Pelvic Inflammatory Disease: Risk Factors and Microbial Etiologies

Objective: To review the risk factors and microbial etiologies of pelvic inflammatory disease (PID).
Data sources: Include 77 current and historical references on PID, PID risk factors, and sexually transmitted diseases.
Study selection: 34 studies that address specific research questions.
Data extraction: Data were used from studies whose methodologies are discussed.
Data synthesis: This review identifies research problems regarding the definition, diagnosis, and identification of microbial profiles and risk factors of PID.
Conclusions: More reliable diagnostic criteria for the varied clinical presentations of this polymicrobial infection are needed. PID is a disease with multiple, interrelated risks. Education is an important nursing intervention.     

Normal Electrophysiological Findings in a Patient with Symptomatic Intermittent Advanced Atrioventricular Block

This report describes an otherwise healthy young woman who presented with syncope during episodes of advanced atriovenlricular (A V) block. The His bundle recordings during normal sinus rhythm and atrial and ventricular pacing were normal. Carotid sinus massage produced no abnormality. Subsequently, (he patient received a permanent pacemaker and has been free of symptoms. In termittent advanced A V block has been observed on follow-up electrocardiograms. This unique case demonstrates a potential limitation of routine electrophysiologic investigation.     

Chorionic Villi Sampling: A Nursing Perspective

A relatively new procedure, chorionic villi sampling is now available as an alternative method for prenatal diagnoses of genetic disorders during pregnancy. Indications, procedures, risks, advantages, and nursing implications of this procedure are defined and described. Readers are thereby provided with current information concerning prenatal genetic diagnosis that may be passed on to patients in need of this information.     

Zinc deficiency impairs T cell function in mice with primary infection of Heligmosomoides polygyrus (Nematoda)

This study was designed to determine whether severe zinc deficiency would prolong the course of a primary Heligmosomoides polygyrus infection in mice, and whether this could be related to impaired T cell function. Female BALB/c mice were fed a zinc-sufficient (Zn+; 60 mg/kg), a zinc-deficient (Zn-; 0.75 mg/kg) or an energy restricted (PF; 60 mg zinc/kg) diet. After four weeks, some mice in each dietary group were given a primary infection with 100 larvae; nutritional, parasitological and immunological parameters were assayed over the following five weeks. Liver zinc concentrations were significantly reduced in Zn- mice compared with Zn+ mice. In certain cases, PF mice also had reduced liver zinc concentrations, showing the negative effects of restricted food intake on zinc status. Zinc deficiency prolonged the course of a primary infection, with the effects being most evident five weeks post-infection when Zn+ mice had only 40% as many worms as Zn- mice. Parasite infection induced strong immunological responses in Zn+ mice in contrast to Zn- mice. The reduced production of IL-4 and IFN-γ, the reduced peripheral eosinophilia and reduced serum levels of IgE and IgG1 in Zn- mice were attributed to the zinc deficiency, whereas the reduced delayed type hypersensitivity response to parasite antigen and reduced production of IL-5 were in certain instances attributed to reduced energy intake rather than zinc deficiency. These results show that zinc deficiency significantly impairs functions normally attributed to both Th1 and Th2 cell populations, and that these alterations are associated with elevated worm numbers in zinc-deficient mice.     

Contraceptive Counseling for the Younger Adolescent Woman A Suggested Solution to the Problem

The younger adolescent woman seeking contraceptive counseling presents clinicians with special problems specific to her age group. These include long-term physiological considerations plus psychological and social dynamics. An individualized clinic program, with emphasis on backup contraceptive methods, is suggested as a comprehensive solution.     

Congenital Erythropoietic Porphyria. II. The Effects of Induced Polycythemia

Polycythemia and anemia were inducedin a patient with congenital erythropoietic porphyria as a possible means ofaltering erythropoiesis and its attendantporphyrin production. Maintenance ofhematocrits at 50 per cent and 60 percent for periods of 2 weeks decreasedboth erythropoiesis and porphyrin excretion to about one-half of their initiallevels. Conversely with a hematocrit of25, erythropoiesis and porphyrin production were increased to about twice thebasal level. Examination of the marrowshowed fluorescence in all late normoblasts and indicated that the patient hasonly one red cell population. During induced polycythemia, a shift in marrowerythroid population to relatively matureforms, apparently related to delayedenucleation, was accompanied by a retention of the reticulocyte pool andfluorescent cells within the marrow. During anemia, the occurrence of relativelymore immature erythroid cells was accompanied by a shift of the reticulocytepool and fluorescent cells into the circulating blood. During polycythemia, increases were observed in the relativenumber of nuclear vacuoles peculiar tothis disease, in the retention of radioironin the marrow and in the relative amountof stercobilin excretion. In anemia theseparameters decreased towards normal.

Submitted on June 30, 1969 Revised on March 16, 1970 Accepted on April 1, 1970     

Trisomy 11: an association with stem/progenitor cell immunophenotype

Summary. The clinicopathological features and the prognostic significance of acute myeloid leukaemia (AML) with trisomy 11 are currently unknown. In this study we describe 15 adult AML cases with trisomy 11. Trisomy 11 was the sole chromosomal anomaly in eight cases; the remaining seven cases were characterized by +11 in association with other karyotypic aberrations. Patient ages ranged from 34 to 79 years. 12 patients were male; three were female. Although there was no correlation of trisomy 11 with any specific FAB subgroup [M2 (n=7). Ml (n=5), M4/5 (n=2), M3 (n=l)] less mature forms predominated. Immunologically, the leukaemic blasts showed a strikingly consistent stem cell phenotype with expression of HLA-DR, CD34 and the myeloid antigens (CD15, CD33 and/or CD13). In addition, two cases expressed the B-cell associated antigen CD19. The presence of trilineage dysplasia, suggesting the presence of an underlying myelodysplasia (MDS), was observed at presentation in five cases; in another case MDS was evident at relapse only. Unexpectedly, MLL gene rearrangements were observed in two of four cases characterized by trisomy 11 as the sole karyotypic abnormality; however, MLL aberrations were not identified in three cases with trisomy 11 accompanied by other karyotypic anomalies. The majority of patients in each subgroup (i.e. those with and without additional cytogenetic abnormalities) achieved a short first complete remission (CR) (mean 8 months) and failed to obtain a second CR. Only one patient in each trisomy 11 subgroup is in a continuous CR for >34 months. These findings suggest that trisomy 11 leukaemia is characterized by a stem/progenitor cell immunophenotype with poor response to standard chemo-therapeutic regimens and an unfavourable prognosis.