bluuebunny/crossref_metadata_2025 huggingface dataset:
A PROSPECTIVE, CONTROLLED TRIAL OF SIX FORMS OF HORMONE REPLACEMENT THERAPY GIVEN TO POSTMENOPAUSAL WOMEN
Authors: Lind T. , Cameron E. C. , Hunter W. M. , Leon C. , Moran P. F. , Oxley A. , Gerrard J.
Published: August 2005

This study was undertaken to investigate the effect of various forms of hormone replacement therapy (HRT) upon postmenopausal women while controlling as many variables as possible. It was felt that the age, duration of amenorrhoea and the general health of the patients should be as comparable as possible and that each patient should provide her own pretherapy and posttherapy control data. In addition, it was felt that any placebo effect should be investigated and the patients were therefore randomly allocated to placebo tablets or one of six available forms of HRT. The age/sex registers of two large general practices were scrutinized and all women between 49 and 54 years of age were asked to cooperate; for a variety of reasons only 56 women were suitable and willing to take part in the project, yielding 8 women for each of the seven possible therapy groups. Blood samples were taken at 7‐day intervals three times before therapy was given and the mean of the three values was used as the control value. The women returned on day 21 of each subsequent therapy cycle for six consecutive months and finally three months after discontinuing therapy. From the data the following broad conclusions can be drawn: (i) some women have classic symptoms of hot flushes and sweating despite high endogenous oestrogen concentrations; (ii) vaginal cytology is a relatively poor indicator of endogenous oestrogen status; (iii) while follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations are reduced on HRT neither is decreased to anywhere near premenopausal values while prolactin is unaffected; (iv) plasma cholesterol levels are reduced on HRT, the pulse rate is slower and both systolic and diastolic blood pressure are reduced to a small but significant extent; (v) there is no adverse effect upon blood clotting; and (vi) most women experience significant or complete relief of symptoms on all forms of HRT as do some women taking a placebo. The combined preparations containing an oestrogen and progestogen produced vaginal bleeding in only 80 per cent of the women. Thus protection by regular endometrical shedding may not be afforded to all women. As vaginal bleeding is unacceptable to most women if they can achieve the same symptomatic relief without inducing menstruation, it is suggested that women have a low dose oestrogen preparation prescribed cyclically for 6 to 12 months. If therapy is to be maintained for a longer time, uterine curretage should be undertaken at regular intervals to exclude the possibility of endometrial carcinoma developing.
THE ACCURACY OF COLPOSCOPICALLY DIRECTED BIOPSY IN PATIENTS WITH SUSPECTED INTRAEPITHELIAL NEOPLASIA OF THE CERVIX
Authors: Kirkup W. , Singer A. , Hill A. Shirley
Published: August 2005

We compared the histological diagnoses of premalignant/malignant lesions of the cervix obtained examining colposcopically directed biopsy material from 201 outpatients with those obtained examining tissues from a subsequent, more extensive operative procedure. In all, 98 per cent of operative diagnoses were never more than one degree in advance of diagnoses made colposcopic biopsy. In all seven patients with invasive or microinvasive squamous carcinoma, the lesion Was suspect at colposcopy and confirmed directed biopsy.
AN UNEXPECTEDLY HIGH RATE OF ECTOPIC PREGNANCY FOLLOWING THE INDUCTION OF OVULATION WITH HUMAN PITUITARY AND CHORIONIC GONADOTROPHIN
Authors: McBain J. C. , Eevans J. H. , Pepperell R. J. , Robinson H. P. , Smith Margery A. , Brown J. B.
Published: August 2005

Six tubal ectopic pregnancies occurred in a series of 193 pregnancies following ovulation induced with human pituitary gonadotrophin (hPG) and human chorionic gonadotrophin (hCG). The ectopic pregnancy rate of 3.1 per cent is higher than quoted incidences in the general population and occurred in the absence of predisposing factors. There was an association between ectopic pregnancy and elevated urinary oestrogen excretion in the peri‐ovulatory phases of the induced ovulatory cycles. A urinary oestrogen excretion of greater than 200 μg/24 hours on day 0 (the day after hCG was given) was associated with a 10 per cent chance of ectopic pregnancy (P <0.05).
ANTENATAL ATTENDANCE AND SCREENING FOR NEURAL TUBE DEFECTS
Authors: Hibbard B. M. , Roberts C. J. , Evans K. T. , Laurence K. M. , Hoole Greta
Published: August 2005

An analysis of factors influencing the time of booking at seven hospital antenatal clinics in one Health Authority Area showed that only 52.5 per cent of patients booked before 16 weeks gestation and 78.9 per cent before 19 weeks gestation. The principle reasons for late booking were delay in the patient seeking medical advice and delay in referral to hospital the general practitioner (GP) after pregnancy was confirmed. Possibilities for improving early attendance and hence implementing an effective screening programme for the detection of neural tube defects are discussed.
FETAL GROWTH RETARDATION AND PRE‐ECLAMPSIA
Authors: Long P. A. , Abell D. A. , Beischer N. A.
Published: August 2005

In a series of 2434 patients with pre‐eclampsia, the prevalence of fetal growth retardation was 8.7 per cent compared with 8.6 per cent in the total hospital population. The prevalence was increased in early‐onset pre‐eclampsia (18.2 per cent) (P <0.001) and reduced in late‐onset pre‐eclampsia (5.6 per cent) (P <0.00l). In patients who later developed early‐onset pre‐eclampsia with fetal growth retardation, the prevalence of subnormal oestriol excretion was significantly increased (79.5 per cent) (P <0.001) as was the prevalence of hypoglycaemia (33.3 per cent) (P <0.001) suggesting that fetal growth retardation in these pregnancies preceded the clinical signs of pre‐eclampsia. The prevalence of placental abruption (8.3 per cent) and the prevalence of perinatal deaths (28.7 per cent) were both significantly higher in pregnancies with early‐onset pre‐eclampsia and fetal growth retardation (P <0.001).
FETAL BIPARIETAL DIAMETER AND MATERNAL PLASMA CONCENTRATIONS OF PLACENTAL LACTOGEN, CHORIONIC GONADOTROPHIN, OESTRIOL, AND ALPHA‐FETOPROTEIN IN NORMAL AND PATHOLOGICAL PREGNANCIES
Authors: Persson P.‐H. , Grennert L. , Gennser G. , Eneroth P.
Published: August 2005

A series of tests for the supervision of pregnancy was evaluated in a prospective study of 93 randomly chosen women. Sixteen of these women (index group) had previously defined complications of pregnancy and/or infants of low birth weight due to preterm delivery or intrauterine growth retardation; the rest provided a normal control group. From the 17th week, fetal cephalometry ultrasound and maternal blood sampling were done every three weeks throughout pregnancy, an average of 9.4 times in every woman. Determinations of the plasma concentrations of alpha‐fetoprotein (AFP), total oestriol, human placental lactogen (hPL), and human chorionic gonadotrophin (hCG) were later made radioimmunoassays. Deviation of the fetal biparietal diameter more than 3 mm from the expected value was considered abnormal; the normal distributions of plasma levels of the fetal protein and the hormones were established in the local population. The five test parameters remained normal during gestation in the entire control group. Twelve women of the index group had an abnormal level of one or more tests on at least one occasion. Eight fetuses had an impaired growth of the biparietal diameter. AFP levels were above normal in nine women, oestriol values were below normal in three, hPL fell below the normal range in one, and hCG remained normal in the entire index group. AFP levels in maternal plasma and fetal cephalometry seemed to have the highest predictive value for pregnancy complications and the well‐being of the newborn; the lag times from the first positive test result to the onset of clinical signs were 6.6 and 6.1 weeks, respectively. For the prediction of low birth weight, measurement of the AFP concentration in maternal plasma, when done serially during pregnancy, can be substituted for fetal cephalometry.
RELATION BETWEEN THE AMNIOTIC FLUID LECITHIN/SPHINGOMYELIN RATIO, FETAL CORD BLOOD CORTICOSTEROID LEVELS AND THE DURATION OF INDUCED LABOUR
Authors: Whittle M. J. , Hill C. M.
Published: August 2005

In serial samples of amniotic fluid from 24 patients in induced labour, the rate of change in the lecithin/sphingomyelin (L/S) ratio correlated significantly with the duration of labour. Cord serum 11‐hydroxycorticosteroid levels were lowest in the group of patients in which the L/S rose during labour, and highest in the group in which the L/S ratio fell. Cord serum 11‐hydroxycorticosteroid levels correlated positively with the duration of labour. It would seem unlikely that the changes in L/S ratio occurring during labour are mediated endogenous corticosteroids.
THE EFFECT OF THE MENOPAUSE ON THE L‐LACTATE‐NICOTINAMIDE‐ADENINE DINUCLEOTIDE OXIDOREDUCTASE ACTIVITY IN VAGINAL ASPIRATES
Authors: Emes A. V. , Latner A. L. , Guthrie D. , Philips P. R. , Way S. A.
Published: August 2005

Lactate dehydrogenase (L‐Iactate‐NAD+ oxidoreductase; EC 1.1.1.27) activity has been assayed in saline extracts of vaginal aspirates obtained from patients attending a Well Woman Clinic and for whom exfoliative cytology was shown to be unequivocally normal. The majority (76 per cent) of premenopausal patients gave aspirate extracts containing less than 25 m units of enzyme while 71 per cent of postmenopausal patients gave aspirate extracts containing more than 50 m units of enzyme. This difference in distribution of activities was highly significant (P = <0.001). Analysis of the isoenzyme distribution showed that aspirates from postmenopausal patients contained a lower proportion of isoenzyme LDH‐5 (P <0.01) and the M subunit (P <0.03) and a higher proportion of isoenzymes LDH‐3 (P <0.001) and LDH‐4 (P <0.01). There was no significant difference between the social class distributions of the pre‐ and postmenopausal patients. Lactate dehydrogenase activity was not related to social class or patients' multiparity. No difference in the distribution of enzyme activities was found between those premenopausal patients in the proliferative phase of the menstrual cycle, those in the secretory phase and those receiving hormone therapy.
IVALON SPONGE HYSTEROSACROPEXY FOR GENITAL PROLAPSE IN PATIENTS WITH BLADDER EXTROPHY
Authors: Dewhurst John , Toplis P. J. , Shepherd J. H.
Published: August 2005

Two patients with bladder extrophy are presented. Both had had corrective surgery in childhood and subsequently presented with recurrent procidentia after a previously unsatisfactory repair operation. Both were treated hysteroscaropexy (a new procedure) which is described in detail and when reviewed 12 months later were symptom‐free with good genital tract support.
RUPTURE OF SPLEEN AT LAPAROSCOPY CASE REPORT
Authors: Makanji H. H. , Elliott H. R.
Published: August 2005

The induction of pneumoperitoneum for laparoscopic sterilization caused distortion and stretching of perisplenic adhesions resulting in splenic rupture and a haemo‐peritoneum.
ANTEPARTUM HAEMOPERITONEUM DUE TO PLACENTA INCRETA CASE REPORT
Authors: Bromham D. R. , Joyce D. N.
Published: August 2005

A patient is described in whom a placenta increta led to a haemoperitoneum. The diagnosis, made abdominal paracentesis, led to laparotomy and Caesarean hysterectomy at 31 weeks; the child survived. Delay in diagnosis of the haemoperitoneum was mainly due to difficulties in clinical assessment caused an episode of premature labour and maternal psychiatric illness.
FACTORS AFFECTING PLASMA ANGIOTENSIN II CONCENTRATION IN LABOUR
Authors: Symonds E. M. , Pipkin Fiona Broughton
Published: August 2005

Concentrations of plasma angiotensin II (All) have been measured in the second stage of labour or before delivery by elective Caesarean section in 134 women and some factors influencing the levels have been assessed. Plasma All concentrations in the second stage of labour were higher than levels previously observed before the onset of labour in both primigravid and multiparous women. Markedly lower levels were found following delivery by elective Caesarean section than following vaginal delivery. Multiparae had higher All concentrations than primigravidae both before the onset of labour and at delivery. Epidural analgesia was associated with significantly lower All concentrations; in primigravidae receiving such analgesia a statistically significant relation was found between All concentration and diastolic blood pressure at delivery. A similar relation was found in the non‐proteinuric patients delivered by Caesarean section. The estimated duration of the second stage of labour was the major factor affecting All concentration in normal multiparae. In both primigravid and multiparous women, All concentrations were markedly raised in association with proteinuria.
RENIN SUBSTRATE, ACTIVE AND ACID‐ACTIVATABLE RENIN CONCENTRATIONS IN HUMAN PLASMA AND ENDOMETRIUM DURING THE NORMAL MENSTRUAL CYCLE
Authors: Johnson I. R.
Published: August 2005

Renin substrate, active and total renin concentrations were measured in plasma and endometrial samples obtained from 101 patients, all of whom were having normal menstrual cycles. The endometrial samples were found to contain all of these components of the renin‐angiotensin system in considerably higher concentrations than those found in the plasma. There was no correlation between the plasma and endometrial concentrations of any of these substances and it is suggested that they may be produced locally in the endometrium. A marked increase in the angiotensin producing potential of the endometrium was noted immediately before menstruation, indicating a possible function in the control of endometrial blood flow.
PROLACTIN CHANGES IN MATERNAL PLASMA FOLLOWING TERMINATION BY VACUUM CURETTAGE AND THE EFFECT OF BROMOCRIPTINE TREATMENT ON THESE CHANGES
Authors: Ylikorkala O. , Röounnberg L.
Published: August 2005

To study the prolactin secretion and its dependence on the sex steroid concentrations during pregnancy, we measured the circulating prolactin, oestradiol‐17β, progesterone and testosterone levels following vacuum curettage for termination of early pregnancy in 10 normal women and in 10 other women whose prolactin levels had been lowered with bromocriptine treatment. In normal women, anaesthesia and vacuum curettage led to consistent and significant (p <0·01) rises in prolactin levels between 0·5 to 5 hours after abortion. This increase was not seen in women treated with bromocriptine whose prolactin level of 8.6±1.4 ng/ml (mean ± SE) before abortion was lower than that of 29.6 ± 6.4 ng/ml found in normal women. The oestradiol and progesterone concentrations decreased rapidly but similarly in both groups of patients following the evacuation of the uterus, whereas the testosterone level did not change significantly. These results indicate: (i) vacuum curettage stimulates prolactin secretion, (ii) the prolactin‐stimulating effect of stress appears to be stronger than the prolactin‐suppressing effect of postabortal oestradiol and/or progesterone declines, and (iii) bromocriptine blocks the stress‐induced prolactin rise.
SALIVA AND BLOOD PETHIDINE CONCENTRATIONS IN THE MOTHER AND THE NEWBORN BABY
Authors: Freeborn S. F. , Calvert R. T. , Black Patricia , Macfarlane T. , D'Souza S. W.
Published: August 2005

In a group of mothers who received pethidine intramuscularly during labour, drug concentrations were higher in saliva than in blood and there was a significant correlation (p <0.001) between saliva and blood concentrations measured between 1 hour and 4 hours 20 minutes after dosage. In newborn babies, the pethidine concentrations detected in pharyngeal aspirates were higher than those in umbilical arterial or umbilical venous blood, but there was no correlation. Pethidine was also detected in the saliva from babies for 48 hours after birth. Furthermore, the appreciably higher levels in breast‐fed babies suggest that such babies may receive a dose of pethidine in the milk.
DIURNAL CHANGES IN MATERNAL PLASMA OESTRONE AND OESTRADIOL AT 30 TO 31, 34 TO 35 AND 38 TO 39 WEEKS GESTATIONAL AGE
Authors: Challis J. R. G. , Patrick J. E. , Campbell Karen , Natale R. , Richardson B.
Published: August 2005

Diurnal changes in the concentrations of oestrone (E1) and oestradiol (E2) in maternal peripheral plasma have been measured in samples of blood taken at one hour intervals from women at 30 to 31, 34 to 35 and 38 to 39 weeks of pregnancy. There was a significant effect of time of sampling on the plasma concentration of E1 at all stages of gestation, and circadian changes in the levels of E1 were apparent at 34 to 35 and 38 to 39 weeks. Peak values were measured around 0830 to 0930 hours, and troughs occurred between 0130 and 0530 hours. Significant effects of time of sampling on the plasma concentration of E2 were found at 34 to 35 and 38 to 39 weeks of pregnancy; night‐time concentrations were lower than the peak values at 0730 to 0830 hours. The relation of these changes to the circadian rhythms in the concentrations of cortisol and oestriol in maternal plasma are discussed.
THE EFFECT OF CHLOROQUINE ON STRIPS OF PREGNANT HUMAN MYOMETRIUM
Authors: Okonkwo P. O. , Chukwudebelu W. O.
Published: August 2005

We investigated the effect of chloroquine on the activity of strips of myometrium obtained at lower segment Caesarean sections from 150 patients. At concentrations below 1 × 10‐4M, chloroquine did not affect the frequency, tonus or amplitude of contraction. At higher concentrations, it more than doubled the frequency of contractions in muscle strips showing spontaneous activity. In quiescent strips requiring stimulation by oxytocin, chloroquine had a generally depressant effect which could be overcome by higher doses of oxytocin. We suggest that chloroquine does not cause premature labour or abortions.
THE EFFECT OF REST AND AMBULATION ON PLASMA UREA AND URATE LEVELS IN PREGNANT WOMEN WITH PROTEINURIC HYPERTENSION
Authors: Mathews D. D , Agarwal Vasantika , Shuttleworth T. P
Published: August 2005

Plasma urea and urate concentrations were determined daily for up to seven days in 40 pregnant women who had been admitted to hospital because of proteinuric hypertension and who were then allocated at random to either complete rest in bed or to being allowed to move freely in the ward. Neither management was superior to the other in improving renal function. The prognostic significance of plasma urea and urate concentrations to maternal and fetal outcome was confirmed.
RAISED MATERNAL SERUM ALPHA‐FETOPROTEIN LEVELS AND LOW BIRTH WEIGHT BABIES
Authors: Smith M. L.
Published: August 2005

In a retrospective study of low birth weight babies (less than 2.5 kg) born in one year it was found that statistically more maternal serum alpha‐fetoprotein levels were above twice the median level than a control group of mothers producing larger babies (more than 3 kg). However, from the results the test cannot be accepted as being a prospective indicator or as a screening test of low birth weight in pregnant women.
THE PSYCHOSOCIAL OUTCOME OF INDUCED ABORTION
Authors: Ashton J. R
Published: August 2005

The psycho‐social outcome of induced abortion was assessed in 64 women after eight weeks and in 86 women after eight months. Three groups were identified. About 5 per cent had enduring, severe psychiatric disturbance following abortion. Women especially at risk were those with a previous psychiatric or abnormal obstetric history or with physical grounds for abortion and those expressing ambivalence towards abortion. Short‐lived disturbances affected about half of all abortion patients. These symptoms included initial guilt and regrets and sensitivity to the comments of people around them which relate to abortion. The third group of women experienced no adverse sequelae. It is suggested that an awareness of the risk factors should lead to the instigation of more adequate counselling and support for those women who need it.
CARCINOMA OF THE OVARY—CORRELATION OF ULTRASOUND WITH SECOND LOOK LAPAROTOMY
Authors: Pussell S. J. , Cosgrove D. O. , Hlnton J. , Wiltshaw E. , Barker G. H
Published: August 2005

In a series of twenty‐six patients with Stage III or IV carcinoma of the ovary, results of ultrasound examination of the pelvis and abdomen were correlated with second look laparotomy. All of these patients had responded clinically to a course of chemotherapy. Elective surgery was used to restage and debulk tumour. Ultrasound examination was done before surgery. Ultrasound was sensitive in detecting ovarian tumour in the pelvis and had an 84 per cent correlation with laparotomy. It was also sensitive in detecting liver and right diaphragmatic metastases with a 92 per cent correlation with the laparotomy findings. However, it consistently failed to detect intraperitoneal spread except when disease was gross or when it could be predicted by the presence of ascites. The correlation with laparotomy in this situation was only 36 per cent. This is to be expected as the size of most peritoneal deposits is below the resolution of ultrasound. These lesions, however, are easily detected by laparoscopy. These findings suggest that ultrasound has an important role in the management of advanced carcinoma of the ovary.
THE ROLE OF PERIURETHRAL COLONIZATION IN THE AETIOLOGY OF RECURRENT URINARY INFECTION IN WOMEN
Authors: Cooper J. , Brumfitt W. , Hamilton‐Miller J. M. T. , Reynolds A. V.
Published: August 2005

Periurethral bacterial colonization was studied in two groups of women by taking samples with a polystyrene sponge. Just over half (56 per cent) of 81 sexually‐active women attending a family planning clinic were not colonized in the periurethral area; subjects who were colonized usually showed large numbers of a single bacterial species. On the other hand, all 38 patients who were attending a clinic because of recurrent urinary infections were colonized in the periurethral area; most of these yielded a heavy growth, and more than one bacterial species was usually isolated. Gram‐positive cocci predominated as the colonizing flora in both groups, a finding which is in marked contrast to the predominant aetiological agents in urinary infections, namely Gram‐negative bacilli. We therefore conclude that colonization of the periurethral area is not the decisive event in the initiation of a urinary infection.
FEMALE PSEUDOHERMAPHRODITISM IN CONJOINED TWINS
Authors: Lawson G. W.
Published: August 2005

A case of female pseudohermaphroditism in ischiopagus conjoined twins is presented and discussed.
TWO PREGNANCIES IN A WOMAN WITH CUSHING'S SYNDROME TREATED WITH CYPROHEPTADINE
Authors: Kasperlik‐Zaluska A. , Migdalska B. , Hartwig W. , Wilczyska J. , Marianowski L. , Stopiska‐Gluszak U. , Loziska D.
Published: August 2005

A young woman with Cushing's syndrome who had had amenorrhoea for six years was treated with cyproheptadine and became pregnant five months later. Treatment with cyproheptadine was continued till six weeks after delivery by which time all the features of Cushing's syndrome had disappeared. The baby developed normally but died of gastroenteritis when four months old. Two years later the patient became pregnant again without further treatment. Pregnancy and labour were uncomplicated and mother and son did well. A full remission of Cushing's syndrome was confirmed two months after delivery.
NOMOGRAMS FOR PRECISE DETERMINATION OF BIRTH WEIGHT FOR DATES
Authors: Altman D. G. , Coles E. C.
Published: August 2005

We have derived a mathematical model (Altman and Coles, 1980) that matches closely the birth weight standards derived from the large Aberdeen survey (Thomson et al, 1968). From this, we have drawn nomograms that can be used to assess an infant's position in relation to these standards. The nomograms are easy to use and give adequate precision.
PROPRANOLOL AND HYDRALLAZINE IN THE MANAGEMENT OF ESSENTIAL HYPERTENSION IN PREGNANCY
Authors: Bott‐Kanner G. , Schweitzer A. , Reisner S. H , Joel‐Cohen S. J , Rosenfeld J. B
Published: August 2005

A combination of propranolol and hydrallazine was administered to 13 patients with longstanding hypertension during 15 pregnancies. Hydrallazine was continued through labour and delivery in all patients, while in eight patients propranolol was discontinued 2 to 15 days before delivery. Blood pressure control was uniformly good and superimposed pre‐eclampsia did not occur during combined therapy. There were 14 livebirths and one unexplained stillbirth. Except for two cases of mild hypoglycemia, there were no neonatal complications.
PLASMA PROSTAGLANDIN F LEVELS AND MALIGNANT TUMOURS OF THE FEMALE GENITAL TRACT
Authors: Sanders R. R. , Lee W. H. , Koh L. , Brennecke A. , Jones W. R.
Published: August 2005

Plasma prostaglandin F (PGF) was measured by a radioimmunoassay method in 24 subjects with tumours of the female genital tract. Levels in the tumour group ranged from 25 pg/ml to 134 pg/ml and were almost all greater than the values observed in a control group of 41 healthy women who had a mean (±SD) level of 21 (±3.4) pg/ml. There was a relationship between plasma PGF levels and the stage of the disease. Patients with resectable tumours showed a fall in PGF levels postoperatively and those with disseminated malignancy demonstrated increasing levels as the disease progressed. Plasma PGF may provide a clinical prognostic marker in the management of patients with malignant tumours.
SCANNING AND TRANSMISSION ELECTRON MICROSCOPY OF MATERIAL ADHERENT TO INTRAUTERINE CONTRACEPTIVE DEVICES
Authors: Sheppard B. L. , Bonnar J.
Published: August 2005

The material adherent to intrauterine contraceptive devices (IUCDs) has been studied by transmission and by scanning electron microscopy coupled with X‐ray microprobe analysis. Inert (Lippes Loop D, Saf‐T‐Coil and Dalkon shield) and medicated (Copper 7 and Progestasert) IUCDs were removed for examination from uteri immediately after hysterectomy. The cellular material identified on the surface of all inert IUCDs consisted mainly of macrophages, with some polymorpho‐nuclear leucocytes, erythrocytes, a few platelets and fibrin fibres. Polymorpho‐nuclear leucocytes were the principle cells on the copper devices. Larger numbers of cells were evident on the inert arms than on the active part of the Progestasert device. All the devices examined exhibited varying amounts of surface calcium deposition. The IUCDs which had been in utero for longer periods showed the greatest amount of calcium deposition. Although a less rapid calcium deposition appeared to occur on the Progestasert device, this deposition may influence the release of medications from IUCDs which are retained in utero for longer periods than one year.
A VIRILIZING HILUS‐CELL TUMOUR IN AN AFRICAN PATIENT WITH TURNER'S SYNDROME
Authors: Lyons N. F. , Wilson P. C. , Connolly M. C. , Crane W. A. J.
Published: August 2005

A 26‐year‐old African female presented with primary amenorrhoea and genital abnormalities. She had the physical stigmata of Turner's syndrome and a 45, X karyotype. Severe masculinization of the external genitalia, apparently present from birth, was present and a laparotomy revealed a hilus‐cell tumour of the right streak gonad. Clitoridectomy and vaginoplasty were performed but subsequent oestrogen therapy failed to produce breast development.
PROSTACYCLIN FORMATION BY THE PREGNANT HUMAN MYOMETRIUM
Authors: Bamford D. S , Jogee M. , Williams K. I
Published: August 2005

Human myometrium taken between 15 and 42 weeks of pregnancy released a material in vitro which possessed anti‐aggregatory activity. This material parallelled authentic prostacyclin in this action; it possessed a similar stability at alkaline pH and generation of activity was inhibited by indomethacin. Production of the prostacyclin‐like material by the myometrium was similar at weeks 15 and 38 of pregnancy but a 4‐fold increase in synthesis had occurred by 40 weeks. It is suggested this increase may be important for parturition.
EFFECTS OF MATERNAL UNDERNUTRITION AND HEAVY PHYSICAL WORK DURING PREGNANCY ON BIRTH WEIGHT
Authors: Tafari N. , Naeye R. L. , Gobezie A.
Published: August 2005

The study attempted to determine if heavy physical labour by mothers during pregnancy affected fetal growth when such mothers had calorie intakes which were below 70 per cent of WHO/FAO recommended standards. Full term infants of such mothers had a mean birth weight of 3060±355 (SD) g compared to 3270±368 SD g for the newborn of less physically active mothers on similar low calorie diets (P<0.01). The mothers who engaged in heavy labour had a mean pregnancy weight gain of 3.3±2.4 (SD) kg, independent of the birth weight of their offspring, compared with 5.9±3.3 kg for the less active mothers (P<0.001). The mothers' weight in early pregnancy had an insignificant influence on birth weights when mothers were on low calorie intakes.
PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA IN PREGNANCY: CASE REPORT
Authors: Spencer J. A. D.
Published: August 2005

Pregnancy in a woman with paroxysmal nocturnal haemoglobinuria was complicated by hepatic venous thrombosis, portal hypertension and haematemesis due to gross oesophageal varices. Labour was induced and a live female infant was born. Dural sinus thrombosis and intracerebral haemorrhage resulted in death on the 46th day post partum. A review of the literature shows that venous thrombosis is common in paroxysmal nocturnal haemoglobinuria.
ASSESSMENT OF ANTEPARTUM CARDIOTOCOGRAMS IN HIGH‐RISK PREGNANCY
Authors: Keirse M. J. N. C. , Trimbos J. B.
Published: August 2005

A ten‐point scoring system was used to assess 2770 antepartum cardiotocograms (CTGs) obtained in 405 pregnancies at risk. There were 284 pregnancies with a last CTG within 24 hours before labour, Caesarean section or intrauterine death; these were analysed separately and their outcome correlated well with the last CTG score, better than with individual CTG criteria. The relationship between CTG score and fetal condition at birth was particularly close for pregnancies with growth retardation, rhesus isoimmunisation or hypertension. A score of 8 to 10 reliably predicted good condition at birth in 95 per cent of pregnancies which ended within 24 hours and in 88 per cent of those which ended after three or four days. A score of 5 points or less invariably indicated poor fetal condition with little chances of a normal outcome unless the cause could be effectively treated. The score provides a highly specific but moderately sensitive test for fetal well‐being with virtually no false positive and only few false negative results. However, almost 15 per cent of CTGs, scoring 6 or 7 points, provide too little information on fetal well‐being to be of clinical value.
IN VITRO STUDIES OF THE CHARACTERISTICS OF THE RELEASE OF PROSTAGLANDINS FROM VISCOUS SOLUTIONS
Authors: Mackenzie I. Z , Burnet F. R. , Embrey M. P
Published: August 2005

The diffusion rates of prostaglandin E2 in different viscous solutions used in clinical practice for inducing abortion and term labour have been studied in the laboratory. The results indicate that of those currently in use, solutions of Dextran might be more appropriate for the purposes. By increasing the viscosity of solutions in use at present, clinical results may be further improved by aiding retention in the vagina or uterus while producing a slow sustained linear release of prostaglandin.
A PROSPECTIVE STUDY OF PRIMARY CYTOMEGALOVIRUS INFECTION IN PREGNANT WOMEN
Authors: Griffiths P. D. , Campbell‐Benzie A. , Heath R. B.
Published: August 2005

During a four year study, sera were obtained from 5575 women attending for antenatal care and 3188 (57.2 per cent) were shown to possess complement fixing antibodies to cytomegalovirus (CMV). A total of 1608 seronegative women were followed to term and 14 (0.87 per cent) primary CMV infections occurred in either the second or third trimester. Transplacental spread of CMV occurred in 3 out of 12 (25 per cent) of the 14 babies born to infected mothers. All 14 babies were apparently normal at birth but short term clinical follow‐up has already revealed that one child has impaired hearing whilst another is microcephalic. The women were also monitored serologically throughout pregnancy for evidence of rubella infections. Only 12 infections were detected and 7 of these occurred during the large rubella epidemic of 1978. Of the 10 pregnancies which were allowed to proceed to term, transplacental spread of rubella virus occurred in 1 out of 7 (14 per cent). During this study period, CMV infections occurred as frequently as did rubella infections. We therefore conclude that, apart from those years when extensive epidemics occur, many more pregnant women are infected with CMV than with rubella virus.
EFFECTS ON SEX HORMONE BINDING GLOBULIN OF DIFFERENT ORAL CONTRACEPTIVES CONTAINING NORETHISTERONE AND LYNESTRENOL
Authors: Odlind Viveca , Weiner E. , Victor A. , Johansson E. D. B.
Published: August 2005

Six combined oral contraceptive drugs containing ethinyloestradiol or mestranol and norethisterone or lynestrenol were studied throughout six 21‐day cycles in healthy female volunteers. There was always one menstrual cycle without treatment between every treatment cycle. Plasma levels of norethisterone were determined throughout treatment by use of a specific radioimmunoassay. Sex hormone binding globulin (SHBG) was measured by an ammonium sulphate precipitation method at the beginning and at the end of each treatment cycle. The results indicated an accumulation of norethisterone in plasma when 1 to 3 mg of norethisterone or lynestrenol was given. There was no obvious accumulation during treatment with 0·5 mg norethisterone. SHBG increased during treatment with all combinations studied. However, this increase was most pronounced with the 50 úg ethinyloestradiol/1 mg lynestrenol, 50 μg mestranol/1 mg norethisterone and 35 μg ethinyloestradiol/0·5 mg norethisterone combinations. There was no statistically significant increase in SHBG with 50 μg ethinyloestradiol/2·5 mg lynestrenol or 50 μg ethinyloestradiol/3 mg norethisterone acetate combinations. The results indicated that the induction of SHBG by the synthetic oestrogens was antagonized by the progestogens in a dose‐dependent manner. The effect on SHBG by a combined preparation could be one assessment of the oestrogenicity or androgenicity of the preparation.
MALIGNANT MELANOMA OF THE VULVA AND VAGINA
Authors: Edington P. T. , Monaghan J. M.
Published: August 2005

Fifteen patients with primary malignant melanoma of the vulva and two with primary malignant melanoma of the vagina were reviewed. Many patients had advanced tumours and the results of surgical treatment were very poor.
MORPHOLOGY OF HAEMOSTASIS IN MENSTRUAL ENDOMETRIUM
Authors: Christiaens G. C. M. L. , Sixma J. J. , Haspels A. A.
Published: August 2005

Light microscopy, electron microscopy and immunofluorescence were used to study the endometrium from nine uteri removed during the first 72 hours of normal menstruation. During premenstrual spotting, stromal disintegration and vessel lesions without any haemostatic reaction were seen. Up to 20 hours after the onset of menstrual bleeding, blood extravasation was prominent in the functional endometrium. The vessels in this layer were partly or totally sealed by intravascular thrombi functioning as haemostatic plugs. The thrombi contained various amounts of platelets and fibrin and were shed with the tissue. New plugs formed up‐stream in the same vessels. Twenty hours after the onset of menstruation, most of the functional endometrium had been desquamated. From 20 to 72 hours after the start of menstrual bleeding no or few thrombi were seen. Haemostasis may then be caused by adherence of vessel lips.
MEDIASTINAL AND SUBCUTANEOUS EMPHYSEMA IN A PREGNANT PATIENT WITH ASTHMA CASE REPORT
Authors: Hague W. M.
Published: August 2005

A pregnant patient with asthma developed mediastinal and subcutaneous emphysema in the third trimester. The aetiology, diagnosis and management of mediastinal emphysema are discussed.
MATERNAL HYPERTENSION AND INTRAUTERINE FETAL DEATH IN MID‐PREGNANCY
Authors: Silverstone A. , Trudinger B. J. , Lewis P. J. , Bulpitt C. J.
Published: August 2005

An analysis of the 156 pregnancies which terminated spontaneously between 16 and 27 weeks gestation, inclusive, indicated that in 41 patients where fetal death was the primary event, maternal arterial pressure was raised in early pregnancy when compared with matched groups of women whose pregnancies had a successful outcome. Blood pressure in the 14th week of pregnancy in women with fetal death was significantly higher than in women with other types of mid‐trimester abortion. It is suggested that maternal hypertension predisposes to intrauterine fetal death in the mid‐trimester of pregnancy as it does in the third trimester.
THE EFFECT OF MATERNAL CIGARETTE SMOKING ON FETAL BIRTH WEIGHT AND ON GROWTH OF THE FETAL BIPARIETAL DIAMETER
Authors: Murphy J. F. , Drumm J. E. , Mulcahy R. , Daly L.
Published: August 2005

Two otherwise comparable groups of patients, 27 of whom were non‐smokers and 20 of whom smoked in excess of ten cigarettes per day, had serial fetal biparietal diameter measurements taken throughout pregnancy; from 21 weeks onwards, the fetal biparietal diameters increased significantly more slowly (p <0·01) in mothers who smoked.
THE DETERMINATION OF A REFERENCE RANGE FOR URINARY OESTROGEN EXCRETION IN LATE PREGNANCY
Authors: McFadyen I. R. , Worth H. G. J. , Wright D. J.
Published: August 2005

A reference range for urinary oestrogen excretion between 28 and 40 weeks has been produced by analysis of 18 870 estimations. The data were transformed logarithmically to give a Gaussian distribution on which parametric analysis was performed: non‐parametric analysis was carried out on the untransformed data : the results of both analyses were compatible. Multiple pregnancies tended to have levels above the 50th centile, light‐for‐dates fetuses below the 50th centile. Antepartum haemorrhage showed no difference from the general reference range. Intrauterine death was preceded by a level below the 5th centile if the estimation was carried out less than one week before the fetus died.
THE RADIOIMMUNOASSAY OF A PREGNANCY SPECIFIC‐β1‐GLYCOPROTEIN IN PLASMA AS A PREGNANCY TEST FOR SUBFERTILE WOMEN
Authors: Anthony F. , Masson G. M. , Wood P. J.
Published: August 2005

We used a pregnancy specific‐β‐glycoprotein (SP1) radioimmunoassay to monitor 72 menstrual cycles of 38 apparently subfertile women who were trying to become pregnant. Blood samples were taken up to day 42 from the start of the previous menstrual cycle. Using serum SP1 levels greater than 6μg/1 as indicative of pregnancy, we obtained 16 positive results of which 11 were later confirmed by a human chorionic gonadotrophin haemagglutination pregnancy test. Three of the five women whose pregnancies were not confirmed had a subsequent history of spontaneous abortion.
DIAZEPAM AS AN INDUCTION AGENT FOR CAESAREAN SECTION: A CLINICAL AND PHARMACOKINETIC STUDY OF FETAL DRUG EXPOSURE
Authors: Haram K. , Bakke O. M.
Published: August 2005

The transplacental passage and clinical effects of diazepam have been studied in 30 patients undergoing elective Caesarean section. General anaesthesia was induced with diazepam (20 mg) and maintained with nitrous oxide/oxygen. The time from completed intravenous injection of diazepam to clamping of the umbilical cord varied from 184 to 810 seconds. The concentrations of diazepam in serial blood samples obtained from the mothers, the umbilical cord and the newborn infants demonstrated that the transplacental passage of the drug was rapid and there was evidence that the distribution of the drug between the mother and the fetus came close to equilibrium. There was no consistent relation between Apgar scores and the extent of the fetal exposure to diazepam.
THE RELATION BETWEEN CORD SERUM SODIUM LEVELS IN NEWBORN INFANTS AND MATERNAL INTRAVENOUS THERAPY DURING LABOUR
Authors: Dahlenburg G. W. , Burnell R. H. , Braybrook R.
Published: August 2005

A retrospective study was made of the relation between the cord serum sodium levels and the intravenous administration to the mother of 5 per cent dextrose and oxytocin. Of the 203 mothers studied, 106 received intravenous fluid before delivery. The mean sodium levels of babies of mothers who had intravenous fluid (133±4.2 (SD) mmol/1) was significantly lower than for babies of mothers who had not (138±4.3(SD)mmol/l).
CARCINOSARCOMA OF THE FALLOPIAN TUBE: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Viniker D. A. , Mantell B. S. , Greenstein R. J.
Published: August 2005

A patient with a carcinosarcoma of the Fallopian tube is presented. She is the first reported from the United Kingdom and the 23rd in the literature. The clinical and pathological features, pathogenesis and management are discussed.
PLASMA PROSTAGLANDIN CONCENTRATIONS AFTER CERCLAGE IN EARLY PREGNANCY
Authors: Toplis P. J. , Shepherdj J. H. , Youssefmejadian E. , Jakubowicz Diana , Dewhurst John
Published: August 2005

A prospective, randomized controlled study was made to measure the circulating levels of 13, 14‐dihydro‐15‐keto‐prostaglandin F (PGFM) in two groups of women having cervical cerclage early in the second trimester of pregnancy. One group of patients was given omnopon by intramuscular injection for 24 hours after operation and the other salbutamol by intravenous infusion. A significant rise in circulating PGFM was found in both groups after cervical cerclage and the magnitude of the rise was similar in the two groups; levels of PGFM in both groups had returned to the preoperative levels within 24 hours of operation. The levels of PGFM before and after operation showed no relation to the eventual outcome of the pregnancy, which was successful in 80 per cent of patients.
MATERNAL PLASMA UNCONJUGATED OESTROGENS IN EARLY HUMAN PREGNANCY
Authors: Harrison R. F. , Kitchin Yvonne
Published: August 2005

The plasma levels of unconjugated oestrone (El), oestradiol (E2) and oestriol (E3) were determined by radioimmunoassay, twice weekly in 21 subjects from the earliest detection of pregnancy up to 16 weeks gestation where possible. Normal ranges for the three oestrogens were established using data from 15 subjects who had a normal pregnancy, including one sampled throughout the cycle of conception. The six other subjects comprised a twin pregnancy, two who aborted and three who received progestogen therapy, and their oestrogen levels were compared with the normal ranges. El and E2 levels showed a steady increase over the period of study with E2 levels exceeding those of El. E3 levels remained low (in many cases less than 50 pg/ml) until week 13 when levels began to rise steadily. In a caseof twin pregnancy, El and E2 levels only became significantly elevated when compared with single pregnancies from week 15. There were differing oestrogen trends in two patients who aborted. In a patient with an incomplete abortion, levels only dropped significantly after abortion had occurred, whereas, in a patient with a complete abortion, a gradual and progressive fall in El and E2 levels was observed. The levels of El and E2 for the three subjects receiving progestogen therapy did not differ significantly from those of the normal subjects.
MATERNAL PLASMA β‐hCG IN EARLY HUMAN PREGNANCY
Authors: Harrison R. F. , O'Moore R. R. , McSweeney J.
Published: August 2005

β‐human chorionic gonadotrophin (β‐hCG) was assayed twice weekly in plasma from 20 subjects from 4 to 16 weeks gestation; 14 of these were normal. There was an initial rise, a plateau at weeks 7 to 9, and a further rise to a maximum at week 11. Levels then dropped steadily to week 16. There was no significant difference when mean levels were subdivided and calculated according to the subsequent sex of the baby. Of the 6 abnormal subjects, the twin pregnancy initially showed normal levels but at week 11 and 13 these were at least one standard deviation above the mean. The plasma β‐hCG levels of the two subjects who aborted were more than one standard deviation below the mean at week 5. Three subjects treated with progestogen therapy had β‐hCG levels which fluctuated within normal limits. The trends of β‐hCG levels were similar to those of plasma hCG levels in the two subjects who had both assays performed but peak times were different. There was considerable within patient and also patient to patient variation in β‐hCG levels.
CLINICAL ASPECTS OF PREGNANCIES ESTABLISHED WITH CLEAVING EMBRYOS GROWN IN VITRO*
Authors: Steptoe P. C. , Edwards R. G. , Purdy J. M.
Published: August 2005

Details are given of four pregnancies established by fertilization in vitro and planting cleaving embryos into the mother. The pregnancies were monitored by hormone assays in early pregnancy and by ultrasound scans. Amniocentesis was used to assess the levels of alpha‐fetoprotein and the karyotype of the fetuses at 15 weeks. Placental function tests and X‐rays were used to monitor late pregnancy in one patient. Three of the pregnancies began uneventfully and the fetuses were normal in all respects. Two were delivered at or near term, the third being aborted spontaneously at 21 weeks while the parents were on holiday. The fourth pregnancy did not develop normally and a triploid fetus was aborted 12 weeks after the last menstrual period. The clinical difficulties inherent in selecting patients and preparing them for treatment are described. Some possible improvements in techniques are also described.
OBSERVATIONS ON PREOVULATORY HUMAN OVARIAN FOLLICLES AND THEIR ASPIRATES*
Authors: Edwards R. G. , Steptoe P. C. , Fowler R. E. , Baillie J.
Published: August 2005

During laparoscopy for the collection of preovulatory oocytes the ovaries were inspected and the numbers of Graafian follicles were counted. Most patients had one large preovulatory follicle but three patients had two and might have had twin ovulations. The large follicle was in the left ovary in 9 patients and in the right ovary in 11. It could be aspirated easily in most patients, viscous follicular fluid, presumably rich in hyaluronic acid, appeared to accumulate in preovulatory follicles between 18 and 27 hours after the luteinizing hormone surge. The content of steroids in follicular fluids indicated that the largest follicle was preovulatory in most patients, the smaller follicles being non‐ovulatory. Granulosa cells aspirated from the large preovulatory follicles were active on the Δ4 pathway and able to aromatise androgens to oestrogens, but did not undertake conversions on the Δ5 pathway.
THE NORMAL CONDITION OF THE FETAL ELECTROCARDIOGRAM DURING LABOUR
Authors: Marvell C. J. , Kirk D. L. , Jenkins H. M. L. , Symonds E. M.
Published: August 2005

A real‐time computer system was employed to monitor continuously the fetal electrocardiogram (ECG) during labour. Signals from a scalp electrode were amplified, filtered and passed through an interface system to a digital computer. From 110 patients studied, 37 were selected by rigid criteria which fulfilled a strict definition of normal fetal condition in labour and delivery. The mean values and the range of the various parameters of the fetal ECG complex were defined. As a large amount of data was generated by the system, a method was developed to display the short and long‐term dynamic behaviour of the fetal ECG during labour in the form of labour profiles. By further averaging of these labour profiles, the pattern of normal behaviour was established. Certain changes in the fetal ECG, previously thought to be characteristic of fetal distress, occurred in normal patients. The P‐R interval was up to 10 per cent shorter during contractions towards the end of labour and there was a long‐term trend towards the end of labour for the P‐R interval to fall by 7 per cent. The P wave amplitude fell by 30 per cent over the last hour. These trends were statistically significant. The QRS complex was found to lengthen slightly towards the end of labour, but the R‐T interval and ST segment displacement displayed no significant changes.