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Contains fulltext : 49716.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To study the outcome and complications of surgical treatment for vulvar vestibulitis syndrome and to identify patient characteristics that may have influenced the outcome. METHODS: Relevant patient characteristics were extracted retrospectively from the medical records of 155 women aged 40 years or younger who had received surgical treatment for vulvar vestibulitis syndrome. To assess outcome and complications, 126 of these 155 women (81%) participated in a telephone interview, conducted 1 to 4 years after surgery. RESULTS: After surgery 93% of the patients could have sexual intercourse compared with 78% before surgery; this increase was statistically significant (Mantel-Haenszel odds ratio 3.43, 95% confidence interval [CI] 1.48-7.96). In 62% of the women (95% CI 53-70%), sexual intercourse was painless after surgery. Eighty-nine percent (95% CI 84-95%) would recommend surgical treatment to other women experiencing vulvar vestibulitis syndrome. There were no major complications. Decreased lubrication during sexual arousal was the most frequently reported adverse effect (24%, 95% CI 16-32%), followed by the development of a Bartholin's cyst (6%, 95% CI 2-10%). More of the women aged 30 years or younger reported that they could have sexual intercourse after surgery, and more of them would recommend surgical treatment to other patients than women aged 31 years or older. CONCLUSION: Surgical treatment for vulvar vestibulitis syndrome achieved high success rates with an acceptable rate of complications. Age of 30 years or younger was associated with a better outcome. LEVEL OF EVIDENCE: III.

Following a one-month prospective study of antimicrobial drug use in surgical departments, new guidelines were implemented. The review was repeated after two years. In both study periods, one third of patients were prescribed antimicrobial drugs. Prophylactic antibiotic consumption decreased from 0.75 to 0.53 defined daily doses/operation. Compliance with guidelines improved from 32% to 79%. Duration of prophylaxis > 24 h decreased from 21 % to 8%. Single dose prophylaxis increased from 34% to 80%. Quality of the prophylactic courses improved, as evaluated by experts using established criteria. For prophylaxis, cost savings amounted to 57%. Better quality of therapeutic courses was associated with a cost increase of 15%. Indicators of satisfactory outcome with the new policy were a stable median length of stay (5.5 days in the first review and 5.0 days after intervention) and a reduction in the number of nosocomial infections treated with antimicrobial drugs/100 bed days (1.0 before intervention vs 0.77 after intervention).

Seventy-nine staphylococcal strains isolated from blood cultures (57 coagulase-negative staphylococci (CNS) and 22 S. aureus) and 308 CNS isolated from the skin of healthy donors were phage typed. S. epidermidis and S. capitis were readily typed with 91 strains out of 124 and 24 strains out of 43 strains being successful. Species such as S. haemolyticus, S. hominis and S. simulans could be moderately phage typed. Others gave only a few strains capable of being typed, such as S. saprophyticus and S. sciuri. Under our experimental conditions the S. warneri, S. xylosus and S. cohnii could not be typed with our set of phages.

A design is descirbed of a modified placebo-controlled double-blind clinical trial procedure. The design was evolved in attempt to overcome certain problems inherent in the conventional double-blind procedure, in particular the ethical problem of prolonged exposure of the patient to placebo treatment. The modified designs consist of two phases. In the first (open) phase, patients selected according to the normal protocol requirements are given the medication under study for a predetermined time. Patients responding favorably to such treatment then enter a second (double blind) phase during which is tested the null hypothesis that all the favorable effects observed during the open phase are placebo effects. Experience with this clinical trial design in the evaluation of an antianginal agent is briefly described. In this case, the null hypothesis was disproved, and a potent therapeutic action was evidenced.

Routine typing was performed on a total of 7089Pseudomonas aeruginosa strains isolated in 16 Belgian hospitals in the period from 1977 to 1986. The annual number of strains received ranged from 318 to 1346. The incidence of serotype O: 12 was less than 2 % until 1981 when it rose to 4 %, steadily increasing to become the predominant serotype in 1984 (22 %), 1985 (18 %) and 1986 (22 %). Since 1980 the O: 12 isolates have exhibited characteristic patterns on pyocin and phage typing, 89 % of O: 12 isolates belonging to pyocin types 1, 39, 43, 45 or 105, whereas only 51 % of isolates of other serotypes belonged to those pyocin types. Ninety-three per cent of serotype O: 12 isolates belonged to phage types 68/119x, 68 or 119x, or were non-typable, whereas only 24.37 % of other serotypes isolates exhibited these phage patterns. These distinctive patterns of pyocin and phage types suggest a high degree of homogeneity within the O: 12 strains isolated in recent years in Belgium. Multi-centre or country-wide survey ofPseudomonas aeruginosa strains isolated in hospitals using epidemiological markers may be of value in identifying a sudden increase in epidemic strains.

Multitechnical non-invasive procedures were used to assess the arteriolar effects of cinnarizine and its difluoroderivative, flunarizine, in 20 normal volun teers and in 43 elderly patients with occlusive disease of the extremities due to arteriosclerosis, 22 of whom had intermittent claudication. The trial involved six separate studies of which three were double-blind cross-over, one was a 6- month open study followed by a 6-month double-blind study and two were open studies. Significant drug-related effects were obtained by venous occlusion plethysmometry, differentiated pulse plethysmometry, oscillometry, claudicom eter, postexercise arm-ankle pressure gradients and exercise tolerance measure ments, but not by light plethysmometry and skin temperature measurements. The results indicated that cinnarizine and flunarizine improved vascular disten sion and blood flow in normal volunteers, as well as in patients with occlusive disease of the extremities due to arteriosclerosis. The patients also showed increased postexercise arm-ankle pressure gradients, improved arterial pulsa tions and better exercise performance and tolerance. The drugs were devoid of effects on sympathetic reflexes, resting blood pressure and pulse rate; they were devoid of side-effects and were well tolerated also by patients treated with antihypertensives and cardiac glycosides. Flunarizine was at least as effective as its parent compound at two to three times lower dose levels.

Aromatase inhibition by delta 1-testolactone [(17 oxa-D-homo 1,4 androstanediene-3,17 dione) 500 mg twice daily for 10 days] in nine normal men lowered circulating estradiol (E2) levels by about 25%, enhanced the secretion of FSH, 17-hydroxyprogesterone (17-OHP), and to a lesser degree testosterone (T), but did not affect serum LH levels. Despite E2 lowering there was greater accumulation of 17-OHP than of T after 7 days of treatment, suggesting 17,20-lyase inhibition. Unexpectedly, administration of delta 1-testolactone almost halved the T response to hCG (Pregnyl, 1500 IU), but did not affect the 17-OHP response. Thus, E2 lowering by testolactone aggravated the hCG-induced 17,20-lyase block present before testolactone administration. Although the present data might suggest that estrogens do not play a role in the genesis of the hCG-induced late steroidogenic block, the results suggest that testolactone per se, in addition to its reported antiestrogenic action, inhibits 17,20 lyase.

An overall analysis was made of 4763 case report forms from 45 anesthesiologists who used etomidate (Hypnomidate) routinely as an induction hypnotic in a total of 4127 surgical cases or compared it to thiopental in a series of controlled studies (325 on etomidate, 311 on thiopental). Premedication was standardized only in the controlled studies, and there were no restrictions on the use of anesthetic agents or techniques. Etomidate proved to be a safe and effective induction hypnotic. Sleep was deep and long enough to allow the normal induction and maintenance procedures. Blood pressure and heart rate remained remarkably stable in the 3 study groups. The incidence of respiratory depression was higher for thiopental; anesthesiologists' acceptance of etomidate was, however, reduced by the occurrence of venous pain during injection and of associated involuntary muscle movements. It is expected that these adverse effects will be largely eliminated by using the recently introduced new formulation of etomidate shortly after fentanyl.