No abstract

To determine whether there is a difference on the historical and clinical characteristics of omphalitis among term and preterm appropriate for gestational age (AGA) and small for gestational age (SGA) infants, we prospectively investigated 85 newborns with bacteriologically proved omphalitis. Study groups were based on gestational age and being SGA. Preterm AGA infants had significantly lower mean age and neutrophil counts. Risk factors such as septic delivery including unplanned home delivery, and bacterial spectrum were similar in the groups. Staphylococcus aureus and Escherichia coli were the most frequent micro-organisms. Mortality rates for the study groups were similar and overall case fatality rate was 13 per cent. Immunological immaturity of preterm newborns may explain the earlier occurrence age of omphalitis and lower absolute neutrophil count. The following features such as early-onset infection, septic delivery including unplanned home delivery and abnormal temperature may be considered as determinants of poor prognosis. However, further studies are needed.

Study objective-The aim was to study the relationship between birth prevalence of neural tube defect (including anencephaly) in Eastern Turkey before and after the Chernobyl disaster.Design-This was a prospective study of time trends in live births and stillbirths over the years [1985][1986][1987][1988][1989][1990]. Medical and sociodemographic data were recorded for the mothers.

Group B streptococcus infection is an important cause of neonatal morbidity and mortality. We studied 114 women and their newborns to determine the relationship between maternal carriage and neonatal group B streptococcal colonisation. Rectal, cervical and vaginal swabs were taken at delivery. Within a few minutes of birth, swab specimens were also taken from throat, ear, umbilicus, conjunctiva and skin of the newborns. Group B streptococcus was isolated in 10 (8.7%) of the 114 pregnant women studied and in five (4.3%) of the 114 newborns. Vertical transmission rate was found to be 50%. Neonatal group B streptococcus colonisation has not reached a high level in Turkey, and consequently does not warrant intrapartum screening at the moment.

Laparoscopy is the access of choice for functional surgery of the gastroesophageal junction, and oesophagocardiomyotomy, as the conventional surgical treatment of achalasia, is one of the favourable indications for laparoscopic surgery. Laparoscopic anterior myotomy technique is highly effective and secure for relieving dysphagia with minimal risk of gastroesophageal reflux. Fifteen patients with the diagnosis of achalasia were treated with laparoscopic anterior face oesophagocardiomyotomy without a concomitant antireflux procedure. There was not any perioperative complication and no procedure was converted to open operation. Oesophageal cineradiography, manometry and 24-h pH monitoring were repeated postoperatively. Manometry showed a significant reduction of the resting tone (48-34.4 to 18-3.2 mmHg), and patients were free of symptoms for reflux and dysphagia at the follow-up between 8 and 96 (median 42) months. Only one patient needed pneumatic dilation, 1 year after the operation for mild dysphagia, and one patient had moderate reflux, which was managed by medication. Thanks to minimal invasive technique of laparoscopic surgery and intraoperative endoscopy, oesophagocardiomyotomy can safely be performed in a length needed without dividing lateral and posterior phrenoesophageal ligamentous attachments. Consequently, adding an antireflux procedure routinely is not necessary. We advocate laparoscopic anterior oesophagocardiomyotomy alone as the first-line treatment for achalasia.