Group B streptococcus: prevalence in a non-obstetric population.

OBJECTIVE: To establish and compare the prevalence of group B streptococcus (GBS) colonization in the vaginas of nonobstetric women with and without vaginitis. MATERIALS AND METHODS: Cross-sectional analysis GBS vaginal culture status of nonpregnant, estrogen-replete women 18 years or older presenting for annual gynecological examinations or vaginal infection. Subjects were classified into 3 groups: no vaginitis if symptoms were absent and examination results was normal; common vaginitis (CV) if microscopic examination revealed yeast, bacterial vaginosis, or trichomonads; or inflammatory vaginitis (IV) if examination revealed inflammation and immature squamous cells but no pathogens. RESULTS: Of the 215 women recruited, 147 (68.4%) showed no evidence of vaginitis, 41 (19.1%) had CV, and 27 (12.6%) showed evidence of IV. The overall prevalence rate of GBS was 22.8%. Vaginitis was associated with a significantly increased risk of GBS colonization (adjusted odds ratio: CV = 2.7, 95% CI = 1.1-6.2; IV = 2.9, 95% CI = 1.1-8.0). Logistic regression revealed pH higher than 4.5, presence of abnormal discharge on examination, and a women's complaint of current symptoms as significant predicators of the presence of GBS. CONCLUSIONS: Group B streptococcus colonization occurs more commonly in women with vaginitis. This suggests that disruption of the normal vaginal bacterial environment is an important predictor for GBS colonization.

Anal canal duplication: case reviews and summary of the world literature.

Anal canal duplication (ACD) is a rare entity that is difficult to recognize. After the presentation of two patients, a review of the literature found 45 reported patients with ACD. This article presents the largest collection of known patients ACD in the literature. Of the 47 patients, 43 were female. The mean age at presentation was 28 months (range 0-24 years). The majority of the duplications were discovered incidentally (n = 21). Several presented with infectious complications such as epidural abscess with sepsis. Forty-two patients manifested an opening in the midline posterior to the native anus. Eighteen patients had associated anomalies, the majority of which were midline. Thirty-five of the patients underwent successful resection with rare complications. ACDs characteristically appear in females as incidental findings of an extra perineal orifice. They are frequently associated with additional congenital anomalies. Generally, ACDs are resectable with excellent outcomes.

Difficult extraction of long-term central venous catheters in children--case report.

Although many publications address the complications associated with insertion of long-term, indwelling central venous catheters, there are only scattered reports of problems related to their removal. We report 4 cases of pediatric patients in whom the lines could not be pulled from the vein by standard methods, requiring 2 intraperiosteal clavicle resections with venorrhaphy, 1 femoral vein exploration and reconstruction, and 1 jugular venorrhaphy. Despite their relative biocompatibility, long-term silicone lines may become fixed in the vein. The rare and unpredictable occurrence of this problem may present the surgeon with unexpected intraoperative dilemmas. Before attempting localized extraction, surgeons should consider what venue, equipment, and anesthesia support may be required to successfully remove these catheters.