Subclinical group A streptococcal throat infection in school children.

Seven hundred and forty nine apparently healthy school children aged 5-15 years were investigated for throat infection with Group A streptococci (GAS) during December 1990 to May 1991. The prevalence of beta hemolytic streptococci (BHS) was 18.8%; most organisms belonged to Group A streptococci (13.7%). The prevalence of BHS in throat was significantly higher (p < .001) in girls as compared to boys. Immune response to extracellular antigens was studied in 53 children who had GAS strain in their throat, 54.7% had elevated titers of antistreptolysin O or antideoxyribonuclease B or both indicating subclinical infection with GAS. Thus it is recommended that serological examinations should be done along with throat culture to identify subclinical Group A streptococcal throat infection.     

Mitral valve prolapse: two dimensional echocardiography reveals a high prevalence in three to twelve year old children.

The prevalence of mitral valve prolapse (MVP) appears to be age related, MVP being commoner in children as compared to adults. This suggests that asymptomatic MVP may be most frequent in children who are very young. In this study, to better define the prevalence of MVP in young children, we used two dimensional echocardiography and prospectively surveyed 213 healthy urban school children between 3 and 12 years of age. MVP was diagnosed when prolapse of mitral leaflet/s was demonstrated by both two-dimensional and M-mode echocardiography at parasternal long-axis views. Overall, MVP was found in 28 of 213 (13.1%) children. MVP was similarly prevalent in all age groups studied (3-5.9 years: 13 of 83 (13.5%); 6-8.9 years: 9 of 71 (11.2%); and 9-12 years: 6 of 31 (16.2%) children; Chi square = 0.57, p greater than 0.5). Univariate analysis showed that the prevalence of MVP was independent of sex, birth weight, resting heart rate and systolic or diastolic blood pressure. A mid systolic murmur was present in 50.6% of the children although it correlated with echocardiographic diagnosis of MVP in only 39.3%. The left ventricular size or wall thickness and mitral EF and DE slopes were similar in children either with or without MVP. Our results indicate that asymptomatic MVP is frequent in children upto 12 years of age. As a diagnostic test of MVP, presence of apical systolic murmur is considerably inferior to echocardiography. No morphological left ventricular correlates were identified in MVP.     

The results of tubal surgery in the treatment of infertility in two non-specialist hospitals

The results of surgery for tubal damage, other than reversal of sterilization, were studied in two large hospitals. This is the first recent study from centres claiming no special expertise in this surgery. An unusually high follow-up rate was obtained. The term pregnancy rate for patients operated on for bilateral distal tubal occlusion was 4%. The success rate is lower than the lowest reported, overall success rates for each cycle of in vitro fertilization (IVF) and very much lower than cumulative term pregnancy rates for tubal surgery reported by most other authors. Patients with distal tubal occlusion but minimal adhesions had the best prognosis. Our results suggest that, provided in vitro fertilization is available, only those patients with good prognostic factors should undergo tubal surgery. These represent the minority of all patients with non-iatrogenic tubal blockage.     

Closure of persistent central perforations of tympanic membrane using 1% hyaluronic acid

Twenty five dry, small or medium sized persistent central perforations were treated by local application of 1% hyaluronic acid after excision of the perforation rim. The duration of the perforation ranged from two months to forty years. 88 percent perforations healed with 16 ± 4 (S.D.) days using 5 ± 1.6 (S.D.) applications. Hyaluronic acid treatment of dry tympanic membrane perforations not exceeding one quadrant seems to be an alternative to surgical myringoplasty.     

Analysis of nodal metastasis in malignancies of upper aerodigestive tract

A mass appearing in the neck can be a diagnostic challenge. The malignancies of upper aerodigestive tract are mostly squamous cell carcinoma and their metastasis remain largely confined to accessible neck areas permitting useful surgical management. In this study 30 patients were taken up with neck node metastasis. It was found that in supraglottic carcinoma even in no neck incidence of nodal metastasis was high. Even the retropharyngeal lymphnodes not involved in routine radical neck dissection were found to be involved in a few cases, which justifies the search for nodes in retropharyngeal area in routine radical neck dissection.