A Truly Knotted Cord

Summary: A case of 4 true knots in an umbilical cord, which did not cause any detectable harm, is presented. Careful examination of the placenta, membranes and umbilical cord continues to be encouraged.     

Ultrasound and neonatal hip screening. A prospective study of 'high risk' babies

We describe a simple, quick ultrasound screening test for CDH, and its use in a prospective study of babies with a 'high risk' factor, over one year from January 1987. From a birth population of 3,879, 812 hip scans were performed on 406 babies and 98 babies were abnormal. So far, there have been no late cases of CDH. Family history, breech malposition, and postural foot deformities were confirmed to be important risk factors, but babies with a simple click were equally at risk. Our early results indicate that a large proportion of the potential late cases are contained within our extended high-risk group.     

Use of latex agglutination testing in diagnosing pediatric meningitis.

BACKGROUND. Latex agglutination (LA) tests are ordered frequently on cerebral spinal fluid (CSF) specimens obtained from pediatric patients to identify pathogenic bacteria as early as possible in an acute infection. METHODS. Six hundred ten LA tests were performed on 176 patients suspected of having meningitis. RESULTS. Five patients with meningitis had positive LA tests. We found that the CSF white blood cell (WBC) count, and differential were the best predictors of meningitis. CONCLUSIONS. By limiting the use of LA tests to those patients having CSF with abnormal WBC counts or with positive Gram stains, the number of tests ordered would have been reduced. This practice would greatly reduce laboratory expense.     

Principles of screening and congenital dislocation of the hip.

The call for screening for an increasing number of surgical diseases is becoming louder and more frequent. There is a general perception that screening is ''good'' but it is important to consider the evidence carefully. There is one surgical disease that provides considerable experience of the process of screening over a period of 30 years and this is congenital dislocation of the hip (CDH). In retrospect, it is clear that screening for this disease has not been a total success. Although some specialised centres have achieved excellent results, in the country as a whole screening has been a failure. The reasons for this are analysed and emphasis is placed on the principles of screening which are briefly summarised. The results of various studies on screening and experiments on the basic functional anatomy of the neonatal hip are described. The initial results of our method of selective ultrasound screening appear to be encouraging and some evidence of a possible collagen abnormality in CDH is presented. As a general principle, however, it is suggested that strict randomised controlled trials should take place before national screening programmes are started.