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Objectives: Kaposi's sarcoma is an acquired immunodeficiency syndrome (AIDS)-defining illness. A spectrum of non-Kaposi's sarcoma clinical and histopathological mimickers contributes to the potential over- or underdiagnosis of Kaposi's sarcoma. The aim of this audit was to investigate the clinical diagnostic accuracy of Kaposi's sarcoma and to find out whether or not knowledge of the human immunodeficiency virus (HIV) serostatus influenced the clinical diagnostic accuracy. Design: Cross-sectional study of 511 mucocutaneous biopsies. Settings and subjects: All the biopsies were from African patients from the Limpopo province. The HIV seropositive status was known in 327 cases (64.2%). The clinical diagnosis, provided in 369 cases (72.2%) was compared with the biopsy. A Kaposi's sarcoma herpesvirus-positive immunophenotype on biopsy served as the diagnostic gold standard. Outcome measure: Concordance or discordance between the clinical provisional diagnosis and the histopathological gold standard. Results: The rate of provisional clinical diagnosis of non- Kaposi's sarcoma in biopsy-proven Kaposi's sarcoma was 18.1% in HIV-positive, and 39.5% in HIV unknown, serostatus (chi-square 11.8, p-value = 0.0006). The concordance between the clinical diagnosis and biopsy was 76.5% in the HIV-positive, and 49.9% in the HIV-unknown, cases (chi-square 16.9, p-value < 0.0001). Conclusion: Knowledge of the patient's serostatus significantly improved the clinical diagnostic accuracy of Kaposi's sarcoma. Biopsy remains the diagnostic gold standard. [ABSTRACT FROM AUTHOR]

The aim was to investigate to what extent low Apgar scores are linked to the partogram's result and, more specifically, if the action line should be set 3 rather than 4 h parallel and right to the alert line. Some 24.0% of all labours evolved left to the alert line and 26.3% of the labours right to the alert line crossed the 4-h action line. An Apgar score of ≤6 at 1 min was an indicator for resuscitation. More than one-third of the low Apgar scores occurred during normal labour left to the alert line. Crossing the alert line yielded a relative risk (RR) for resuscitation of 1.91 (95% confidence interval, CI 1.44 – 2.52); p [ABSTRACT FROM AUTHOR]

Objective: To determine the yield of opportunistic Pap smears taken in an unscreened and medically underserved population in the Transkei Region of South Africa., Study Design: Cross-sectional study of 22,160 cervical cytology specimens from an unscreened population attending gynecologic outpatient clinics between January 1990 and December 1996., Results: The overall prevalence of atypical squamous cells of uncertain significance (ASCUS), low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL) was, respectively, 34.7%, 8.3% and 2.4%. The ASCUS: SIL ratio was 3:1. The prevalence of invasive squamous cell carcinoma was 1.6%. The yield of opportunistic Pap smears was 10.7% including only LSIL and HSIL., Conclusion: The pathologic process of precursor lesions of cervical cancer appears to start at an early age since > 20% of cases are diagnosed before the age of 30 years. In the absence of a national screening program, opportunistic testing of medically underserved women needs to be maintained and encouraged.

Objective: To investigate the value of maternal height and foot length as predictors of pelvic adequacy and to evaluate the influence of body components' proportions on the mode of delivery., Methods: Retrospective study of the anthropometry of women having normal vertex deliveries (NVD), caesarean sections (CS) and vaginal birth after caesarean (VBAC)., Results: NVD patients were taller, had a longer vertebral column, longer lower limbs and longer feet than CS and than VBAC patients. The anthropometric measurements of VBAC patients yielded values intermediate between CS and NVD patients. The ratios of height to any of the other measured variables (vertebral column, lower limb and foot length) were similar in the three groups indicating that the body proportions were the same., Conclusion: Maternal height and foot length are of limited value as predictors of pelvic (in-)adequacy. The anthropometric features of women delivered by CS only are similar to those of women having a vaginal birth after Caesarean.

Objective: To determine whether or not breast cancer with 'clandestine' lymph node metastases differ in any important way from breast cancer with macrometastases., Methods: A study of 116 female breast cancers over a period of two years, whose axillary contents were immuno-stained prospectively to detect the possible presence of clandestine metastases, that is tumour cells identifiable only after monoclonal antibody immunostaining., Results: The prevalence of 'clandestine' lymph node metastases was 14.7%. The maximum number of 'clandestine' lymph node metastases was three per axilla. In the cases with 'clandestine' metastases the infiltrating lobular carcinoma (ILC) type was more frequently seen than in the node negative cases: (p = 0.038) (RR = 2.44; OR = 4.0). There was no difference in the hormone receptor status between the cases without lymph node metastases and with lymph node metastases, 'clandestine' or macrometastases., Conclusion: No significant difference was found between breast cancers with 'clandestine' or with macrometastases with regard to their clinico-pathologic features and hormone receptor status. The detection of 'clandestine' metastases is a painstaking and time-consuming procedure which, so far, has not been shown to be of clinical significance.

Objective: To investigate whether wrapping and/or elevation of the legs prevents post-spinal hypotension at cesarean section (CS)., Methods: 82 parturients in a community hospital were randomly allocated to one of 4 groups: raising, wrapping, raising and wrapping of the legs and no intervention. The outcome measures were the upper level of blockade, pulse rate and arterial systolic pressure (SAP). Statistical evaluation included paired and unpaired t-test, contingency table analysis and repeated measures analysis of variance., Results: The SAP remained significantly higher with wrapping; elevation did not add any benefit. The number of episodes of severe hypotension (defined as a SAP decrease > or = 20% of baseline and < 100 mmHg) was significantly reduced by wrapping (15.8% of cases) as compared to controls (45.5%)(chi2 = 11.02; P = 0.012). Elevation alone did not prevent hypotension (chi2 = 0.76; P = 0.38)., Conclusion: Wrapping of the legs at spinal block for Cs is recommended to reduce hypotension.

The microbiology, epidemiology and pathophysiology of ophthalmia neonatorum are reviewed with special emphasis on its prevention and management in the developing world. Although prophylaxis should be mandatory, no single topical agent is effective to prevent the ocular complications of both Neisseria gonorrhoea and Chlamydia trachomatis. Where levels of resistance to tetracyclines are low, however, tetracycline eye ointment is permissible for ocular prophylaxis. Eye prophylaxis has a relatively low failure rate. Management of ophthalmia neonatorum should be syndromic and systemic. Contact tracing is an integral part of the management.

The objective of this work was to determine whether parturients with pregnancy-induced hypertension (PIH) are at higher risk of post-spinal hypotension at caesarean section. This was an observational study of 24 women with PIH undergoing caesarean section under spinal analgesia with 0.5% hyperbaric bupivacaine, compared with 24 matched normotensive parturients receiving a spinal block for caesarean section. The mean intra-operative systolic arterial pressure (SAP) was similar with and without PIH (p = 0.38). The mean percentage decrease in SAP of baseline was more with PIH (16.2%) than in the controls (0.5%) (p < 0.001). The number of episodes of severe hypotension (SAP decrease to < or = 80% of baseline and < 90 mmHg) (p = 0.80) as well as the magnitude (p = 0.31) of severe hypotension was similar in both groups. There was no difference in the evolution of diastolic arterial pressure and maternal pulse rate between cases and controls. Maximum levels of upper sensory blockade were similar. Foetal and maternal outcome was similar with and without PIH. The decrease in SAP is less on an absolute scale but more on a percentile basis with PIH at caesarean section under spinal analgesia than in normotensive patients. The difference, however, is not clinically sufficient to discourage spinal analgesia for caesarean section with a low dose (1.5 ml, 7.5 mg) of 0.5% hyperbaric bupivacaine in parturients with PIH.