Bacteriuria of pregnancy: results of treatment

A screening programme involving approximately 6,000 pregnant negro females has revealed the incidence of bacteriuria to be three per cent in Jamaica. Asymptomatic bacteriuria was shown to be associated with a higher incidence of pyelonephritis, prematurity, pre-eclamptic toxaemia and other hypertensive disorders of pregnancy (Stuart et al, 1965, Brit. Med. J., 1, 554). Present study was undertaken, in order to eradicate bacteriuria and study the results of this. One hundred and fifty bacteriurics were treated with nitro-furantoin (100 mg. twice daily) and a matching placebo on a double blind basis. In distinction to long-term therapy (Kincaid-Smith, P., 1965, International symposium on Progress in Pyelonephritis, Ed. by E. H. Kass, p. 11, Davis, Philadelphia a short three-week course was found sufficient to keep approximately 80 per cent patients bacteria-free for the rest of the pregnancy. All relapses except one cleared on a repeat course. Approximately 60 per cent of subjects on placebo therapy remained positive to delivery. Clinical pyelonephritis occurred in 30 per cent of untreated or unsuccessfully treated bacteriurics. Early foetal loss, prematurity and relatively small size of babies were twice as common in persistent bacteriurics as compared with successfully treated group. The offspring of the treated and persistent bacteriurics were studied for rates of growth in the first four months of life. No clearcut difference has emerged as yet. Twenty treated and untreated patients have been subjected to renal function tests. The tests include urinalysis, blood urea, electrolytes, dehydrated osmolaity, water concentration test, creatinine clearance test and intravenous pyelogram by the infusion technique. No gross abnormality has been demonstrated although the results in successfully treated groups seem to be superior to those in untreated groups (AU)

Haemorrhage - a complication in the treatment of chorion carcinoma by chemotherapy

Brief mention is made of this condition which is infrequent in Jamaica as compared with the Orient. The incidence of this condition among Orientals living in the U.S.A. and among Orientals in the East is compared. Four cases of chorion carcinoma treated with chemotherapy are described. Two cases were treated with chemotherapy without hysterectomy and bilateral internal iliac artery ligation. In both of these case with every course of chemotherapy continuous and profuse vaginal haemorrhage occurred during therapy. The difficulty in controlling this haemorrhage is described. One of these cases subsequently had an uneventful pregnancy. In the other case, gross complications followed attempts to control this haemorrhage. The two other cases were treated by hysterectomy and bilateral internal iliac artery ligation and hysterectomy prior to the institution of chemotherapy. In both cases vaginal haemorrhage did not occur during chemotherapy. Passing mention is made of the dosage employed and the desirability of using combination of drugs to prevent and for the development of tumour resistance. The complication of depression of haemoposesis is mentioned and what is being done in other parts of the world to limit this. Finally, the submission is made that unless it is the intention to preserve the child-bearing propensity of the patient, it is better to perform hysterectomy plus bilateral internal iliac artery ligation prior to chemotherapy. In cases where the patient wishes to continue child-bearing the recommended procedure would be bilateral internal iliac artery ligation, without hysterectomy, prior to chemotherapy. Without this, continuous profuse vaginal haemorrhage is a complication due to the chemotherapeutic agents as a result of acute necrosis of secondary deposits in the vagina (AU)

Haemorrhage - a complication in the treatment of chorion carcinoma by chemotherapy

Three recent cases of chorion carcinoma have been treated with methotrexate and 6 mercaptopurine. One patient fell pregnant following therapy and was subsequently delivered, after an uneventful ante-natal course, of a normal infant. The main complication during the therapy was haemorrhage from the necrosing vaginal secondaries, which was felt to be the direct effect of the drugs. The bleeding was best controlled by bilateral internal iliac ligation, prior to chemotherapy. (Summary)

Datura poisoning: A case report

A case of accidental poisoning with Datura strammonium in an adult male is reported. (AU)