Treatment of asymptomatic congenital syphilis: benzathine versus procaine penicillin G therapy.

We compared the efficacy of two treatment regimens for asymptomatic congenital syphilis. Between June 1989 and July 1991, we prospectively and randomly assigned 169 patients to receive either one dose of benzathine penicillin G or procaine penicillin G for 10 days. There were no significant differences between the treatment groups in regard to birth weight, sex, race, gestational age, Apgar scores, infant or maternal rapid plasma reagin (RPR) titers, fluorescent treponemal IgM antibody, or maternal treatment. Patients were examined at 2 to 3, 6, and 12 months after treatment; treatment failure was defined as clinical signs or persistent laboratory evidence of congenital syphilis. Nine patients were removed from the study during the neonatal period, eight were lost to follow-up, and 152 patients were examined 2 to 3 months or more after treatment. Among these 152 patients, none had clinical evidence of congenital syphilis at follow-up, and all the patients tested at 2 to 3 months after treatment (68 in the benzathine penicillin G group and 61 in the procaine penicillin G group) had at least a fourfold decrease in RPR titers. The RPR became nonreactive in all but three of the infants (two in the procaine penicillin G group and one in the benzathine penicillin G group; all three were 2 to 3 months of age when last tested). We conclude that treatment failure did not occur with either regimen and that there was no significant difference in outcome between the two groups.

Community-wide estimation of illicit drug use in delivering women: prevalence, demographics, and associated risk factors.

OBJECTIVE: To determine the community-wide prevalence of illicit drug use in delivering women and to compare rates in women delivering in an urban center serving the medically indigent with those delivering in private hospitals. METHODS: Over 6 weeks, 1062 urine samples were obtained anonymously from women presenting for delivery in seven hospitals in the Jacksonville, Florida area. All urine samples were analyzed blindly for illicit drugs using fluorescent polarized immunoassay. RESULTS: The percentage of women with positive urine toxicology was 7.1%. Positive results were more frequent in the public hospital population (12.7%) than the private hospital population (3.9%). The prevalence of cocaine use was 2.1% and marijuana 5.3%. Urine positivity was similar in black and white women, with cocaine metabolites more prevalent in black women and cannabinoids more common in white women. Women with positive screens for cocaine were more likely to use tobacco and alcohol, admit to substance abuse, and receive limited prenatal care. Women with positive screens for marijuana were difficult to differentiate from the urine-toxicology-negative group. CONCLUSIONS: Urine samples positive for illicit drugs were significantly more common in women delivering in an urban center serving the indigent population than in those delivering in private hospitals. Based on associated factors, cocaine users fit a more indentifiable profile than marijuana users. The overall incidence of positive urine toxicology was no different in black and white pregnant women, but the more frequent finding of cocaine metabolites in black women may lead to biased over-reporting of substance abuse in this population.

Hospital costs for cocaine-exposed infants.

A retrospective study was done at University Medical Center at Jacksonville for the period November 1988 through October 1989 to estimate the cost of treatment for 207 infants from cocaine-exposed pregnancies, 151 (76%) black and 56 (24%) white. The mean age of the mothers was 26. Twenty-five (12%) infants were admitted into the neonatal intensive care nursery (NICU) and 82 (88%) into the normal nursery where 45% of total days was due to "social hold" pending clearance for discharge by the Florida Department of Health and Rehabilitative Services. Average stay was 21.5 days in the NICU and 6.7 days in the normal nursery. Average costs varied from $36,481 for NICU to $801 for normal nursery in excess of the usual charge for a normal full-term infant. Laboratory fees accounted for the largest percentage (41.5%) of the total cost of hospitalization in the NICU, while rooming charges are the major factor (50.8%) in the normal nursery. Total charges in the 12-month period amounted to $1,057,921 or $5,110 per patient and for a control group $520,251 or $2,513 per patient. A major concern above the cost of treatment is the special education needs when these children enter the school system.

Antibiotic therapy in preterm premature rupture of membranes: a randomized, prospective, double-blind trial.

The use of antibiotics in the management of preterm, premature rupture of membranes remains controversial. By use of a prospective randomized double-blind design we investigated the maternal-fetal benefits associated with antibiotic therapy in 85 women with premature rupture of membranes at 34 weeks' estimated gestational age. In the treatment group 40 patients received intravenous mezlocillin for 48 hours followed by oral ampicillin until delivery. In the control group 45 patients received intravenous and oral placebo. Patients who received antibiotics had chorioamnionitis and endometritis less frequently than the control group (p less than 0.01 and p less than 0.05). Pathologic examination of the placentas showed a lower incidence of chorioamnionitis in the treatment group (p less than 0.05). The period from premature rupture of membranes to delivery (latency) was prolonged with antibiotics (p less than 0.05) and resulted in significant weight gain in the infants in the antibiotic group (p less than 0.0001). These infants also had higher 1- and 5-minute Apgar scores. Clinically suspected sepsis, respiratory distress syndrome, intraventricular hemorrhage, perinatal death rate, and prolonged hospitalization (greater than 30 days) were also increased in the control group.

Complete sequence and structure of the gene for human adenosine deaminase.

The nucleotide sequence of the human adenosine deaminase gene was determined. The gene was isolated in a series of overlapping lambda phage clones containing human germ line DNA. A total of 36,741 base pairs were sequenced, including 32,040 base pairs from the transcription initiation site to the polyadenylation site, 3935 base pairs of 5'-flanking DNA, and 766 base pairs of 3'-flanking DNA. The gene contains 12 exons separated by 11 introns. The exons range in size from 62 to 325 base pairs while the introns are 76-15 166 base pairs in size. The area sequenced contains 23 copies of Alu repetitive DNA and a single copy of an "O" family repeat. All but one of these repeat sequences are located in the first three introns or the 5'-flanking region. The apparent promoter region of the gene lacks the "TATA" and "CAAT" sequences often found in eucaryotic promoters and is extremely G/C rich. Contained within this region are areas homologous to other G/C-rich promoters, including six decanucleotide sequences that are highly homologous to sequences identified as functional binding sites for transcription factor Sp1.

Neurofibromatosis in monozygotic twins: a case report of spontaneous mutation.

We report female monozygotic twins with neurofibromatosis. The family history is unremarkable, and careful examination of other family members did not show evidence of the condition. It is concluded that the occurrence in this family is due to a spontaneous mutation arising in one of the parental gametes. This article examines the similarity and difference in manifestations of the disorder in this pair of monozygotic twins.