A pilot study of pre-operative misoprostol in reducing operative blood loss during hysterectomy.

OBJECTIVE: To investigate the effectiveness of a single pre-operative dose of sublingual misoprostol on reducing blood loss in abdominal hysterectomies performed for symptomatic uterine leiomyomas. STUDY DESIGN: A cohort of 64 women undergoing total abdominal hysterectomy for symptomatic uterine leiomyomas were randomly assigned to receive a single dose of sublingual 400 mcg misoprostol (n=32) or placebo containing 20mg vitamin B(6) (n=32) 30 min before the operation. The primary outcome was the operative blood loss. The secondary outcomes were requirement for blood transfusion, change in haemoglobin level after operation, and the incidence of side effects. RESULTS: Women who had misoprostol were found to have similar operative blood loss to those who had placebo (570.9 ± 361.3 ml versus 521.4 ± 297.4 ml, for misoprostol and placebo group respectively; P=0.803). This study with a sample size of 64 was sufficient to have 80% power at the 5% level of significance to detect a reduction of blood loss greater than or equal to 30%. There were no observed differences in the need for post-operative blood transfusion (25% versus 15.6%, for misoprostol and placebo group respectively; P=0.536), the change in haemoglobin level after the operation, and the side effects profiles between the two groups. CONCLUSION: A single pre-operative dose of sublingual misoprostol is not effective in reducing intra-operative blood loss and need for post-operative blood transfusion after total abdominal hysterectomies for symptomatic uterine leiomyomas.

Actinomyces hongkongensis sp. nov. a novel Actinomyces species isolated from a patient with pelvic actinomycosis.

A bacterium was isolated from the pus of a patient with pelvic actinomycosis. The cells were strictly anaerobic, straight, non-sporulating, Gram-positive rods. It grows on sheep blood agar as non-haemolytic, pinpoint colonies after 24 hours of incubation at 37 degrees C in anaerobic environment. It is non-motile and does not produce catalase. 16S ribosomal RNA (rRNA) gene sequencing showed that there were 6.6% difference between the 16S rRNA gene sequence of the bacterium that of Actinomyces marimammalium (GenBank Accession no. AJ276405), a new species described in 2001, isolated from two seals and a porpoise. For these reasons a new species, Actinomyces hongkongensis sp. nov., is proposed, for which HKU8(T) is the type strain. Further studies should be performed to ascertain the potential of this bacterium to become an important cause of actinomycosis.

Diagnosis of pelvic actinomycosis by 16S ribosomal RNA gene sequencing and its clinical significance.

Traditional ways of identification of anaerobic Gram-positive non-sporulating bacilli by isolation of the organism and studying it phenotypically by elucidation of its morphologic and biochemical characteristics and metabolic end products are associated with a need for special equipment and expertise, and strains that are "unidentified" because of ambiguous biochemical profiles. In this study, an anaerobic Gram-positive non-sporulating bacterium was isolated from the intrauterine contraceptive device of a 36-year old woman with pyosalpinx. The Vitek system (ANI) showed that it was 99% Propionibacterium granulosum; whereas the API system (20A) showed that it was 78% Actinomyces meyeri/odontolyticus. The 16S ribosomal RNA gene of the strain was amplified and sequenced. There was 0 base difference between the isolate and A. odontolyticus (GenBank Accession no. AJ234047), indicating the isolate most closely resembled a strain of A. odontolyticus. Identification of the organism in this study was important because the duration of antibiotic therapy would be entirely different. In the present case, identification of the bacterium as A. odontolyticus inferred that the patient suffered from an intermediate form of pelvic actinomycosis. A prolonged course of antibiotics would be more desirable, as the relapse rate of actinomycosis after a short course of antibiotics is high.