Traumatic hip dislocation in childhood.

Eighteen cases of traumatic dislocations of the hip in children under 15 years of age presenting between 1985 and 1995 were reviewed. Fifteen of the dislocations were posterior. There were two groups: a younger group dislocating with minimal trauma and an older group whose injuries involved significantly more trauma. All patients were treated by closed reduction, but two required open reduction because of intraarticular fragments preventing a full reduction. On long-term follow-up of the 16 available patients (average length of follow-up, 5 years 10 months; range, 17-132), there were no cases of avascular necrosis or early degenerative change.

Comparison of Diamond's medium modified and Kupferberg medium for detection of Trichomonas vaginalis.

Diamond's medium modified, the commercially available version of the Klaas modification of Diamond's medium, was compared to Kupferberg medium and to direct wet-mount examination for detection of trichomonads in symptomatic patients. Diamond's medium was found to be superior to both Kupferberg medium (P less than 10(-4) and wet mount (P less than 10(-6].

Quality control standards for the proline aminopeptidase assay used to detect bacterial vaginosis.

We describe the preparation and usage of positive and negative quality control standards for the proline aminopeptidase assay of vaginal secretions as an indicator of bacterial vaginosis.

Effectiveness of Gonozyme for detection of gonorrhea in low-risk pregnant and gynecologic populations.

The Gonozyme Diagnostic Kit (Abbott Laboratories, North Chicago, IL) was evaluated in a population at low-risk for gonorrhea. Two hundred seventy-two female patients, consisting of 152 obstetrical patients and 120 gynecologic patients attending a family-planning clinic, were tested for Neisseria gonorrhoeae by use of culture and Gonozyme testing of specimens from the endocervical canal. The average ages were 16.1 years for the obstetric patients and 17.8 years for the gynecologic patients. The overall sensitivity of Gonozyme as compared with culture was 60.8% (57.1% for obstetric patients and 62.5% for gynecologic patients); the overall specificity was 98.4%. An association was observed between the number of colony-forming-units (cfu) per plate and a positive Gonozyme test; specimens with less than 60 cfu/plate usually yielded a negative Gonozyme result. We conclude that Gonozyme is a highly specific test but its low sensitivity as compared with that of culture does not allow it to replace standard culture media for screening of low-risk women for infection with N. gonorrhoeae.

Is analysis of vaginal secretions for volatile organic acids to detect bacterial vaginosis of any diagnostic value?

A study was undertaken to determine which fermentation products in vaginal secretions serve as the best markers for bacterial vaginosis. Three categories of markers had been previously identified, but due to cost considerations it was necessary to accurately determine if analysis for all three were necessary. With the use of vaginal secretions from well-defined patient populations, we applied gas-liquid chromatography to test for both volatile and nonvolatile acid fermentation products. It was found that only the detection of nonvolatile acids was necessary, because no additional patients with bacterial vaginosis were identified by subsequent analysis of volatile acids. Routine analysis of volatile acids to identify patients with bacterial vaginosis is labor intensive and costly and had no clinical diagnostic value.

Comparison of four methods to detect Trichomonas vaginalis.

Four methods for the detection of Trichomonas vaginalis in vaginal secretions from 88 symptomatic patients were compared: wet-mount examination, Kupferberg liquid medium, Hirsch charcoal agar, and the Papanicolaou smear. Hirsch diphasic slants and Kupferberg medium did not significantly differ in sensitivity from direct examination of wet mounts. The Papanicolaou smear identification of trichomonads was found to be the least sensitive method evaluated.

Proline aminopeptidase activity as a rapid diagnostic test to confirm bacterial vaginosis.

Two biochemical indicators of bacterial vaginosis, proline aminopeptidase activity and gas-liquid chromatographic analysis, were compared. Five hundred women had their vaginal secretions tested for pH, presence of a positive amine test, levels of volatile and nonvolatile short-chain organic acids, and proline aminopeptidase activity. In addition, direct microscopic and Gram stain examinations were performed. Of the 500 women, 349 (70%) had some form of vaginitis. One hundred sixteen were diagnosed as having bacterial vaginosis, and 69 of these (59%) had Mobiluncus sp on either direct microscopic or Gram stain examination. Two hundred thirty-three had either mixed or other forms of vaginitis. One hundred fifty-one patients were normal. The sensitivity of the proline aminopeptidase assay was 83 and 79%, respectively, in patients having bacterial vaginosis with and without Mobiluncus morphotypes. In contrast, gas-liquid chromatography of short-chain organic acids had sensitivities of 71 and 30%, respectively. Specificity of both assays was about 95%. The greater sensitivity of the proline aminopeptidase assay, especially in patients without Mobiluncus morphotypes, proves its superiority.

Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984.

Two hundred fifty-six vacuum extractions and 300 randomly chosen forceps deliveries were analyzed retrospectively. Vacuum extraction use increased from 0.3 to 3.1%, while forceps use declined from 10.1 to 4.9% over a five-year period. No differences were found in indications for vacuum extraction and forceps, but the preapplication position differed (occiput posterior or transverse in 81.2% in the vacuum group and 27% in forceps patients). Preapplication station also differed, with 59.8% of vacuum extraction at +1 or higher stations, compared with 9% of forceps. Under these conditions we found less maternal trauma, similar failure rates (3.9 versus 2%), and no difference in maternal morbidity. There was a higher incidence of shoulder dystocia and neonatal jaundice in the vacuum group, but cephalohematoma frequency did not differ significantly (3.9% vacuum extraction, 4.3% forceps). Cosmetic injuries (ecchymoses, abrasions) were more likely with vacuum extraction than with forceps (44.1 versus 29.5%). One death occurred in each group. Vacuum extraction replaced midforceps in our institution in the study period. We consider vacuum extraction a useful technique to teach house staff in view of today's decreasing instrumental delivery rate.

Amniocentesis for gram stain and culture in preterm premature rupture of the membranes.

A retrospective study was conducted to assess the predictive value and clinical usefulness of amniotic fluid Gram stain and culture in the management of preterm premature rupture of the membranes (PROM). Amniocentesis was attempted in 79 patients and was successful in 53 patients for a success rate of 67%. The complication rate was 1.8%. Fifty-three patients from whom amniotic fluid was obtained after preterm PROM were studied. Patients were managed expectantly unless clinical chorioamnioitis developed, a positive Gram stain or culture was found, or a mature lung profile after 34 weeks' gestation was established. A low incidence of chorioamnionitis (5.5%), postpartum endometritis (11%), and neonatal sepsis (3.5%) was found with expectant management. A statistically significant association between Gram stain and antepartum infection, postpartum infection, and neonatal infection was noted. Gram stain had a 100% sensitivity and 82% specificity as predictor of chorioamnionitis. Amniotic fluid culture had a 100% sensitivity and 76% specificity as predictor of chorioamnionitis. As predictor of a positive culture result, Gram stain had a sensitivity of 60% and specificity of 92%. No patient with a negative Gram stain or culture developed infectious sequelae regardless of the timing of amniocentesis. All positive Gram stains and cultures were found within 48 hours of rupture of membranes. Amniocentesis for Gram stain and culture has clinical usefulness in preterm PROM and, despite false-positive tests, the authors' data support intervention on the basis of a positive Gram stain.

Comparison of lecithin: sphingomyelin ratio, fluorescence polarization, and phosphatidylglycerol in the amniotic fluid in the prediction of respiratory distress syndrome.

The significance of the lecithin sphingomyelin (L:S) ratio as a determining factor in fetal lung maturity is well established. An L:S ratio of greater than 2.0 to 2.5 is indicative of fetal lung maturity in most assays. The fluorescence polarization method (fluorescence polarization less than 0.320) has been associated with fetal lung maturity. The presence of phosphatidylglycerol in amniotic fluid has been related to fetal lung maturity and the absence of respiratory distress syndrome. Amniotic fluid samples from 235 amniocentesis procedures and vaginal pool collection at varying gestational ages were analyzed for L:S ratio, fluorescence polarization, and phosphatidylglycerol. All samples with meconium or hemolyzed blood contamination and selected complications of pregnancy were removed from the study. A positive result will predict the absence of respiratory distress syndrome, and a negative result will predict the presence of respiratory distress syndrome. Correlation of L:S ratio, fluorescence polarization, and phosphatidylglycerol were favorable. False-positive results in three (3.3%) fluorescence polarization samples were noted, whereas there were none (0%) in the L:S ratio sample and one (1%) in the phosphatidylglycerol sample. Twenty-four (77.4%), 28 (73.7%), and 37 (77%) were the number of false-negatives in the fluorescent polarization, L:S ratio, and phosphatidylglycerol samples. Fluorescence polarization, L:S ratio, and presence of phosphatidylglycerol compare favorably as fetal lung maturity tests. The prediction of respiratory distress syndrome is as sensitive with the three modalities. The specificity and the predictive value of a positive test is more favorable with L:S ratio and phosphatidylglycerol.

Neonatal myotonic dystrophy as a cause of hydramnios and neonatal death. A case report and literature review.

A woman had three consecutive pregnancies complicated by hydramnios and early neonatal death. The identical prenatal and neonatal course, family history and, ultimately, maternal diagnosis supported the diagnosis of recurrent severe neonatal myotonic dystrophy. Ultrasonographic observation of the last fetus affected suggested and predicted the neonatal features of the disease.

Prenatal diagnosis in two pregnancies of an achondroplastic woman.

We present the results of the ultrasonographic examination of two successive pregnancies of an achondroplastic woman. The limb bones were measured and shown to be normal in length. Other pertinent literature reports are discussed.

Early-onset preeclampsia, triploidy and fetal hydrops.

Early-onset preeclampsia (16-24 weeks) is frequently associated with fetal and placental anomalies. Hydatidiform mole, fetoplacental triploidy with partial molar changes and idiopathic hydrops fetalis are commonly associated ones. Two patients had severe, early-onset preeclampsia and ultrasonically documented fetal anomalies, one fetal triploidy, the other idiopathic hydrops with normal karyotype. The management of early-onset preeclampsia benefits from ultrasonography, and an aggressive search for fetal anomalies is recommended. Seventy-two percent of cases of early-onset preeclampsia in our institution were associated with significant fetal and placental malformations. An immunologic basis of the preeclampsia in these cases seems likely but remains unproven.