Anti-Kell in Pregnancy and Hydrops Fetalis

Summary: A case of hydrops fetalis resulting in neonatal death as a result of maternal Kell isoimmunization is presented, with a review of the literature and a suggested protocol for antenatal management of women with Kell antibodies.     

Perinatal Infection with listeria Monocytogenes

Summary: Listeria monocytogenes has been increasingly recognized as a cause of intrauterine sepsis with associated perinatal wastage. The condition is mostly acquired through dietary intake and appropriate advice should be given to all pregnant women. The most common presentations in pregnancy include premature labour, an influenza-like illness and reduced fetal movements.
In this report, we present a series of 24 cases of perinatal listeria infection presenting to either our obstetric or neonatal units and confirmed by the microbiology department of the hospital. In particular, we wish to highlight 3 cases in which antenatal diagnosis and aggressive therapy was associated with a successful outcome. Amongst the remaining 21 cases in which an antenatal diagnosis was not made, there were 5 perinatal deaths and 1 mid-trimester loss at 18 weeks.
Clinicians must maintain a high index of suspicion for listeria, particularly in gravid patients who present with fever in the setting of a persistent 'flu-like' illness and premature labour. Once suspected, appropriate specimens for listeria culture should include blood, cervical swabs and midstream urine. Empirical antibiotic therapy with amoxicillin should be instituted while waiting for culture results in patients with possible Listeria monocytogenes sepsis.     

Cerebral air embolism due to disconnection of a central venous catheter

A case of cerebral air embolism complicating disconnection of a central venous catheter is presented. In the context of increasing use of central venous catheterization this case highlights the risk of cerebral air embolism associated with the use of central venous catheters. In this case there was no patent foramen ovale and air must have passed from the venous to the cerebral circulation through physiologic shunts in the lung. Possible means of entry of air with central venous catheters, pathogenetic mechanisms relating to cerebral air embolism, treatment and preventative measures are also discussed.     

Primary tubulointerstitial nephritis and uveitis syndrome

Primary acute tubulointerstitial nephritis and uveitis is an uncommon syndrome involving the kidney and eye. Although rare, to date 28 cases having been reported, it is important to recognise this entity to facilitate appropriate investigation and treatment. We report an unusual case of this syndrome in which the patient suffered a relapse of her nephritis concurrently with the onset of the first episode of uveitis. Both responded to treatment, although the uveitis subsequently recurred.     

THE GRANULOMATOUS REACTION IN HERPETIC STROMAL KERATITIS: IMMUNOHISTOLOGICAL AND ULTRASTRUCTURAL FINDINGS

A granulomatous reaction was identified in six corneal buttons obtained from patients with herpetic stromal keratitis. The inflammation, characterized by lymphocytes, plasma cells, macrophages and multinucleate giant cells, was associated with Descemet's membrane in five cases and with a break in Bowman's membrane in one case. The ultrastructural changes were documented by scanning electron microscopy in all cases. Transmission electron microscopy, performed in four cases, failed to disclose the presence of viral inclusions. Immunoperoxidase stains utilizing antibodies to the herpes simplex virus were done on all cases. Positivity (the presence of herpes simplex virus antigen or herpes simplex-like antigen) was detected within epithelium (three cases), within stroma (three cases), and within some inflammatory cells of the granulomatous reaction at Bowman's membrane. Positive staining was not detected in cells of the granulomatous reaction at Descemet's membrane. These results suggest that the reaction at Descemet's membrane, which has been found in a variety of corneal conditions, may be due to a poorly understood alteration in the antigenicity of Descemet's membrane.     

Hexachlorophene preparations and the newborn infant

The various incidences of staphylococcal skin disease recorded in 43876 newborn infants nursed in the maternity wing of the Geelong Hospital between January 1959 and June 1979 are given. Of these infants, 39270 underwent routine skin cleansing or care with one or other of three differing hexachlorophene preparations. The benefits and possible risks, if any, of the topical use of such hexachlorophene preparations as prophylactic aids against staphylococcal cross infection in maternity hospitals are discussed, and compared with the various blood hexachlorophene concentrations which occurred in 1100 infants during their routine skin cleansing or care.     

Ovarian Ectopic Pregnancy—A Diagnostic Dilemma

A recent case of ovarian pregnancy, the diagnosis of which is often retrospective, is presented. The discussion is based on current literature concerning the diagnostic difficulties associated with this condition.     

Extraskeletal chondroma with lipoblast-like cells

An extraskeletal chondroma occurring over the dorsum of the wrist of a 61-year-old woman is reported. The lobulated tumor is cellular and shows mild-to-moderate nuclear pleomorphism of the chondroid cells. A unique feature is that some tumor cells are univacuolated and multivacuolated owing to accumulation of lipid, mimicking the appearances of lipoblasts.     

Scedosporium endophthalmitis: two fatal disseminated cases of Scedosporium infection presenting with endophthalmitis

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post‐mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.