Bruce B. Dan

Toxic-shock syndrome in menstruating women. Association with tampon use and Staphylococcus aureus and clinical features in 52 cases.

To determine the risk factors associated with toxic-shock syndrome (TSS) in menstruating women, we conducted a retrospective telephone study of 52 cases and 52 age-matched and sex-matched controls. Fifty-two cases and 44 controls used tampons (P < 0.02). Moreover, in case-control pairs in which both women used tampons, cases were more likely than controls to use tampons throughout menstruation (42 of 44 vs. 34 of 44, respectively; P < 0.05). There were no significant differences in brand of tampon used, degree of absorbency specified on label, frequency of tampon change, type of contraceptive used, frequency of sexual intercourse, or sexual intercourse during menstruation. Fourteen of 44 cases had one or more definite or probable recurrences during a subsequent menstrual period. In a separate study, Staphylococcus aureus was isolated from 62 of 64 women with TSS and from seven of 71 vaginal cultures obtained from healthy controls (P < 0.001).

Toxic Shock Syndrome Surveillance in the United States, 1980 to 1981

Between 1 January 1980 and 18 October 1981, investigators from the Centers for Disease Control collected information on 1407 cases of toxic shock syndrome using a nationwide passive surveillance system. Ninety-two percent of the reported cases were associated with menstruation. Information available on the type of menstrual device used shows that 99% of the cases occurred in tampon users. Menstrual cases occurred predominantly in whites (98%) under the age of 25 (65%). The case/fatality ratio for menstrual toxic shock syndrome was 3.1% for cases with onset in 1981. The distribution of reported cases by date of onset showed a gradual increase in the number reported before the summer of 1980, a sharp increase during the summer and early fall of 1980, a marked decrease in the late fall of 1980, and a subsequent gradual decrease. Factors affecting the incidence and reporting of toxic shock syndrome during these periods include changes in the number of tampon users, changes in the availability and usage patterns of tampons, changes in the prevalence of toxin-producing strains of Staphylococcus aureus, improved recognition of the syndrome, and publicity.

Nosocomial surgical infections: incidence and cost

The data reported in this article support the findings of Dr. Altemeier; that is, infections among surgical patients remain a serious problem today. Urinary tract infections account for approximately 40 per cent of nosocomial infections among surgical patients. Surgical wound and skin infections account for one third of the nosocomial infections among surgical patients. Rates for wound infections rise with age, with increased length of hospitalization before surgery, and with increased duration of surgery. They are higher for patients who have an infection at a distant site and for those who have the more hazardous surgical procedures as determined by risk categories. Gram-negative organisms are more prevalent than gram-positive organisms. A nosocomial surgical wound infection lengthens the hospitalization by an average of 7.4 days and raises the cost of hospitalization by more than 800 dollars. Further analysis of the data is necessary in order to identify the risk factors likely to be most helpful in determining which patients are at increased risk of acquiring a nosocomial infection. Only when these factors are identified can the most direct and effective contact and preventive measures be implemented.

Vaginal Colonization with Staphylococcus aureus in Healthy Women: A Review of Four Studies

Four studies assessed the frequency of vaginal Staphylococcus aureus colonization in healthy women and associated risk factors. An association was found between S. aureus vaginal colonization and colonization at the labia minora and the anterior nares. Significant risk factors associated with an increased risk of vaginal S. aureus in at least one study were a history of genital herpes simplex infection, insertion of tampons without an applicator, and the use of Rely (Procter & Gamble) tampons. The use of systemic antibiotics within 2 weeks of the vaginal culture decreased the risk of recovery of S. aureus. The overall frequency of vaginal S. aureus in the 808 women in the four studies was 9.2%.

Toxic Shock Syndrome: The Emerging Picture

Excerpt Nature, in the production of disease, is uniform and consistent, so much so that for the same disease in different persons the symptoms are for the most part the same—Thomas Sydenham A litt...

Toxic Shock Syndrome: Case-Control Studies at the Centers for Disease Control

Abstract In June and September 1980 the Centers for Disease Control (CDC) conducted two case-control studies to identify risk factors associated with menstrual toxic shock syndrome. The first study...

The Physician's Ethical Obligation to Take Care of Patients in Times of Plague-Reply

In Reply. —I applaud Dr Clarks decision to continue to treat patients infected with the human immunodeficiency virus (HIV) and I am heartened by his statement that he considers treating patients with AIDS an obligation of a physician. That was precisely the point of my editorial. I believe that the singular duty incumbent on anyone who takes up the call of medicine is to care for patients, and that caring also encompasses those involved in teaching and research. The distinguishing feature of the medical profession as opposed to all other fields of endeavor is the absolute dedication to those in need of medical care. The essence of being a physician is the healing of the sick; any other activity is extraneous to that mission. Even if the risk of acquiring HIV from contact with patients infected with the virus was substantial, physicians would still incur the duty of treating those

Citius, Altius, Fortius

In recognition of the first summer Olympic Games held in the United States in more than 50 years, we are dedicating this issue ofThe Journalto the topic of sports medicine. We initiated our own competition by inviting authors to submit manuscripts on exercise physiology, training, nutrition, or any subject relevant to the aspirations typified by the Olympic Games. We received more than 100 major contributions for this singular issue. After undergoing rigorous review, the articles presented herein represent those selected by the editors for our Olympic issue. Sports medicine, a relatively new specialty, owes its emergence to the technological advances of modern society and the burgeoning of leisure-time activity. Our ancestors, the hunters and gatherers of a more primitive planet, depended on their physical talents for existence. They survived each day on their ability to find dinner while avoiding becoming something elses lunch. The fleet of foot found