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ABSTRACT
A simple and inexpensive test is described
which permits positive identification of
amniotic fluid by its fern-type crystallization. It permits a rapid and certain differential diagnosis between leukorrhea, hydrorrhea, urinary incontinence and spontaneous
amniotomy. The crystallization te:st was
shown to be most reliable and the few
sources of error are easily avoided. The
test is inhibited by cellular debris or blood
when it is in a concentration greater than
1:10. Centrifugation permits the reappearance of fern-leaf crystallization. The typical
image resembles that of the crystallization
of cervical mucus. However, amniotic fluid
crystallizes on the entire smear, whereas
mucus crystallizes in a linear fashion.
Cervical mucus crystallization is normally
absent during pregnancy. It may occur in
cases of threatened abortion. The authors
have performed the test in combination with
a nitrazin paper test in a series of 192
patients. In their hands it has given nearly
perfect results.
RESUME
II arrive fr.quemment qu'on ait .i faire un
diagnostic pr6cis d'un Scoulement vaginal
subit durant la grossesse. L'histoire, Vexamen clinique, et le laboratoire peuvent
aider . faire le diagnostic diff&entiel entre
leucorrhee abondante, hydrorrh6e, incontinence urinaire ou rupture spontan6e des
membranes.
Un nouveau test de laboratoire est ici
d6crit qui permet un diagnostic s.r: le test
de cristallis.tion du liquide amniotique.
Les faux n6gatifs sont rares, ils peuvent
.tre d.s aux d6bris vaginaux et au sang. La
centrifugation permet Ia r6apparition du test
quand il y a trop de sang ou de cellules.
Les faux positifs peuvent .tre, dfts & l'albuminurie ou & la cristallisaton de Ia glaire
cervicale. Cette 6ventualit6 est Ia plus
plausible. Elle est habituellement la marque
du mucus de Ia phase pnSovulatoire ou
annonce la menace d'avortement.
Le test de cristallisation associ6 au test
au papier Nitrazine a donn6 des r.sultats
exacts .i 98% et grAce A sa simplicit6 ii peut
.tre utile aussi bien au bureau et A Ia
clinique qu'A Ia salle de travail.
1065
1066
mucin, which is dependent upon the estrogenprogesterone hormonal relationship. This dependence explains the variation in cervical mucus during
the menstrual cycle and also its appearance during
pregnancy in cases of threatened abortion. There
seems to be a higher incidence of spontaneous abortion when the mucus shows an arborization emanating from a clear ground substance, little mucoid
matrix, few cells and a distinctive image of clear
nuclei.9-'1
Although cervical mucus is normally absent
during pregnancy, its crystallization in the cervical
film may lead to a false interpretation of amniotic
fluid crystallization. Experience in the interpretation of the test, however, permits easy differentiation of these substances. Crystallization of amniotic
liquid involves the entire smear (Fig. 3), whereas
that of cervical mucus occurs in linear bands (Fig.
4) secondary to its stringlike macroscopic nature
(Spinnbarkeit).
With knowledge of possible sources of error, we
combined the results of the aforementioned test
with that of nitrazin paper in a study of 192 female
patients seen on the obstetrical service of the
"H6pital Maisonneuve", Montreal (Table I). There
were 108 positive smears indicating amniotomy and
84 negative smears.
The nitrazin test consists of the introduction into
the vagina of a small piece of nitrazin paper. It is
Primiparas 55
(ages 17 to 34 years)
Dilation
of cervix
Multiparas 53
(ages 20 to 41 years)
Site of collection
Site of collection
En4oEndoFornix cervix Glove Forrtix cervix Glove
0-2cm...
18
2-5cm... 15
5-8cm...
1
Total true
positives.52
7
0
0
1
0
10
7
15
0
51
7
0
0
0
13
9
= 103
FALSE POSITIvES
Total.5
%error.0.92
NEGATIVES: 84
True negatives.
Debris.
False negative.
Primiparas 28 Multiparas 56
27
55
.
0
1
.
1
0
%error.1.2
1067
SUMMARY
PAGES OUT OF THE PAST: FROM THE JOURNAL OF FIFTY YEARS AGO
MONThEAL MEDICO-CHIRURGICAL
SOCIETY
Pathological Specimens. Dr. A. M. Burgess exhibited
the following series
Two cases of tumour of the neck; one from Dr. Elder's
clinic and one from Dr. Hutchison's.
Both cases were of rapid development, having grown
in less than six weeks . . . The diagnosis of these cases,
to use the ordinary term, is lym.hosarcoma. I was asked in
both cases whether or not e disease was Hodgkin's
disease. The rapid growth and extension of these and the
number of mitotic figures present in the growth seem to
leave no doubt that here we are dealing with a true malignant tumour. You will see, however, from the sections,
that the typical histological picture, which has been
described as pseudo-leukaemia, or Hodgkin's disease (the
presence of marked fibrosis and eosinophile leucocytes and
large multinuclear cells, many of which are in mitosis),
is present in one of these entirely and in the other paitially.
Dr. J. M. Elder: Clinically speaking, I do not think
the differentiation of Hodgkin's disease from lymphosarcoma is of very great importance. Both conditions should
be left alone. This case of mine was a man, stout, finelooking, from the Townships, who said that he had noticed
within a few weeks two masses, one at the root of the
neck on the left side and a smaller mass growing in the
axilla of the same side. The question came up at once, is
this lymphosarcoma or Hodgkin's disease, or is there any
differentiation between them? They are both essentially
malignant. One thing, in diagnosing from a clinical standpoint, is the enlargement of the superficial veins. It is in
the neighbourhood of this tumour, over the front of the
chest, that they are enormously enlarged. This, to me,
nearly always spells sarcoma. I do not know why the
sarcoma definitely interferes with the deep circulation, but
there it is .. The case reported, upon whom I did operate,
is now going down hill rapidly.
Dr. A. M. Burgess: Mention has been made of the
prevalent view that Hodgkin's disease is an intoxication
and not a true tumour and it is with that in mind that I
brought up this case as evidence of the neoplastic nature
of the disease. The papers mentioned on this subject have
been further supplemented by a Congress of Pathologists
in Germany in which they practically all agreed that
Hodgkin's disease was an intoxication and not a neoplasm.-Canad. Med. Ase. J., 3: 824, 1913.