Evaluation of a rapid diagnostic test for bacterial vaginosis

Objective To evaluate a new rapid diagnostic test for bacterial vaginosis.
Design Comparison of a new biochemical diamine test with low technology tests and microbiological culture.
Setting General practice, family planning clinic.
Participants Patients attending a general practice with vaginal symptoms, women consulting for family planning and cervical smears, and women invited for health checks.
Main outcome measures Comparison of the new diamine test with microbiological culture for Gardnerella vaginalis, with clue cells, and with the amine test.
Results Two hundred and twenty-nine vaginal swabs were assayed quantitatively by the new diamine test. When compared with microbiological culture of Gardnerella vaginalis , the sensitivities and specificities were 86% and 81%, respectively. When compared with clue cell findings, the sensitivities and specificities were 97% and 83%, respectively. In the third comparison with the amine test the sensitivity was 94% and the specificity 84%. Since microbiological diagnosis of organisms related to bacterial vaginosis is difficult, the new test and existing sideroom tests may be more sensitive to the condition and the true frequency of false positives may be less than the specificity in this study suggests.
Conclusions The new diamine test is accurate, sensitive and specific, and provides the basis for the rapid diagnosis of bacterial vaginosis. Such a test is needed if bacterial vaginosis is to be diagnosed and managed effectively in both general and specialist practice.     

Cardiac abnormalities in pulmonary oedema associated with hypertensive crises in pregnancy

Objective To describe the cardiac abnormalities by two-dimensional and Doppler echo-cardiography (echo-Doppler) in hypertensive crises in pregnancy (HCP) complicated by pulmonary oedema and identify pathogenic factors.
Design A prospective observational study.
Setting King Edward VIII Hospital, Durban, South Africa.
Participants Sixteen patients with HCP complicated by pulmonary oedema over a six-month period. Two control groups, 55 patients with HCP alone and 16 with normotensive pregnancies, were also studied.
Results Echocardiography diagnosed impaired left ventricular systolic function in 4 of 16 (25 %) patients with HCP and pulmonary oedema. In the remaining 12 patients with preserved systolic function, left ventricular diastolic filling abnormalities were demonstrated in a significant proportion compared to control hypertensive and normotensive groups. Fifteen of 16 (94%) study patients presented with pulmonary oedema antepartum; in seven of these patients, the use of dexamethasone to enhance fetal lung maturity appeared to be a contributing factor in precipitating pulmonary oedema.
Conclusion This study demonstrates the value of echo-Doppler to diagnose structural and functional cardiac abnormalities in HCP complicated by pulmonary oedema. The potential role of left ventricular diastolic filling abnormalities in the pathogenesis of pulmonary oedema complicating HCP is discussed.     

Pregnancies complicated by placenta praevia: what is appropriate management?

Objective To review the outcome of pregnancies complicated by placenta praevia over a three-year period (1991–1993) and to describe in detail the antenatal course and the events leading to delivery, assessing retrospectively whether there are clinical features predictive of outcome and whether outpatient management would be reasonable.
Design A retrospective review of the case records of women with a pregnancy complicated by placenta praevia.
Setting A tertiary referral teaching hospital in Edinburgh.
Results There were 15,930 deliveries in the study period. Fifty-eight women (0.4%) had a placenta praevia in the third trimester, 42 of whom (72%) had at least one episode of bleeding. Overall, 62% of the women had a major praevia with no differences in the grade of praevia between those women who did or did not have bleeding. Both diagnosis and delivery occurred significantly earlier in women with antepartum bleeding than in those without (median gestation at diagnosis 28.6 weeks versus 33.3 weeks (   P < 0.01  ) and at delivery 36.0 weeks versus 37.1 weeks (   P = 0.04  ), respectively). Delivery by emergency caesarean section was more common in women with bleeding (62% versus 38%). An increasing number of bleeding episodes experienced by individuals was not associated with significant differences in outcomes. Rapid emergency delivery for bleeding was necessary for three women, in none of whom could the bleeding have been predicted.
Conclusions The clinical outcomes of placenta praevia are highly variable and cannot be predicted confidently from antenatal events. Nonetheless, in the majority of cases with or without bleeding and irrespective of the degree of praevia, outpatient management would appear safe and appropriate.     

皮下埋植避孕185例临床总结

应用LNG皮下埋植剂185例控制生育,无1例妊娠,有效率100％。截至1996年3月30日,使用≥2年、≥1年,不足1年的累积终止使用率分别为0.54、2.16和6.48每百妇女。主要副反应为月经失调,也是终止使用的主要原因;但总失血量不多,对身体健康无明显影响。随着使用时间的延长,副反应逐渐减少,月经失调逐渐好转。埋植剂的放置和取出术容易掌握。185例中无感染和其它合并症。     

Vit C,Trolox对阿霉素损伤鼠培养心肌细胞的作用

在原代培养的大鼠心肌细胞受阿霉素损伤的模型上,观察到合适浓度的维生素C(Vit C)能显著减少受损心肌细胞乳酸脱氢酶释放、减少细胞内丙二醛的形成,并改善细胞超微结构的变化,显示其具有抑制脂质过氧化,保护心肌细胞的作用.该作用与Vit c浓度密切相关,高浓度时反而加重细胞损伤.维生素E的水溶性类似物Trelox则没有上述作用。     

1993～1996年1312株烧伤感染菌的耐药性调查分析

目的长期监测烧伤中心病房感染细菌的菌种和耐药率，以指导临床用药。方法应用ＶＩＴＥＫ－ＡＭＳ系统检测１９９３～１９９６年我院烧伤中心１３１２株细菌的检出率及细菌耐药性变化。结果４年来检出菌种中铜绿假单胞菌居首位，检出率为３１．１６％～４８．４８％；金黄色葡萄球菌次之，检出率为１１．４８％～１６．１６％；其后为粪肠球菌、阴沟肠杆菌及不动杆菌等，但各年度位次不一。抗生素对铜绿假单胞菌敏感率超过５０％者，１９９３年为７种，１９９４～１９９６年下降为４种。万古霉素对金黄色葡萄球菌（ＭＲ－ＳＡ）为１００％敏感，而头孢菌素及喹喏铜类，对金葡菌均高度耐药（７９％～８６％）。结论长期监测烧伤中心致病菌种的变更，细菌药敏变化及选择应用敏感抗生素非常重要。     

Angiogenesis factor in endometrial carcinoma: A new prognostic indicator?

OBJECTIVE: Tumor angiogenesis is believed to be a prognostic indicator associated with tumor growth and metastasis. Studies of angiogenesis in breast, prostate, and lung cancer, as well as melanoma, have shown that neovascularization correlates with the likelihood of metastasis and recurrences. The purpose of this study was to evaluate microvessel density as a prognostic factor in endometrial cancer. METHODS: Between 1980 and 1991 the tumor registry identified 25 patients with a diagnosis of recurrent endometrial cancer. These patients were matched with 25 patients with nonrecurrent disease for age, stage, grade, and treatment. The histologic slides of the 50 patients were reviewed. The paraffin blocks were obtained, and the area of the deepest myometrial invasion was selected for staining. The microvessels within the invasive cancer were highlighted by means of immunocytochemical staining to detect factor VIII - related antigen. Microvessels were counted by two investigators who were blinded to the patients' clinical status. Survival data were analyzed with Kaplan-Meier survival curves. RESULTS: Microvessel count was related to likelihood of recurrence, although this trend did not reach statistical significance. Patients with tumors of low capillary density had a mean survival time of 123 months. Patients with tumors of high capillary density had a mean survival time of 75 months (p = 002). Among patients with recurrent disease, those with a low capillary count survived a mean of 64 months. Patients with recurrent disease with tumors of high capillary density survived a mean of 45 months (p = 0.002). CONCLUSION: Angiogenesis factor correlates with survival in endometrial carcinoma. (Am J Obstet Gynecol 1996;174:1879-84.)     

失血性休克对内毒素诱导肿瘤坏死因子α产生的影响

观察了大观察失血性休克（ＨＳ）条件下小剂量内毒素（ＬＰＳ，１μｇ／ｋｇ）对肿瘤坏死因子α（ＴＮＦα）的诱生作用及其细胞来源。结果显示，静脉注射ＬＰＳ后９０ｍｉｎ，ＨＳ＋ＬＰＳ组血浆ＴＮＦα水平分别较ＨＳ组高２０倍（Ｐ〈０．０１），较ＬＰＳ组高２．７倍（Ｐ〈０．０５）。体外研究结果显示，复苏后即刻，外周血白细胞（ＰＷＢＣ）体外产生ＴＮＦα的能力明显受抑，分别较休克前和假手术组低５５．８％和３６．５％