Abnormal Pap smear: colposcopy and cryosurgery.

Colposcopic evaluation of patients with abnormal Papanicolaou smears permits the physician to visualize cervical lesions and determine the extent of intraepithelial neoplasia. Through the use of colposcopy with cryotherapy, many patients with cervical intraepithelial neoplasia may avoid a more invasive form of treatment. Family physicians should become familiar with colposcopic technique so that they can select patients who are suitable for local treatment with cryotherapy.

Lumbar puncture in infants.

Lumbar puncture is indicated in any infant with symptoms suggestive of meningitis (seizures, intractable vomiting and unexplained fever) and in the evaluation of neonatal intracranial bleeding. The infant must be held firmly in the lateral decubitus or sitting position. Under sterile conditions, a 22- to 25-gauge needle is inserted into the L3-4 interspace. The most important complication is unrecognized compromise of respiratory status.

Endotracheal intubation of the neonate.

Endotracheal intubation in the newborn may be a lifesaving procedure, a especially in cases of meconium aspiration and congenital diaphragmatic hernia. All equipment for performing intubation should be available in the delivery area. The most common and potentially serious error is leaving the endotracheal tube in the wrong position. Auscultation of the chest and abdomen must be performed and a chest x-ray obtained to document the location of the tube.

Helping parents cope with perinatal death.

Physicians often fail to realize the severe emotional impact of a perinatal death on the parents. The family physician is in an ideal position to assist the family through the normal grieving response. The parents should be promptly informed of the diagnosis of fetal or perinatal death, and the physician and parents should discuss the grief reaction. Funeral services often help the family deal with their grief. Follow-up interviews are valuable in assessing the family's adjustment.

Group B beta-hemolytic streptococcal sepsis in the neonate.

In the past 40 years, the predominant organisms responsible for neonatal sepsis have changed. Whereas Group A betahemolytic streptococci were originally most common and staphylococci later became the major pathogens, Group B beta-hemolytic streptococci have become increasingly important in recent years. Predisposing factors include premature rupture of membranes, prolonged difficult labor, prematurity and congenital anomalies. The causes and clinical features of early-onset infection (in the first week of life) and late-onset infection are different.

Use and abuse of oxygen in the newborn.

Hypoxia must be prevented in the newborn. It causes atelectasis, acidosis and pulmonary vasoconstriction, which leads to further hypoxia and, ultimately, brain damage. On the other hand, retrolental fibroplasia and bronchopulmonary dysplasia may result from too-vigorous use of oxygen therapy. Frequent blood gas measurements are required. Administered oxygen must be humidified and heated, and the oxygen concentration must be monitored with each delivery system. It is not enough to know the oxygen flow rate; an oxygen analyzer is essential.