Are There Any Significant Differences in Terms of Age and Sex in Pedestrian and Cyclist Accidents?

This study has analyzed sex-specific differences in pedestrian and cyclist accidents involving passenger cars. The most frequently injured body regions, types of injuries, which show sex-specific differences and the general accident parameters of females and males were compared. Accident data from three different European countries (Austria, Netherlands, Sweden) were analyzed. The current analysis shows that for both, females and males, pedestrian and cyclist injuries are sustained mainly to the body regions head, thorax, upper extremities and lower extremities. The results show that the odds for sustaining skeletal injuries to the lower extremities (incl. pelvis) in females are significantly higher. It was observed in all datasets, that the odds of females being involved in a rural accident or an accident at night are lower than for males. Elderly pedestrian and cyclist (≥60YO) tend to sustain more severe injuries (AIS2+ and AIS3+) than younger pedestrian and cyclists (<60YO) in some of the datasets. The findings of this study highlight the differences in males and females in both, accident scenarios and sustained injuries. Further investigations are needed to distinguish between gender- and sex-specific differences causing the different injury patterns.

Operative Gynecological Laparoscopy Under Conscious Sedation.

BACKGROUND AND OBJECTIVES: Operative laparoscopy is generally performed under general anesthesia. Local anesthesia and conscious sedation may be useful in select short procedures. In the present study, we evaluated safety and efficacy of operative laparoscopy under conscious sedation. METHODS: Retrospective observational study evaluating patients undergoing gynecologic laparoscopy. Laparoscopy under conscious sedation was performed for each patient with umbilical direct insertion of a 12-mm port, followed by 2 ancillary ports at 1 cm medially to the anterior superior iliac spine. Conversion to conventional laparoscopy or laparotomy was recorded. Conscious sedation was obtained using Remifentanil and Propofol, administered by an infusion system based on pharmacokinetic and pharmacodynamic models. Local anesthesia was administered at port insertion sites and for paracervical block. Pain intensity was evaluated with the Visual Analog Scale (VAS). Adverse events and drug concentrations throughout the procedure were retrieved. RESULTS: Our study population included 166 patients. They underwent laparoscopic unilateral versus bilateral salpingo-oophorectomy, ovarian cystectomy, bilateral salpingo-oophorectomy and omentectomy for a borderline ovarian tumor, myomectomy; or underwent surgery for unexplained infertility evaluation, pelvic pain, staging of ovarian cancer. Mean duration of pneumoperitoneum was 22.3 ± 7.2 min. Rate of conversion to laparoscopy under general anesthesia was 17/166 (10.2%) and there were only 3 cases of patients with low tolerability to the procedure. No severe adverse events occurred. Hospital discharge occurred in all unconverted cases after 6 to 18 h. CONCLUSIONS: Operative laparoscopy under conscious sedation and local anesthesia appears to be a feasible technique in gynecologic surgery with no adverse patient outcomes.

Simple and Accurate Border Detection Algorithm for Melanoma Computer Aided Diagnosis.

The interest of the scientific community for computer aided skin lesion analysis and characterization has been increased during the last years for the growing incidence of melanoma among cancerous pathologies. The detection of melanoma in its early stage is essential for prognosis improvement and for guaranteeing a high five-year relative survival rate of patients. The clinical diagnosis of skin lesions is challenging and not trivial since it depends on human vision and physician experience and expertise. Therefore, a computer method that makes an accurate extraction of important details of skin lesion image can assist dermatologists in cancer detection. In particular, the border detection is a critical computer vision issue owing to the wide range of lesion shapes, sizes, colours and skin texture types. In this paper, an automatic and effective pigmented skin lesion segmentation method in dermoscopic image is presented. The proposed procedure is adopted to extract a mask of the lesion region without the adoption of other signal processing procedures for image improvement. A quantitative experimental evaluation has been performed on a publicly available database. The achieved results show the method validity and its high robustness towards irregular boundaries, smooth transition between lesion and skin, noise and artifact presence.

The potential of different countermeasures to prevent injuries with high risk of health loss among bicyclists in Sweden.

Objective: As bicyclists account for the largest share of serious injuries in Sweden, focus to improve safety for bicyclists is needed. While knowledge about fatal bicycle crashes is rather extensive, the number of studies that have investigated non-fatal injuries is still rather limited. The aim of this study was to estimate the potential of different countermeasures to reduce crashes resulting in injuries with high risk of health-loss among cyclists in Sweden. A further aim was to describe the residual-that is, crashes that were not considered to be addressed by the analyzed countermeasures.Methods: A sample of individuals with specific injury diagnoses was drawn from the Swedish national crash database Strada. A survey form was used to collect additional information about the crash and the health-related outcomes. The potential of countermeasures currently included in the Swedish Safety Performance Indicators, as well as of countermeasures that could be described as "existing but not fully implemented" was assessed. The overall potential of all countermeasures assessed was calculated, giving a grand total without double counting. Cases that were considered not to be addressed by any of the countermeasures included (i.e., the residual crashes) were described in more detail.Results: The current Swedish Safety Performance Indicators that relate to safe cycling addressed 22% of crashes. Improved maintenance by deicing and removal of snow from bicycle infrastructure was found to have the highest potential (8%), followed by improved crashworthiness of passenger cars (5%) and safer bicycle crossings (4%). The potential for existing but not fully implemented safety improvements was 56%. The greatest potential was found for Autonomous Emergency Braking with cyclist detection for passenger cars (12%), followed by studded winter tyres for bicycles (12%), and improved maintenance on non-bicycle infrastructure (11%). In total, taking double counting into consideration, all safety improvements could address 64% of all crashes. Among the residual crashes, the majority (69%) were single bicycle crashes of which most were related to wheel locking during braking and losing balance at low speed or stationary.Conclusions: Compared with fatal crashes that involve a majority of bicycle-car crashes, the crashes leading to health-loss are mostly single bicycle crashes. Therefore, innovation and development of additional countermeasures to improve safety for bicyclists should focus on single bicycle crashes.

Evaluation of the Active Melioidosis Detect™ test as a point-of-care tool for the early diagnosis of melioidosis: a comparison with culture in Laos.

BACKGROUND: Melioidosis is difficult to diagnose clinically and culture of Burkholderia pseudomallei is the current, imperfect gold standard. However, a reliable point-of-care test (POCT) could enable earlier treatment and improve outcomes. METHODS: We evaluated the sensitivity and specificity of the Active Melioidosis Detect™ (AMD) rapid test as a POCT and determined how much it reduced the time to diagnosis compared with culture. RESULTS: We tested 106 whole blood, plasma and buffy coat samples, 96 urine, 28 sputum and 20 pus samples from 112 patients, of whom 26 (23.2%) were culture-positive for B. pseudomallei. AMD sensitivity and specificity were 65.4 and 87.2%, respectively, the latter related to 10 weak positive reactions on urine samples, considered likely false positives. The positive predictive value was 60.7%, negative predictive value was 89.3% and concordance rate between operators reading the test was 95.7%; time to diagnosis decreased by a median of 23 h. CONCLUSIONS: Our findings confirm that a strongly positive AMD result can reduce the time to diagnosis of melioidosis. However, the AMD currently has a disappointing overall sensitivity, especially with blood fractions, and specificity problems when testing urine samples.

Allogeneic hematopoietic stem cell transplantation in the elderly. Predicting the risk for non relapse mortality.

We have retrospectively reviewed 137 medical records of patients older than 50 years receiving an allogeneic hematopoietic stem cell transplantation (HSCT) between January 1997 and July 2013. Median follow up was 1.3 years. Sex, age, diagnosis, disease stage, comorbidities (according to HCT-CI score), type of donor, histocompatibility, conditioning regimen and graft-versus-host disease (GVHD) prophylaxis were evaluated. The incidence and severity of acute and chronic GVHD, overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and relapse were investigated according those variables. Acute GVHD incidence was 41% (7.3% GIII-IV). Patients with acute myeloid leukemia had lesser aGVH GII-IV (14% vs. 35%, p<0.01) comparing to the entire population. Extensive cGVHD incidence was 9.4%. Global OS 1-3 years was 44-20%, DFS 33-20%, relapse 35-41% and NRM 36-43% respectively. The presence of comorbidities showed a significant increase in NRM (CT-CI 0 vs. 1 vs ≥2: 1-3 years 17-24% vs. 40-46% vs. 45-67%, p=0.001, MA HR 2.03, CI 95% 1.02-5.29), as well as cyclosporine vs. tacrolimus (1-3 years 47-53% vs. 25-36%, p=0.01). Tacrolimus patients had higher 1-3 years OS (49-25% vs. 31-13%, p=0.01) and DFS (41-26% vs. 20-11%, p<0.01). Age, type of donor and myeloablative conditioning showed no significant differences in any outcome. Allogeneic HSCT is a valid therapeutic option for older patients in Argentina. The main risk factor for a significantly increased NRM and a trend to inferior OS was the number of comorbidities. Age was not a factor for a worse result. The other factor having a significant effect in better outcome was tacrolimus administration.

Allogeneic hematopoietic stem cell transplantation in the elderly: Predicting the risk for non relapse mortality

We have retrospectively reviewed 137 medical records of patients older than 50 years receiving an allogeneic hematopoietic stem cell transplantation (HSCT) between January 1997 and July 2013. Median follow up was 1.3 years. Sex, age, diagnosis, disease stage, comorbidities (according to HCT-CI score), type of donor, histocompatibility, conditioning regimen and graft-versus-host disease (GVHD) prophylaxis were evaluated. The incidence and severity of acute and chronic GVHD, overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and relapse were investigated according those variables. Acute GVHD incidence was 41% (7.3% GIII-IV). Patients with acute myeloid leukemia had lesser aGVH GII-IV (14% vs. 35%, p < 0.01) comparing to the entire population. Extensive cGVHD incidence was 9.4%. Global OS 1-3 years was 44-20%, DFS 33-20%, relapse 35-41% and NRM 36-43% respectively. The presence of comorbidities showed a significant increase in NRM (CT-CI 0 vs. 1 vs ≥ 2: 1-3 years 17-24% vs. 40-46% vs. 45-67%, p = 0.001, MA HR 2.03, CI 95% 1.02-5.29), as well as cyclosporine vs. tacrolimus (1-3 years 47-53% vs. 25-36%, p = 0.01). Tacrolimus patients had higher 1-3 years OS (49-25% vs. 31-13%, p = 0.01) and DFS (41-26% vs. 20-11%, p < 0.01). Age, type of donor and myeloablative conditioning showed no significant differences in any outcome. Allogeneic HSCT is a valid therapeutic option for older patients in Argentina. The main risk factor for a significantly increased NRM and a trend to inferior OS was the number of comorbidities. Age was not a factor for a worse result. The other factor having a significant effect in better outcome was tacrolimus administration.

Se efectuó un análisis retrospectivo de 137 historias clínicas de pacientes mayores de 50 años que recibieron un trasplante alogénico de precursores hematopoyéticos (TAPH). Se evaluaron las siguientes características: sexo, edad, enfermedad, estadio, comorbilidades (según el HCT-CI), donante, acondicionamiento e inmunosupresión. Se analizó la incidencia de enfermedad injerto vs. huésped aguda (aEICH) y crónica (cEICH), supervivencia global (SG), supervivencia libre de enfermedad (SLE), recaída y mortalidad libre de enfermedad (MLE). Los trasplantes fueron realizados entre 1997-2013, mediana de seguimiento 1.3 años. La incidencia de aEICH fue de 41% (7.3% GIII-IV). Los pacientes con leucemia mieloide aguda presentaron menor incidencia de EICHa GII-IV (14% vs. 34%, p < 0.01). La incidencia de EICHc extenso fue de 9.4%. La SG a 1-3 años fue 44-20%, SLE 33-20%, recaída 35-41% y la MLE 36-43%. Los pacientes con comorbilidades tuvieron un aumento significativo de la MLE (HCT-CI 0 vs. 1 vs. ≥2: 1-3 años 17-24% vs. 40-46% vs. 45-67%, p = 0.001, AMV HR 2.03, IC 95% 1.02-5.29), al igual que el uso de ciclosporina vs. tacrolimus (1-3 años 47-53% vs. 25-36%, p = 0.01). Los pacientes que recibieron tacrolimus tuvieron una mayor SG (1-3 años 49-25% vs. 31-13%, p = 0.01) y SLE (1-3 años 41-26% vs. 20-11%, p < 0.01). La edad, tipo de donante y acondicionamiento no resultaron significativos para ningún evento. El TAPH es una herramienta terapéutica válida en pacientes mayores. Los factores pronósticos que inciden mayormente en el trasplante son las comorbilidades y no la edad. El otro factor que demostró un efecto significativo fue el uso de tacrolimus.

Laparoscopic Salpingo-oophorectomy in Conscious Sedation.

INTRODUCTION: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. CASE DESCRIPTION: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic-pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure. DISCUSSION AND CONCLUSION: Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index.

Recaída extramedular de leucemia linfocítica aguda: reporte de un caso / Extramedullary relapse of acute linfoblastic leukemia: report of a case

El síndrome de vena cava superior (SVCS), considerado una emergencia, requiere tratamiento inmediato, por lo que el diagnóstico etiológico es esencial antes de decidir una conducta terapéutica. El manejo del SVCS consiste en el alivio de los síntomas y de la enfermedad subyacente. Los tratamientos tienen el objetivo de restituir el flujo sanguíneo. Se presenta un paciente de 5 años de edad, masculino, con antecedente de LLA tipo B. Su estado oncohematológico era remisión total y, en febrero de 2013, consultó por síndrome de dificultad respiratoria (SDR) de rápida evolución y edema facial, que progresó en 24 h. Se realizó angio TC de tórax y vasos de cuello, que evidenció tejido pseudonodular que comprime VCS. Se realiza biopsia endocavitaria de urgencia, que informa infiltración difusa Knfroproliferativa. Tratamiento quimioterápico, con buena evolución y egreso hospitalario. El SVCS es una emergencia oncológica que requiere diagnóstico oportuno y tratamiento inmediato a fin de mejorar los resultados.(AU)

The superior vena cava syndrome (SVCS) is considered an emergency and requires immediate treatment; therefore, the etiologic diagnosis is essential before deciding on its implementation. The management of SVCS consists on the relief of symptoms and treatment of the underlying disease, aiming to restore the blood flow. We present a 5 years old boy with a history of B-cell ALL. His oncologic state was that of complete remission. In February 2013 he consulted for respiratory distress syndrome (RDS) of rapid evolution, and facial edema which progressed within 24 hours. CT chest and neck angiography was performed, showing pseudo nodular tissue compressing the SVC. Emergency endocavitary biopsy reported diffuse lymphoproliferative infiltration Chemotherapy is administered, with good results and hospital discharge. The SVCS is an oncologic emergency that requires prompt diagnosis and immediate treatment in order to improve results.(AU)

Recaída extramedular de leucemia linfocítica aguda: reporte de un caso / Extramedullary relapse of acute linfoblastic leukemia: report of a case

El síndrome de vena cava superior (SVCS), considerado una emergencia, requiere tratamiento inmediato, por lo que el diagnóstico etiológico es esencial antes de decidir una conducta terapéutica. El manejo del SVCS consiste en el alivio de los síntomas y de la enfermedad subyacente. Los tratamientos tienen el objetivo de restituir el flujo sanguíneo. Se presenta un paciente de 5 años de edad, masculino, con antecedente de LLA tipo B. Su estado oncohematológico era remisión total y, en febrero de 2013, consultó por síndrome de dificultad respiratoria (SDR) de rápida evolución y edema facial, que progresó en 24 h. Se realizó angio TC de tórax y vasos de cuello, que evidenció tejido pseudonodular que comprime VCS. Se realiza biopsia endocavitaria de urgencia, que informa infiltración difusa Knfroproliferativa. Tratamiento quimioterápico, con buena evolución y egreso hospitalario. El SVCS es una emergencia oncológica que requiere diagnóstico oportuno y tratamiento inmediato a fin de mejorar los resultados.

The superior vena cava syndrome (SVCS) is considered an emergency and requires immediate treatment; therefore, the etiologic diagnosis is essential before deciding on its implementation. The management of SVCS consists on the relief of symptoms and treatment of the underlying disease, aiming to restore the blood flow. We present a 5 years old boy with a history of B-cell ALL. His oncologic state was that of complete remission. In February 2013 he consulted for respiratory distress syndrome (RDS) of rapid evolution, and facial edema which progressed within 24 hours. CT chest and neck angiography was performed, showing pseudo nodular tissue compressing the SVC. Emergency endocavitary biopsy reported diffuse lymphoproliferative infiltration Chemotherapy is administered, with good results and hospital discharge. The SVCS is an oncologic emergency that requires prompt diagnosis and immediate treatment in order to improve results.

[Extramedullary relapse of acute lymphoblastic leukemia: report of a case]. / Recaída extramedular de leucemia linfocítica aguda: reporte de un caso.

The superior vena cava syndrome (SVCS) is considered an emergency and requires immediate treatment; therefore, the etiologic diagnosis is essential before deciding on its implementation. The management of SVCS consists on the relief of symptoms and treatment of the underlying disease, aiming to restore the blood flow. We present a 5 years old boy with a history of B-cell ALL. His oncologic state was that of complete remission. In February 2013 he consulted for respiratory distress syndrome (RDS) of rapid evolution, and facial edema which progressed within 24 hours. CT chest and neck angiography was performed, showing pseudo nodular tissue compressing the SVC. Emergency endocavitary biopsy reported diffuse lymphoproliferative infiltration Chemotherapy is administered, with good results and hospital discharge. The SVCS is an oncologic emergency that requires prompt diagnosis and immediate treatment in order to improve results.

Recaída extramedular de leucemia linfocítica aguda: reporte de un caso. / [Extramedullary relapse of acute lymphoblastic leukemia: report of a case].

The superior vena cava syndrome (SVCS) is considered an emergency and requires immediate treatment; therefore, the etiologic diagnosis is essential before deciding on its implementation. The management of SVCS consists on the relief of symptoms and treatment of the underlying disease, aiming to restore the blood flow. We present a 5 years old boy with a history of B-cell ALL. His oncologic state was that of complete remission. In February 2013 he consulted for respiratory distress syndrome (RDS) of rapid evolution, and facial edema which progressed within 24 hours. CT chest and neck angiography was performed, showing pseudo nodular tissue compressing the SVC. Emergency endocavitary biopsy reported diffuse lymphoproliferative infiltration Chemotherapy is administered, with good results and hospital discharge. The SVCS is an oncologic emergency that requires prompt diagnosis and immediate treatment in order to improve results.

Nomogram of fetal liver volume by three-dimensional ultrasonography at 27 to 38 weeks of pregnancy using a new multiplanar technique.

We sought to establish normative data for fetal liver volume (FLV) between 27 and 38 weeks' gestation using three-dimensional ultrasonography. The study design was a longitudinal prospective study involving 53 participants. A total of 250 FLV measurements were obtained, using the multiplanar method with 3.0-mm intervals. Polynomial regressions with adjustments using the determination coefficient ( R2) were used to assess the correlation between FLV and gestational age (GA) and fetal parameters (biparietal diameter, head circumference, abdominal circumference, and estimated fetal weight). The mean, standard deviation, and median, minimum, and maximum values were calculated for each gestational age. The intraclass correlation coefficient (ICC) was used to determine inter- and intraobserver reliability. There was a high correlation between FLV and GA. The mean FLV went from 43.5 +/- 7.6 cm (3) (29.1 to 62.2 cm (3)) to 130.5 +/- 20.1 cm3 (87.5 to 191.1 cm3). There was a high correlation between FLV and all fetal biometric parameters (all P < 0.0001). Intraobserver and interobserver correlations were excellent with an ICC = 0.993 and 0.984, respectively. There was a high correlation between GA and biometric parameters. Reference limits were generated for FLV between 27 and 38 weeks. FLV is highly reproducible.

Procoagulant factors in patients with cancer.

BACKGROUND: Clotting activation and thromboembolic manifestations are common features in patients with cancer. Tumor cells can directly activate the clotting through two procoagulants: tissue factor (TF) and cancer procoagulant (CP). AIMS: The aim was to evaluate the levels of TF and CP in patients with different tumors in order to: (1) establish an association between these markers and the tumor localization, (2) establish a correlation between the levels of procoagulants and the status of the disease, (3) evaluate if the treatment with chemotherapy induced some modifications on the levels of procoagulants, (4) evaluate the possibility of using procoagulants as predictors in the development of thrombosis. METHODS: Sixty-one patients with different types of cancer (lung, breast, digestive and genitourinary) and 20 normal controls were included. The activity of TF and CP was studied in serum samples. Statistical analysis of the data was performed by two-tailed Fisher exact test. RESULTS: The TF was increased in 72.5 and 0% (p < 0.01) of cancer patients and normal controls, respectively. PC was found to be increased in 88% of the cancer patients but in healthy controls it was increased in only 15% (p < 0.01). The patients with genitourinary cancer presented the highest values of both procoagulants coinciding with a major prevalence of thrombotic events. The activity CP was found in 93% of patients with stages I and II but in patients with stages II and IV disease it was found in 85% (not significant). There were no differences in the levels of both procoagulants between the patients treated with chemotherapy and those with other treatments. CONCLUSIONS: TF and CP are elevated in patients with cancer. The highest values of both procoagulants are in the genitourinary cancer group in agreement with the greater presence of thrombosis observed in this group. Clinical follow up is important in order to determine the potential value of these procoagulants and the tendency to develop thrombosis in patients with cancer.

Factores procoagulantes en pacientes con cáncer / Procoagulant factors in patients with cancer

El objetivo del presente estudio fue determinar los niveles de factor tisular (FT) y procoagulante del cáncer (PC) en pacientes con enfermedades neoplásicas para intentar establecer: 1) si existe asociación entre la presencia de estos marcadores y el origen del tumor; 2) si los niveles de estas proteínas procoagulantes se correlacionan con los estadíos I/II o III/IV de la enfermedad; 3) si los tratamientos con quimioterapia modifican los niveles séricos del FT y PC y, finalmente 4) evaluar si estos procoagulantes podrían comportarse como marcadores predictivos en el desarrollo de trombosis. Se incluyeron 61 pacientes con diferentes tipos de cáncer: pulmón (n=14), mama (n=19), digestivo (n=13), y génitourinario (n=12) y controles normales (n=20). Los resultados demostraron una sensibilidad y especificidad del 87,9% y 85%, respectivamente, para el PC y del 72,4% y 100% para el FT. Los pacientes con cáncer génitourinario presentaron los valores más altos de ambos procoagulantes coicidiendo con la mayor prevalencia de trombosis objetiva clínica y radiológicamente. Ninguno de los procoagulantes evaluados permitió difenciar estadío I-II de III-IV de la enfermedad. Por otra parte, el tratamiento con quioterapia no modificó con significancia estadística, los niveles de ambos procoagulantes. Un seguimiento clínico y de laboratorio en función del tiempo y del tratamiento sería importante para establecer el valor pronóstico de los niveles de estos procoagulantes y su propensión a desarrollar trombosis en pacientes con cáncer.

Ultrasound markers of fetal infection, Part 2: Bacterial, parasitic, and fungal infections.

Up to 1% of all pregnancies have clinically overt intra-amniotic bacterial infections, and an even larger percentage of pregnant women may be affected by silent infections. Although most pregnant women with overt intra-amniotic bacterial infection have experienced prolonged rupture of membranes (PROM), symptomatic and most silent nonviral intra-amniotic infections may occur with intact membranes. The etiology of intra-amniotic infection after PROM is almost always polymicrobial and consists of genital tract pathogens, such as group B streptococci, Chlamydia trachomatis, Neisseria gonorrhoeae, mycoplasmas, aerobic Gram-negative bacilli, such as the coliforms, and facultative and anaerobic endogenous organisms, such as peptococci, peptostreptococci, and Bacteroides species. These organisms gain access to the uterine cavity by the ascending route. Organisms such as Treponema pallidum, Listeria monocytogenes, Toxoplasma gondii, trypanosomes, and plasmodia are capable of gaining access to the amniotic cavity by transplacental hematogenous spread, and cause devastating fetal infections. Symptomatic intra-amniotic infection is usually a diagnosis of exclusion. Diagnostic criteria based on both clinical and laboratory findings lack sensitivity and are nonspecific. It is difficult to obtain uncontaminated intra-amniotic samples, especially when there is PROM. The problem is even greater with silent infections. In most cases, fetal infection is suspected after an unexplained and unexpected adverse outcome. Maternal morbidity is increased with intra-amniotic infection; although maternal mortality is extremely rare in developed countries, this is not the case in societies where pregnant women have limited or no access to medical care. Although infected women who are treated early and aggressively with wide-spectrum antibiotics do well, more than 10% of these women develop bacteremia and up to half of them will require cesarean delivery because of poor uterine contractions and arrest of labor. The overwhelming majority of term neonates exposed to intrauterine infection after PROM do well, but up to 30% of these neonates require treatment of neonatal pneumonia or bacteremia. Outcomes for preterm neonates or for neonates who experienced silent fetal infections are more severe. Morbidity and mortality rates in these cases are high, and survivors may have long-term devastating sequelae. The ability to identify ultrasound markers of fetal infection will help clinicians identify etiologic agents with greater accuracy and correlate these infections with specific antepartum and postpartum syndromes. The recognition of markers of intrauterine infection will also reduce unexpected adverse outcomes that result from undiagnosed fetal infections.