Abnormal cervical cytology leading to the diagnosis of a primary serous adenocarcinoma of the peritoneum.

A case is presented where abnormal cervical cytology in an asymptomatic female led to the diagnosis of a primary serous adenocarcinoma of the peritoneum. We would like to highlight the importance to the physician of a tumour diathesis on malignant cervical cytology.

Comparison of PCR/nucleic acid hybridization and EIA for the detection of Chlamydia trachomatis in different populations in a regional centre.

Culture on McCoy cell monolayers has been accepted as the reference method for the detection of Chlamydia trachomatis. Recent studies have shown that polymerase chain reaction (PCR)/nucleic acid hybridization based methods have increased sensitivity over culture while still retaining specificity. In situations where organism viability is of concern, due to factors such as transportation delays, culture is inappropriate. Regional laboratories therefore have not been able to utilize the reference method and have been forced to use less reliable methods. The aims of our study were to assess the feasibility of performing PCR to diagnose infections due to C. trachomatis in a regional laboratory using a new commercial kit--Amplicor (Roche Molecular Systems, Branchburg, NJ) and to compare the current enzyme-immunoassay (EIA) based-methods used in our laboratory (VIDAS [bioMerieux Vitek, Hazelwood MO] and IDEIA [Novo Nordisk Diagnostics, Cambridge, UK]) against PCR. Thirteen positive Amplicor specimens were found in 267 urine specimens collected from asymptomatic adolescent males and females. All 13 were confirmed positive using major outer membrane protein gene PCR (MOMP). VIDAS and IDEIA showed 100% correlation to each other but only detected 5/13 positives. Of 140 consecutive patients attending the regional sexual health clinic, 13 were Amplicor positive, 11/13 MOMP positive and 10/13 positive by VIDAS. Five of 254 patients attending the hospital antenatal clinic were positive by Amplicor, all being confirmed by MOMP. No PCR inhibition was detected in a random sample of 100 varied negative Amplicor tests using a modification of the Amplicor kit. No contamination was experienced. The Amplicor kit was shown to be suitable for use in the routine clinical laboratory with minimal disruption to workflow. For regional laboratories this kit should provide more accurate results than EIA based methods, particularly in the detection of asymptomatic persons.

Caesarean section rate reduced.

The Caesarean section rate in consecutive years was decreased from 20.5% to 11.1% of total public deliveries (p < 0.0001). On retrospective analysis the emergency Caesarean section rate decreased from 10.9% to 6.0% (p < 0.0001) and elective Caesarean section rate from 9.6% to 5.1% (p < 0.0001) in consecutive years. Interventions which have accounted for the decrease were 3-fold. Firstly, vaginal birth after Caesarean delivery was encouraged, secondly, the active management of labour and thirdly, extensive, regular peer review were introduced as unit policy. The decrease in the Caesarean section rate was not achieved at the expense of the fetus as judged by perinatal mortality rates and 5-minute Apgar scores of less than 7.

Ureaplasma urealyticum chorioamnionitis.

Controversy reigns over the role of Ureaplasma urealyticum in determining pregnancy outcome. U. urealyticum infection of the chorioamnion is strongly associated with chorioamnionitis (1-3), premature birth (2-4), and perinatal morbidity (4-6). We present 4 cases of U. urealyticum chorioamnionitis and associated morbidity and mortality.

Evaluation of the significance of Mycoplasma hominis and Ureaplasma urealyticum in female genital tract infection--a retrospective case note study.

Routine screening for sexually transmitted diseases in new patients attending the Genitourinary Clinic in Stoke-on-Trent includes a culture for Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU). A retrospective study was carried out on 400 female patients to ascertain whether there were any significant differences between the group positive for MH and UU and the negative control group. The positive group were found to be younger on average, but to have similar sexual histories to the negative control group. An association was found between the presence of genital mycoplasmas and Gardnerella vaginalis. An odourous vaginal discharge was more common in the positive group. Erythromycin was ineffective in eradicating the organisms in 62.5% of patients with MH, and 70% of those with UU. Continuing work is required to identify those women in whom the presence of MH or UU could have pathogenic effects. Treatment regimens for this group of women need to be carefully reassessed, in the light of increasing antibiotic resistance.