173
Campylobacter fetus var. fetus has been associated with gastroenteritis, endocarditis, and bacteraemia in man; Campylobacter fetus var. intestinalis, Campylobacter fetus var. jejuni, and Campylobacter sputorum var. sputorum clinical isolates. Of these four the first is clearly established as a human species, only pathogen; the others appear to be predominantly animal pathogens or saprophytic members of the normal human flora which may be pathogenic for man under unusual circumstances. Other members of the genus Campylobacter have also been described whose precise taxonomic position and role in human disease remain unclear. Although confusion has been inevitable in the past because of the poorly defined status and questionable pathogenicity of many of these organisms, it is nonetheless obligatory at this point for both clinicians and microbiologists to adhere to what is now standard taxonomy and nomenclature in referring to these organisms in the literature.
are
the other
adenovirus and herpesvirus infections. Also one single application was effective in the prevention of infection after removal of foreign bodies and after ophthalmic surgery. Moscow Helmholtz
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, U.S.A.
MICHAEL L. TAPPER.
SOLUBLE OPHTHALMIC DRUG INSERTS SIR,-An experimental and clinical study has been completed on a better way of introducing medication into the eye. Experiments demonstrated the potential of new films (inserts) polyvinylalcohol medicinal ophthalmic mpregnated with antibiotics.1 Yet it was observed 2,
Ophthalmological
Institute, Moscow, U.S.S.R.
common
Y. F. MAICHUK.*
INTRAVENOUS PROSTAGLANDINS AND OXYTOCIN FOR MID-TRIMESTER ABORTION
SIR,-Opinions still vary as to the most effective way of terminating mid-trimester pregnancies, although most clinicians now favour prostaglandins. We report the successful termination of 19 consecutive late first and second trimester pregnancies using a combination of intravenous prostaglandins E2 (P.G.E.2 Upjohn) and
oxytocin (’ Syntocinon’). P.G.E.:(5 mg. in 500 ml. of 5% glucose) was infused into a superficial arm vein at an initial rate of 2-5 (.Lg. per minute, the rate being increased to 5 ;jLg. per minute after half an hour. If after four hours the uterine response was regarded as inadequate
the P.G.E.. infusion was increased to a maximum of 10 jj.g. per minute. To allow ample time for the enhancement phenomenon,’,2 INDUCTION OF ABORTION BY A COMBINATION OF INTRAVENOUS P.G.E.. AND OXYTOCIN
that they, like polypeptide-polysaccharide ocular inserts,33 did not dissolve in the conjunctival sac, and discomfort necessitated their removal from the sac. Therefore soluble ophthalmic drug inserts (S.O.D.I.) have been suggested2 and produced by the Moscow Helmholtz Ophthalmological Institute in collaboration with the All-Union Research Institute for Medical Equipment, U.S.S.R. S.O.D.I. were endorsed for use in ophthalmic practice in the U.S.S.R., following the June 11,1971, decision of the Pharmacological Committee, Ministry of Health. S.O.D.1. are made from polymers of polyacrylamide, ethylacrylate, and vinylpyrrolidone, prepared as thin elastic oval plates with neomycin, kanamycin, sulphamethoxypyrid-
azine, idoxuridine,Florenal ’, atropine, pilocarpine, dexamethasone, and other drugs used in ophthalmology. S.O.D.I. offer a number of advantages over eye-drops (aqueous solutions, viscous solutions of polymers, suspensions), ointments, and subconjunctival injections. In fact, their use makes it possible to achieve prolonged
bioavailability of active substances in the conjunctival fluid and conjunctival and corneal tissue. Though in many of the applications studied S.O.D.I. dissolved in 60-90 minutes, the incorporated active material was found in the conjunctival fluid for up to 34-72 hours. This long duration secures therapeutic concentrations in the conjunctival sac, enhances the penetration of drugs into the tissues and may therefore replace subconjunctival injections in certain cases. This possibility has, of course, to be weighed against tolerance of the active material. However, experience with more than 500 patients (a single application daily or every other day for a maximum of 10 days) demonstrated good tolerance and therapeutic efficacy in different forms of glaucoma, keratitis, iridocyclitis, cornea ulceration, trachoma, conjunctivitis, and 1. 2.
Maichuk, Maichuk,
Y. F. Antibiotiki, 1967, 5, 435. Y. F. in Proceedings of Moscow
Ophthalmological
Conference, 1967, p. 403. 3. Dohlman, C. H., Pavan-Langston, Dr., Rose, J. Ann. Ophthalmol. 1972, 4, 823. 4. Maichuk, Y. F., Khromov, G. L., Koneva, E. B., Tishina, I. F., Pozdnijkov, V. I. in Proceedings of Conference on Ophthalmology, Chuvash, A.S.S.R., 1970, p. 136.
+ = 1 or 2 episodes of vomiting. + + 3 or 4 episodes of vomiting. + + + =more than 4 episodes of vomiting. =
c=complete.
oxytocin
i/c=incomplete.
started two hours after the P.G.E’2 and infused at a of 128 mu per minute. Mixing the P.G.E., and in the same bottle of 5 % glucose had no adverse effects. was
constant rate
oxytocin
Individual results are shown in the accompanying table. The mean total dose of P.G.E’2 used was 5-9 mg.- at an overall rate of 6-1 g. per minute. The average induction/ delivery interval was 16 hours, with only 1 patient (13) taking more than 24 hours. In 13 cases (68%) abortion was
complete. 13 women experienced vomiting, but the nursing staff said that this was distressing in only 2 cases, the remainder responding well to ’Stemetil’ by intramuscular injection. Pain was not a problem and was well controlled by pethidine, the average dose of which was 100 mg.
When the two uterine stimulatants
were run
through the same infusion set, there was a tendency to superficial thrombophlebitis, but this was never anything *
Present address: Regional Adviser, W.H.O., E.M.R.O., P.O., Box 1517, Alexandria, Arab Republic of Egypt.
1. 2.
Brummer, H. C. J. Obstet. Gynœc. Br. Commonw. 1971, 78, 305. Gillespie, A. Br. med. J. 1972, i : 150.
Campylobacter fetus var. fetus has been associated with gastroenteritis, endocarditis, and bacteraemia in man; Campylobacter fetus var. intestinalis, Campylobacter fetus var. jejuni, and Campylobacter sputorum var. sputorum clinical isolates. Of these four the first is clearly established as a human species, only pathogen; the others appear to be predominantly animal pathogens or saprophytic members of the normal human flora which may be pathogenic for man under unusual circumstances. Other members of the genus Campylobacter have also been described whose precise taxonomic position and role in human disease remain unclear. Although confusion has been inevitable in the past because of the poorly defined status and questionable pathogenicity of many of these organisms, it is nonetheless obligatory at this point for both clinicians and microbiologists to adhere to what is now standard taxonomy and nomenclature in referring to these organisms in the literature.
are
the other
adenovirus and herpesvirus infections. Also one single application was effective in the prevention of infection after removal of foreign bodies and after ophthalmic surgery. Moscow Helmholtz
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, U.S.A.
MICHAEL L. TAPPER.
SOLUBLE OPHTHALMIC DRUG INSERTS SIR,-An experimental and clinical study has been completed on a better way of introducing medication into the eye. Experiments demonstrated the potential of new films (inserts) polyvinylalcohol medicinal ophthalmic mpregnated with antibiotics.1 Yet it was observed 2,
Ophthalmological
Institute, Moscow, U.S.S.R.
common
Y. F. MAICHUK.*
INTRAVENOUS PROSTAGLANDINS AND OXYTOCIN FOR MID-TRIMESTER ABORTION
SIR,-Opinions still vary as to the most effective way of terminating mid-trimester pregnancies, although most clinicians now favour prostaglandins. We report the successful termination of 19 consecutive late first and second trimester pregnancies using a combination of intravenous prostaglandins E2 (P.G.E.2 Upjohn) and
oxytocin (’ Syntocinon’). P.G.E.:(5 mg. in 500 ml. of 5% glucose) was infused into a superficial arm vein at an initial rate of 2-5 (.Lg. per minute, the rate being increased to 5 ;jLg. per minute after half an hour. If after four hours the uterine response was regarded as inadequate
the P.G.E.. infusion was increased to a maximum of 10 jj.g. per minute. To allow ample time for the enhancement phenomenon,’,2 INDUCTION OF ABORTION BY A COMBINATION OF INTRAVENOUS P.G.E.. AND OXYTOCIN
that they, like polypeptide-polysaccharide ocular inserts,33 did not dissolve in the conjunctival sac, and discomfort necessitated their removal from the sac. Therefore soluble ophthalmic drug inserts (S.O.D.I.) have been suggested2 and produced by the Moscow Helmholtz Ophthalmological Institute in collaboration with the All-Union Research Institute for Medical Equipment, U.S.S.R. S.O.D.I. were endorsed for use in ophthalmic practice in the U.S.S.R., following the June 11,1971, decision of the Pharmacological Committee, Ministry of Health. S.O.D.1. are made from polymers of polyacrylamide, ethylacrylate, and vinylpyrrolidone, prepared as thin elastic oval plates with neomycin, kanamycin, sulphamethoxypyrid-
azine, idoxuridine,Florenal ’, atropine, pilocarpine, dexamethasone, and other drugs used in ophthalmology. S.O.D.I. offer a number of advantages over eye-drops (aqueous solutions, viscous solutions of polymers, suspensions), ointments, and subconjunctival injections. In fact, their use makes it possible to achieve prolonged
bioavailability of active substances in the conjunctival fluid and conjunctival and corneal tissue. Though in many of the applications studied S.O.D.I. dissolved in 60-90 minutes, the incorporated active material was found in the conjunctival fluid for up to 34-72 hours. This long duration secures therapeutic concentrations in the conjunctival sac, enhances the penetration of drugs into the tissues and may therefore replace subconjunctival injections in certain cases. This possibility has, of course, to be weighed against tolerance of the active material. However, experience with more than 500 patients (a single application daily or every other day for a maximum of 10 days) demonstrated good tolerance and therapeutic efficacy in different forms of glaucoma, keratitis, iridocyclitis, cornea ulceration, trachoma, conjunctivitis, and 1. 2.
Maichuk, Maichuk,
Y. F. Antibiotiki, 1967, 5, 435. Y. F. in Proceedings of Moscow
Ophthalmological
Conference, 1967, p. 403. 3. Dohlman, C. H., Pavan-Langston, Dr., Rose, J. Ann. Ophthalmol. 1972, 4, 823. 4. Maichuk, Y. F., Khromov, G. L., Koneva, E. B., Tishina, I. F., Pozdnijkov, V. I. in Proceedings of Conference on Ophthalmology, Chuvash, A.S.S.R., 1970, p. 136.
+ = 1 or 2 episodes of vomiting. + + 3 or 4 episodes of vomiting. + + + =more than 4 episodes of vomiting. =
c=complete.
oxytocin
i/c=incomplete.
started two hours after the P.G.E’2 and infused at a of 128 mu per minute. Mixing the P.G.E., and in the same bottle of 5 % glucose had no adverse effects. was
constant rate
oxytocin
Individual results are shown in the accompanying table. The mean total dose of P.G.E’2 used was 5-9 mg.- at an overall rate of 6-1 g. per minute. The average induction/ delivery interval was 16 hours, with only 1 patient (13) taking more than 24 hours. In 13 cases (68%) abortion was
complete. 13 women experienced vomiting, but the nursing staff said that this was distressing in only 2 cases, the remainder responding well to ’Stemetil’ by intramuscular injection. Pain was not a problem and was well controlled by pethidine, the average dose of which was 100 mg.
When the two uterine stimulatants
were run
through the same infusion set, there was a tendency to superficial thrombophlebitis, but this was never anything *
Present address: Regional Adviser, W.H.O., E.M.R.O., P.O., Box 1517, Alexandria, Arab Republic of Egypt.
1. 2.
Brummer, H. C. J. Obstet. Gynœc. Br. Commonw. 1971, 78, 305. Gillespie, A. Br. med. J. 1972, i : 150.
