A clinicobacteriological study on leucorrhoea.

The pathogens like Trichomonas vaginalis (4.5%), N gonorrhoeae (2.7%) and C albicans (6.7%) were exclusively present in leucorrhoea. The other potential agents with their respective percentages in normal women and cases of leucorrhoea were U urealyticum (21.2% and 50.2%), actinomyces (29.7% and 41.6%), Chlamydia trachomatis (17% and 48.8%), candida-like organisms (CLO) (1.2% and 9.5%) and non-group B streptococci (4.2% and 16.7%). The percentages of urethral syndrome (65.8%), vaginal irritation (63.4%), sore vulva (17%), cervicitis (13.4%), cervical erosion (11%) of the STD clinic were more than those of gynaecological cases. The latter group more often revealed infertility (15.8%) and pelvic inflammatory disease (13.6%). The exclusive isolation rate of N gonorrhoeae (7.3%) and prevalence of G vaginalis (19.5%) and Trichomonas vaginalis (8.5%) in the STD clinic were notable. The cases of gynaecological clinic more commonly showed C albicans (8%) and CLO (13.6%). Significant differences pertaining to U urealyticum (leucorrhoea and inapparent group p < 0.01; leucorrhoea and normal cases p < 0.01), M hominis (leucorrhoea and inapparent group p < 0.05; leucorrhoea and normal cases p < 0.01), Chlamydia trachomatis (leucorrhoea and normal cases p < 0.01) and also actinomyces (leucorrhoea and normal cases p < 0.01; inapparent and normal cases p < 0.05) were recorded. There was conspicuous association of U urealyticum, M hominis, G vaginalis, Chlamydia trachomatis, CLO and actinomyces with leucorrhoea. An almost exclusive presence of Staph aureus, Esch coli and Klebsiella in cases of leucorrhoea appeared meaningful.

Small for gestational age babies: Indian scene.

Intrauterine growth retardation (IUGR) is an important determinant of neonatal mortality, morbidity and poor neurologic outcome. The study was aimed to evaluate the magnitude of perinatal risk factors in causation and the neonatal outcome of small for gestational age (SGA) babies. One hundred and three SGA babies born over a period of one year were retrospectively analysed during their hospital stay. 3.53 per cent of the babies were SGA with mean birth weight of 1657 +/- SD 354 gm (range 600-2200 gm). 68.9 per cent were term babies and 51.5 per cent were females. Toxemia of pregnancy (30.09%), hypertensive diseases of pregnancy (HDP) excluding toxemia (5.8%), diabetes mellitus (1.94%), medical disorders including renal and cardiac (3.88%), anemia (Hb < 8 gm%) and IU infection (0.97%) were the main conditions responsible for SGA. In 56.3% pregnancies, no cause could be ascertained. The common perinatal problems were infections in 27 (26.2%), birth asphyxia in 22 (21.36%), polycythemia in 25 (24.3%), jaundice in 22 (21.36%) and hypoglycemia in 7 (6.8%). Congenital malformations in 2 (1.94%) and Hyaline membrane disease in 1 (0.97%) were uncommon problems. 5.8 per cent babies died due to various perinatal problems. Based on these findings it was concluded that idiopathic (? Constitutional) intrauterine growth retardation was the commonest cause of SGA in Indian babies. 58.3 per cent babies had neonatal problems and they had a better survival compared to their western counterparts.

Kinetics of theophylline in apnea of prematurity in small for gestational age babies.

OBJECTIVES: To study the pharmacokinetics of theophylline and its correlations to pharmacodynamic effects in apnea of prematurity in small for gestational age babies. DESIGN: Prospective case control study. SETTING: Level III Neonatal Intensive Care Unit. SUBJECTS: Ten small for gestational age (SGA) babies and 10 gestation matched appropriate for gestational age (AGA) babies with recurrent apnea of prematurity. METHODS: All babies were investigated to exclude secondary causes of apnea. 5 mg/kg of aminophylline loading dose followed by 2 mg/kg as maintenance dose every 8 hourly intravenously was used. The trough and peak levels of theophylline were assessed on different days of therapy. Clinical monitoring was done for the efficacy and toxicity of the drug. Analysis was done using unpaired Student's 't' test and the correlation between plasma theophylline levels of different days was performed by using ANOVA. RESULTS: The therapeutic drug levels were achieved within 24 hours in all babies. The SGA babies showed 25% higher drug levels as compared to AGA babies. The mean trough plasma theophylline levels ranged from 8.15 +/- 1.59 to 12.37 +/- 1.54 micrograms/ml in SGA babies while in AGA babies they ranged from 6.26 +/- 1.93 to 9.96 +/- 1.96 micrograms/ml in first 8 days of therapy. The mean peak levels in SGA babies ranged from 11.91 +/- 1.84 to 17.13 +/- 1.63 micrograms/ml and in AGA babies ranged from 8.17 +/- 1.84 to 13.02 +/- 1.48 micrograms/ml. Twenty per cent SGA and AGA babies each developed clinical toxicity though toxic drug levels were found in 50% SGA and 30% AGA babies. CONCLUSION: There is a need to modify dosage schedule for these babies.

Pathogenic potential of Gardnerella vaginalis on the female urogenital system.

The prevalence of certain characteristics of genital discharge like (a) watery variety in sexually transmitted disease (STD) clinic 34% and in gynaecology clinic 26.6%, (b) fishy odour in STD clinic 29.2% and in gynaecology clinic 12.2% and (c) pH > 4.5 in STD clinic 53.6% and in gynaecology clinic 43% was notable. On the other hand, occurrence of "clue cells" (in STD clinic 41.4% and in gynaecology clinic 39.5%) did not show difference in the aforesaid clinics. The preponderance of watery discharge in the STD clinic appears to be related to G vaginalis (in STD clinic 26.8% and in gynaecology clinic 9.3%). It is intriguing to note that G vaginalis was isolated from leucorrhoea (in STD clinic 19.5% and in gynaecology clinic 9.3%) and inapparent (in 10%) cases and normal (in 4.2%) cases. Single infection with G vaginalis in one particular case had profuse watery discharge, pH > 4.5 and there was occurrence of "clue cells". Likewise, in multiple infections revealing G vaginalis (29 cases) as one of the potential agents, 78.5% had profuse, 53.8% watery discharge of which 53.5% had "clue cells" and 81% had pH > 4.5. In mixed type of infections, the U urealyticum (53.8%) and M hominis (30.6%) were conspicuous in bacterial vaginosis. Cervicitis, erosion cervix or urethral syndrome were unrelated to G vaginalis. All cases of G vaginalis infection responded to metronidazole with remission of leucorrhoea in 25.9% cases.

Breast lumps: a study of 10 years.

A retrospective study of lumps in the breast sent for histopathological examination in Calcutta National Medical College for a period of last 10 years was done. It was found that 2062 cases (6.82%) of histopathological examination of breast lump were studied out of a total 30208 specimens during that period. There were 1528 cases from benign breast lesions and 504 cases from the malignant breast lesions. The most common lesion found histologically was fibro-adenoma in 950 cases. Others included 150 cases of inflammatory breast diseases of which 36 cases were diagnosed as tuberculosis, 386 cases as fibrocystic disease and 42 cases as other benign neoplastic diseases. Out of 504 malignant cases 456 had carcinoma and 48 had sarcoma. Only 30 cases of male breast lesions were sent of which only a single case of infiltrating duct carcinoma was found, 28 cases had gynaecomastia and one case showed the evidence of fibrocystic disease.

Functional and behavioral responses as marker of illness, and outcome in infants under 2 months.

Value of abnormal findings on 11 functional and behavioral items were studied for identification of serious illness, presence of bacteremia and prediction of the outcome (recovery or death) in infants upto 2 months of age. All the items were graded on a 3 point scale (0, 1 and 2) in the ascending order of severity. A total of 116 infants who were being evaluated for suspected sepsis were enrolled. The assessment was completed before detailed history and physical examination. Significant associations were observed between presence of serious illness and six items by lambda2-test and/or Pearson's correlation and multiple stepwise regression analysis. These were decreased activity, abnormal quality of cry, presence of pallor, fast breathing, decreased consolability, and consciousness level. The sensitivity of six item model was > 90% and negative predictive value >95%. The negative predictive value of several individual items was also above 90%. Consciousness level was the most important predictor of the outcome followed by poor feeding, hydration, color, consolability and abnormal expression (combined multiple R = 0.51). A total score of 7 or more on above six items had a sensitivity of 80%, and negative predictive value of 97% for death. In conclusion, behavior and functional responses (as mentioned above) were fairly useful in predicting the outcome and/or the severity of the illness. These items may be combined to develop a scale to help in therapeutic decision making.

Symptomatic solitary giant congenital cysts of liver.

Three cases of non-parasitic liver cysts are reported. Each of them presented with upper abdominal pain and enlarged liver, and a cyst of enormous size was detected by ultrasound and isotopic scan. Residual cavity following cyst surgery was obliterated by different surgical techniques.

Giant cavernous hemangioma of liver.

An abscess forming in a giant cavernous hemangioma of the left lobe of the liver is reported. It was treated by lateral segmentectomy.

Study of cell mediated immunity in chronic tonsillitis.

The cell mediated immune status (CMI) of twenty three patients with chronic tonsillitis was studied with a view to ascertain any possible role of CMI deficiency in causation of the disease. No evidence of significant CMI deficiency was detected in these cases.