The use of once-daily dosing of gentamicin in obstetrics and gynecology

Gentamicin is a widely-used antimicrobial agent for obstetric and gynecologic infections. Renewed excitement in this antibiotic has arisen from recent information supporting less frequent dosing. In this symposium, we will describe the pharmacokinetics of gentamicin and review new information advocating the use of once-daily administration of gentamicin.     

Uses of nitric oxide in obstetrics and gynecology

A cDNA clone encoding a human ribosomal protein L39 (hRPL39) was isolated through a random cDNA sequencing approach to a cDNA library constructed from a human colon carcinoma cell line of COLO 205. Although levels of hRPL39 mRNA were different in several cell lines including carcinoma cell lines from different tissues, they were shown not to be cell cycle-dependent in a human fibroblast cell line of TIG-1.     

A blueprint for academic obstetrics and gynecology

A consensus conference sponsored by the Council of University Chairs of Obstetrics and Gynecology in February 1997 formulated the organization's response to the many external issues affecting academic medicine and obstetrics and gynecology including 1) a new practice model based on "wellness," 2) reimbursement changes that have jeopardized traditional revenue sources, 3) an emphasis on quality assurance based on outcomes research and evidence-based medicine, 4) the concept of lifelong learning dictated by an expanding knowledge base and new technology, 5) insufficient resources for basic and clinical investigation in obstetrics and gynecology, 6) workforce statistics indicating stabilization in the number of subspecialists, 7) the increasing diversity of the United States population. Recommendations were developed that are intended to foster change and contribute to the design of academic programs. These include appropriate training for residents as providers of primary care, with an emphasis on continuity clinics, an interdisciplinary curriculum in women's health for medical students; promotion of gender, racial, and ethnic diversity at all levels of medical education and academic leadership; creation of clinical trials research units; and the development of expanded opportunities for research in obstetrics and gynecology supported by the National Institutes of Health.     

Application of DNA fingerprinting to obstetrics and gynecology

Restriction fragment length polymorphisms (RFLP) are variations in the size of restriction fragments of genomic DNA that hybridize to specific probes. They are the consequence of changes in primary DNA sequences, most of which result from small-scale changes in DNA. Recently minisatellite DNA probes that detect many regions of great variability within the human genome have been described. Minisatellite probes consist of multiple repeated copies of a common 10-15 base pair core sequence. On hybridization to restriction enzyme digests of human DNA, they simultaneously detect many highly polymorphic minisatellites at different loci in the genome, and produce band patterns that are individual specific. The band patterns are called "DNA fingerprints" or "DNA barcode" which can be used for individual identification on forensic and legal medicine. In addition to forensic and legal medicine, DNA fingerprinting can be used in both basic research and clinical examination of obstetrics and gynecology. The RFLP bands in DNA fingerprinting are inherited as single Mendelian co-dominants and we can use such minisatellite DNA probe for the determination of zygosity in multiple pregnancy. This probe can be used for the determination of androgenesis as a cause of complete hydatidiform mole. Each polymorphic band in molar tissues could be identified as being of paternal but not maternal origin. Some polymorphic bands of paternal origin were not observed in molar tissues, indicating that endoreduplication of a normal haploid sperm or fertilization by dispermy to an anuclear oocyte with no effective genome could be the cause of complete hydatidiform mole (androgenesis).(ABSTRACT TRUNCATED AT 250 WORDS)     

Three-dimensional ultrasonography in obstetrics and gynecology: preliminary experience

OBJECTIVE: Technologic advances in ultrasonographic imaging have revolutionized the management of women's health care. We recently began to evaluate the clinical applications of three-dimensional ultrasonography. STUDY DESIGN: This study prospectively evaluated 161 obstetric and gynecologic patients. Both two- and three-dimensional imaging data were acquired from real-time ultrasonography. Three orthogonal planes were displayed on a monitor and were used to create the rendered three-dimensional images. RESULTS: To date, 201 three-dimensional ultrasonographic studies have been performed, 165 transabdominally and 36 transvaginally. Transabdominally, an average of eight acquisitions per patient were obtained. Of the clinically suspected abnormalities, 29 of 32 (91%) were confirmed by three-dimensional imaging. Three of 32 (9%) improved the diagnostic capabilities or changed the diagnosis. Of the 36 transvaginal studies, an average of four acquisitions per patient were done. Thirty (83%) of these patients had suspected abnormalities and all were confirmed. CONCLUSIONS: Three-dimensional ultrasonographic imaging appears to be highly promising in the clinical setting.     

妇产科护理促进护患交流

妇产科护士把握好护士角色,可以和患者进行心理交流和沟通,从而改善护患关系,促进病人早日康复.     

Gas embolism in obstetrics and gynecology. A review

Recent data suggest that the clinical course of reactional states in leprosy is closely related to the cytokine profile released locally or systemically by the patients. In the present study, patients with erythema nodosum leprosum (ENL) were grouped according to the intensity of their clinical symptoms. Clinical and immunological aspects of ENL and the impact of these parameters on bacterial load were assessed in conjunction with patients' in vitro immune response to mycobacterial antigens. In 10 out of the 17 patients tested, BI (bacterial index) was reduced by at least 1 log from leprosy diagnosis to the onset of their first reactional episode (ENL), as compared to an expected 0.3 log reduction in the unreactional group for the same MDT (multidrug therapy) period. However, no difference in the rate of BI reduction was noted at the end of MDT among ENL and unreactional lepromatous patients. Accordingly, although TNF-alpha (tumor necrosis factor) levels were enhanced in the sera of 70.6% of the ENL patients tested, no relationship was noted between circulating TNF-alpha levels and the decrease in BI detected at the onset of the reactional episode. Evaluation of bacterial viability of M. leprae isolated from the reactional lesions showed no growth in the mouse footpads. Only 20% of the patients demonstrated specific immune response to M. leprae during ENL. Moreover, high levels of soluble IL-2R (interleukin-2 receptor) were present in 78% of the patients. Circulating anti-neural (anti-ceramide and anti-galactocerebroside antibodies) and anti-mycobacterial antibodies were detected in ENL patients' sera as well, which were not related to the clinical course of disease. Our data suggest that bacterial killing is enhanced during reactions. Emergence of specific immune response to M. leprae and the effective role of TNF-alpha in mediating fragmentation of bacteria still need to be clarified.     

Quality assurance and risk management in gynecology and obstetrics]

The predominance of medical experts in hearings on so-called professional malpractice has frequently been bemoaned, but is indispensable since lawyers lack the necessary knowledge and requisite expertise. Court decisions are therefore essentially dependent on the quality of expert medical opinions, which in turn are dependent on the professional competence of the expert and on whether the expert is aware of the judicial demands made of him, i.e. whether the expert correctly understands his status and function within the scope of the civil or criminal proceedings. For example,the fact that court practice allows for differing standards (i.e. that medical standards can vary within limits) is important for the expert's appraisal, as is also knowing to what extent he is bound by the assignment and which requirements apply for proving causality (i.e. of an error leading up to damage) in civil and criminal proceedings. Strict objectivity, comprehensible language, restriction to one's own special field, preparation of the report within a reasonable time, intellectual integrity, no dealing with legal issues, ex ante assessment of the case and personal responsibility for the opinion are other important precepts that must be adhered to in order to avoid a miscarriage of justice. Quality control as exercised by specialised experts is therefore of vital significance.     

Ethical challenges in the managed practice of obstetrics and gynecology

Obstetrics and gynecology has been transformed from a fee-for-service, unmanaged system to a prepaid managed system. This change poses significant ethical challenges, which we address. We show that obstetrician-gynecologists and medical institutions are moral co-fiduciaries of female and pregnant patients, that the obstetrician-gynecologist should be economically disciplined without capitulating to managed care, and that managed care organizations have an obligation to support the medical education and research from which they benefit.     

Improving the processes of care and outcomes in obstetrics/gynecology

BACKGROUND: The obstetrics/gynecology department of York Hospital (York Health System, York, Pennsylvania) initiated a program to improve the processes of care and control costs for common women's and newborns' health care services. Twelve clinical policies were established between June 1993 and February 1995. CONDUCTING THE QUALITY IMPROVEMENT (QI) PROJECTS: Using the plan-do-check-act (PDCA) improvement cycle method, the QI group established clinical pathways for high-volume conditions or procedures known to have low rates of complications and clinical guidelines for those conditions or procedures not requiring coordinated efforts of a group of health care professionals. EXAMPLE--PYELONEPHRITIS IN PREGNANCY: The literature had indicated that the prevalence of pyelonephritis can be decreased by identifying and treating asymptomatic bacteriuria early in prenatal care. After the validity of the clinical policy was demonstrated in the resident service, the policy was extended to all private obstetric practices. Dissemination of the finding that most of the admissions for pyelonephritis were for referred patients (for whom we had no control over prenatal care) or for patients referred by private physicians who were not yet following the guidelines quickly led to complete compliance by our obstetricians and other health care providers referring patients to the York Health System. RESULTS: The 12 clinical policies resulted in the elimination of 113 admissions and 5,595 inpatient days and in the reduction of the cost of patient care by $1,306,214 for the years 1994-1995 and 1995-1996 combined, without apparent adverse effects on patient health. CONCLUSION: A voluntary clinical policies program can change the culture of a department and lead to cost-effectiveness and better quality of patient care.     

Possibilities of the use of 3-dimensional ultrasonography in gynecology and obstetrics

The authors report their experiences with 3 dimensional ultrasound technique applied in cases of 286 obstetrical and 35 gynecological examinations. Combison 530, 3 D ultrasound equipment was used. Pathological signs were found in 14 cases. The introduction of this technique has been increasing the diagnostic accuracy of prenatal and gynecological ultrasound examinations, and some malformations, that could have never been seen by "traditional" 2 D methods, can be visualized as well.     

围手术期间妇产科感染的分析

本文通过对本院妇产科2007年5月至2010年3月收治的216例妇产科手术患者进行了临床研究分析,在对妇产科患者围手术期感染的预防及处理时,一定要遵照本文中预防性使用抗生素时的原则,同时加大对感染病原体研究,力争做到对症下药,提高感染预防及处理的成功率,为广大患者带来福音、为和谐社会出一份力.     

Rationalization of the use of preoperative thoracic radiography in obstetrics and gynecology

Mitochondria of helminth parasites produce energy in a number of ways that vary from species to species, and, in general, do not possess a classical tricarboxylic acid (Krebs) cycle. The process of protein synthesis, which is energy dependent, is not well understood in this organelle. However, protein synthesis in helminth mitochondria seems to serve the purpose to the desired level despite its limited capacity to produce ATP compared to its mammalian counterpart. Data presented here demonstrate that helminth mitochondria can synthesize proteins in vitro and the process can be supported by energy supplied exogenously by the cytosol, by an ATP generating system utilizing a substrate such as malate, or by ATP itself.     

Psychosomatic obstetrics and gynecology in the next millennium: some thoughts and observations

Diagnostic pitfalls exist when benign salivary gland diseases are mistakenly classified as malignant, with consequences for treatment and prognosis. Examples are necrotizing sialometaplasia, metaplastic Warthin tumour and sclerosing polycystic sialadenopathy. The proper diagnosis is of eminent importance to distinguish cases of primary tumours that have developed in salivary glands or their lymph nodes from cases of extraglandular tumours with metastases in these glands or their nodes. In these cases clinical data and additional immunocytochemical methods are necessary to clarify the exact diagnosis, especially when the primary salivary gland tumours have a structure largely identical to the metastases (e.g. squamous cell carcinoma). Nasopharyngeal or cervical chordomas can be mistaken for pleomorphic adenoma or mucinous adenocarcinoma. The initial stage of malignant MALT lymphomas in association with Sj?gren's syndrome demands identification of clonal rearrangement for therapeutic implication. The diagnostic criteria for proper classification are analysed in detail.