Form Of Vaginal Suppositories Research Articles

Возможности профилактики инфекционных осложнений при выполнении малых хирургических вмешательств в гинекологии

Aim: to evaluate the efficacy of an antiseptic disinfectant containing benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride as an active ingredient in the form of vaginal suppositories as a preoperative management for scheduled surgery in women with vaginal microbiocenosis disorder. Patients and Methods: a prospective open-label study of the prevention of postoperative complications in 58 women admitted to a gynecological short-stay unit was conducted. The initial examination included history taking, comprehensive clinical and laboratory examinations, bacterioscopy of cervical and vaginal discharge with Gram stain, and vaginal discharge pH measurement. Surgery (diagnostic dilation and curettage along with hysteroscopy for endometrial hyperplasia) was scheduled in all women. 8.0±1.0 days before surgery, preoperative treatment to prevent infectious complications was performed using benzyl-dimethyl-[3-(tetradecanoylamino)propyl] ammonium chloride monohydrate in the form of 15-mg vaginal suppositories (1 suppository), once daily for 7 days. 30 days after surgery, re-examination of vaginal microflora and microbiocenosis was performed in all women. Results: an increase in WBC count, mixed microflora, and Candida spores were detected at the first visit. Before preventive treatment, vaginal microbiocenosis was characterized by a decrease in the number of obligate microbes in the vaginal biotope. No infectious postoperative complications were reported, and the early and late postoperative period was uneventful. In 56 women (96.5%), normocenosis was revealed (19 women were previously diagnosed with bacterial vaginosis, 25 with candidiasis, and 12 with nonspecific vaginitis). Two women (3.5%) had intermediate-type vaginal microbiocenosis. In 54 women (93.1%), the preparation was well-tolerated, while 4 women (6.9%) complained of short-term burning. Conclusions: the preparation can be recommended as a preventive antiseptic agent before scheduled minor gynecological surgeries in women with vaginal microbiocenosis disorder. KEYWORDS: minor gynecological surgeries, postoperative infectious inflammatory complications, prevention, vaginal microflora, hysteroscopy, antiseptic agent. FOR CITATION: Khlynova S.A., Dobrokhotova Yu.E., Kerchelaeva S.B., Fisenko A.D., Dimitrova V.I. Prevention of infectious complications in minor gynecological surgeries. Russian Journal of Woman and Child Health. 2023;6(3):270–275 (in Russ.). DOI: 10.32364/2618-8430-2023-6-3-9.

Restoration and preservation of the vaginal ecosystem in postmenopausal women

The article is devoted to the problem of restoring the physiological conditions of vaginal contents with improving the degree of vaginal cleanliness and reducing atrophic manifestations of the vagina in postmenopausal patients, which reduces the recurrence of vaginal infections and improves the quality of life of menopausal women. The use of a combination of low concentrations of estriol and acidophilic lactobacilli, after the main etiotropic therapy allows to restore the vaginal ecosystem and reduce the manifestations of atrophic vaginitis in menopause.The objective: saving and recovering of the vaginal ecosystem after anti-inflammatory therapy and prevention of vaginal disorders in women in menopause; establishment of clinical effects of complex treatment of sexually transmitted infections, followed by normalization of vaginal flora using a combination of low doses of estriol with lactobacilli and lactose in the form of vaginal suppositories at menopause.Materials and methods. During the examination and treatment of women were divided as follows: I — the main group — 58 women with physiological menopause, who after a comprehensive treatment of colpitis with vaginal suppositorium with a combination of a minimum dose of estriol with lactobacilli and lactose (1 time per day for 12 days, then — 1 time per week for six weeks); ІІ — comparative — 29 patients who underwent only etiotropic therapy with no further correction of vaginal biocenosis.Results. The first control was performed 3–5 days after the end of the main therapy, the second control was performed two months later. After our proposed treatment, the percentage of women with pathological secretions in group I was 12% (7), in II — 66% (19). After 2 months in the main group there was no atrophic changes of the vagina in 39 (67,2%) patients, insignificant — 12 (20,7%), moderate — 6 (10,4%), pronounced — only in 1 (1,7%), and the absence of high atrophy. In the comparison group, the indicators remained unchanged. Conclusions. The combination of low doses of estriol, acidophilic lactobacilli and lactose contributes to sufficient population and maintenance of healthy vaginal flora, as well as the restoration of physiological properties of the vaginal mucosa in women during menopause, as evidenced by the reverse dynamics of atrophic disorders in the main group.

Experience of clinical use of diindolylmethane in the treatment of HPV-associated low-grade cervical lesions

Introduction. A genital human papillomavirus infection receives the sword-point attention of both researchers and practitioners, due to its large prevalence in the human population, high contagiousness and, in particular, the ability of some HPV strains to contribute to the development of malignancy. This is particularly so with cervical cancer (CC), one of the most common types of cancer both in the Russian Federation and most countries of the world. It ranked first among the causes of malignant tumour deaths of women aged over 30 years. Objective. To present the experience in using the 3,3’-diindolylmethane-containing drug in the treatment of patients with HPVassociated low-grade cervical intraepithelial lesion. Material and methods. 62 women with HPV-associated low-grade cervical intraepithelial lesion were examined and received treatment with the 3,3’-diindolylmethane-containing drug (Cervicon-DIM). The primary diagnosis and therapeutic outcomes monitoring included the following research methods: colposcopy, histological examination of biopsy cervical specimens, Pap test, RT-PCR of high carcinogenic risk (HCR) HPV. The therapy compliance was evaluated using the clinical psychological test method (Morisky Green scale): compliant patients 4 scores (noncompliant 2 scores or less, insufficiently compliant 3 scores). Results. The therapeutic outcomes using 3,3’-diindolylmethane-containing drug (Cervicon-DIM) in the form of vaginal suppositories (100 mg twice daily for 90 days) showed clinical (recovery of colposcopic status in 83.0% of patients), cytological (confirmed absence of LSIL in 98.3% of women) and microbiological (PCR-negative HCR HPV in 91.5% of women) efficacy with satisfactory tolerance of the drug. Сonclusions. The therapeutic outcomes obtained using 3,3’-diindolylmethane-containing drug in the treatment of patients with HPV-associated low-grade cervical intraepithelial lesion could be considered as satisfactory. The data presented may be of interest to practicing gynecologists and other specialists.

Povidon-iodine (betadine) in modern obstetric-gynecological practice

The article describes the pharmacocodynamics of povidone-iodine, the release form under the brand name Betadine, pharmacological benefits, as well as evidence of its effectiveness in preventing infection in the field of surgical intervention. Povidone-iodine is indicated to be a depot of iodine, constantly releasing elemental iodine, which has strong oxidizing properties, and therefore most microorganisms are destroyed in vitro in less than a minute, and the main destructive effect of the drug occurs in the first 15–30 seconds. Povidone-iodine has a wide spectrum of antimicrobial and antiviral action. The data on medications of povidone-iodine in the form of vaginal suppositories, antiseptic solution and ointment under the trade name Betadine are presented. Own data on the effective use of vaginal suppositories in symptomatic vaginal dysbiosis caused by mixed opportunistic bacterial flora (facultative and obligate anaerobes) with the presence of Atopobium vaginae in diagnostically significant amounts are presented. In the presented comparative studies, the advantages of Betadine compared with other antiseptics in the spectrum of microbiological effects, resistance of microorganisms, effects on wound healing, dependence of the effect on the physico-chemical parameters of the environment, side effects, the purpose of application – prevention and/or treatment are shown. The results of recent comparative studies on the treatment of the surgical area with chlohexidine-alcohol and povidone-iodine, according to which povidone-iodine should still be considered acceptable for the preoperative treatment of the caesarean section, are highlighted. It is indicated that the irrigation of the wound cavity with an aqueous solution of povidone-iodine during surgery and before suturing the surgical wound is one of the WHO recommendations for the prevention of infection in the field of surgical intervention. The authors conclude that povidone-iodine, including Betadine, has a broad spectrum of antimicrobial and antiviral activity; high activity in the presence of organic compounds (blood, pus); ability to penetrate through biofilms, necrotic tissue, eschar; low incidence of antiseptic resistance; positive dynamics of wound healing by preventing the spread of inflammation and increasing the ability to heal; well tolerated by patients; low cost; ease of use.

ОСОБЛИВОСТІ БІОЦЕНОЗУ ТА ФУНКЦІОНАЛЬНОЇ АКТИВНОСТІ ВАГІНАЛЬНОГО ЕПІТЕЛІЮ ПРИ МІСЦЕВОМУ ЛІКУВАННІ НЕСПЕЦИФІЧНОГО ВАГІНІТУ

Мета дослідження – оцінити клінічну та мікробіологічну ефективність і безпечність застосування препарату «Кломезол» у лікуванні неспецифічного вагініту.Матеріали та методи. Для вирішення поставленого завдання проведено обстеження і лікування 60 жінок репродуктивного віку з діагнозом аеробного вагініту. Проведено оцінку клінічної та мікробіологічної ефективності терапії у пацієнток з аеробним вагінітом. Вивчено терміни зникнення об’єктивних і суб’єктивних симптомів запального процесу, особливості функціональної активності епітелію піхви, вплив препарату на стан нормальної мікрофлори піхви. Дослідження проведено відповідно до міжнародних нормативів і правил GCP.Результати дослідження та їх обговорення. У результаті проведеного дослідження було встановлено, що комбінований препарат «Кломезол» у вигляді вагінальних свічок є ефективним по відношенню до умовно-патогенних мікроорганізмів – збудників аеробного вагініту і є препаратом вибору для лікування бактеріального вагінозу та аеробного вагініту. Кломезол не здійснює імуносупресивного впливу на епітелій піхви, завдяки цьому відновлення функціональної активності епітелію після лікування кломезолом відбувається швидше, ніж після лікування тержинаном. Відмічено покращення якості життя пацієнток після лікування.Висновки. Відмічена висока ефективність комбінованого препарату «Кломезол» по відношенню до широкого спектра мікрофлори, доведена висока терапевтична активність та безпечність у використанні у пацієнток з аеробними вагінітами. Кломезол добре переноситься та не викликає резистентності мікрофлори. Препарат може використовуватись у ІІ і ІІІ триместрах вагітності.

Важка дисплазія епітелію шийки матки та внутрішньоепітеліальна карцинома (ЦІН 3) з поширенням на склепіння та стінки піхви. Діагностика та лікування

The objective: to study and systematize the main clinical variants of CIN 3 with the spread of atypical epithelium to the vaults and walls of the vagina; to develop complex approaches to the treatment of patients with CIN 3 with the spread of atypical epithelium to the vaults and walls of the vagina with neoadjuvant therapy and surgical treatment; to study the therapeutic effectiveness of the use of a2b-interferon in the form of vaginal suppositories and Tyloron in the complex treatment of patients with CIN 3 with the spread of abnormal epithelium to the vaults and walls of the vagina during the first stage of complex drug treatment. Patients and methods. A survey of 62 patients with histologically verified CIN 3 with the spread of atypical epithelium to the vaults and walls of the vagina was carried out. At the stage of neoadjuvant etiotropic therapy, the patients were randomized into two groups. 31 patients were included in the main group (A), 31 patients were included in the control group (B). In group A, patients with neoadjuvant were given б2b-interferon at 500 000 IU in the form of vaginal suppositories twice a day for 14 days and a Tyloron 1 tablet 125 mg once a day in a day No.10. In group B, the standard therapy is intended for patients – an a2b-interferon of 500 000 IU in the form of vaginal suppositories twice a day for 14 days. The surgical stage of treatment was carried out in accordance with the clinical and histological diagnosis and the variant of the process spread to the walls of the vagina. Diathermoconization of the cervix and combined vaginal trachelectomy type A with resection of the upper third of the vagina were performed. Results. Three clinical variants of CIN 3 with spreading to the vaults and walls of the vagina were established. The first clinical variant – CIN 3 is localized to ectocervix, CIN 1–2 (IHC p16 negative) is localized on the vaults and walls of the vagina. The second clinical variant – CIN 3 is localized on ectocervix and extends to the vault and walls of the vagina. The third clinical variant – CIN 3 is localized on ectocervix and multicentric dissemination of CIN 3 – on vaults and walls of the vagina. The choice of an integrated treatment program with a surgical component depends on the clinical option. Conclusions. 1. Three clinical variants of CIN 3 with spreading to the vault and walls of the vagina have been established. Half the patients had the first clinical variant. 2. The main colposcopic signs of CIN 3 with spreading to the vaults and walls of the vagina: dense acetic-white epithelium, coarse mosaic, a sign of the internal border. 3. In 3 weeks after the course of treatment with neoadjuvant therapy in combination of Тyloron with a2b-interferon in the form of vaginal suppositories, it is possible to achieve from 85 to 100.0% positive dynamics, whereas in the traditional method of treatment, from 41 to 75%, which is statistically significant less (p<0.01). 4. The study showed that there is a relatively strong statistically significant association of neoadjuvant therapy using a combination of Tyloron with interferon-a2b suppositories in the complex treatment of CIN3 with spreading to the vault and vaginal walls compared to conventional therapy (c21=10.64; j=0.41; p<0.01). After three weeks, the positive dynamics in the main group (A) significantly increased (RR=1.6; 95% CI: 1.2–2.2; p<0.01). Key words: CIN 3, vaginal vault, vagina, trachelectomy, treatment.

Double-blind randomized placebo-controlled multicenter clinical trial (phase IIa) on diindolylmethane's efficacy and safety in the treatment of CIN: implications for cervical cancer prevention.

BackgroundThe article presents the results of a clinical trial on the efficacy and safety of a novel pharmaceutical composition in the form of vaginal suppositories containing diindolylmethane in the course of cervical intraepithelial neoplasia (CIN) I–II conservative treatment. It offers an attractive drug therapy for more personalized prevention of cervical cancer.MethodsA total of 78 women of reproductive age were included. This was a multicenter, randomized, placebo-controlled, double-blind, parallel-group trial with efficacy determined by histological evaluation of cervical biopsies. The efficacy of active drug treatment (100 and 200 mg/day) in both treatment groups was significantly higher in comparison with the placebo group, according to the primary efficacy end point (proportion of patients with complete CIN regression after 90–180 days of the study drug treatment).ResultsThe efficacies were 100.0 % (confidence interval (CI) 95 %: 82.35–100.00 %), 90.5 % (CI 95 %: 69.62–98.83 %), and 61.1 % (CI 95 %: 35.75–82.70 %), for the high dose, low does, and placebo, respectively. Adverse events in the placebo group were reported in 22 % of patients (CI 95 %: 7.5–43.7 %); in the first treatment group (100 mg/day), adverse events were reported in 40.0 % of patients (CI 95 %: 21.1–61.3 %); in the second treatment group (200 mg/day), adverse events were reported in 42.0 % of patients (CI 95 %: 22.1–63.4 %). The differences in side effects between treatment groups treated with the active drug and placebo were statistically significant. No serious adverse events were reported in any of the groups.ConclusionsThus, the use of diindolylmethane in the form of intravaginal suppositories can be effective in patients with CIN I–II and is not accompanied by clinically significant side effects. This approach could be a better option for young women with CIN I–II as it takes in attention their reproductive plans.Trial registrationID: ChiCTR-INR-15007497 (2 December 2015)

Intravaginal Administration of Sildenafil Citrate Increases Blood Flow in the Bovine Uterus

Abstract The aim of the study was to evaluate the influence of sildenafil citrate administrated intravaginaly on the blood flow in the bovine uterus during dioestrus. Uterine blood flow was examined in six healthy adult cows. Sildenafil was administrated intravaginaly to each co w between the 6th and 8th d of the ovarian cycle, in the form of vaginal suppositories containing 100 mg of active substance at a dose of 100, 200, or 300 mg per animal. Uterine perfusion was estimated by the colour Doppler examination, and obtained results were analysed with the Pixel Flux Software (Chameleon, Germany). Moreover, cardiovascular parameters were also evaluated. Animals were examined before and five times after drug application (two times at 15 min intervals, and three times at 2 h intervals). A placebo suppository was also given to the cows. The analysis of the intensity and velocity of blood flow in the uterus proved that sildenafil administrated intravaginaly significantly increased blood flow in the uterus and the effect of increased perfusion was observed for 4 h and 30 min after administration. The effect of increased uterine perfusion was observed after low as well as high doses of sildenafil. Significant changes in the cardio-vascular parameters were not detected. There were no changes in the uterine perfusion as well as in cardiovascular parameters after placebo administration.

Optimization of the therapy and prevention of vulvovaginal candidiasis

The article describes modern views on the problem of vulvovaginal candidiasis.Study of the ketoconazole (Livarol) effectiveness in the treatment and prevention of vulvovaginal candidiasis in women of reproductive age was performed.Vaginal suppository Livarol (400 mg) was administered 28 women once a day for 10 days for the treatment of vaginal candidiasis (study group). Also Vaginal suppository Livarol (400 mg) was administered once a day for 10 days for 20 women without vulvovaginal candidiasis on the background of antibiotic treatment of sexual transmitted infections to prevent the development of candidiasis infection (comparison group).The effectiveness of the drug Livarol in the form of vaginal suppositories is demonstrated in treatment and prevention of vulvovaginal candidiasis. The presence of high-performance component of the drug – ketoconazole and polyethylene oxide bases determine the most widely use of Livarol by women with vulvovaginal candidiasis.

Вагинальная атрофия в практике акушера-гинеколога

Vaginal atrophy is a characteristic symptom of menopause, which can develop in young women as a result of temporary or permanent deficiency of estrogen, as well as after operations of the cervix or connective tissue diseases. Manifestations of diverse vaginal atrophy, affect sexuality and significantly reduce the quality of life of women. The diagnosis of vaginal atrophy is clinical and depends solely on the skill of the doctor who expertly evaluates medical history and examines, since patients with vaginal atrophy often do not complain. Estrogens are considered to be the most effective option for the treatment of all forms of vaginal atrophy in the local application. In Russia, it is only estriol - estrogen deprived of systemic metabolic effects and does not require monitoring of the endometrium and breast, as well as the additional use of progestogen to protect the endometrium - that is registered for the vaginal use. Estriol in the form of vaginal suppositories (Ovipol Clio®) can be used in women with urogenital atrophy in postmenopausal women with amenorrhea or in the reproductive age, in the treatment of stenosis of the cervical canal, or after unclear smear from the cervix to the background of vaginal atrophy, as well as in urology in relapsed urinary tract infection in young women or as a preoperative preparation for operations on the pelvic floor.

Interleukin-8 potentiates the effect of interleukin-1-induced uterine contractions.

The aim of this research was to study the effect of exogenous interleukin (IL)-8, IL-1 and IL-8 + IL-1 on uterine contractions in rabbits. Four equal groups of non-pregnant rabbits (n = 24) were investigated using either placebo or experimental drugs in the form of vaginal suppositories. The suppositories contained human recombinant IL-8 (200 ng), IL-1 (200 ng), IL-8 (200 ng) + IL-1 (200 ng) or vehicle Witepsol base, 500 microliters). Subsequently, the plasma concentration of prostaglandin (PG) E2 was estimated 3 h after the last dose of treatment. Neutrophil infiltration in the endometrial tissue was studied with anti-rabbit RT2 staining. Suppositories with IL-1 and IL-8 + IL-1 produced contractile responses with increased frequency (P < 0.003, P < 0.0005) and amplitude (P < 0.0001) in vivo, compared with vehicle. IL-1 and IL-8 + IL-1 also caused similar contractile effects with increased frequency (P < 0.01, P < 0.0007) and amplitude (P < 0.0001) in an in-vitro experiment than vehicle. The frequency and amplitude of uterine contractions were more significant with IL-8 + IL-1 than that of IL-1, both in vivo (P < 0.002, P < 0.05) and in vitro (P < 0.005, P < 0.01). IL-8 did not induce any contractions. Prostaglandin concentration was increased approximately 8-fold with IL-8 + IL-1 (P < 0.0001) and 2.5-fold with IL-1 treatment (P < 0.0001). Neutrophil numbers were significantly increased with IL-8 + IL-1 > IL-8 > IL-1 (P < 0.002, P < 0.0003 and P < 0.008) compared with vehicle. Our data suggest that IL-8 stimulates IL-1-induced uterine contractions through PGE2 production and could be an important process during labour and delivery.

The effect of urinary trypsin inhibitor on uterine muscle contraction and cervical maturation

Summary To study the intrauterine defensive role of fetal urine, we focused urinary trypsin inhibitor (UTI) from fetal urine. Urinary trypsin inhibitor (UTI) is a glycoprotein secreted with fetal urine. Until now, its real function has been unknown. The expression of IL-8 induced by LPS were completely abolished in the presence of physiological concentration of UTI in various cells. LPS or IL-8 in the form of vaginal suppositories induced cervical ripening in rabbits. UTI applied after LPS or IL-8 could successfully inhibit the changes induced by IL-8 or LPS in the rabbit cervix. UTI or fetal urine inhibits the increase of intracellular Ca 2+ of uterine muscle cells induced by LPS. Possibly, this regulatory effect of intracellular Ca 2+ is involved in preventing uterine muscle contraction. UTI or fetal urine suppresses premature cervical ripening and prevents uterine muscle contraction. We conclude that UTI of fetal urine is important role in maintaining pregnancy.

Biochemical changes in the cervical tissue of rabbit induced by interleukin-8, interleukin-1 dehydroepiandrosterone sulphate and prostaglandin E2: a comparative study

The aim of this research was to study and compare the mechanism of action of interleukin (IL)-8, IL-1beta dehydroepiandrosterone sulphate (DHEA-S) and prostaglandin (PG)E2 on the cervix. Five equal groups of pregnant rabbits (n = 45) were tested by either placebo or tested drugs in the form of vaginal suppositories once daily for 3 days. The suppositories contained human recombinant IL-8 (100 ng), IL-1beta (200 ng), DHEA-S (10 mg) or PGE2 (1 mg). All rabbits were tested by one dose, two doses or three doses. Consistency, dilatation and water contents were estimated 24 h after the last dose of treatment. Leukocyte infiltration of the cervices was studied after staining the cervical tissue sections with antirabbit RT2 monoclonal antibodies. Relative collagen concentration was assessed after staining with Picrosirius Red. Collagenase, gelatinase and elastase activities were measured in 100 mg of homogenized cervical connective tissue. Water contents were significantly increased in all tested cervices. Neutrophil numbers were increased in IL-8 and IL-1beta groups after the second dose of treatment (P < 0.0005 and 0.001 respectively). In the PGE2 group, neutrophils were increased after the third dose of treatment, whereas in DHEA-S group no significant changes were observed. Collagen content was significantly decreased in IL-8, IL-1beta and PGE2 groups after the first dose of treatment (P < 0.004, and 0.005 and 0.03 respectively). In the DHEA-S group, the decrease in collagen content occurred after the third dose (P < 0.05). Collagenase activity was markedly increased in IL-8, IL-1, and DHEA-S groups after the second dose of treatment (P < 0.001, 0.003 and 0.007 respectively). No significant increase in collagenase activity was found in PGE2 group. Gelatinase activity was significantly increased in IL-8, IL-1beta, PGE2 and DHEA-S groups after the second dose of treatment (P < 0.008, 0.01, 0.003 and 0.05 respectively). Also, elastase activity was increased after the second dose of treatment in all groups (P < 0.001, 0.001, 0.001 and 0.006 respectively). Our data suggest that ripening of the cervix in rabbit can be initiated by different mechanisms. Cytokines play a vital role in cervical ripening, especially IL-8 and IL-1. IL-8 is one of the factors which could ripen the cervix in a manner similar to the physiological process at term.

The abortifacient effect of 16,16-dimethyl-trans-δ 2-PGE 1 methyl ester, a new prostaglandin analogue, on mid-trimester pregnancies and long-term follow-up observations

The present clinical trials revealed that 16,16-Dimethyl-trans-δ 2-PGE 1 methyl ester in the form of vaginal suppositories is highly effective in inducing mid-trimester termination of pregnancies. It also showed that prior treatment with laminaria and metreurynter may enhance the success rate while reducing the incidence and severity of side effects. It is easy and safe to use clinically, with minimal side effects, and in our series, revealed no deleterious effects on ensuing reproductive physiology. However, the definite mechanism involved in the action of this new analogue to cause myometrial contractions is still not completely understood, and requires further intensive investigation.

Cervical dilatation in late first trimester termination by prostaglandin, hylase and isogel

Pre-operative dilatation of the cervix was attempted in 223 cases prior to vacuum aspiration in patients seeking late first trimester termination beyond ten weeks. 15 Me PGF 2a was used in the form of vaginal suppositories, intramuscular and intracervical injections. Dilatation of cervix of 10 mm or more was achieved within 4 hours in 86% cases with intra-cervical injections. Gastro-intestinal disturbances caused by intra-muscular injections could be avoided by intra-cervical injections, as the amount of prostaglandin required was only 100 ugm, but the success rate was significantly lower. The success with multiple dose suppositories was 80%. There was no significant difference in the success with 1.5 mgm or 1.0 mgm dosage, but the side effects were significantly higher with 1.5 mgm suppositories. Intra-cervical Hylase did not dilate the cervix but successfully softened it within 5 minutes to make metallic dilatation simple. The hygroscopic Isogel tents achieved dilatation of 10 mm or more in 73% of the patients in 12 hours. The tents as well as intracervical prostaglandin injection had the disadvantage of requiring an additional theatre procedure prior to suction curettage.

Trichomoniasis in a closed community: 100 per cent follow-up.

The scepticism with which gynaecologists and venereo logists regarded the possible effectiveness of an oral trichomonacide was doubtless justified by the unsubstan tiated claims that had been put forward some years ago for a chemical compound which is now happily superseded by metronidazole ( flagyl ). This does, in fact, destroy the parasite in the great majority of cases of trichomonal vaginitis. Where it fails to do so there are several possible explanations. The patient might not have taken the pills at all, or might have taken them irregularly. She might have been reinfected after being cured. The drug might in some cases not have been adequately absorbed from the gastro-intestinal tract ; or, where there was no defect in absorption, the concentration of metronidazole in the blood might have been insufficient to destroy the trichomonads in the depth of the uterine cervical glands in which long standing inflammation had led to decreased vascularity. A final theoretical possibility is that some strains of Trichomonas vaginalis might have a natural or acquired resistance to the drug. I am informed (J. A. McFadzean and S. Squires, private communication) that there is little laboratory evidence of defective absorption and no evidence at all of drug-resistant trichomonads. Presumption of cure after treatment with metronidazole is arrived at after a series of negative reports of microscopical and cultural examinations of specimens taken at intervals throughout the three-months follow-up ; but some patients default long before the end of that time. It was thought that it would be of interest to ascertain the effects of oral metronidazole in a closed community in which all the patients could be kept under observation for as long as was considered desirable, and where the risk of reinfection was negligible. These conditions were found in Her Majesty's Prison, Holloway, where the 102 women who are the subjects of this report were treated. In order to save space I have listed the names of the early investigators of metronidazole only in the bibliography. I differ from those French, German, and Canadian workers who continue to give the drug in the form of vaginal suppositories as well as oral tablets. I have used the latter solely, believing that local treatment with this substance is likely to be no more successful than earlier topical applications, the use of which was followed so often by relapse. An actively trichomonicidal substance applied to the vaginal mucosa can never reach deep-seated foci of infection ; and metronidazole so exhibited can cause local irritation.

The physiologic effectiveness of progesterone vaginal suppositories.

This communication provides evidence that progesterone administered in the form of vaginal suppositories (25-50 mg) is readily absorbable utilizable and of greater potency and clinical effectiveness than progesterone used sublingually. Amenorrheic women show a rise in basal temperature of 1/2-1 degree within 24-36 hours of treatment with progesterone suppositories. The temperature drops back to the basal level within 24 hours after stopping treatment. The cervical mucus of women treated with progesterone suppositories for 5-10 days does not crystallize in an arboreal form on drying. Vaginal smears from women using progesterone suppositories show increased desquamation and clumping in the vaginal epithelial cells similar to that seen normally in the luteal phase of the cycle. 125-250 mg of progesterone administered vaginally appears to induce some secretory changes in the endometrium in over 40% of cases. Only 1 of 8 patients tested showed a significant rise in urinary pregnanediol excretion during progesterone suppository therapy but some evidence suggests that the clinical effectiveness as demonstrated by the induction of withdrawal bleeding may not be equated with pregnanediol levels. Withdrawal bleeding occurred in 131 instances following 144 trials after administration of progesterone suppositories in doses of 25-50 mg for 5-10 days. The potency of progesterone administered through vaginal suppositories is comparable to that of ethisterone orally but it is less expensive.

Effect of bacitracin suppositories on the vaginal flora and on morbidity in vaginal hysterectomies

1. 1. Patients undergoing vaginal hysterectomies were given bacitracin prophylactically m the form of vaginal suppositories containing io,u00 units. 2. 2. Cultures taken twelve to fourteen hours after insertion of the suppository revealed a marked reduction in the number and variety of organisms. 3. 3. In vitro resistance studies showed a high incidence of penicillin-resistant and a low incidence of bacitracin-resistant bacteria. 4. 4. A striking reduction in postoperative morbidity and number of patients requiring additional medication was found in the bacitracin series as compared to the controls. 5. 5. No untoward reactions to this antibiotic were encountered.