bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the Value of Routine Blood Cultures in the Evaluation and Treatment of Patients WithChorioamnionitis
Authors: Locksmith Gregory J. , Duff Patrick 
Published: March 2007

Objective: The objective of this investigation was to determine the usefulness of blood cultures in
evaluating patients with chorioamnionitis who were treated in accordance with a specific antibiotic protocol.Methods: We reviewed the records of 539 patients with chorioamnionitis who delivered at our
facility over a 3 year period (July 1, 1989–June 30, 1992). Patients had one set of aerobic and anaerobic blood cultures
at the time of their initial assessment. They were treated initially with ampicillin or vancomycin plus gentamicin. Those
who required cesarean delivery also received clindamycin postoperatively. Patients who had a poor initial response to
therapy were treated empirically with selected antibiotics targeted against likely resistant organisms until the results of
bacteriologic cultures were available. Bacteremic patients had repeat blood cultures while on therapy. We analyzed the
medical records to determine the frequency with which blood culture results led to meaningful changes in patient
management. We also compared the duration of febrile morbidity in bacteremic vs. nonbacteremic patients.Results: Thirty‐nine of 538 patients (7.2%, 95% confidence interval [CI] 5.2–9.2%) had
positive blood cultures. In only one patient did the result of the blood culture definitively alter therapy. This patient had
a fever of unknown origin, and the finding of a positive blood culture ultimately led to the diagnosis of chorioamnionitis.
The mean duration of febrile morbidity was not significantly different in bacteremic vs. nonbacteremic patients (2.03 vs. 1.74 days). None of the repeat blood cultures was positive. The cost of blood cultures in the study population was
$72,759.00.Conclusions: The routine use of blood Cultures in the assessment of patients with chorioamnionitis
rarely provides information that justifies a change in clinical management when patients are treated in accordance with
the specific antibiotic protocol outlined in this investigation.
Comparison of Culture and Rapid Enzyme Immunoassay for the Detection of Group B Streptococcus inHigh‐Risk Pregnancies
Authors: Dinsmoor Mara J. , Dalton Harry P. , Peng Thomas C. C. , Christmas James T. , Sayahtaheri-Altaie Sousan , Harvey Kevin , VanDorsten J. Peter 
Published: March 2007

Objective: The purpose of this study was to evaluate the Equate Strep B® test for clinical use in
patients at high risk for complications from group B streptococcus (GBS) disease.Methods: Vaginoperineal swabs were obtained from patients with preterm premature rupture of
the membranes and/or preterm labor and semiquantitative GBS cultures and Equate® assay were performed.Results: From May 14, 1990, to April 30, 1992, 650 patients were enrolled; 626 had both culture
and Equate® results available, of whom 24% were colonized with GBS. The sensitivity, specificity, positive predictive value, and negative predictive value of the rapid assay were 28%, 84%, 35%, and 79%, respectively. Although the prevalence of GBS was higher in patients with ruptured membranes compared with those with intact membranes, rupture of membranes did not affect test sensitivity or specificity.Conclusions: We conclude that the Equate® rapid assay is not a sensitive method of GBS detection in high‐risk patients.
Comparison of Short Vs. Long Half‐Life Single‐Dose Prophylactic Antibiotics for Cesarean Section
Authors: Gonik Bernard , McGregor James 
Published: March 2007

Objective: Numerous studies demonstrate the efficacy of antibiotic prophylaxis for reducing postcesarean
section infectious morbidity. The duration of therapy, however, remains controversial.
Cost containment measures and the ease of single dosing have led to the introduction of “extended”
half‐life agents for cesarean‐section chemoprophylaxis. We tested the hypothesis that there was no
difference in efficacy between a single dose of a short half‐life agent (cefoxitin) and a longer half‐life
agent (cefotetan).Methods: A prospective, double‐blind trial of 375 non‐elective cesarean‐section cases was carried
out. Study antibiotics (2 g) were administered intravenously (IV) at cord clamping only.Results: Demographic and clinical variables between the 2 study groups were similar. No significant
differences were noted in major or minor morbidity or in infectious morbidities for patients
receiving the 2 prophylactic regimens. The occurrence of postoperative endometritis was likewise
similar for the subjects receiving cefoxitin (10%) and cefotetan (15%). When cases whose surgery
lasted >60 min were evaluated separately, no differences in outcomes between the 2 groups were
identifiedConclusions: These findings confirm our hypothesis that the half‐life difference between these 2
agents does not impact on single‐dose Prophylactic efficacy in cesarean section.
Detection of Human Papillomavirus DNA by AffiProbe HPV‐DNA Test Kit in Cervical Scrapes orBiopsies‐Histopathologic Correlates
Authors: Nieminen Pekka , Jalava Tarja , Kallio Arja , Ranki Marjut , Paavonen Jorma 
Published: March 2007

Objective: The aim of this study was to evaluate and compare the efficacy of punch biopsies and
cervical scrapes in the detection of human papillomavirus (HPV) DNA from the cervix and compare the results with the
histopathologic diagnosis.Methods: The specimens were collected simultaneously, and HPV DNA was detected using a
liquid hybridization test.Results: Biopsies and scrapes were equally efficient, but each detected only two‐thirds of all
HPV‐DNA‐positive patients. Thus, the positivity rate increased when both tests were used. Overall, 13% of patients with normal histopathology, 38% of patients with benign atypia, and 66% of patients with squamous intraepithelial lesions (SIL) were HPV‐DNA positive. HPV‐DNA 16 was found in 54% of HPV‐DNA‐positive patients with SIL, in 20% of HPV‐DNA‐positive patients with atypia, and in none of patients with normal histopathology.Conclusions: The liquid hybridization test used in this study detects HPV DNA equally efficiently
from both biopsies and scrapes. The test can be performed in 1 working day. However, the sensitivity of the test is low,
and it only detects a limited number of HPV types.
Occult Intraamniotic Infection at the Time of Midtrimester Genetic Amniocentesis:A Reassessment
Authors: Cherouny Peter H. , Pankuch Glenn A. , Botti John J. 
Published: March 2007

Objective: The objective of this study was to reevaluate the incidence of occult early midtrimester
intraamniotic infection in asymptomatic patients at the time of genetic amniocentesis.Methods: A total of 177 amniotic fluid (AF) specimens from patients referred for genetic amniocentesis between 15 and 20 postmenstrual weeks were evaluated for the presence of bacteria by
detailed light microscopy, after Gram and Wright stain, and by cultures for aerobic and anaerobic
baceria, Mycoplasma sp., and Ureaplasma urealyticum. Seventy‐seven AF specimens were also tested for the presence of bioactive leukoattractants by a leukotaxis bioassay.Results: All fluids were negative for bacteria and bioactive leukoattractants [95% confidence interval (CI), 0–1.9%; 99% CI, 0–2.9%]. This is significantly less than a recently reported incidence of 5.09% (P = 0.002). Incidentally, artifacts with light microscopic morphology consistent with spermatozoa were found during the detailed light microscopic evaluation of AF Gram stains from 2 (1.1%) AF samples in otherwise uneventful pregnancies, a previously unreported finding. Scanning electron microscopy was used to confirm the light microscopic findings.Conclusions: Occult intraamniotic infection in the second trimester is not as high as recently
reported. AF culture in all cases of second‐trimester amniocentesis is not necessary. The identification
of spermatozoa on Gram stain of second‐trimester AF specimens needs further confirmation.
Case‐control Analysis of Clostridium difficile—Associated Diarrhea on a Gynecologic Oncology Service
Authors: Waggoner Steven E. , Barter James , Delgado Gregorio , Barnes Willard 
Published: March 2007

Objective: The incidence, morbidity, and risk factors associated with Clostridium difficile‐associated
diarrhea (CDAD) were studied in a group of gynecologic oncology patients.Methods: A case‐control analysis of gynecologic oncology patients with CDAD was carried out
from August 1986 through January 1989 in a university medical center.Results: One hundred twenty‐three stool samples were tested for C. difficile using the CDT latex
agglutination test (Marion Diagnostics, Kansas City, MO). Thirty episodes of CDAD developed in
23 patients. From August 1986 through July 1988, the incidence was stable at 1.5 episodes/100
admissions. From August 1988 through January 1989, the incidence increased to 9.9 episodes/100
admissions (P = 0.005). Compared with patients with nonspecific antibiotic‐associated diarrhea, the
study patients were hospitalized longer prior to the development of symptoms (mean 15.2 vs. 9.2
days, P = 0.006) and were admitted more frequently with diarrhea (37% vs. 11%, P = 0.015). The
rates of surgery, chemotherapy, and radiation therapy were similar. Fever (57% vs. 14%, P < 0.001),
abdominal pain (40% vs. 6%, P < 0.001), bloody stools (27% vs. 3%, P = 0.006), and leukocytosis
(64% vs. 26%, P = 0.011) were more common among the study cases. The duration, indication, and
number of antibiotics administered were similar, though once started, the mean time to symptoms
was longer in the study cases (13.7 vs. 6.1 days, P = 0.004). Seven relapses, 1 death, and 1 unplanned
colostomy occurred among women with CDAD.Conclusions: C. difficile is a serious cause of nosocomial morbidity in gynecologic oncology
patients. Diarrhea developing after antibiotic exposure is more likely to be associated with C. difficile
in patients whose symptoms develop several days after completing antibiotics and in patients with a
history of CDAD.
Evidence for In Utero Hematogenous Transmission ofGroup B β‐hemolytic Streptococcus
Authors: Robischon Kathleen , Amstey Marvin S. 
Published: March 2007

Background: The presumed ascending route of group B β‐hemolytic streptococcus (GBS) infection
from the colonized maternal genital tract is well accepted. This case report proposes a hematogenous,
selective infection of one unruptured amniotic sac over the other ruptured amniotic sac in a
twin gestation in a patient with known GBS vaginal colonization.Case: This is a case report of GBS sepsis in twin B with intact membranes. Twin A, with 28 h of
ruptured membranes, failed to show any signs of infection. The pathology of the placenta confirmed
chorioamnionitis in twin B and the absence of infection in twin A.Conclusion: The presence of culture‐positive GBS sepsis in the twin with the unruptured amniotic
sac, as well as the absence of GBS infection in the twin with the ruptured sac, suggests an alternative
means of infection for GBS infection, such as hematogenous transplacental transmission.
Candidal Retinitis in a Gynecologic Patient
Authors: Copas Pleas R. , Spann Cyril O. , Lim Jennifer I. , Horowitz Ira R. 
Published: March 2007

Background: Candidal retinitis is a rare but potentially devastating infection in the postoperative
patient. Due to the possibility of blindness if the diagnosis and treatment are delayed, we present this
report to help educate gynecologic surgeons.Case: A postmenopausal patient presented for the treatment of ovarian carcinoma. Her surgical
therapy required radical tumor debulking with partial bowel resection. The patient was begun on
intravenous (IV) hyperalimentation through a central venous catheter. On the 7th postoperative
day, a cephalosporin antibiotic was administered. Because of persistent fever, a septic workup was
instituted and revealed an infected central venous catheter that was culture positive for Candida
albicans. The patient complained of visual disturbances and an ophthalmological examination revealed
candidal retinitis. Amphotericin B and fluconazole were administered with resolution of her
fever and visual changes.Conclusion: The risk factors of malignancy, abdominopelvic surgery, antibiotic therapy, and IV
catheters are discussed. In view of the common association of these iatrogenic factors in gynecologic
and obstetrical practice, we present this case to help make physicians aware of this potentially
devastating infection.
Schistosomiasis as a Cause of Chronic Lower Abdominal Pain
Authors: Yoganathan Kathir G. , McManus Tom J. 
Published: March 2007

Background: Chronic intestinal schistosomiasis is rare in the United Kingdom. The symptoms are
nonspecific and may mimic several other gastrointestinal conditions. We present a case of chronic
intestinal schistosomiasis in a West Indian woman presenting to a genitourinary clinic.Case: The patient presented with chronic lower abdominal pain and dysuria. A sexually transmitted
disease (STD) screen was negative and midstream urine cultures were sterile. A rectal biopsy
revealed a non‐necrotizing granulomatous reaction around the ova of Schistosoma. Her symptoms
resolved with anti‐schistosomiasis therapy.Conclusion: This case illustrates that physicians should be aware of chronic schistosomiasis in the
differential diagnosis of chronic lower abdominal pain in women who have come from or visited
areas where schistosomiasis is endemic.
First‐trimester Septic Abortion Due to Salmonella enteritidis Oranienburg
Authors: Zettell LoriAnn , Jelsema Russel D. , Isada Nelson B. 
Published: March 2007

Background: Septic abortion caused by transplacental salmonella infection is extremely rare; there
are no reported cases of serotype oranienburg as an etiology.Case: We describe a patient with non‐typhoidal Salmonella enteritidis serotype oranienburg as a
cause of first‐trimester pregnancy loss. The rapid progression of this patient′s septicemia and adverse
outcome is described. The epidemiology and natural history of salmonella infections are also discussed.Conclusion: Non‐typhoidal salmonella is still a cause of morbidity in Western countries. This
infection can result in rapid‐onset fetal demise and septic abortion.
Effect of Successive Single‐gestation Pregnancies on the Course of Maternal Human Immunodeficiency VirusDisease and Perinatal Transmission
Authors: Robinson William R. , Wiley Dan , Van Dyke Russ 
Published: March 2007

Objective: This study was undertaken to examine the effect of successive pregnancies over a 3‐year
period on the course of maternal human immunodeficiency virus (HIV) infection and the rate of
perinatal transmission of HIV.Methods: A retrospective analysis of 32 pregnancies in 14 known HIV‐infected women vs. a
matched control group of HIV‐infected women who had been pregnant only once was done.Results: The multiple‐pregnancy group was similar to the single‐pregnancy group for age, race,
duration of known HIV infection, initial CD4 count, and date of first pregnancy. The delivery data
were similar as well. The CD4 counts in the multiple‐pregnancy group fell from 595 to 460, while
counts in the single‐pregnancy group fell comparably from 669 to 638, both over 37 months
(P = 0.1476). Five of 5 second‐born infants of known serostatus vs. 8 of 21 first‐born infants were
HIV‐infected (P < 0.05).Conclusions: Successive pregnancies do not alter the course of HIV infection in asymptomatic
women followed up to 3 years. The infants of second pregnancies of known HIV‐infected women
may be at higher risk for perinatal transmission.
Trichomonas vaginalis Weakens Human Amniochorion in an In Vitro Model of Premature Membrane Rupture
Authors: Draper Deborah , Jones Ward , Heine R. Phillip , Beutz Michelle , French Janice I. , McGregor James A. 
Published: March 2007

Objective: Trichomonas vaginalis (TV) infection is associated with preterm rupture of membranes
(PROM) and preterm birth. We evaluated the effects of TV growth and metabolism on preparations
of human amniochorion to understand and characterize how TV may impair fetal‐membrane
integrity and predispose to PROM and preterm birth.Methods: Term fetal membranes were evaluated using an established in vitro fetal‐membrane
model. Fresh TV clinical isolates were obtained from pregnant women. The protozoa (5.0 × 105 to
1.5 × 106/ml) were incubated with fetal membranes in modified Diamond′s medium for 20 h at 37°C
in 5% CO2.The effects of fetal‐membrane strength (bursting tension, work to rupture, and elasticity)
were measured using a calibrated Wheatstone‐bridge dynamometer. Tests were also performed to
evaluate the effects of 1) inoculum size; 2) metronidazole (50 μg/ml); and 3) cell‐free filtrate.Results: The TV‐induced membrane effects were 1) isolate variable; 2) inoculum dependent; 3)
incompletely protected by metronidazole; and 4) mediated by both live organisms as well as protozoan‐free culture filtrates. Six of 9 isolates significantly reduced the calculated work to rupture
(P ≤ 0.02); 7 of 9 reduced bursting tension; and 1 of 9 reduced elasticity. One isolate significantly
increased the work to rupture and bursting tension (P ≤ 0.002).Conclusions: In vitro incubation of fetal membranes with TV can significantly impair the measures
of fetal‐membrane strength. This model may be used to delineate the mechanisms of TV‐induced
membrane damage. This study suggests that there are enzyme‐specific effects as well as pH effects.
Vaginal Mucositis in Measles
Authors: Chamales Ingrid A. , Napolitano Peter G. , Rosa Cesar 
Published: March 2007

Background: Measles (rubeola), a common childhood exanthema, occurs infrequently in adults.
Vaginal mucositis in association with measles is not commonly described.Case: During a recent measles epidemic, 2 female patients presented with high fever, myalgia,
exanthema, and prostration. On examination, each patient had marked inflammation and tenderness
of the vaginal mucosa, prompting the presumptive diagnosis of toxic shock syndrome. The
evolution of the illness was consistent with measles. Cervicovaginal cultures were negative for
pathogens. Acute and convalescent antibody titers for Rocky Mountain spotted fever, rubella,
leptospirosis, and Proteus Ox‐19 were not consistent with a recent infection. The sera also were
negative for anti‐toxic shock toxin‐1 and anti‐streptolysin. Measles antibody titers were consistent
with a recent infection.Conclusion: Vaginal mucositis is an unusual manifestation of measles that may mimic toxic shock
syndrome.
Meconium in the Amniotic Fluid of Pregnancies Complicated by Preterm Premature Ruptureof Membranes Is Associated With Early Onset Neonatal Sepsis
Authors: Kupferminc Michael J. , Wickstrom Elizabeth , Cho Nam H. , Garcia Patricia M. 
Published: March 2007

Objective: This study was to determine the significance of meconium in the amniotic fluid of pregnancies complicated by preterm premature rupture of membranes (PPROM) without labor.Methods: A case‐control study of 31 pregnancies complicated by PPROM at 27–36 weeks gestation with meconium present (study group) and 93 pregnancies complicated by PPROM but without meconium was performed. The patients were matched for year of delivery, gestational age, race, and parity. Pregnancy and neonatal outcome variables of the 2 groups were compared.Results: The incidence of early onset neonatal sepsis was significantly increased in the study group (16.1% vs. 1.1%; P < 0.001). Similarly, chorioamnionitis (48.3% vs. 22.5%; P < 0.01), cesarean delivery for a nonreassuring fetal heart rate pattern (19.4% vs. 3.2%; P < 0.01), a 5‐min Apgar score < 7 (22.5% vs. 8.6%; P < 0.05), and fetal growth retardation (FGR) (12.9% vs. 2.2%; P < 0.05) were also more common in pregnancies complicated by PPROM with meconium. The mean umbilical cord arterial pH was significantly lower in these pregnancies (7.18 ± 0.07 vs. 7.28 ± 0.08;
P < 0.001). After controlling for confounding variables with multiple logistic regression analysis, we found that meconium in the amniotic fluid remained associated with early onset neonatal sepsis.Conclusions: The presence of meconium in the amniotic fluid of pregnancies complicated by
PPROM is associated with an increased incidence of early onset neonatal group B β‐hemolytic streptococcus (GBBS) sepsis.
Antepartum Mastitis: A Case Report
Authors: Smith-Levitin Michelle , Skupski Daniel W. 
Published: March 2007

Background: Acute mastitis commonly occurs in the postpartum period. It has been reported only rarely in the antepartum period.Case: A 14‐year‐old patient presented at 29 weeks gestation with her symptoms and examination consistent with bilateral mastitis that had worsened over 2 months. She had evidence of systemic infection. She was treated with parenteral antibiotics and local skin care. She gradually improved and delivered a healthy infant at term.Conclusion: The management of antepartum mastitis can be derived from experience with puerperal mastitis. It must include early recognition, a search for predisposing factors and causative organisms, and aggressive treatment. Such an approach can lead to successful pregnancy outcome with minimal fetal or maternal morbidity.
Lewis Phenotype in Women With Preterm Labor and Premature Rupture of the Membranes
Authors: O′Brien William F. , Leparc German F. , Holbrook Jodi 
Published: March 2007

Objective: The purpose of this study was to evaluate the possible association between Lewis phenotype status in pregnant women and preterm labor (PTL) or preterm rupture of the membranes (PROM).Methods: Red blood cell (RBC) Lewis phenotype was determined in 113 pregnant women admitted for PTL or PROM and in 121 controls. The results were controlled for the influence of race on Lewis phenotype.Results: Pregnancy was associated with a higher frequency in women with the a–b– phenotype. There was no association between RBC Lewis phenotype and the occurrence of PTL or PROM.Conclusions: A susceptibility to PTL or PROM is not due to a lack of Lewis antigen expression on
the plasma membrane of the vaginal mucosa.
Nonpuerperal Breast Infection
Authors: Casas C. Miranda , Pérez M. , Alados J. C. , Fontes J. , Orellana G. , Aguilar J. M. , Miranda J. A. , de la Rosa M. 
Published: March 2007

Objective: We undertook a microbiological study of purulent specimens from women with symptomatic breast abscesses.Methods: Fifty‐one purulent samples were collected in 2 periods (December 1991–April 1992 and January 1994–June 1994) from nonpuerperal breast abscesses in 44 patients attending our hospital.Results: One of the most frequently isolated microorganisms was Proteus mirabilis (9 patients, 20.4%), present as a pure culture in all but 1 specimen (isolated together with Peptostreptococcus spp.). Staphylococcus aureus was isolated in 10 specimens, 6 of which were post‐tumorectomy abscesses. Polymicrobial anaerobic flora were isolated in 11 specimens (21.5%); Staphylococcus epidermidis in 4 (8%); and Streptococcus milleri,Alcaligenes sp., and mixed aerobic‐anaerobic flora in 1 specimen each. The 7 remaining samples (13.7%) were negative bacteriological cultures.Conclusions: We draw attention to the frequent isolation of P. mirabilis in recurrent and torpid breast abscesses in 4 women in whom surgery was necessary in addition to antibiotic treatment.
Intrauterine Infection With Coxsackievirus: Is it a Cause of Congenital Cardiac Malformations?
Authors: Watson William J. , Awadallah Sami , Jaqua Mary Jo 
Published: March 2007

Background: Although maternal infections with coxsackievirus during pregnancy are relatively common, fetal infections are quite rare. Coxsackievirus infection in utero has been associated with myocarditis, but has not been proven a teratogen.Case: A patient whose fetus had structural cardiac anomalies and hydrops was found to have an intrauterine infection with Coxsackie B‐1 virus, proven by virus isolation from the amniotic fluid. This infection led to increasing intrauterine hydrops and subsequent neonatal death.Conclusion: This interesting association of intrauterine infection with Coxsackie B virus and structural cardiac anomalies in the fetus warrants further investigation.