The prevalence of genital Chlamydia trachomatis and mycoplasmal infections during pregnancy in an American Indian population

The epidemiology of cervical infection with Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum among a group of pregnant American Indian women was investigated. The prevalences of these microorganisms were 24-30% for C. trachomatis, 50% for M. hominis, and 80% for U. urealyticum. These rates are unusually high for an unselected sample. Infection with C. trachomatis was correlated with younger age but not with primigravidity or educational level. Neither M. hominis nor U. urealyticum infection was correlated with younger age, primigravidity, or level of education. The possible consequences of the increased prevalences of C. trachomatis, M. hominis, and U. urealyticum in this group of American Indians are of concern and are being investigated.

Ectopic pregnancy--a new surgical epidemic

Between March 1972 and September 1981, 154 patients with the diagnosis of ectopic pregnancy were treated at the University of Arizona. A retrospective review of these cases was performed to determine etiologic and demographic factors. Fertility follow-up was obtained in 58 women. Findings are discussed along with the presentation of various thoughts in an attempt to explain this proliferation of a surgical disease.

Prenatal diagnosis of occipital encephalocele by ultrasound scanning

Fetal visualization in utero can be routinely accomplished using noninvasive ultrasound techniques that do not administer ionizing radiation. Image resolution with real time sonography is sufficient to demonstrate details of possible congenital central nervous system malformations before delivery. The case reported illustrates the advantages of advance warning in an infant with occipital meningoencephalocele for determining prognosis, planning delivery by cesarean section, and preparing for immediate neurosurgical repair.

Radionuclide ventriculographic study of adaptations to exercise in aortic regurgitation

Exercise-gated radionuclide ventriculography has been proposed as a method to evaluate cardiac reserve in patients with aortic regurgitation (AR). Characterization of ventricular function, however, in AR is complicated by the dynamic nature of the leak in individual patients and by variations in severity among patients. Twenty patients with isolated AR were studied to assess the effects of exercise on the regurgitant index. The regurgitant index (left ventricular divided by right ventricular stroke counts) estimates the severity of the leak. The regurgitant index at rest was significantly higher in patients with AR than in patients without AR (3.46 +/- 1.25 versus 1.08 +/- 0.16, p less than 0.001). In patients with AR, the regurgitant index decreased during exercise to 2.6 +/- 0.8 (p less than 0.001), whereas it did not change in the control group (1.16 +/- 0.21, difference not significant). Further, in patients with AR, the greater the regurgitant index at rest, the greater the decrease during exercise (y = 0.56x -- 1.08, r = 0.78, p less than 0.001). End-diastolic counts and stroke count responses from rest to exercise were highly variable, but were explained in part by the decreasing regurgitant index. These data support previous catheterization studies and confirm gated radionuclide ventriculography as a useful tool for monitoring adaptations to exercise in AR.

Ultraviolet light-induced mutation of diploid human lymphoblasts

Ultraviolet irradiation (254 nm) of immortal diploid human lymphoblasts killed cells, caused mutation at three genetic loci studied, and transiently inhibited 3H-TdR uptake into DNA. A shoulder of about 6 J/m2 and a D0 of 6 J/m2 was observed for survival. Mutation rose in a monotonic non-linear fashion through 6 J/m2; above 6 J/m2, complex behavior approximating a plateau in induced mutation was observed. Irradiation at 4.4 J/m2 caused a transient increase in the number of cells synthesizing DNA and a decrease in the rate of DNA synthesis relative to mock-irradiated controls. The parameter of rate of DNA synthesis per cell in DNA synthetic phase showed a rapid recovery toward control values between 2 and 4 h after irradiation and a slower recovery to control values by 22 h post-irradiation. Fractionated dose schedules were used to measure the effects of allowing a time interval between doses at nontoxic fluences (2.2 J/m2), moderately toxic fluences (8.8 J/m2) and toxic fluences (17.6 J/m2). These measurements indicate that in the non-toxic range of fluences common to human exposure, mutational response is mediated by a post-irradiation process which seems to show an enhanced ability to protect against mutation induced by subsequent irradiation. However, at moderately toxic fluences there was little effect of dose fractionation, and at toxic fluences, a time-dependent increase in mutation fraction was observed at separation times greater than 7 h. We suggest that these latter observations arise primarily from cell cycle heterogeneity with regard to sensitivity to UV killing and mutation.

Antepartum treatment of Listeria monocytogenes septicemia

Maternal septicemia with Listeria monocytogenes is becoming a more prevalent problem for those dealing with obstetric patients. A flu-like illness is often present in the mother prior to delivery of the infected infant. Treatment regimens have included intravenous antibiotic therapy for the mother and induction of labor. The infant often dies of respiratory distress syndrome due to prematurity. Data from the literature tend to support the concept of antepartum therapy without delivery, unless the fetus shows signs of pulmonary maturity or has died in utero. It is believed that this approach to maternal Listeria septicemia will improve perinatal morbidity and mortality.

Balanced translocation karyotypes in patients with repetitive abortion. Case study and literature review

Cytogenetic studies were conducted upon 100 consecutive couples with abortions. Eight balanced carrier translocation karyotypes were discovered (8%): three cases of Robertsonian translocations and five reciprocal translocations. Two structural variant karyotypes and a poly-X mosaic were also found. A review of the literature on repetitive abortion revealed 82 balanced translocations in 1,331 couples, a rate of 6.2%. Cytogenetic studied should be routine for patients with repetitive abortion. In the pooled series, 3.7% of couples with translocation had wastage, including some with normal offspring; 9.2% had malformed offspring; 62% of the carrier couples lacked the malformation history. Seventy-four percent of the translocations were reciprocal; risk rates for imbalanced progeny were undefined for 90% of the carrier couples. Only 11 imbalanced conceptuses were demonstrated cytogenetically in 262 pregnancies of the carrier group.

Irregular antibodies causing hemolytic disease of the newborn: a continuing problem

The known antigens associathfed with hemolytic disease of the newborn, along with the grade of severity of the disease caused by each antigen, are presented in Table 11. The term "expectant" management means the obstetrician does not need to perform an amniocentesis and may deliver the patient at term. The obstetrician must notify the pediatrician about the delivery of te potentially sensitized infant so that proper nursery treatment of this infant can be initiated. Periodic screening of all antenatal patients for irregular antibodies can alert the physician to a potential problem with hemolytic disease of the newborn and allow the laboratory time to find acceptable donors for possible exchange transfusion. If the antibody is discovered before delivery, it is possible to obtain and store maternal blood to be utilized if a maternal transfusion is needed. When the antenatal patient with an irregular antibody is discovered, her partner should be tested for the antigen. If present, the physician can determine the severity of the disease than can be caused by this antibody from the data in Table 11 and manage the patient appropriately. The information presented should help the physician decide when further testing is needed and when unnecessary testing can be avoided.

Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy

Data are presented to define a unique group of preeclamptic/eclamptic patients with the finding of hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). This entity has been termed the HELLP syndrome and may occur when the usual clinical findings to diagnose severe preeclampsia are absent. Often the patient is given a nonobstetric diagnosis and treatment is withheld or modified. The possible pathophysiology of this syndrome, the management of the patient, and the maternal and neonatal outcomes are presented. Recognition of the clinical and laboratory findings of the HELLP syndrome is important if early, aggressive therapy is to be initiated to prevent maternal and neonatal death. The practicing obstetrician must be knowledgeable about this severe consequence of hypertension in pregnancy.

Forearm plethysmography in normotensive and hypertensive pregnant women

Forearm plethysmography affords a simple noninvasive method of studying dynamic changes in the microcirculation. This technic was used to study the peripheral circulation of normotensive nongravid women and normotensive and untreated hypertensive pregnant women during the third trimester. The variables of forearm blood flow, vascular resistance, venous capacitance, and capillary filtration coefficient were measured in the resting state and during and after exercise. The pregnant women demonstrated an increase in forearm blood flow over the nonpregnant women. As expected, vascular resistance was higher in the hypertensive pregnant patients than in normotensive pregnant women. The possible predictive value of these findings is discussed.

Intestinal cryptosporidiosis complicated by disseminated cytomegalovirus infection

A 48-yr-old man with profuse diarrhea for about 9 mo was found to have intestinal cryptosporidiosis. Treatment with antibacterial, antimalarial, and other antiprotozoal agents failed to control the disease. The organisms were identified by light and electron microscopy in a biopsy specimen from the duodenum. Disseminated infection with cytomegalovirus developed during treatment, and the patient died. Five other instances of intestinal cryptosporidiosis have been reported. Immunologic incompetence, related to either disease or therapy, or both, was present in 4 cases but, although suspected, could not be proved in the patient described in this paper.

Caffeine and the fetus: is trouble brewing?

The developing fetus is often subjected to the influence of various drugs ingested by the mother during gestation. Currently, caffeine is one of the more common drugs used by the pregnant patient. It is important that the patient be made aware that caffeine is a drug and that it may cause potential harm to the fetus. Until more scientific data are available, it is our recommendation that moderate to excessive use of caffeine during pregnancy be curtailed and that mild use be decided on an individual basis.

Immunologic detection of condylomata acuminata-specific antigens

A rabbit serum fraction was prepared which contained antibody specific for unique antigen(s) found in human condylomata acuminata tissue but not in other human papillomatous or normal tissues. Indirect immunofluorescent staining of cryostat sections of human tissues demonstrated an intense nuclear fluorescence in cells of the prickle cell layer of condylomata acuminata sections. Nuclear fluorescence was not apparent in cells in the basal or dermal layers. The serum fraction did not elicit nuclear fluorescence in epithelial cells of tissue from human vulva, human foreskin, juvenile hand wart, plantar wart, or squamous cell papilloma of the cervix. This demonstration of antigens unique to epithelial cells of condylomata acuminata may prove useful in the often difficult diagnosis of cervical condylomata.

Successful treatment of cerebral cryptococcoma and meningitis with miconazole

Cryptococcal meningitis and a cerebral cryptococcoma developed in a patient with pulmonary cryptococcosis ("coin lesion") shortly after infected area of lung was removed. Treatment with amphotericin B and flucytosine failed to clear the organisms and antigen from the spinal fluid or alter the neurologic manifestations related to the cerebral lesion. Therapy with miconazole cured the meningitis and led to disappearance of the lesion in the brain (serial computed tomographic scan). Study of the patient over the next 5 years disclosed no evidence of relapse of infection and completely normal findings on neurologic examination.

Preliminary testing of the contraceptive collagen sponge

The results of 3 years of developing the collagen sponge as an intravaginal contraceptive are presented. Postcoital tests were used to evaluate the efficacy of the sponge as a mechanical barrier. Results with the collagen sponge alone were compared to those of the sponge with spermicidal cream or spermicidal solution (acid buffer and zinc) and of spermicidal cream alone. The presence of any motile spermatozoa in the cervical mucus was considered a failure of the barrier method. The collagen sponge alone or with acid and zinc and spermicidal cream alone had failure rates of 22, 20, and 14%, respectively, whereas the collagen sponge with spermicidal cream had a 6% failure rate. The authors conclude that the combination of a mechanical and a chemical barrier is a more effective contraceptive method than a mechanical barrier or chemical agent alone.

Predicting adult stature: a comparison of methodologies

Three methods of predicting a child's adult height are in common use: Bayley and Pinneau (1952), Tanner et al. (1975) and Roche et al. (1975). The relative accuracies of these methods have been assessed using growth records (22 male, 24 female) from the Child Research Council, Denver, Colorado. A series of six ages from five years to mid-adolescence was examined. Testing all methods and ages within each sex with a multivariate design yielded significant differences in the methods' accuracies, but inspection of the data by age disclosed that the major discrimination occurred during adolescence, not childhood. Results also indicated that the method of skeletal age assessment (either Greulich--Pyle or TW2) is more critical to accurate height prediction than is the choice of prediction method per se. This is because of inter-population differences in the rate and pattern of progress towards maturity and thus indicates the need to compare the children under examination to the most appropriate population standards available.

Breast milk--a natural resource

As practitioners in obstetrics, we must always concern ourselves with supplying the best care for the mother and her newborn infant. Our concern for good health for both patients must extend beyond the delivery room and the early puerperium. Currently, a large proportion of our patients are electing to bottle-feed and we are losing a valuable natural resource--breast milk. It is important that the patient be educated in the advantages and techniques of breast-feeding and that all false rumors be dispelled.