
Authors: Marrazzo Carlo , Maio Ernesto Di , Iannace Salvatore
Published: March 2007

Biodegradable polymers, both synthetic and natural, often show poor foamability, in terms of the ability to form a fine-celled structure and to retain it. In fact, foams with high density and/or non uniform morphology are generally obtained with these materials. Poor rheological properties, poor solubility and inadequate diffusivity of the ordinary foaming agents, and insufficient setting mechanisms (e.g., crystallization kinetics), are the possible reasons. In this work different approaches, tuned to the different materials, have been investigated to improve the foamability of biodegradable materials, such as polyesters, polysaccharides, vegetal and animal proteins. This comprehensive analysis allows one to gain a wide and clear picture of the relevance and efficiency of the available strategies: process optimization, macromolecular design, choice of blowing agent, and use of additives.
Simulation studies of a GPC controller for a hydroelectric plant
Authors: Muñoz-Hernández G. A. , Jones D. I.
Published: March 2007

In this paper, the performance of constrained Generalized Predictive Control (CGPC) is investigated on a comprehensive non-linear multivariable simulation of the Dinorwig pumped-storage hydroelectric power station. The responses of the system are compared with those of the classic PI controller, as currently implemented on the plant. The results show that CGPC offers significantly better performance over the whole operating envelope. Fixed-parameter CGPC produces a faster primary response and better steady-state accuracy when the station is operating with a single unit, while also preserving stability when the operating conditions change as multiple units come on-line. It can accommodate large amplitude ramp power changes in combination with feed-forward control. It is less sensitive than PI to changes in hydraulic head and gives better power-tracking when units operate in frequency-control mode. Finally, the computational time of the CGPC algorithm is investigated.
Views of oncology patients, their relatives and oncologists on cardiopulmonary resuscitation (CPR): questionnaire-based study
Authors: Ackroyd Rajeena , Russon Lynne , Newell Rob
Published: March 2007

Background: Doctors are justified withholding a treatment, such as cardiopulmonary resuscitation (CPR), if it is unlikely to benefit a patient. The success rates for CPR in patients with cancer is <1%. Guidelines produced in 2001 recommended that CPR should be discussed with patients, even when it is unlikely to be successful. Therefore, should oncologists always discuss resuscitation, even when it is likely to be futile?

Method: Sixty oncology in-patients and 32 of their relatives were asked their views on CPR, and their views were compared with the oncologist involved in their care.

Results: Some 58% of patients wanted to be resuscitated. There was a moderate-strong correlation between patients and their next of kin and the desire for resuscitation. There was also a positive correlation between the doctor’s views on suitability for resuscitation, patient’s prognostic score, and World Health Organisation (WHO) performance score.

Conclusion: Most patients wanted to be resuscitated despite being given the likely poor survival rates from CPR. They also wanted to be involved in the decision-making process, and wanted their next of kin involved, even when, medically, the procedure was unlikely to be successful. The findings that patient and next of kin views correlated well shows that relatives’ views are a good representation of patient views. In contrast, consultant’s decisions were strongly correlated with the patient’s performance status and clinical state. No patients were upset by the study, although nine patients declined to participate.
Demographic factors and awareness of palliative care and related services
Authors: Koffman Jonathan , Burke Geraldine , Dias Angela , Raval Bharti , Byrne Judi , Gonzales Juan , Daniels Charles
Published: March 2007

Background: Palliative care is not accessed by all those who can benefit from it.

Survey aim: To explore awareness of palliative care and related services among UK oncology out-patients, and to analyse the relationship between demographic characteristics and knowledge.

Design: Cross-sectional interview-based survey. Analysis comprised univariate and multiple logistic regression.

Participants and settings: Oncology out-patients receiving curative treatments at two district general hospitals in north-west London between December 2004 and April 2005.

Results: A total of 252 (94%) eligible clinic patients were interviewed. Only 47 (18.7%) patients recognised the term ‘palliative care’, but 135 (67.8%) understood the role of the hospice, and 164 (66.7%) understood the role of Macmillan nurses. Age-adjusted multiple logistic regression showed that recognizing the term ‘palliative care’ was more likely among the most socially and materially affluent patients than those who were the poorest (OR: 8.4, CI: 2.17-31.01, p =0.002). Understanding the role of Macmillan nurses was also more likely among the most socially and materially affluent patients compared with the poorest patients (OR: 7.0, CI: 2.41-18.52, p <0.0001), and was independently less likely among patients from black and minority ethnic groups than those who were classified as being white British (OR=0.5, CI:0.25-0.96, p =0.04).

Conclusions: Awareness of palliative care and related services was low among black and minority ethnic groups, and the least affluent.
Dying trajectories in heart failure
Authors: Gott Merryn , Barnes Sarah , Parker Chris , Payne Sheila , Seamark David , Gariballa Salah , Small Neil
Published: March 2007

Objectives: To explore dying trajectories in heart failure.

Design: Prospective, longitudinal study.

Setting: Sixteen GP surgeries in four demographically contrasting areas of the UK.

Participants: A total of 27 heart failure patients, >60 years of age, who completed questionnaires for at least five time-points before death.

Main outcome measures: Kansas City Cardiomyopathy Questionnaire Physical Limitation Scale.

Results: No ‘typical’ dying trajectory could be identified, and only a minority of patients conformed to the theoretical trajectory of dying in heart failure.

Conclusions: This study provides the first prospective data regarding physical decline prior to death in heart failure. Findings challenge current efforts to plan and deliver palliative care services on the basis of the theoretical heart failure dying trajectory.
Knowledge Network Driven Coordination and Robust Optimization to Support Concurrent and Collaborative Parameter Design
Authors: Hu Jie , Peng Yinghong , Xiong Guangleng
Published: March 2007

This study presents a parameter coordination and robust optimization approach based on knowledge network modeling. The method allows multidisciplinary designer to synthetically coordinate and optimize parameter considering multidisciplinary knowledge. First, a knowledge network model is established, including design knowledge from assembly, manufacture, performance, and simulation. Second, the parameter coordination method is presented to solve the knowledge network model, monitor the potential conflicts due to engineering changes, and obtain the consistency solution space corresponding to the given knowledge. Finally, the robust parameter optimization model is established, and genetic arithmetic is used to obtain the robust optimization parameter. A design instance is introduced to show the validity of this method.
Knowledge Modeling for Eco-design
Authors: Houe Raymond , Grabot Bernard
Published: March 2007

The present major concern on sustainable development is at the beginning of a growing interest on product recyclability. More and more strict norms and regulations will be prescribed to companies in order to increase the level of recyclability of industrial products. Usually described in natural language, these norms can be difficult to interpret for the product designer. There will also be an increasing need in tools to verify the compliance of a product with given norms and standards. A prototype of such a system is described in this article: the information to be added to the product model is first specified. It is then shown how the knowledge contained in standards and norms in textual form can be translated into constraints which can be propagated through the product structure in order to identify the inconsistencies between the present design and a given norm. An example of the literature is used to illustrate the suggested methodology and the results of its application through a software prototype.
Resistance Based Modeling of Collaborative Design
Authors: Ostergaard Karen J. , Summers Joshua D.
Published: March 2007

This study presents a new model for collaborative design that is analogous to electrical circuits with current (rate of design artifact synthesis and analysis), voltage (knowledge that drives the design process), and resistance (barriers to the exchange of design information). An electric analogy is used to capture the flow of information throughout the design process, it maps well to existing models of collaboration, and it provides a mechanism to capture resistances to flow. Specifically, the resistances are identified from a collaborative design taxonomy. Currently, these resistances are qualitatively captured based upon empirical evidence, but they may in the future be calibrated with additional experimental investigations. The model is illustrated through a simple example. Extensions and an assessment of the model are provided.
Quality of Green Beans And Energy Required For High Temperature Processing
Authors: Blumenberg Linda S. , Snider Sue , Vollmar E. Karla
Published: March 2007

The objectives of this research were to compare processing of green beans at 15 psig with processing at ten psig to determine if differences in ascorbic acid retention, energy consumption and eating quality would result. Green beans were processed, according to current USDA recommendations (ten psig for 20 minutes), at ten psig for 43 minutes, and at 15 psig for 15 minutes. A significant difference among the three treatments was found in energy consumption, with processing beans at ten psig for 43 minutes requiring significantly more energy than the other two treatments. There were no significant differences among the three treatments in ascorbic acid retention as determined by the 2,4 dinitro‐phenyl hydrazine method, and in eating quality as indicated by the results of triangle sensory tests, or in Warner‐Bratzler shear values.