[Cervical congenital hemangioma: diagnosis and management difficulties]. / Hémangiome cervical congénital: difficultés de diagnostic et de prise en charge.

Rapidly involuting congenital haemangioma (RICH) is a rare vascular tumour whose antenatal diagnosis is difficult. During ultrasound examination at 32nd weeks' gestation, a voluminous heterogeneous cephalic lesion was discovered that could be a haemangioma or a teratoma. A caesarean delivery was performed. The tumour was removed directly after birth. The pathology examination concluded on a RICH. Antenatal, prepartum and postnatal management are not consensual and must consider the lesion size.

[Fifteen practical questions concerning gestational diabetes]. / Quinze questions pratiques concernant le diabète gestationnel.

With a review of the current literature, a clarification on screening and management of gestational diabetes is hereby set out, within the frame of a Clinical Expert Series. According to the ethnic group, the prevalence varies from 1 to 14%. The treatment is based on dietary advice, insulin. The ACHOIS study demonstrates that the treatment of gestational diabetes significantly decreases perinatal complications (4 to 1%). The place of the oral treatment (glyburide) remains to be defined. In most countries, diagnosis rests on oral glucose test tolerance: Sullivan 50 g glucose test (1 hour) and 100 g test of glucose if positive (3 hours); WHO 75 g test (2 hours). The screening can be systematic or only on risk factors (wide variations between studies). Screening of gestational diabetes is required because its management improves pregnancy outcomes. Despite this, there is no consensus on the strategy of screening and diagnosis.

Influence of management system on litter size, lamb growth, and carcass characteristics in sheep.

Three management systems (winter, spring, and late summer) distinguished by season of lambing and management practices were compared for litter size born and weaned and growth and carcass characteristics of lambs. Three sire breeds (Cheviot, Rambouillet, and Suffolk) and three dam breeds (Florida Native, Native-X, and Synthetic-X) were used in 698 matings over a 3-yr period. System affected (P < .01) litter size born. Spring lambing yielded more lambs (1.62) than winter (1.49) and late summer (1.12). The winter-born lambs were lighter but fatter (P < .05), and spring-born lambs were leaner with higher leg conformation and carcass quality scores. The late summer-born lambs were not different from spring-born lambs. Wethers had higher (P < .01) weights off test than ewe lambs (43.9 vs 42 kg) but had lower (P < .01) leg conformation scores, percentage kidney and pelvic fat, yield grade, and dressing percentages. Dam breed effects were significant (P < .05) for average preweaning daily gains with 249+/-5, 201+/-9, and 191+/-9 g for progeny of Native-X, Florida Native, and Synthetic-X, respectively. Single-born lambs had higher daily gains (P < .05) than twins in a preweaning period in all management systems and higher postweaning and lifetime daily gains for winter and spring management systems.

Impact of socioeconomic status on health care utilization: factors influencing length of stay.

Using multivariate analysis, this study evaluates the relationship between socioeconomic status and hospital resource utilization as measured by length of stay for elderly Medicare patients, age 65 and older, within Shelby County, Tennessee. Variations in length of stay are compared across income groupings for seven different Diagnosis Related Groups (DRGs) and relative effects are measured for socioeconomic status, age, race, gender, discharge status, and severity of illness. Despite the lack of provider specific and patient specific information, the analysis does suggest that, once patients access the medical care system, socioeconomic status has a limited effect on discharge decisions. The results also indicate that the effect of administratively necessary days on length of stay needs further policy review.

Patient and family education: an interdisciplinary process.

An interdisciplinary education and discharge plan was developed in a 404-bed teaching hospital to coordinate and integrate the function of patient and family education across disciplines using one common form. This education plan was instrumental in providing improved documentation of patient and family education in both inpatient and outpatient departments.

Beef Quality Assurance education via satellite videoconference.

A 1.5-h satellite video program was developed for a statewide Beef Quality Assurance (BQA) producer education activity. Twenty-seven downlink sites were identified across the state, and additional known downlink sites included one each in Minnesota, Indiana, and Monterrey, Mexico. The videoconference was formally evaluated by viewers and resource people at each site. Program participants included representatives of the Ohio and National Cattlemen's Associations and two producers currently implementing BQA programs. A toll-free telephone number was available for viewer's questions during the last 15 min of air time and following the video program. A demographic data form and pre- and postconference evaluations were completed by 368 participants. Twenty-seven percent of the respondents were age 56 or older; 76% were age 36 or older. A one to five scale (strongly disagree to strongly agree) was used for evaluation. Beef Quality Assurance was considered by viewers to be an important consideration for the future in pre- (mean = 4.5, SD = .99) and post-evaluations (mean = 4.6, SD = .83). The mean response to the question regarding using more videoconferencing for agriculture programming was 3.9 (SD = .91). Four percent of participants indicated less or no videoconferencing should be used, 24% were neutral, and 72% felt more videoconferencing should be done. Comments were neutral with regard to the length of the conference (mean = 3.5, SD = .86) and the complexity of the subject matter (mean = 3.1, SD = .64). More than 88% of the participants agreed or strongly agreed that they intended to examine their overall production strategies to see where they could improve the quality of beef they produce (mean = 4.3, SD = .85). After the videoconference, 2.6% of respondents still strongly believed that BQA was not an important consideration for the future of the beef industry. The cost of all activities associated with this satellite video program was $13,000.

The value of tests of cure following cervical chlamydial infection.

Test of cure (TOC) was performed 2, 4 and 6 weeks after treatment for cervical chlamydia infection with 10-14 days of Deteclo one tablet twice daily, erythromycin 500 mg twice daily or doxycycline 100 mg twice daily. Testing was by chlamydia culture and IDEIA (DAKO diagnostics Ltd). Discrepant results were subsequently checked by immunofluorescence (Syva MicroTrak) of both sets of left over transport media. Two hundred and three patients attended on at least one occasion; 189, 146 and 107 at 2, 4 and 6 weeks respectively. Of these 127, 70 and 34, respectively, denied sexual intercourse or had consistently used condoms. Fourteen were positive over the study period by either or both methods of detection. Of 8 culture positive results 3 were negative by IDEIA. Two of these had elementary bodies (EBs) on immunofluorescence of both sets of saved transport media. One had EBs on immunofluorescence of the saved culture transport medium only. None of the 6 IDEIA positive, culture negative patients had immunofluorescent EBs in the IDEIA transport media although one had EBs in the saved culture transport medium. One IDEIA suspicious, culture negative patient had EBs in both sets of saved transport media. There was no significant difference in the rate of chlamydia detection from patients admitting to or denying unprotected intercourse. TOC has a low yield in cases of cervical chlamydial infection when there has been careful contact tracing and treatment has been completed. If TOC is performed culture should be used if available and where antigen detection methods are used confirmation should be sought for any positive results.

Prevalence of sexually transmitted disease infection in women alleging rape.

During a 2-year period ending in October, 1989, 110 women who claimed to have been raped were treated at the sexually transmitted disease clinic at Birmingham General Hospital. A total of 22 sexually transmitted infections were found in 14 (13%) women, of which Chlamydia trachomatis (in 8%) and Trichomonas vaginalis (in 6%) were the most frequently found pathogens. In none of these patients was it possible to determine whether infection resulted from rape or from voluntary intercourse with another person. The high prevalence of infection found in this study and in previous studies indicates that all women alleging rape should be investigated at a sexually transmitted disease clinic.

Evaluation of a novel solid-phase immunoassay, Clearview Chlamydia, for the rapid detection of Chlamydia trachomatis.

Clearview Chlamydia (Unipath Limited, Bedford, United Kingdom) is a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen. This assay was evaluated against the tissue culture method by using 376 paired endocervical specimens. The Clearview assay had a sensitivity of 93.5% and a specificity of 99% when it was compared with the tissue culture method. This assay does not require specialized equipment or trained personnel and yields results within 30 min from the time that a specimen is collected.

Efficacy of ceftizoxime in the treatment of uncomplicated gonorrhoea: comparison with amoxycillin.

Four centres contributed a total of 466 patients to a study comparing the efficacy of oral amoxycillin with that of probenecid and intramuscular ceftizoxime. Both treatments were equally efficacious, except in the small number of penicillinase-producing Neisseria gonorrhoeae patients, all of whom responded to ceftizoxime and none to amoxycyllin. Both treatments were well tolerated, the only two adverse effects occurring in the ceftizoxime group.

Evaluation of a genus-specific monoclonal antibody in an amplified enzyme-linked immunoassay in the detection of Chlamydia in urine samples from men.

In this study, the authors used amplified enzyme-linked immunoassay (IDEIA Chlamydia test) on urine samples of 623 male patients attending a sexually transmitted disease clinic. They compared the results with routine urethral cell culture isolation, which showed a sensitivity and specificity of 72.6% and 98.6%, respectively. The sensitivity was significantly higher (79.7%) in patients with clinical evidence of urethritis as compared with those without such evidence (59%). The use of first-catch, early-morning urine may improve the sensitivity of the test.

Patterns of psychiatric morbidity in a genito-urinary clinic. A validation of the Hospital Anxiety Depression scale (HAD).

The prevalence of psychiatric disorder (by DSM-III criteria) in a population attending a genito-urinary clinic was found to be 31%. The performance of the Hospital Anxiety Depression (HAD) scale as a screening questionnaire for psychiatric disorder was assessed. Case definition by a score of 8 or more on either of the anxiety or depressive subscales produced optimal results, giving sensitivities of 82% and 70%, and specificities of 94% and 68%, for depressive and anxiety disorders respectively.

Practical problems of diagnosing trichomoniasis in women.

Analysis of eight groups of data collected at varying intervals during a period of seven years showed fluctuations in the sensitivity of tests to diagnose trichomoniasis in women. The best results were obtained from fresh, correctly prepared Diamond's medium, Feinberg-Whittington's medium, and modified Squires and McFadzean's medium (which showed 82% to 94% relative sensitivity). Poor results were identified consistently in commercially prepared Bushby medium from one source (40% relative sensitivity) and in a batch of commercially prepared Squires and McFadzean's medium from which chloramphenicol had been omitted (23% relative sensitivity). Examination of wet film, culture, and exfoliative cytology stained by Papanicolaou's method were shown to be indispensable for auditing the performance of each test and to maintain the quality of a diagnostic service.

Detection of leukocyte esterase in urine: a new screening test for nongonococcal urethritis compared with two microscopic methods.

First-catch urine samples of 130 men attending a clinic for genitourinary medicine were screened with the leukocyte esterase dipstick test. Conventional microscopy of centrifuged sediment and inverted microscopy of unspun urine samples were performed 2-4 hr later. The leukocyte esterase test had sensitivities of 100% and 96.6% and specificities of 55% and 52.8%, respectively, when compared with the two microscopic methods. The apparently low predictive value of the positive leukocyte esterase test was probably linked to its ability to detect lysed cells and the limitations of the microscopic methods, which were used as the absolute indicator of nongonococcal urethritis. Of the 42 patients with microscopic pyuria, 45.2% had positive cultures for Chlamydia trachomatis, and the leukocyte esterase test was positive in every case. Twenty-one per cent of the C. trachomatis-positive patients were asymptomatic, and 42% had fewer than five polymorphonuclear leukocytes per high-power field (X1000) of the gram-stained urethral smear. The leukocyte esterase test appears to be a simple, practical, and sensitive test that is useful in screening for nongonococcal urethritis, especially asymptomatic nongonococcal urethritis.

Pooled specimens for Chlamydia trachomatis: new approach to increase yield and cost efficiency.

Pooled specimens from the urethra and cervix accounted for 97% of 101 positive chlamydial isolations in 332 women, and this yield compared favourably with the individual yield from either the urethra (77%) or the cervix (88%). Pooling specimens caused no apparent increase in toxicity to the cell culture system. These results indicate the advantages, in terms of higher yield and no higher cost, of combining the urethral and cervical specimens in one container.

Penicillinase producing strains of Neisseria gonorrhoeae in the West Midlands 1979-83.

All cases of gonorrhoea caused by penicillinase producing strains of Neisseria gonorrhoeae (PPNG) occurring in the population served by the West Midlands Regional Health Authority were surveyed. Isolates that were subjected to plasmid analysis were found to be mainly the "Asian" type in travellers from abroad and their immediate contacts, whereas isolates apparently indigenous in origin were mainly "African" type. The emerging sigmoid curve of yearly incidence, which is apparent for both the country and the region, may indicate that a dynamic equilibrium is being approached in the susceptible core populations. The importance of vigorous contact tracing is underlined by the contrast between the incidence of PPNG strains in the United Kingdom and the larger numbers found in areas where they are hyperendemic and where contact tracing is ineffectual or non-existent.