William J. Ledger

Prophylactic cephaloridine in the prevention of postoperative pelvic infections in premenopausal women undergoing vaginal hysterectomy

Abstract A prospective double-blind study was performed utilizing 3 Gm. of cephaloridine or placebo on the day of operation in premenopausal women undergoing vaginal hysterectomy. In approximately two years, 100 of 138 women eligible for the study elected to participate; 50 patients received placebo and 50 received active drug. The preoperative profile of the two groups of patients was similar. Postoperatively, there were statistically significant differences in the clinical courses of the two groups of patients. In those women receiving cephaloridine prophylaxis, fewer patients had postoperative morbidity (p

The hospital care of patients undergoing hysterectomy: An analysis of 12,026 patients from the Professional Activity Study☆☆☆

Abstract The 12,026 patients undergoing hysterectomy were selected for study by choosing every seventh patient of 5,208,710 discharged from over 1,300 Professional Activity Study hospitals from January to June 1970. Approximately 70 per cent of this sample had an abdominal hysterectomy and 30 per cent had a vaginal hysterectomy. Those women who had a vaginal hysterectomy had more frequent postoperative fevers and more of them received antibiotics, while more of the patients undergoing abdominal hysterectomy had blood transfusions. Nonwhites had a higher incidence of postoperative fever, received more antibiotics and blood transfusions, and had a hospital stay a day and a half longer than whites. Patients undergoing hysterectomy had less than half the mortality rate of patients having an appendectomy and less than one eighth the mortality rate of patients undergoing cholecystectomy. Transfusions and antibiotics were used significantly more often with hysterectomy than with appendectomy and cholecystectomy.

The effect of an intrauterine contraceptive device on the histologic pattern of the endometrium

Abstract The histologic pattern of the endometrium of women wearing Margulies polyethylene spirals differs from the normal. The most consistent changes are increased superficial vascularity with the development of large thin-walled vascular channels and the presence of edema in the superficial layers. No cellular changes suggestive of neoplasia were observed.

The fever index: A quantitative indirect measure of hospital-acquired infections in obstetrics and gynecology

Abstract The fever index is a numerical expression of the total quantity of fever for a patient. A FORTRAN computer program was written to calculate the area above a base line of 99° F., when oral temperatures are recorded at least 4 times a day, and the result is expressed in degree hours. This calculation was used to evaluate various groups of obstetric and gynecologic patients with hospital-acquired infections.

IN VIVO steroid biogenesis and metabolism in the human term placenta 1. IN SITU placental perfusion with isotopic pregnenolone

Abstract Three human term placentas have been perfused in situ with labeled pregnenolone. Perfusions were performed at the time of elective repeat cesarean section, prior to the onset of labor. Placentas and venous effluents were separately analyzed. As is true in midtrimester placentas, rapid and extensive conversion to progesterone was effected by the placenta. In addition to progesterone, 6 β-hydroxyprogesterone was identified.

Complications associated with the use of intrauterine contraceptive devices in women of middle and upper socioeconomic class

The complications associated with the use of intrauterine contraceptive devices by 710 women of middle and upper class strata over a total period of 14,901 woman-months are described. The most frequent was bleeding which occured in almost all women and persisted in 41 per cent. There were three perforations and infection occurred in 1.3 per cent. The pregnanc rate was 2.51 per 100 woman-years of use. The other complications are minor annd have little effect on general health or reproductive function. Since most of the complications are either minor or avoidable, this form of contraception, when properly used, has many advantages over conventional methods.

Death from pseudomembranous enterocolitis.

During the past 2 years at the Los Angeles County-University of Southern California Medical Center (LAC-USC), there have been 2 deaths from pseudomembranous enterocolitis. Each of these deaths occurred postoperatively in previously healthy women who received pronlonged antibiotic prophylasix. The implications of these poor therapeutic results are discussed. The distinctive clinical symptology of a patient with pseudomembranous enterocolitis is described, and current treatment recommendiations are presented.

Operative removal of intraperitoneal intrauterine contraceptive devices—a reappraisal

A case report of small bowel obstruction following the operative removal of an intrauterine device (IUD) is presented and problems involved in the management of uterine perforation with an open-end IUD (there have been no reports of bowel obstruction with closed-end devices) are discussed. Celiotomy or therapeutic nihilism have been suggested by some authors. However if conditions are psychologically appropriate and the IUD is free of or loosely adherent to omentum removal by laparoscopy or colpotomy is recommended. Celiotomy is neithe r necessary nor indicated if the IUD is densely adherent to omentum.

The fever index: A technic for evaluating the clinical response to bacteremia.

The fever index, quantitative measure of the total amount of fever in degree hours, was determined in obstetric-gynecologic patients with bacteremia. Comparison of the mean fever index between those women with hospital-or community-acquired infections, those patients monitored or not monitored during labor, or by grouping of single organisms recovered by culture revealed no significant differences. Bacteremia patients over the age of 40 had significantly more fever than those under the age of 40. Patients with postpartum with postpartum bacteremia following cesarean section had a mean fever index significantly greater than women who had vaginal delivery. The implications of these findings are discussed.

THE USE OF A CERVICAL DILATATION GRAPH IN THE MANAGEMENT OF PRIMIGRAVIDAE IN LABOUR

One thousand consecutive labours in primigravid patients were evaluated to show the value of the combined use of a cervical dilatation graph and a policy of active management. Intervention was required at a significantly higher rate in patients with abnormal cervical dilatation patterns. Significantly more Caesarean sections were performed in patients with abnormal cervical dilatation pattern. Early recognition of cervical dilatation problems, early intervention, and the avoidance of difficult vaginal deliveries have contributed to the good results.