bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent Modifications to the International Clinical Staging of Cancer of the Cervix, Corpus Uteri and a New Staging in Vaginal Carcinoma
Authors: McGarrity K. A.
Published: February 2008

1. A short history has been given of the development of the Annual Report on the Results of Treatment in Carcinoma of the Uterus, since its formation.

2. A short history of the development of stage‐grouping in relation to carcinoma of the cervix has been traced since its development in 1929.

3. Stage‐grouping adopted by the General Assembly of National Societies of the International Federation of Gynaecology and Obstetrics in Vienna in 1961 is given.

4. General rules relating to classification and staging are described.
The Gynaecological Sequelae of Blood in the Peritoneal Cavity
Authors: Brake Ian T.
Published: February 2008

A histopathological study of the material from 229 patients with ectopic pregnancy is presented, with particular emphasis on changes in the blood clot (organization) in relation to the fallopian tube and other pelvic viscera.

Distinct differences in the rate and degree of organization were noted, according to whether the blood clot was intra‐ or extra‐luminal.

There is evidence to suggest that previous inflammation has little or no effect on the rate of organization of the clot.

By analogy with changes observed in this series it is postulated that intra‐luminal spread of infection from the uterus may be commoner than is generally supposed.

After reviewing the evidence concerning the fate of blood in the peritoneal cavity, it is recommended that a thorough but gentle evacuation of blood and clot is in the best interests of the patient.
Phonocardiography as a Foetal Heart Monitor
Authors: Maxwell Ian
Published: February 2008

The normal phonocardiogram of the foetus in utero is described. The commonly observed variants are indicated.

Phonocardiography is a simple and practical method of activating an instantaneous ratemeter for continuous foetal heart monitoring. Successful recordings were obtained in 84% of cases.

Examples of normal and abnormal tracings are illustrated. Variations in rate and rhythm may be detected early by monitoring.

The value of continuous monitoring of the foetal heart is outlined.
Amniotic Embolism and Uterine Rupture
Authors: Attwood H. D. , Rome R. M.
Published: February 2008

Three cases of amniotic embolism associated with uterine rupture are reported. In one, the embolism was an incidental finding; in the second, the embolism clinically and pathologically was an associated cause of death and in the third, the amniotic fluid embolism was the only cause of death.

An assessment of the incidence of amniotic embolism requires examination of blocks from all pulmonary lobes. The significance placed on the finding of emboli in such material should be assessed in the light of the clinical history and the anatomical findings.

In the case where amniotic embolism was the only cause of death the right ventricle was collapsed — a finding against pulmonary vascular obstruction. The effects of experimental amniotic embolism can be counteracted by the pulmonary vasodilator, isoproterenol.
The Use of Radioactive Isotopes in Determining Placental Function
Authors: Cox L. W. , Munday R. N. , Sauer H. H. A.
Published: February 2008

Using Na24, 79 uterine muscle clearance tests were performed.

Of these, successful calculation was possible in 54 cases.

Prolonged clearance times are not more common in hypertension and pre‐eclampsia.

Prolonged clearance times are not more common in postmaturity.

Prediction of “placental insufficiency” by prolonged clearance times is not reliable enough to use this test clinically.
The Non‐Surgical Treatment of Vulval Condylomata Acuminata
Authors: Quinlan Desmond K.
Published: February 2008

Vulval condylomata acuminata occur most commonly during the child‐bearing period of life. Pregnancy causes a marked exacerbation in the rate of growth.

The growths may be pre‐malignant in Africans.

A plea is made for conservative treatment, using podophyllin, as opposed to surgery.

The method of podophyllin treatment is described.
Experience with Medroxy‐progesterone Acetate in the Control of Threatened Late Abortion and Premature Labour
Authors: Wurm Roger
Published: February 2008

A new progestational agent, medroxyprogesterone acetate (Provera), has been used in the second and third trimesters of pregnancy in an attempt to prolong gestation and thereby increase foetal salvage.

Experience in 89 pregnancies has been recorded. In 21 pregnancies, cervical suture has provided supportive therapy.

Sixty‐one surviving infants have resulted from 65 pregnancies in which prolongation was achieved for a significant period of time.

The intravenous injection of an aqueous suspension of crystalline Provera has been used in 12 patients. On 6 occasions, where cervical dilatation was less than 3 cm., parturition was postponed.

No significant side‐effect, in either mother or infant, has resulted from the use of this synthetic progestational agent.
An Evaluation of the Conservative Treatment of Endometriosis
Authors: Grant Alan
Published: February 2008

An evaluation has been made of the treatment of endometriosis by conservative surgery and by progestogens.

In our series of patients, progestogens were given by the intermittent, discontinuous or cyclic method for 20 days every month for 6 months.

The results of treatment with such a regime have been compared with those obtained by other workers, both in Australia and abroad, using the continuous regime (pseudo‐pregnancy).

The pseudo‐pregnancy technique gave a 15% better result than the cyclic one when the patients were re‐assessed 6 months after cessation of treatment.

The pseudo‐pregnancy regime produced a slightly better incidence of subsequent pregnancy in the hands of most clinicians.

The cyclic treatment is cheaper, available to a larger group of patients, and less psychologically disturbing, since some sort of period usually ensues each month.

When oestrogens were added to the progestogens there was more nausea but less amenorrhoea.

Reasons are given why conservative surgery is preferred to progestogens in the initial treatment plan.

Before conservative surgery is performed, the administration of progestogens for a month softens the endometriotic adhesions so that less oozing occurs and the tissue planes become easier to dissect.

Thirty‐eight per cent, of patients who desired to conceive were successful after conservative surgery.

A radical procedure (operation or X‐ray castration) was necessary after conservative surgery in 5% (lowest) and 15% (highest) of those treated. Another 5% required hormonal treatment after operation.

The apparent cure rate after conservative surgery was therefore not less than 80%.

Endometriosis is present in private patients suffering from infertility and pelvic pathology in one‐third to one‐half of the cases.
Advanced Ovarian Pregnancy
Authors: Aitken Graham
Published: February 2008

A patient with an advanced ovarian pregnancy is described, in whom a living infant was delivered after laparotomy.

Errors in the management of the case are discussed.

The literature of ovarian pregnancy is reviewed.

It is suggested that Iffy's concept of delayed ovulation and fertilization, together with his “reflux theory” in the mechanism of ectopic implantation of the fertilized ovum, should enable the possibility of abdominal pregnancy, as a rare but simple variant, to be kept in mind more easily.
The Colposcopic Appearances with Adenocarcinoma of the Cervix
Authors: Cope Ian
Published: February 2008

The colposcopic appearances of early adenocarcinoma of the cervix are described. The difficulties which may be experienced in distinguishing the condition from an area of columnar epithelium undergoing micropolypi formation are discussed.
Theca Cell Tumour of the Ovary
Authors: Fleming Neil
Published: February 2008

Eleven patients with theca cell tumours of the ovary have been presented.

The pertinent literature has been reviewed.
The Control of Ovulation by Oestrogens
Authors: Walker Ruth
Published: February 2008

Cyclic administration of oestrogen appears to mimic metropathia haemorrhagica in that the patients had heavy, irregular uterine bleeding, often preceded by amenorrhoea. The possibility that cyclic administration of oestrogens alone might provide a method of oral contraception has been rejected for three reasons. Firstly, there may develop a lack of continued effectiveness during continued use of a drug known to have been initially effective. Secondly, cycle control is not satisfactory; the abnormalities experienced are amenorrhoea and a tendency to heavy withdrawal bleeding during continued cyclic administration. Thirdly, there are theoretical long‐term hazards associated with the endometrial proliferation produced by oestrogens, although experimental evidence suggests that these and other hypothetical problems are related to continuous rather than cyclic administration. It is likely that they can be avoided by using progestins which are known to antagonize the proliferative effects of oestrogen administration.
The Investigation of Glycosuria in Pregnancy
Authors: Breidahl Harald D.
Published: February 2008

Glycosuria is common in pregnancy, and because of the possibility of its being due to gestational diabetes, with attendant risk to the foetus, all patients with this finding should be investigated with a glucose tolerance test.

The upper limits for the normal values obtained in pregnancy with a 50 g. glucose tolerance test were as follows:

Fasting…less than 100 mg.%

hour…less than 170 mg.%

hours…less than 120 mg.%

hours…less than 100 mg.%

The whole curve is more reliable than single figures, one or two of which may be elevated in an otherwise normal curve.
Heart Disease and Pregnancy
Authors: Etheridge M. J.
Published: February 2008

A series of 370 consecutive patients with heart disease and pregnancy observed during a 10‐year period at the Royal Women's Hospital, Melbourne, is described. The diagnosis and management of these patients is discussed.

Five patients had mitral valvotomy during pregnancy and one of these died 14 days after operation from staphylococcal bronchopneumonia.

There were 6 women in all who died during pregnancy or in the post partum period. Two of these deaths were unavoidable and due to the natural history of their disease, one other patient had both mitral and aortic valve lesions, whilst the remaining 3 had mitral stenosis.
Fatal Gunshot Wound of Foetus Inflicted by the Mother
Authors: Kloss M.
Published: February 2008

A case is presented of a fatal gunshot wound to the foetus inflicted by the mother.

The bullet passed through the uterine fundus and the foetal skull; there was no injury to other structures apart from the abdominal wall.

The literature has been briefly reviewed.
Nutrition Studies in Pregnancy
Authors: Hankin M. E. , Burden J. K. , Symonds E. M.
Published: February 2008

The eating habits and nutrient intakes have been related to the outcome of pregnancy in a series of 174 women.

The majority of the women were eating diet3 which appeared to be adequate, if not optimal, in regard to most nutrients.

No relationship was found between maternal diet and the outcome of pregnancy in this series.

No relationship was demonstrated between maternal nutrient intake and the birth‐weight of the baby.

The intake of calcium was below most currently accepted standards.
The Management of Threatened Abortion by Pregnanediol Estimation and Vaginal Cytology
Authors: Cox L. W. , Cox R. I. , Skipper J.
Published: February 2008

Forty‐four patients with threatened abortion have been investigated for progestational activity by pregnanediol excretion and lateral vaginal smears.

The prognostic accuracy of both methods of estimation was similar.

When both pregnanediol and smear reports were normal over 80% of pregnancies reached viability.

When either report indicated severe progesterone deficiency no pregnancy reached viability.

It is suggested that the lateral vaginal smear should be used as an index in most cases of threatened abortion if progestational therapy is considered.
Alterations in Pregnanediol Excretion in Threatened Premature Labour Following Massive Progestogen Therapy
Authors: Cox R. I. , Wurm R. S.
Published: February 2008

1. A notable increase in pregnanediol excretion has been found in 9 out of 14 pregnant patients receiving massive Provera therapy, after viability has been reached, to control uterine contractions.

2. The increase in pregnanediol excretion is most apparent 2–3 weeks after commencing Provera treatment.

3. An hypothesis is submitted as a possible explanation of this phenomenon.
Salt Atresia in Arabia
Authors: Fahmy Kamal
Published: February 2008

The literature on salt packing of the vagina after labour and its various aftereffects is reviewed.

A series of 32 gynaecological and 2 obstetric cases met with in Saudi‐Arabia and Kuwait is presented.

Important points in the diagnosis and treatment of this interesting condition are discussed.
Post Partum Retention of Urine Due to an Incarcerated Retroverted Uterus
Authors: Forster Frank M. C.
Published: February 2008

A case is reported of retention of urine due to incarceration of an acutely retroverted uterus occurring 78 hours post par turn.
Ovarian Twin Pregnancy
Authors: Miller John M.
Published: February 2008

A third case of ovarian twin pregnancy is reported.

The clinical features were atypical and ectopic pregnancy was diagnosed only after the expulsion of a decidual cast.

The larger of the two foetuses measured 3.25 cm. (crown‐rump).

The literature is briefly reviewed.
A Case of Imminent Eclampsia Witnessed from the Onset
Authors: Lind T.
Published: February 2008

A case of imminent eclampsia is described. It is considered that so long as the word eclampsia is used to describe a syndrome and not a finite clinical entity, cases of ‘fulminating eclampsia’ will occur. Such cases will largely be independent of the amount or degree of antenatal care given. Accepting the work of Hamlin, however, the incidence should be less than 1: 5000 patients.
The Role of Radioactive Phosphorus (P32) in the Localisation of Vulval Lesions*
Authors: Thoms George
Published: February 2008

1. A study of the ageing changes in normal vulval skin of 200 patients and of the changes in 50 patients with vulval dermatoses and in a similar number with invasive carcinoma, is presented. It was evident that accurate localization of the; biopsy site was desirable.

2. Such localization was obtained by measurement of P32 emission from 30 or more vulval sites, 0.5 mc. of the isotope having been administered by the oral route 24 hours previously.

3. Histological findings were related to P32 uptake rates.

4. Although benign and malignant conditions could not be strictly categorized, localization of sites for biopsy enabled rational treatment to be instituted.
A Review of Intra‐Epithelial Carcinoma of the Uterine Cervix in New South Wales
Authors: McGarrity K. A.
Published: February 2008

Age specific incidence rates of non‐invasive and invasive cancer for 1963 are reviewed.

 Comparative figures for non‐invasive (506 patients) and invasive cancer (1,679 patients) from 1955 to 1964, inclusive, are given.

 Results of diagnosis by Papanicolaou smear are analysed, with surprise positive and false negative rates.

 Results of colposcopic examinations are given, including false negative rate and pick‐up rate for false negative Papanicolaou smear.

 Association of marital status, motherhood, and pregnancy with non‐invasive cancer is given.

 Methods of treatment of intra‐epithelial cancer are given and a comparison is drawn between the periods 1955‐60 and 1961‐64.

 Follow‐up figures are analysed with a brief review of causes of death.

 A histological review of 71 sections according to the definitions of the Vienna Committee on Terminology showed that only 65% were considered to be noninvasive, 28% were thought to be benign dysplasia and 7% were classified as invasive (Stage 1a). A description of treatment and follow‐up of the latter group of patients is given.
Sparteine Sulphate and Synthetic Oxytocin: A Comparative Study
Authors: Aickin D. R.
Published: February 2008

The effects of intravenous infusions of sparteine sulphate and synthetic oxytocin, when given to induce labour, were compared.

 Episodes of hypertonic uterine activity were recorded with both agents.

 When given to the same patient, response to the two drugs was not uniform. If oxytocin fails to stimulate efficient contractions, sparteine sulphate may be substituted with some hope of success.

 The administration of sparteine sulphate by the intravenous route is recommended as being the safest method of use of this drug; a dosage schedule is described.

 If sparteine sulphate is given intravenously, all the precautions normally observed in the conduct of oxytocin infusions should be adhered to.

 Sparteine appears to have no advantage over oxytocin as a routine intravenous uterine stimulant.
Thrombin Clotting Time in Mild Pre‐Eclamptic Toxaemia
Authors: Searle J. W.
Published: February 2008

A comparison between the thrombin clotting times of a group of patients with pre‐eclamptic toxaemia and of group of normal pregnant controls has shown that there is a tendency of unknown significance towards prolongation of the thrombin clotting time in the pre‐eclamptic group.

Factors involved in this reaction have been found to be within normal limits, and reasons have been given for suggesting that electrolyte imbalance might be the cause of this alteration.
Studies of Nutrition in Pregnancy V: Ascorbic Acid Levels of Blood and Milk in Pregnancy and in Lactation
Authors: Hankin M. E. , Cellier K. M.
Published: February 2008

The mean daily As. A. intakes of subjects in the second trimester, third trimester and at 6 weeks post partum were 81, 72 and 77 mg., respectively.

 Weak correlations were found between As. A. intakes and whole blood, plasma and blood cells levels at all times.

 Those women who received 100 mg. As. A. supplementation from approximately 20 weeks of pregnancy had significantly higher levels of As. A. in the whole blood, plasma and blood cells than the unsupplemented group.

 The value of As. A. supplementation in pregnancy and lactation is discussed.
A Clinical Evaluation of Buccal Oxytocin
Authors: Hennessey J. F. , Lang L. P.
Published: February 2008

A series of 60 patients is recorded in whom transbuccal oxytocin was used for the induction of labour. This would appear to be a satisfactory method with an overall success rate of 83%.

Success varied with the method used and was 100% when the membranes had been ruptured 24 hours earlier. The presence of an unfavourable cervix considerably reduced the likelihood of successful induction. The parity of the patient in this series made little difference, but there appeared to be a significant reduction in success rate in the older patient.

Blood levels of oxytocin were estimated during induction in 3 patients and were well within the upper limits of those found in normal labour.

There were 3 cases of significant uterine overactivity without any apparent ill‐effects on the foetus. The post partum blood loss was higher than that recorded for an un‐selected hospital group of patients.

Oxytocin used in any form is a potentially dangerous drug and close supervision of the patient is required. It is to be hoped that the ease of administration of this form of oxytocin does not increase its risk through misuse. Patients in this and similar series have been carefully watched and an understanding of the drug has developed as the number of cases has grown. This, naturally, leads to a higher efficiency and presumably less complications than for those who use the drug less often.
The Clinical Value of a Quantitative Immunological Assay for Human Chorionic Gonadotrophin
Authors: Connon Aileen F.
Published: February 2008

An immunological method for the detection of human chorionic gonadotrophin in urine is outlined.

 The results obtained with this method in 1,517 normal antenatal patients are given.

 These findings are related to the results obtained in patients with abnormal pregnancies (rhesus isoimmunization, abortion, ectopic pregnancy and hydatidiform mole).

 When its limitations are recognised this test can be of value in certain abnormal pregnancy states.
Ligation of the Hypogastric and Uterine Arteries*
Authors: Fahmy Kamal
Published: February 2008

Four patients with uncontrollable pelvic haemorrhage due to various causes are presented. Bleeding was brought under control by performing bilateral hypogastric artery ligation in 3 patients and bilateral uterine artery ligation in 1 patient.

The available literature on the subject is reviewed. All obstetricians and gynaecologists should be familiar with these techniques and should not hesitate in their performance in situations where other measures fail to control the bleeding.

Of the two procedures, we consider that uterine artery ligation is superior, since it is easier, quicker, requires less manipulation, and it stops uterine bleeding by shutting off the major portion of the blood flow to the uterus.
Cone Biopsy — A Survey of 100 Cases
Authors: Byrne G. D.
Published: February 2008

One hundred consecutive cases of cone biopsy have been reviewed. The complication rate, particularly that of cervical stenosis and primary haemorrhage, was found to be higher than in other reported series.

The frequency of complications and the large number of inadequate specimens is related to the poor techniques used. Various technical details have been discussed and compared with those used in other series.

Cone biopsy is still the most generally useful method of diagnosis of carcinoma in situ.

As a definitive method of treatment the value of cone biopsy was lessened by the high infertility rate in this series.
Monoamniotic Twins: A Case‐Report and Some Comments on the Condition
Authors: Atlay R. D.
Published: February 2008

A case of monoamniotic twin pregnancy with double survival in the presence of true cord knotting is described.

 The aetiological and clinical aspects of the condition are discussed.

 Awareness of the condition, meticulous inspection of the placentae, umbilical cords and membranes of all multiple pregnancies and the reporting of all cases of monoamniotic twins should produce a more accurate estimation of the incidence of this condition.
The Reliability of the Safe Period
Authors: Dunn H. P.
Published: February 2008

A group of 359 patients, selected on a basis of proved subsequent fertility, was investigated to test the reliability of the safe period. The total failure rate was 11.9 per 100 woman‐years. This is compared with failure rates reported for other birth control procedures. The reasons for the failures are analysed.
Vaginal Hysterectomy
Authors: Callagher Hugh C.
Published: February 2008

summary

A review of 1041 personal vaginal hysterectomies has been presented. Reference is made to mortality, morbidity, complications and limitations of this operation.

Mortality of two in this series is in accord with that of other statistical reviews. This confirms the claim that vaginal hysterectomy has an appreciably lower mortality rate than the abdominal operation.

Serious complications were virtually negligible whilst post‐operative comfort of the patient was improved, period of convalescence shortened and return to full activity expedited.
Thrombosis of the Umbilical Cord Vessels
Authors: Nayak S. K.
Published: February 2008

summary

A case has been described of thrombosis of the umbilical cord vessels. Pathogenesis of thrombosis is discussed in general, and the factors concerned with the generation of thrombosis in the present case are considered

It is pointed out that further work is needed on the subjects of platelet count of umbilical cord blood; and of immune complexes in relation to generation of thrombosis.

It is suggested that thrombotic episodes in some stillbirths and neonatal deaths could be the result of dissemination of thrombi in the umbilical cord or the placental vessels. A plea is therefore made for careful examination of these organs.

The literature related to the phenomenon of thrombosis of the umbilical cord vessels is reviewed, and it is considered that this is the first completely documented case report of this condition.
Cancer of the Vagina
Authors: McGarrity Kelvin A.
Published: February 2008

summary

Ninety cases of carcinoma of the vagina are reviewed, 72 being primary cancers (1 non‐invasive) and 18 secondary cancers.

The incidence of primary carcinoma of the vagina is 1.6% of 4,446 cases of primary genital cancer registered at the NewSouth Wales Gynaecological Cancer Registry.

Staging was conducted according to the recommendation of the Cancer Committee of F.I.G.O. and this showed that 31 tumours were Stage 1, 28 Stage 2, 4 Stage 3 and 8 Stage 4.

The site of the tumour was in the upper vagina in 39 cases, in the lower vagina in 15 cases, and in the middle third of the vagina in the remaining 17 cases.

The mean age of patients with primary invasive carcinoma was 66.5 years, compared with 58.5 years for those with secondary carcinoma. The highest incidence of primary carcinoma was noted in the 70–80 age group, whereas for secondary carcinoma it was in the 50–60 age group.

Primary invasive tumours were of squamous type in 80% of cases and adenocarcinoma in only 8 % Two‐thirds of the secondary tumours were adenocarcinomas.

Neither marital status nor parity appeared to have any significant association and there was no predisposing cause that could be substantiated.

Lymphatic involvement was observed clinically in 20% of patients; 25% of surgically removed nodes showed histological evidence of metastases.

Difficulty was often experienced in determining whether a tumour involving the cervix or vulva was a primary or secondary vaginal tumour.

For primary tumours, irradiation alone was used in 45 of the 71 patients, surgery alone in 12, surgery and irradiation in 7 and no treatment was employed in 7. A description of methods of applying radiotherapy is given and a dissection is made of the results of treatment according to both the site and the stage of the disease. Fifty per cent. of secondary tumours were treated by surgery compared with 27% of primary tumours.

The best results, regardless of the nature of treatment, were obtained when the tumour was in the upper vagina and the principles of treatment applied in carcinoma of the cervix could be carried out.

Annual and cumulative relative survival ratios are given for primary carcinoma of the vagina and these are compared with those for primary carcinoma of other genital sites. The 5‐year survival figure of 33.8% is considerably lower than that for other sites except the ovary.

Secondary tumours of the vagina from the colon, rectum, cervix, vulva, body of the uterus, and urethra are discussed in relation to pathology and treatment.

Secondary squamous tumours appear to have a better outlook than glandular tumours, particularly if treated by surgery.
The Analysis of 326,333 Cervical Smears
Authors: Ryan T. J.
Published: February 2008

summary

A description is given of the procedures adopted at a central diagnostic laboratory for the handling of a large volume of cytological smears.

Results of a preliminary analysis of 326,333 smears is presented.

Details of a computer programme for the analysis of smears is outlined.
Carcinoma of the Endometrium
Authors: Bonham D. G. , Seddon R. J.
Published: February 2008

summary

Of 301 patients treated at National Women' Hospital from 1946 to 1961 only 8 have been lost to follow‐up. The 5‐year survival was 65 per cent. This was influenced by the ageof onset of the disease. The modal age of patients at diagnosis was 59 years.

The value of the different forms of therapy did not emerge with clear‐cut differences. A plea is made for better recording of data and a higher necropsy rate with more care in death certification.
The Value of Urinary Oestriol Measurements During Pregnancy
Authors: MacLeod S. C. , Brown J. B. , Beischer N. A. , Smith Margery A.
Published: February 2008

The excretion of oestriol in the maternal urine increases approximately a thousandfold from conception to term. During the first weeks of pregnancy, the oestriol is derived from the metabolism of oestrone and oestradiol produced by the corpus luteum. Later, the placenta becomes the major site of oestrogen production, and synthesises oestriol as well as oestrone, oestradiol and other oestrogens. From this time, the urinary oestriol is derived in two ways—directly from placental oestriol and indirectly from the metabolism of the other oestrogens. The placenta, in turn, derives many of the steroid precursors required for oestrogen synthesis from other sites, the most important being the foetus. The levels of oestriol in the urine therefore reflect the combined functional capacity of the foeto‐placental unit.

The urinary oestriol excretion in 265 patients with complicated pregnancies (30 perinatal deaths) and 211 normal pregnancies is presented.

In the 70 patients with oestriol values below the normal range there were 21 foetal deaths, and 6 of the 49 surviving infants showed placental insufficiency. Ery‐throblastosis was the cause of 6 of the 9 deaths which occurred in patients with normal oestriol values.

Low oestriol excretion was present in the majority of patients with impending intra‐uterine death and therefore the test is of value in selection of the optimum time for termination of such pregnancies. However, low oestriol excretion did not always signify that an infant at birth would appear placentally insufficient nor did a normal oestriol value exclude the possibility that an infant would exhibit this syndrome.
Clinical and Chromosomal Study of 4 Patients with XX'XO Mosaicism
Authors: V. Mackay E. , G. Cockburn K. , G. S. Biggs J.
Published: February 2008

The development of karyotype analysis has provided a rational basis for many previously obscure clinical conditions. It has proved of particular value in chromosomal abnormalities of a mosaic nature, where the clinical expression may not be striking. The present paper describes 4 patients with mosaic Turner's syndrome.
The Action of Mebeverine on the Human Uterus
Authors: Widdowson R. , Wansbrough H. , Nakanishi H.
Published: February 2008

Mebeverine hydrochloride (Duspatalin†), synthesized during the course of a study on a series of reserpine derivatives, was found to be an active smooth muscle relaxant.
Splenic Rupture Complicating Pregnancy
Authors: W. Gudgeon C.
Published: February 2008

Splenic rupture from any cause is an uncommon complication of pregnancy. Spark‐man (1958) reviewed the literature and tabulated 44 cases including 2 of his own. Embrey and Painter (1962) reported a further case and mentioned 5 others. At least 4 further reports (O'Brien, 1963; Cairns et al., 1964; Gilbert et al., 1964; Bookstaver, 1965) have appeared in English literature and the subject has also been dealt with in the foreign literature (Huiskes, 1960; Mollegaaro, 1960; Ogien and Massi, 1963; Bertulozzo, 1964; Colombetti, 1965; Koskela, 1965). Cases occurring in Australia have been reported by Leslie (1966) and Elliott (1966).
The Vomiting Hazard in Obstetric Anaesthesia
Authors: R. Hutchinson B.
Published: February 2008

It is known that the gastric emptying time may be prolonged in women in labour, yet not all anaesthetists are agreed that the gastric contents should be evacuated prior to obstetric anaesthesia. The dangerous effects of regurgitation and inhalation of acid gastric content have often been stressed since Mendelson's paper of 1946.
Neuroleptanalgesia in Obstetric Practice
Authors: T. Cordingley F. , T. O'Connor D.
Published: February 2008

When general anaesthesia has been required it has been our experience that the obstetric patient is often nervous and apprehensive. In addition, the use of atropine alone, while necessary, has tended to aggravate the patient's discomfort by producing an uncomfortably dry mouth and, occasionally, disturbing palpitations. Similarly, with regional anaesthesia there are many patients in whom anxiety is present, particularly if there has been any technical difficulty with the procedure.
The Place of the Vacuum Extractor in Obstetric Practice
Authors: Fahmy Kamal
Published: February 2008

Although the vacuum extractor is now employed in most obstetric units, the indications for its use and its complications still give cause for some controversy.

In the present paper, the results for the 5‐year period 1962–66 are presented.
Trophoblastic Tumours: A Test of Cure?
Authors: F. Lawson D.
Published: February 2008

Chorion‐epithelioma arises as a result of malignant degeneration of the trophoblast of a previous pregnancy. It is usually regarded as being non‐predictable when it follows a normal pregnancy, an abortion, or an ectopic pregnancy. It should be predictable when it follows a hydatidiform mole but, in fact, often it is not predicted. Close attention to this group of cases should result in early treatment and a high cure rate.
Arrhenoblastoma
Authors: Elliott Peter , Heseltine Mary
Published: February 2008

The literature on arrhenoblastoma is briefly reviewed and a large undifferentiated tumour resulting in extreme virilisation is reported.

Personality changes associated with progressive defeminisation and their disappearance on extirpation of the tumour are discussed.

Conservative surgical treatment appears to have been justified as the follow‐up period approaches 5 years.
A Review of 307 Cases of Infertility
Authors: Baeyertz J. D.
Published: February 2008

A detailed analysis is presented of a 91% follow‐up of 307 primary and secondary infertility patients seen in private consultant practice over a period of 8 years, and reference is made to the work of other authors in this field.
Culdoscopy in Infertility
Authors: Corkill Brian
Published: February 2008

A series of 83 planned examinations with the culdoscope is described. Infertility and amenorrhoea (sometimes associated with infertility) were the major indications for the procedure.

A satisfactory view of the pelvic organs was obtained in 88% of patients.

Pathology was discovered in 44% of so‐called “normal” infertile women.

Reliability of the findings when compared with later laparotomy is extremely high.

The technique, which is similar to that of Decker, is described. Without general anaesthesia, the procedure is both safe and simple.
The Effects of Pregnancy and Wounding on the Mast Cell Population of the Rat Uterus
Authors: Donaldson E. , Morwood P. L. , Whitting H. W.
Published: February 2008

The uterine mast cell population has been observed in virgin, parous, and pregnant rats.

The mast cell population of the uterus was also studied after vaginal delivery and hysterotomy.

An increase in the number of mast cells was observed during pregnancy but this was not statistically significant.

A significant increase in mast cell numbers occurred in the puerperium whether delivery was per vaginam or by hysterotomy.
Traumatic Decapitation and Foetal Ascites
Authors: Campbell J. M.
Published: February 2008

Three cases of foetal ascites are described. Each was characterized by obstruction to labour after delivery of the head and in each case the head was avulsed before the final diagnosis was made.

Mention is made of other causes of gross abdominal distension and the possibility of antenatal radiological diagnosis is discussed.
Cryptomenorrhoea Due to a Transverse Vaginal Septum
Authors: Stewart A. D.
Published: February 2008

A case of cryptomenorrhoea with associated haematosalpinges due to a transverse vaginal septum in a girl aged 15 years is presented.

The excised hymen showed squamous epithelium on the lower surface and columnar secretory epithelium on the upper surface.

Review of the literature shows that haematosalpinx is an uncommon complication of a low vaginal septum.

Once diagnosed an occluding vaginal septum is a surgical emergency and the retained fluid should be drained promptly.

The question of fertility after the presence of a haematosalpinx is discussed.
Labour Complicated by Intestinal Volvulus
Authors: Perry R. A. , Carroll Kenneth J.
Published: February 2008

A case of volvulus of the ileum complicating labour is reported. The diagnosis was elusive pre‐operatively, and may have been missed at operation had not a decision been made to carry out a complete abdominal exploration.
Acute Axial Torsion of the Fibromyomatus Uterus
Authors: Page S. W. , Blunt V. A. W.
Published: February 2008

A case of acute axial torsion of the fibromyomatus uterus through 270o is reported. The relevant literature is briefly discussed.
Problems in the Diagnosis and Treatment of Choriocarcinoma Illustrated Case Report
Authors: Chan Lawrence K. C. , Teoh E. S.
Published: February 2008

A case of choriocarcinoma with a relentlessly fatal course in spite of therapy is presented.

The uncommon mode of clinical presentation as a threatened and later missed abortion is discussed and its importance for early diagnosis emphasised. An accurate, quantitative method for assaying H.C.G. titres in serum and urine is a sine qua non for early diagnosis of choriocarcinoma.

Preliminary hysterectomy followed by chemotherapy may increase metastases.
Pregnancy and Quadriplegia —the Problem of Autonomic Dysreflexia
Authors: Saunders Douglas , Yeo John
Published: February 2008

The course of pregnancy and labour in a quadriplegic patient is described. The literature on autonomic dysreflexia associated with pregnancy is briefly reviewed and the use of a cystometrogram to predict the onset and severity of this complication of labour is discussed.
Intrauterine Osteogenesis Imperfecta: Report of a Case Associated with Hydramnios and Dystocia
Authors: Monks Peter L.
Published: February 2008

A case of intrauterine osteogenesis imperfecta associated with hydramnios and foetal dystocia is presented.

Postmortem skeletal survey showed extremely poor calcification and marked fracture deformities of the long bones.
Urinary Oestriol Excretion in Pregnancies Complicated by Proteinuria
Authors: Reid Stanley , Beischer N. A. , Brown J. B. , Smith M. A.
Published: February 2008

1. Oestriol excretion was studied in 147 patients with proteinuria in pregnancy. In the group as a whole the incidence of low oestriol excretion was 39.4% and the perinatal mortality rate was 1.5%. When the oestriol excretion was normal the perinatal mortality rate was 3.4% compared with 31.7% when the values were low.

2. Oestriol excretion was low in 36 of 41 patients whose infants had intrauterine growth retardation.

3. In 22 patients with proteinuria alone the oestriol excretion was usually normal and the perinatal results favourable.

4. In 78 patients with moderate preeclampsia no perinatal deaths occurred when oestriol values were normal and the foetal death rate was 24% when oestriol excretion was low.

5. In 37 patients with severe pre‐eclampsia oestriol excretion was low in 8 of the 10 pregnancies which resulted in foetal death.

6. In 10 patients with chronic renal disease, oestriol excretion was low in 8 including the 5 pregnancies which resulted in a stillbirth.
An Evaluation of Serum Uric Acid Estimations in Toxaemia of Pregnancy
Authors: Connon Aileen F. , Wadsworth R. J.
Published: February 2008

1. There was an increase in the proportion of patients with raised serum uric acid (SUA) levels with increasing severity of pre‐eclamptic toxaemia.

2. Raised SUA levels were also found in one‐third of patients with unclassified toxaemia. The criteria of diagnosis of unclassified toxaemia requires revision.

3. In the hypertensive patients in this study, the frequency of multiple pregnancy was twice that expected in normal pregnancy.

4. The ratio SUA/BUN x 100 was similar in pre‐eclampsia of all three grades of severity and in unclassified toxaemia, but the ratio in essential hypertension in this study was lower than in the other groups. Therefore this ratio may be of value in separating the patients with essential hypertension from the unclassified toxaemia patients.

5. While an elevated SUA from 6.0‐10.0 mg./100 ml. was suggestive of preeclampsia, and an increasing level was highly significant, half the patients with pre‐eclampsia had normal SUA levels.

6. There is a place for SUA estimations in the management of hypertension in pregnancy, but the results require to be interpreted in the light of clinical findings. patients under their care. Special thanks are due to Professor L. W. Cox for his interest in this study, and to Dr. J. R. Lawrence, for helpful criticism.
Transverse and Oblique Lie of the Foetus
Authors: Cockbum K. G. , Drake R. F.
Published: February 2008

A review of 185 successive deliveries in which the lie of the presenting foetus was either transverse or oblique is presented.

The aetiological factors are discussed and the important role of prematurity is noted.

Excluding twin pregnancies, macerated foetuses and infants weighing less than 1000 g. (2.2 lb.) the corrected perinatal loss was 21.1% and the morbidity rate of those who survived was 33.9%.

For delivery by Caesarean section the uncorrected perinatal loss was 6.4% and the neonatal morbidity rate was 19.3%.

A method of management of transverse or oblique lie is suggested.
Brow Presentation with Vaginal Delivery
Authors: Jennings P. N.
Published: February 2008

A series of 53 brow presentations (0.14% of all deliveries) occurring in a 10‐year period at National Women's Hospital, Auckland, is presented. Of these, 43% were in nulliparae. Cephalo‐pelvic disproportion, present in about one‐third of the patients, was the only notable aetiological factor. The method of delivery was spontaneous in 7 patients, operative vaginal in 16, and Caesarean section in 30. It is inferred that spontaneous vaginal delivery from a brow presentation where the infant and the maternal pelvis are of average size may be more common than is thought.

There were 2 perinatal infant deaths attributable to the abnormality and no maternal deaths.
Controlled‐Release Iron Therapy in Pregnancy
Authors: Symonds E. M. , Radden H. S. , Cellier K. M.
Published: February 2008

One hundred and three antenatal patients with initial haemoglobin levels of 10.7 g./100 ml. or less at their first antenatal visit were treated with either ferrous gluconate, Ferrogradumet or intravenous Astrafer. A significant rise in haemoglobin level occurred in the first month in those groups receiving iron therapy compared with the control group. From the end of the first month until 36 weeks gestation, there was no significant difference between the treatment groups.

A double‐blind trial in the Ferrogradumet group involving 52 patients over the first month of the trial showed no significant difference in side‐effects between the inert vehicle and the Ferrogradumet groups. Controlled‐release iron in the form of Ferrogradumet is a convenient and effective method of iron administration in pregnancy, both for prophylactic and therapeutic purposes.
Unrecognised Ovarian Pseudomucinous and Serous Cystadenomata in Late Pregnancy Associated with Procidentia
Authors: Need Jillian A. , Connon Aileen F.
Published: February 2008

Ovarian tumours in pregnancy are rare, the incidence in several series being 1:1,000 to 1:8,000 (Gustafson et al., 1954). The commonest tumours are pseudomucinous cystadenomata, and benign cystic terato‐mata the second commonest. These two tumours may coexist in the same patient (Novak and Novak, 1965). Coexistent bilateral serous cystadenocarcinoma and bilateral benign cystic teratoma in pregnancy was recorded by Gleichert (1964).
The Incidence of Neoplastic Trophoblastic Disease in Australia
Authors: Steigrad S. J.
Published: February 2008

The incidence of hydatidiform mole and choriocarcinoma over a 16‐year‐period (1950–1966) is presented for 3 major hospitals in Sydney.

The cases are analysed with particular reference to previous pathology.

The general social conditions in Australia are discussed with reference to the incidence of trophoblastic disease.
Continuous Chlormadinone Acetate for Contraception: Preliminary Findings
Authors: Leeton John
Published: February 2008

Chlormadinone acetate, 0.5 mg. daily, has been assessed as a contraceptive drug. Drug and patient failure rates in this series were both 0.005/cycle of exposure. This was equivalent to a combined figure of 12 pregnancies 100 woman years.

Of 25 women who had previous sideeffects on at least 1 oral contraceptive, 15 had no symptoms on chlormadinone acetate.

Women taking chlormadinone acetate while breastfeeding showed no evidence of inhibition of lactation.

No significant difference in the incidence of side‐effects was found in a low economic group when compared with a private patient group.
Ultrasonic Scanning in Obstetrics
Authors: Morrison J. , Kohorn E. I. , Ashford C. , Tredgold C. , Blackwell R. J.
Published: February 2008

Placental localisation by ultrasonic compound scanning is described. In a series of 250 patients, placenta praevia was present in 23, and in 21 of these an accurate diagnosis was made in relation to position and degree. In one of two patients where there was a diagnostic error, the difference between the suggested and actual placental margin was slight.
Ovulation Induction for the Treatment of Infertility
Authors: Black Tania L. , Cox R. I. , Cox L. W.
Published: February 2008

Summary

Of 100 patients who were not ovulating, 88 have been treated for infertility using clomiphene citrate, or follicle stimulating hormone, or combinations of these, together with human chorionic gonadotrophin.

All patients have ovulated at least twice, excepting those who conceived during the first ovulatory cycle. 66 pregnancies have occurred in 60 patients and there were 5 multiple pregnancies.

Three types of response to an ovarian function test using HMG are reported, and their significance with respect to menstrual abnormality and response to clomiphene and FSH treatment is discussed.

Mention is made of the likelihood of return normal function after ovulation‐induced pregnancy or ovulation induction.

Daily monitoring and individualization of treatment has kept the incidence of complications much lower than in most other reported series.
The Spontaneous Cure Rate of Various Infertility Factors or Post Hoc and Propter Hoc
Authors: Grant Alan
Published: February 2008

Summary

A prospective study has been made on 2,581 patients suffering from primary and secondary infertility.

secondary infertility. Thirty‐five per cent of these patients became pregnant during the course of investigation and before any treatment could be given.

Half of the pregnancies followed the performance of tuba1 patency tests. Salpingograms were twice as effective in producing a pregnancy as were Rubin's tests (11% versus 5%).

Fifteen per cent of 1,177 patients became pregnant after the cause of the sterility was known and before any treatment was given.

Anovulation underwent a spontaneous cure in 25% of patients and 20% became pregnant.

The spontaneous cure rate amongst patients with tubo‐ovarian adhesions was about 15%.

Tubal patency tests frequently have a curative effect where the post‐coital test is

Only about 1 in every 7 patients with known infertility factors will become pregnant without treatment. Definitive attempts to cure specific infertility factors were successful in 47% of such patients.

If we give the reproductive tract of an infertility patient a good “spring cleaning” by plodding through the various tests for this condition, we can expect a third of the patients to become pregnant without our ever knowing what infertility factors were present.

Patients with infertility come to us because they want to be pregnant soon and not sometime. The way to achieve this is by early active investigation and treatment, and not by platitudes, placebos or procrastination.