Prenatal presentation of congenital chloride diarrhea: clinical report and review of the literature

A case of congenital chloride diarrhea was diagnosed after delivery in a patient whose antenatal course was notable for massively dilated small and large bowel and persistent, severe hydramnios refractory to therapy. The pathophysiologic mechanism is a dysfunctional chloride-bicarbonate exchange in the brush border of the ileum. Antenatal presentation, prenatal diagnosis, and a review of the current literature are discussed.

Management of midtrimester oligohydramnios: a case for amnioinfusion

Ultrasonic evaluation and diagnosis in cases of severe oligohydramnios is extremely difficult, and management problems exist. With appropriate diagnostic procedures, management becomes less of a dilemma. Amnioinfusion, which is the instillation of fluid into the amniotic cavity, enhances ultrasonic resolution necessary for observation of fetal anatomy and behavior. The cases of severe oligohydramnios reviewed typify those in which amnioinfusion was used to diagnose and manage mid-trimester pregnancies. This technique enabled the practitioner to define the specific cause of the oligohydramnios. Interventions, risks, and outcomes of the cases are discussed.

Laboratory diagnosis of boutonneuse fever by enzyme-linked immunosorbent assay

Little is known about the use of the enzyme-linked immunosorbent assay (ELISA) in the diagnosis of boutonneuse fever, and the reports which do exist have concerned the use of a strain of African origin and a peroxidase-labelled conjugate. We have used, as antigen, a Sicilian strain of Rickettsia conorii recently isolated from a patient with boutonneuse fever and anti-human immunoglobulins G and M labelled with alkaline phosphatase as conjugate. 432 (84.6%) of 500 sera from patients with boutonneuse fever, 4.4% of 384 sera from patients with various other pathologies, and 2.9% of 204 sera from blood donors gave positive reactions. The ELISA was highly sensitive and specific in the diagnosis of boutonneuse fever, and seems to be the test of choice for sero-epidemiological investigations, and when a large number of specimens must be examined. The test is more sensitive than the indirect immunofluorescence test, at least in the early stage of the disease (44.9% vs 21.3% positive respectively), and a long time after an acute attack.