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Objective: To document the frequency of genital herpes recurrences in men and women with histories of recurrent genital herpes during 1 year of continuous, suppressive therapy with valacyclovir hydrochloride (HCl)., Methods: In an open-label clinical trial conducted at 11 centers, 127 subjects (46 women and 81 men) with histories of recurrent genital herpes (at least 6 recurrences per year) were treated with valacyclovir HCl (500 mg once daily), and their clinical status was followed up for 1 year. Genital herpes recurrences were documented in diaries, and quarterly clinic visits were made for evaluating lesion recurrences and drug safety. In cases of recurrence, subjects self-treated with valacyclovir HCl 500 mg twice daily for 5 days, then resumed once-daily treatment., Results: After the first 3 months of suppressive therapy, 81% of subjects were free of recurrence. Recurrence-free rates remained undiminished during the second, third, and fourth quarters (84%, 84%, and 91%, respectively) and were similar for men and women. Thirty of 46 women (65%) and 56 of 81 men (69%) remained recurrence free during the study and therapy was well tolerated. Adverse events were mild, infrequent, and not considered related to the study drug., Conclusion: Valacyclovir HCl was highly effective and well tolerated as continuous suppressive therapy in men and women with recurrent genital herpes. Potential benefits of the once-daily regimen of valacyclovir HCl include improved patient compliance.

Objective: To compare the effectiveness of the Cytobrush plus plastic spatula with that of the Cervex Brush for obtaining acceptable yields of endocervical cells in Papanicolaou smears., Methods: We collected 309 smears over a 6-month period, 132 with the Cytobrush plus spatula and 177 with the Cervex Brush. About one-third of the patients in each group were pregnant. Numbers of endocervical cells in the smears were described as none, few, moderate, or many., Results: Moderate or large numbers of endocervical cells were collected from 60.5% of the women in the Cervex Brush group and 65.2% of those in the Cytobrush-spatula group. The percentages were not statistically different., Conclusion: The Cytobrush plus spatula and the Cervex Brush sampling methods were equally effective in obtaining endocervical cells in routine Papanicolaou smears.

Radiation-induced fistulas of the vagina are rare, occurring in only 1 of 3% of patients treated for cancer of the uterine cervix. Primary surgical repair of these fistulas is usually unsuccessful because the defect is a result of devascularization. This type of radiation injury results from endarteritis obliterans, and successful repair requires an accessory blood supply. From 1971 to 1980, the authors performed 14 Martius procedures on 12 patients with radiation-induced rectovaginal fistulas. Eleven patients had successful closure of their fistulas using this procedure, and no operative complications occurred. The Martius procedure is effective for most radiation-induced vaginal fistulas, and the operation is well tolerated by most patients.

This project was designed to determine if the presence of fibrin degradation products (FDP) in the blood are of value in the preoperative evaluation of patients with pelvic masses. This study comprised 120 consecutive patients who were evaluated for a diagnosis of pelvic mass, ovarian cyst, or ovarian carcinoma. A blood sample was drawn from each patient and fibrin degradation products were determined utilizing the Thrombo-Wellcotest. Platelet counts and partial thromboplastin time (PTT) were also determined on each patient. Ovarian carcinoma was present in 17 (14.2%) of the patients. The FDP was found in the serum of 16 (94.1%) of the patients with ovarian carcinoma. One (5.9%) of 17 patients with ovarian carcinoma had a negative FDP (less than 10 mg/ml). Eleven of the 120 patients (9.2%) had a positive FDP with no demonstrable etiology. A sample of fluid was obtained from two cystic ovarian carcinomas and when analyzed for FDP both samples were strongly positive.

A double-blind, placebo-controlled study was undertaken to evaluate the long-term efficacy and safety of oral acyclovir suppressive therapy over a 1-year period. Results from the multicenter trials, based on a total of 261 patients with frequently recurring genital herpes, were analyzed. Of the patients enrolled in the study, 131 received oral acyclovir capsules (800 mg) daily and 130 received placebo capsules. Medication was taken twice daily. Analysis of data from patients who completed a full year of therapy demonstrated that only 5% of patients receiving placebo were free from recurrences, as compared with 46% of acyclovir recipients. The mean number of recurrences for patients on acyclovir therapy was 1.8, as compared with a rate of 8.7 recurrences for the placebo group over the course of the year. The mean time to the first recurrent herpes outbreaks was 19 days for the placebo group and 274 days for the acyclovir-treated patients. There were no significant differences between the two groups in laboratory data or in the frequency or nature of side effects reported. Daily administration of acyclovir capsules for 1 year is a safe and effective therapy for control of frequent recurrences of genital herpes.

The healing of a midfibular fracture was studied in mature rats. The strength of the healing fracture was determined by a constant speed-driven tensiometer which measured the force required to separate the healing callus. The breaking strength of the healing experimental fracture was ascertained in control, estrogen-treated, and oophorectomized animals. The fracture strength was not significantly different in any of these groups.

Spontaneous rupture of the esophagus is associated with continuous nausea and vomiting in the chronic alcoholic. The following is a case report of a similar occurrence in a young, healthy, primigravida with hyperemesis gravidarum. To our knowledge, this has not previously been reported in the obstetric literature.

Six hundred ambulatory women were screened with the Endo-pap cytology sampler in two medical centers. None of the women developed complications from the use of the instrument. Their smears were routinely processed together with cervical cytology smears. One hundred fifty-three of these women had a tissue diagnosis by endometrial biopsy, dilatation and curettage, or hysterectomy. Adequate cytology specimens were obtained in 93% of these patients. In these 153 patients, 32 (18%) had a tissue diagnosis of endometrial adenocarcinoma, and 31 patients had a tissue diagnosis of endometrial hyperplasia. The cytology samples obtained with this device were diagnostic of endometrial adenocarcinoma in 30 (94%) of these 32 patients and ten (32%) of the patients with endometrial hyperplasia. Two patients (1.6%) were diagnosed falsely positive. The Endo-pap cytology sampler is considered a safe and effective screening tool for endometrial adenocarcinoma. Its value in diagnosing endometrial hyperplasia remains to be determined.