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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.

Resume Staphyloccocus aureus represente 18,5 % des germes isoles des plaies operatoires et des prelevements de l'environnement hospitalier. Dans notre etude, c'est le germe le plus frequent, isole 34 fois seul, 80 fois en association avec d'autres. Vingt deux pour cent des souches S. aureus sont methicilline resistantes. Trente et un lysotypes ont ete determines; parmi eux le lysotype 3A/3C/55/71, le plus frequent, est incrimine dans l'epidemic hospitaliere observee. Les souches identifiees ont determine des autoinfections et des heteroinfections dans les services investigues.

The influence of serum and protamine on the in vitro effectiveness of some preservatives has been studied. The products tested were formaldehyde, benzalkonium chloride, esters of parahydroxybenzoic acid, benzoic and sorbic acids. Serum only strongly depleted the activity of benzalkonium chloride. In the case of protamine, this basic protein markedly enhanced the bactericidal effect of benzoic and sorbic acids and allowed a reduction in the concentration by a factor of four while still maintaining the same bactericidal power on Pseudomonas aeruginosa .

The influence of protamine and d -mannose on the adhesion of Escherichia coli to human urinary epithelial cells was investigated using one collection strain, two urinary and one fecal strain from hospital origin. At a concentration of 100 μg/ml of protamine, inhibition occurs after a brief period of contact of inhibitor with either the bacteria or epithelial cells. The same inhibition was observed with d -mannose at 1.25 mg%.

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).

We have studied the influence of protamine on the sensitivity of three strains of Pseudomonas aeruginosa to various antibiotics: streptomycin, gentamicin, polymyxin B, and β-lactams. While protamine enhanced the antibacterial action of β-lactams towards P. aeruginosa, it did not alter the effect of aminoglycosides. The antibacterial power of polymyxin B, on the other hand, was drastically reduced. The observed changes in this strain's sensitivity to antibiotics could be due to changes in the permeability of the outer membrane.

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.

There is a need for legal control of sensitivity discs. False results are obtained by the use of discs containing an antibiotic and an unlabelled antimicrobial drug. Results of sensitivity tests (performed by the disc agar diffusion method) using Levocyclin8 discs furnished by the manufacturers were highly improbable. It appeared that these discs also contained thimerosal with which they were not labelled. Excellent In vitro results were exclusively due to the mercuric compound. This experience clearly illustrates the need for control ensuring that sensitivity discs comply with the manufacturer's description.

Protamine, a basic protein, was shown to influence the activity of antibacterial agents. When added to tryptic soy broth it enhanced the bactericidal activity of cefotaxime, sulphadimethoxine, ticarcillin, piperacillin and carbenicillin against Pseudomonas aeruginosa. In contrast, the activity of polymyxin B against this species was markedly reduced in the presence of protamine.

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.

The influence of protamine on the adhesion of Pseudomonas aeruginosa to human buccal cells was investigated using 2 collection strains and 5 other strains isolated from the hospital environment. The serotype and pyocin type of the strains was established and their antibiotic sensitivity determined. For concentrations lower than 100 μg/ml there was a decrease in adhesion correlating with protamine concentration. Maximum inhibition was reached at about 100 μg/ml.

The authors recorded notable difference of sensitivity of Pseudomonas aeruginosa to chloroxylenol according to the growth medium; the amount of magnesium of the culture medium and the growth phase were not major factors. This difference, which can be extended to various strains, is due to a difference of permeability of the outer membrane. It is suggested that adsorption of medium components on the surface of the bacteria could participate in the phenomenon. Similar results were obtained with phenol and crystal violet.

Resume Nous avons rassemble les donnees concernant la sensibilite a differents antibiotiques (penicillines : carbenicilline, piperacilline, ticarcilline ; cephalosporines : cefotaxime, cefsulodine, ceftazidime ; aminoglycosides : amikacine, gentamicine, netilmicine, tobramicine ; colistine) de 462 souches de P. aeruginosa du groupe serologique 012, isolees de prelevements dans 6 hopitaux belges pendant la periode 1984–1985. Chaque hopital a utilise sa serie specifique d'antibiotiques, soit par diffusion en gelose (tous sauf Liege), soit par dilution en microplaques (Liege). Pour la serie de ces souches de 1984–1985, encore etendue aux souches de l'annee 1986 et a des souches de trois autres hopitaux bruxellois, nous avons determine les marqueurs epidemiologiques que sont le lysotype et le pyocinotype. Quoique la proportion de souches resistantes varie d'un hopital a l'autre lorsque l'on considere chaque antibiotique separement, l'on observe toujours 80 % de souches 012 montrant une resistance etendue au sein de la gamme antibiotique utilisee. Nos souches sont, pour la plupart, caracterisees par un petit nombre de lysotypes et de pyocinotypes, que l'on peut encore considerer comme apparentes ; elles pourraient donc representer un groupe relativement homogene.

Gas-liquid chromatography is suitable for the study of the bioconversion yield of dehydroisoandrosterone into Δ1,4-androstadiene-3, 17-dione. Fusarium oxysporum (a wild isolated strain) exhibits the greatest activity for this bioreaction. The optimalization of the bioconversion efficiency has been studied in culture media or in buffered solutions using free and immobilized cells. Microbiological (cell weight, choice of strains and substrate, induction) and physicochemical (pH, temperature, ionic strength and choice of buffers, organic solvents, artificial cofactors) factors influencing the reaction yield are discussed. The same operating conditions can be used for free and immobilized cells. For both techniques, about 90% of Δ1,4-androstadiene-3,17-dione is formed in 48 h with non-induced cells and in 24 h with induced cells. A simple prototype of a laboratory bioreactor is employed and tested in order to describe the advantages and limitations.

The paper presents a method for the in vitro evaluation of the effectiveness of disinfectants. It is a capacity test performed in hard water with or without horse serum. Some results are presented showing the ability of growth in disinfectant solution.

During the evaluation of the bactericidal effect of some disinfectants, the authors observed major differences of sensitivity in the case of Pseudomonas aeruginosa depending on the culture medium used for the preparation of the inoculum. In particular for chloroxylenol the results were much more favourable when the culture was made in brain heart infusion (Difco) than in tryptic soy broth (Difco).

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.

In this study, we have tried to determine the magnitude of the inaccuracy of the radioactive microsphere method - due to variations in the diameter distribution of the spheres - for measuring regional myocardial blood flow after coronary artery occlusion. In 5 mongrel dogs, three types of 15 mum microspheres, labelled with 125I, 141Ce or 85Sr, were injected simultaneously after the descending branch of the left coronary artery had been ligated. Myocardial samples wert taken from the left ventricle and divided into four groups according to the number of spheres per sample. The radioactivity of the various isotopes per gram tissue was expressed as percentage of their activity per milliliter of the reference sample. The diameter distribution of microspheres, labelled with each of the isotopes, was determined light-microscopically in suspensions belonging to three different batches. The relative error, as determined from the difference in relative radioactivity of the various types of microspheres in the tissue samples, was higher than the theoretical error for each of the number of spheres per sample. It is very likely that this discrepancy is caused by the differences in diameter distribution of the various types of microspheres, resulting in non-random error. The smaller spheres tended to go to low flow areas and the larger ones to high flow areas. Because of the non-randomness, the error due to diameter variations in the spheres can be diminished by randomizing the order of injection of the various isotopes. The present study indicates that the relatively high degree of accuracy of the microsphere method for the determination of blood flow to large parts of the myocardium with an unimpeded coronary circulation, as was described in literature, cannot be extrapolated to the determination of regional myocardial blood flow after coronary artery occlusion, when the combination of small tissue samples, variations in the diameter distribution of the spheres and an unevenly distributed myocardial blood flow unfavourably affect the accuracy of the method.

Two bacterial electrodes have been studied for the determination of nicotinamide (vitamin PP) with a linear range of 2.8 × 10-4 M to 2 × 10 -2 M. The used strains, although taxonomicaly different and differently improved (E. coli mutated and B. pumilus induced), present the same nicotinamide deaminase activity, able to be used for analytical assays. Their long-term stability (more than 100-fold higher than the purified enzyme) is realized by the regeneration of living cells on the electrode itself. The parameters involved in this type of electrode construction are discussed. This type of bacterial electrodes presents a very good selectivity for nicotinamide in multivitamin pharmaceutical formulations. © 1984., SCOPUS: ar.j, info:eu-repo/semantics/published

Stress urinary incontinence (SUI) can be due to different anatomic aberrations such as loss of the posterior urethrovesical angle, loss of the appropriate urethral axis and stability, urethral funneling and telescoping. Usually more than one of these aberrations play a part in the development of genuine SUI. The surgical procedure which results in repair of all the anatomical aberrations which contribute to stress urinary continence will be the most successful. Only a thorough preoperative investigation will disclose the underlying pathology and result in a proper diagnosis and an adequate therapy.

The authors discuss their data on quantitative and qualitative microbial contamination of vegetal raw materials and some cosmetics. Microbial limits are proposed for the cosmetics.

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.

The microbial contamination and antimicrobial effectiveness of seven topical disinfectants prepared at the hospital pharmacy were studied. These products were controlled throughout storage and use. The manufacturing routine investigated was able to deliver larger batch sizes and quality products that allowed increased storage time. The formulations chosen by the pharmacists were effective against bacteria for their intended uses. For chloramine only, loss of effectiveness required reduced storage time. No significant modification in the microbial quality of these products was observed during use in our hospital.