bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of the Vaginal Microbiological Ecosystem and Cytokine Profile in the Promotion of Cervical Dysplasia: A Case–Control Study
Authors: Behbakht Kian , Friedman Jennifer , Heimler Ira , Aroutcheva Alla , Simoes Jose , Faro Sebastian 
Published: March 2007

Objective: To identify alterations in the cytokine profile and microbial ecosystem of the vagina in association
with cervical dysplasia.Methods: Demographics, lifestyle variables and Papanicolau (Pap) smear results of subjects presenting to the
same site for gynecologic complaints, obstetric visits or colposcopy were prospectively recorded. Vaginal smear
for Gram stain, aerobic and anaerobic culture, pH, and wet mount and KOH examination for Trichomonas vaginalis ,
Gardnerella vaginalis and yeast organisms were performed. Vaginal lavage specimens were centrifuged, and the
pellets and supernatants were assayed for human papillomavirus (HPV) by polymerase chain reaction and for
cytokines interleukin (IL)‐1ß IL‐6, IL‐10 and IL‐12 by enzyme‐linked immunosorbent assay (ELISA) respectively.
Subjects with abnormal Pap smears underwent colposcopy and biopsy as indicated.Results: Of 51 patients, 32 were referred for colposcopy, 12 presented with gynecologic needs, and seven
presented for obstetric visits. Median age was 24 years. Demographics did not differ significantly between the
dysplasia and control groups except for a trend towards more sexual partners in the dysplasia group. Biopsies were
performed in 81% (26/32) of patients presenting for colposcopy and 17 revealed cervical intraepithelial neoplasia.
IL‐1ß, IL‐6, IL‐10, and IL‐12 levels were elevated in 63% (20/32), 38% (15/39), 4% (2/49), and 0% of samples
respectively. Elevated vaginal lavage IL‐1ß was associated with a 6.1 odds ratio (95% confidence interval 1.06–35)
of cervical dysplasia. Alterations in other variables studied were not associated with cervical dysplasia.Conclusions: Elevated IL‐1ß, possibly representing a complex host inflammatory response to multiple pathogens,
was demonstrated in patients with cervical dysplasia.
Case–Control Study of Vulvar Vestibulitis Risk Associated WithGenital Infections
Authors: Smith Elaine M. , Ritchie Justine M. , Galask Rudolph , Pugh Erica E. , Jia Jian , Ricks-McGillan Joan 
Published: March 2007

Objective: To evaluate the risk of vulvar vestibulitis syndrome (VVS) associated with genital infections in a
case–control study.Methods:Diagnosed cases with VVS (n = 69) and age‐frequency‐matched healthy controls (n = 65) were
enrolled from gynecology clinics in a university medical hospital during 1999. They were compared for potential
risk factors and symptoms of disease.Results: VVS cases had a significantly higher risk of physician‐reported bacterial vaginosis (BV) (odds ratio,
OR = 9.4), Candida albicans (OR = 5.7), pelvic inflammatory disease (PID) (OR = 11.2), trichomoniasis
(OR = 20.6), and vulvar dysplasia (OR = l5.7) but no risk associated with human papillomavirus (HPV), ASCUS,
cervical dysplasia, genital warts, chlamydia, genital herpes or gonorrhea. Genital symptoms reported significantly
more often with VVS included vulvar burning (91 vs. 12%), dyspareunia (81 vs. 15%), vulvar itching (68 vs. 23%)
and dysuria (54 vs. 19%) (p < 0.0001).Conclusion: A history of genital infections is associated with an increased risk of VVS. Long‐term follow‐up
case–control studies are needed to elucidate etiologic mechanisms, methods for prevention and effective
treatment.
Comparison of Gram Stain and Pap Smear Procedures in theDiagnosis of Bacterial Vaginosis
Authors: Vardar Enver , Maral Izzet , Inal Murat , Özgüder Özgül , Tasli Funda , Postaci Hakan 
Published: March 2007

Objective: The purpose of this study was to examine the characteristics of Gram stain versus Pap smear in
diagnosis of bacterial vaginosis (BV).Methods: One‐thousand and sixty women were enrolled in this study. All cases with symptoms of BV were
determined by Amsel′s criteria, which were accepted as the gold standard for diagnosis of BV. Pap smear and
Gram stain evaluations were compared according to Amsel′s criteria, without viewing the clinical results of the
patients. Gram stain and Pap smear results were determined as negative or positive according to Amsel’s criteria.
Sensitivity, specifity and positive predictive values were calculated.Results: After accepting the cases that were diagnosed as BV according to Amsel′s criteria as reference cases, the
sensitivity of the Gram stain method was calculated as 97% and the sensitivity of the Pap smear method as 93%.
Similar specificity rates were obtained with both methods in diagnosis of BV related to the clinical results. There
were no statistically significant differences in diagnosis of BV between these two groups.Conclusion: If Amsel′s criteria are accepted as the gold standard for diagnosis of BV, Gram stain and Pap smear
methods will give similar results in diagnosis.
Group A Streptococcal Toxic Shock Syndrome Developing inthe Third Trimester of Pregnancy
Authors: Crum Nancy F. , Chun Helen M. , Gaylord Thomas G. , Hale Braden R. 
Published: March 2007

Background: Group A streptococcal (GAS) toxic shock syndrome (TSS) is an uncommon, but life‐threatening
infection during pregnancy and should be considered in rapid onset of shock.Most cases described in the literature
have occurred in the puerperium.We report a case of GAS TSS occurring during the third trimester of pregnancy
in a previously healthy woman.Case: A 31‐year‐old female, who was 34 weeks pregnant, presented with fevers and a prodromal ‘flu‐like’
illness. She rapidly developed shock and multiorgan failure. Blood cultures revealed GAS bacteremia and the
patientmet criteria for streptococcal TSS.Despite her eventual recovery, her infant died on postpartumday 15 as a
consequence of the mother′s TSS.Conclusions: This case is unusual in that there were no identifiable initiating events or source of the streptococcal
infection, and the TSS developed during pregnancy rather than after delivery. Early recognition of GAS infections is
important given the rapid onset and high morbidity and mortality associated with these infections. This is the first
reported case utilizing intravenous immunoglobulin for GAS TSS in the puerperium.
Two Cases of Delayed Diagnosis of Postpartal StreptococcalToxic Shock Syndrome
Authors: Schummer Wolfram , Schummer Claudia 
Published: March 2007

Background: Puerperal sepsis due to group A β‐hemolytic streptococcal (GAS) toxic shock syndrome is
associated with very high morbidity and mortality. Luckily it is now rare, but diagnosis is not always easy. This
report demonstrates the problem of recognizing this disease, and summarizes the current knowledge on the
pathomechanism and management of streptococcal toxic shock syndrome.Case: Two cases of postpartum streptococcal toxic shock syndrome due to GAS are described. In both cases
the correct diagnosis was delayed for several days. The first patient was sent home with the diagnosis of German
measles; the second patient was transferred to our neurological intensive care unit with the diagnosis of meningitis.
Both patients were admitted to the intensive care unit in profound shock, both developed multiple organ failure,
and one patient died.Conclusions: GAS may produce virulence factors that cause host tissue pathology. Besides aggressive modern
intensive care treatment, early diagnosis and correct choice of anti‐streptococcal antibiotics are crucial. A possible
adverse effect of non‐steroidal anti‐inflammatory agents requires confirmation in a multicenter study.
Ertapenem Once a Day Versus Piperacillin–Tazobactam Every6 Hours for Treatment of Acute Pelvic Infections:A Prospective, Multicenter, Randomized, Double‐Blind Study
Authors: Roy Subir , Higareda Iliana , Angel-Muller Edith , Ismail Mahmoud , Hague Caren , Adeyi Ben , Woods Gail L. , Teppler Hedy 
Published: March 2007

Objective: To compare ertapenem therapy with piperacillin–tazobactam therapy for the management of acute
pelvic infections.Methods: In a multicenter, double‐blind study, 412 women with acute pelvic infection were assigned to one of
two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then
randomized to ertapenem, 1 g once a day, or piperacillin–tazobactam, 3.375 g every 6 hours, both administered
intravenously.Results: In total, 163 patients in the ertapenem group and 153 patients in the piperacillin–tazobactam group were
clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common
single pathogen was Escherichia coli . At the primary efficacy endpoint 2–4 weeks post therapy, 93.9% of patients
who received ertapenem and 91.5% of those who received piperacillin–tazobactam were cured (95%
confidence interval for the difference, adjusting for strata, –4% to 8.8%), indicating that cure rates for both
treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by
stratum and severity of infection. The frequency and severity of drug‐related adverse events were generally
similar in both groups.Conclusions: In this study, ertapenem was as effective as piperacillin–tazobactam for the treatment of acute pelvic
infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin–tazobactam.
Abscess in Adenomyosis Mimicking a Malignancy in a54‐Year‐Old Woman
Authors: Erguvan Rezzan , Meydanli Mehmet M. , Alkan Alpay , Edali Mehmet N. , Gokce Hasan , Kafkasli Ayşe 
Published: March 2007

Background: Although there are a few reports describing abscess formation in endometriotic foci no report of
abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis
of adenomyosis is frequently difficult because of non‐specific signs and symptoms. Synchronous pelvic pathologies
such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause
differential diagnostic problems.Case: A 54‐year‐old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is
presented. Radiologic examinations of the pelvis revealed a 95 × 85 mm leiomyoma‐like lesion including a
53 × 43 mmcystic space and 9 × 6 mmpapillary formation within the uterus raising clinical suspicion of malignancy.
A total abdominal hysterectomy and bilateral salpingo‐oophorectomy were performed accompanied by a
frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis.
The postoperative period of the patient was uneventful.Conclusion: The present case, to our knowledge, is the first report representing abscess formation in
adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly
if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive
histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical
intervention.
Does Method of Placental Removal or Site of UterineIncision Repair Alter Endometritis After Cesarean Delivery?
Authors: Magann Everett F. , Dodson Mark K. , Harris Robert L. , Floyd Randall C. , Martin James N. , Morrison John C. 
Published: March 2007

Objective: his investigation was undertaken to evaluate the relationship between postcesarean endometritis
and (1) method of placental removal and (2) site for uterine repair.Methods: This prospective, randomized study included 120 patients who underwent primary or
repeat abdominal delivery for arrest of progress in labor, fetal distress, or breech presentation.
Parturients were divided into four groups: I—spontaneous placental detachment, in situ uterine
repair; II—spontaneous placental detachment, exteriorized uterine repair; III—manual placental
removal, in situ uterine repair; and IV—manual placental removal, exteriorized uterine repair.
Prophylactic antibiotics were not used.Results: Endometritis was significantly increased in the manual removal/exteriorized uterine
repair group versus all the other groups including the spontaneous removal in situ (group I,
P = 0.012), the spontaneous removal/exteriorized repair group (group II, P = 0.034), and the manual
removal/in situ repair group (group III, P = 0.043). Comparison of group IV (manual removal/
exteriorized repair) with the combined groups I, II, and III (spontaneous removal/in situ repair,
spontaneous removal/exteriorized repair, and manual removal/in situ repair) was significantly different
(P = 0.005). Prior to delivery, use of an internal monitoring system, skill of the operating
surgeon, and type of anesthesia were similar among groups.Conclusions: The findings of this investigation suggest that; when other known causes of infectious
morbidity are constant, manual placental remvol in association with exteriorization for
uterine repair significantly increases postcesarean endometritis.
Presence of Chlamydia, Mycoplasma, Ureaplasma, and Other Bacteriain the Upper and Lower Genital Tracts of Fertile and Infertile Populations
Authors: Martens Mark G. , Young Ronald L. , Uribe Marco , Buttram V. C. , Faro Sebastian 
Published: March 2007

Objective: The genital mycoplasmas (Mycoplasma hominis and
Ureaplasma urealyticum) and Chlamydia trachomatis have been implicated as possible
etiologic factors in infertility. Their role in patients with infertility needs to be further defined.Methods: Seventy‐nine infertile patients underwent laparoscopy with
cultures obtained for aerobic and anaerobic bacteria, Chlamydia, Mycoplasma, and
Ureaplasma from the peritoneal fluid, fallopian tube, endometrium, and endocervix.
Cultures for similar organisms were taken from the endocervix of 80 fertile women in their
first trimester. Culture results were also compared according to ovulatory status and
laparoscopic findings in the infertile group.Results: There were no differences in the recovery of Ureaplasma
(29% vs. 28%) or Chlamydia (4% vs. 0%) positive cervical cultures in the fertile and
infertile groups, respectively. However, a significantly higher number of Mycoplasma
positive cervical cultures (14% vs. 5%, P = 0.05) were found in the fertile group. Only two upper
genital tract cultures were found to be positive (Ureaplasma).Conclusions: Therefore, if these organisms play a role in infertility,
they are present and eradicated prior to infertility work‐up and thus do not supports the use
of a routine trial of antibiotics prior to laparoscopy.
Effect of Isoflurane on Neutrophil Phagocytic Function During Pregnancy
Authors: Clark Penny , Layon A. Joseph , Duff Patrick 
Published: March 2007

Objective: General anesthesia has been considered an
independent risk factor for postcesarean infection, but the mechanism for this association
has not been delineated. The purpose of this prospective investigation was to determine
if phagocytic response of neutrophils was impaired by in vitro exposure to isoflurane, a
commonly used anesthetic.Methods: Twelve milliliter venous blood samples were withdrawn from
18 term patients during labor. Neutrophils were separated by Ficoll gradient centrifugation.
Aliquots of 2 × 106
neutrophils/ml were exposed to anesthesia using an airtight modular
incubator chamber through which a 0.5% isoflurane:50% N2O + 50% O2
mixture flowed
at a rate of 4 l/min for 90 min at 37℃. Neutrophils were assayed for phagocytosis by
incubation with Escherichia coli conjugated with fluorescein isothiocyanate for 30 min
at 37℃. Phagocytosis was assessed by flow cytometry. Neutrophils from the same
patient that were not exposed to anesthesia served as controls.Results: The mean percentage of phagocytizing neutrophils in the
isoflurane‐treated group was 82.8 ± 24 compared to 83.5 ± 22 in the control group.
The difference between the two groups was not significant.Conclusions: In vitro exposure to the general anesthetic isoflurane
for 90 min does not significantly alter the phagocytic capacity of neutrophils.
Management of Intrauterine Device‐Associated Actinomycosis
Authors: Chatwani Ashwin , Amin-Hanjani Soheil 
Published: March 2007

Objective: To assess various methods of management of
actinomyces‐like organisms associated with intrauterine devices.Methods: A retrospective chart review of 173 patients with intrauterine
device‐associated actinomyces‐ like organisms detected on Pap smear was performed.
The patients were managed by IUD removal with or without antibiotic therapy, antibiotic
therapy alone, or no treatment at all.Results: The success rate as reflected in negative follow‐up smear was
100% for IUD removal combined with antibiotics, 97.4% for IUD removal alone, and 36.8% for
antibiotics therapy alone.Conclusions: The best way to manage intrauterine device‐associated
actinomyces‐like organisms is removal of the device with or without antibiotics.
Correlation Between the Clinical Diagnosis of Bacterial Vaginosis and the Results of a Proline Aminopeptidase Assay
Authors: Nelson George H. , Bacon Janice L. 
Published: March 2007

Objective: The object of this study was to develop a simple and
inexpensive test for detection of bacterial vaginosis (BV) in pregnant patients and to test its
accuracy in a clinic population.Methods: We developed a modified proline aminopeptidase (PAMP)
assay to detect BV and compared the results of the assay with the clinical diagnosis of BV.Results: The results of the PAMP assay in 55 asymptomatic and 50
symptomatic subjects significantly correlated with a clinical diagnosis of BV. The prevalence
of BV in the asymptomatic population was 42% (PAMP assay) and 38% (clinical diagnosis).
In the symptomatic population, it was 50% (PAMP assay) and 54% (clinical diagnosis).
The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive
value (NPV) of the PAMP assay were 86, 85, 86, 78, and 91%, respectively, in asymptomatic
patients and 89, 96, 92, 96, and 88%, respectively, in symptomatic patients.Conclusions: The modified PAMP assay, which we describe,
met our goals for simplicity, cost, and accuracy. We feel it could be best used as a screening
test for BV in asymptomatic pregnant patients.
Genital Mycoplasmas in Placental Infections
Authors: Stein Andreas , Boubli Léon , Blanc Bernard , Raoult Didier 
Published: March 2007

Objective: The involvement of the genital mycoplasmas Ureaplasma urealyticum
and Mycoplasma hominis in complications of pregnancy has remained
controversial especially because these microorganisms are frequent colonizers of the
lower genital tract. Recovery of bacteria from the placenta appears to be the sole technique
to represent a true infection and not vaginal contamination. Therefore, we investigated the
presence of genital mycoplasmas, aerobic and anaerobic bacteria, and fungi in human
placentas and evaluated their association with morbidity and mortality of pregnancy.Methods: We cultured placentas from 82 women with complicated
pregnancies. One hundred placentas from women with uncomplicated pregnancies were
evaluated as controls. When possible, placentas were examined histologically for presence
of chorioamnionitis.Results: Microorganisms were recovered from 52% of the placentas
of complicated pregnancies and U. urealyticum was the microorganism isolated most
frequently from the placenta. A significant association between positive mycoplasma
culture of the placenta and complication of pregnancy was found, and chorioamnionitis
was positively related to isolation of mycoplasmas.Conclusions: These data suggest that genital mycoplasmas are
able to infect the human placenta where they can cause chorioamnionitis.
This infection of the placenta by genital mycoplasmas is related to preterm birth and
fatal outcome of pregnancy.
Streptococcus pneumoniae as a Cause of Salpingitis
Authors: Patterson David , Johnson Celeste M. , Monif Gilles R. G. 
Published: March 2007

Background: A case of pneumococcal septicemia associated with
laparoscopically documented acute salpingitis is reported.Case: Gram‐stained cul‐de‐sac pus revealed gram‐positive
encapsulated diplococci.Conclusion: This case coupled with reanalysis of prior genital tract
involvement in nonpregnant individuals argues that Streptococcus pneumoniae can
mimic gonococcal diseases.
Detection of Trichomonas vaginalis Using the Polymerase Chain Reaction in Pregnant andNon‐Pregnant Women
Authors: Jeremias J. , Draper D. , Ziegert M. , Jones W. , Inglis S. , McGregor J. A. , Witkin S. S. 
Published: March 2007

Objective:Trichomonas vaginalis vaginal infections are often both asymptomatic and difficult to
detect by current methods. We evaluated the ability of a newly developed polymerase chain reaction (PCR) assay to
identify T. vaginalis in vaginal samples from pregnant and non‐pregnant women.Methods: In the 1st study, we compared the prevalence of T. vaginalis detection by PCR and culture
using Diamond′s medium in 52 women with symptoms of vaginal infection. In the 2nd study, T. vaginalis was detected
using PCR and wet mount microscopy in 131 asymptomatic pregnant women.Results: Among the women with symptoms of vaginitis, 7 (13.5%) were PCR‐positive for T. vaginalis.
Six of the PCR‐positive women, but none of the PCR‐negative women, were culture‐positive for this organism. All but 1 of the
women with candidal vaginitis or bacterial vaginosis were PCR‐negative for T. vaginalis. Among the asymptomatic pregnant
women, all of whom were negative for T. vaginalis by wet mount, l0 (7.6%) were PCR‐positive for T. vaginalis.Conclusions: PCR offers a rapid and sensitive alternative to culture and microscopy for the detection
of T. vaginalis vaginal infections in both symptomatic and asymptomatic women.
Rapid Immunoassay for the Detection of Genital Herpes Infection
Authors: Alexander Samuel M. , Gebhardt Bryan M. 
Published: March 2007

Objective: We evaluated a new affinity membrane strip test for the diagnosis of herpetic genital
infections. Test strip results, which are available by immunoassay in 30 min without the need for special equipment,
were compared with the results of viral culture.Methods: Twenty‐eight female patients with vulvar lesions thought to be due to genital herpes
simplex virus (HSV) infection were tested. The affinity membrane strip was applied to the genital lesion. Dacron swabs
were then applied to the lesions and the swab contents cultured for HSV. For the immunoassay, the test strip was immersed
in peroxidase‐labeled antibodies specific for HSV type 2 (HSV‐2), incubated, washed, and developed in the substrate
tetramethylbenzidine. Positive reactions appeared as intense blue spots roughly the shape and size of the lesion. Sensitivity
and specificity of the test were determined using the results of viral cultures as the standard.Results:The lesions of 8 patients yielded positive strips that correlated with positive cultures. The
lesions of 6 patients produced positive strips but the cultures were negative. None of the patients whose lesions yielded
negative strips had positive cultures. The lesions of 14 patients produced negative strips and negative cultures. Strips
and viral cultures from 10 control patients (no lesions) were negative. Sensitivity and specificity were 100% and
70%, respectively. Positive (PPV) and negative (NPV) predictive values were 57% and 100%, respectively.
The accuracy was 78%.Conclusions: The affinity membrane test was extremely sensitive in detecting herpetic genital
infection compared with viral culture. The specificity was lower, resulting from false positives based on negative cultures.
However, negative cultures may occur in the presence of disease, depending in part on the type of lesion. Thus, specificity
may be higher than this preliminary study indicates, and more elaborate search for virus including serologic studies as
well as larger groups of patients may be needed to refine this evaluation. With further testing and development, this
membrane affinity test for herpes may yield a valuable adjunct to clinical diagnosis of this infection.