Elemental analysis of Anethum gravedlens, Sismbrium Irio Linn and Veronia Anthelmintica seeds by instrumental neutron activation analysis.

Instrumental neutron activation analysis has been used to characterize As, Ba, Br, Ce, Cl, Co, Cr, Cs, Eu, Fe, Hg, K, Mn, Na, Rb, Sb, Se and Zn, and Sc in seeds of Anethum graveolens (Dill), Sisymbrium irio Linn. (Wild Mustard) and Vernonia anthelmintica (Iron Weed). Dill seed was found to contain high K while Wild Mustard has high Fe, Mn and Na levels. Iron Weed has highest Cl, Co, Cr and Zn content with least concentration of Fe.

Measurement of natural radioactivity and dose rate assessment of terrestrial gamma radiation in the soil of southern Punjab, Pakistan.

Activity concentrations of (226)Ra, (232)Th, (40)K and (137)Cs in soil samples collected from the most populous area of southern Punjab of Pakistan have been measured by gamma-ray spectrometry. The measured activity concentrations for these radionuclides are compared with the reported data from different other countries and it is found that measured activity concentrations are comparable with the worldwide measured average values reported by the UNSCEAR. Subsequently assessed radiological effects show that the mean radium equivalent activity (Ra(eq)) is 96.7 +/- 15.2 Bq kg(-1) and air absorbed dose rate (D) is 46.1 +/- 7.3 nGy h(-1). The values of internal and external radiation hazard indices are found to be less than unity. The annual effective radiation dose is calculated to be 0.28 +/- 0.05 mSv, which is well below the limit of 1.0 mSv y(-1) recommended by the International Commission on Radiological Protection, for the general public.

The interpretation and clinical application of the word 'parity': a survey.

The objective of this study was to evaluate the use of the term 'parity' in multiple pregnancies using a questionnaire survey. One hundred and fifty obstetricians and midwives in five maternity units in southeast Thames region of the London deanery were administered the questionnaire. One hundred and twenty-six questionnaires were returned (84% response rate). Only 21% described twin delivery as a single parous experience. The improper clinical application of the word parity was shown in both obstetricians and midwives. Standardisation of the definition to ensure accuracy and uniformity in record keeping is necessary.

Measurement of natural radioactivity in bottled drinking water in Pakistan and consequent dose estimates.

Natural radioactivity was determined in 11 different brands of commonly sold bottled drinking water in the federal capital Islamabad and Rawalpindi city of Pakistan using gamma spectrometry technique. Mean concentrations of 226Ra, 232Th and (40)K were found to be 11.3 +/- 2.3, 5.2 +/- 0.4 and 140.9 +/- 30.6 mBq l(-1), respectively. The annual cumulative effective doses due to all three natural radionuclides for different age groups of 1-5 y, 5-10 y, 10-15 y and adults (>or=18 y) were estimated to be 4.0, 3.4, 3.1 and 4.1 microSv y(-1), respectively. Among the three natural radionuclides, annual effective doses for all age groups from 226Ra were significant. Children in the age group of 1-5 y appeared to be at risk with respect to the annual effective doses from 226Ra as compared to the other age groups. Results obtained in this study are compared with the reported values from other countries of the world and it was observed that measured activity concentrations of three natural radionuclides in the bottled drinking water were lower than these values. Annual estimated effective doses for all four age groups from the intake of natural radionuclides in bottled drinking water were also found below the World Health Organisation (WHO) recommended limit of 0.1 mSv y(-1) as well as the average radiation dose of 0.29 mSv y(-1) received per head worldwide due to ingestion of natural radionuclides assessed by UNSCEAR (2000).

Activity Concentration of 137Cs in soil samples from Punjab province (Pakistan) and estimation of gamma-ray dose rate for external exposure.

Punjab is one of the most populated provinces of Pakistan having 34 districts. There is always a need to have baseline background level information about 137Cs and the corresponding gamma-ray doses to the population. In this respect, soil samples were collected to a depth of 30-50 cm from all 34 district headquarters of the Punjab province of Pakistan and 137Cs activity concentrations were measured. 137Cs activity concentration was found to be in the range from 1.1 +/- 1.0 to 5.3 +/- 2.5 Bq kg(-1). The average value of estimated external gamma-ray dose rate from all 34 districts of Punjab province was computed to be 0.18 +/- 0.07 nSv h(-1) from 137Cs in soil samples. The measured 137Cs activity concentration range was compared with the reported ranges in the literature from some of the other locations in the world. Results obtained in this study show that 137Cs concentration is of a lower level in the investigated area. The average value of estimated external effective dose rate is found far below the dose rate limit of 1.0 mSv y(-1) for members of the general public recommended by the International Commission on Radiological Protection (ICRP) as well as the external gamma radiation dose of 0.48 mSv y(-1) received per head from the natural sources of radiation assessed by UNSCEAR (2000). It is concluded that 137Cs soil contamination does not pose radiation hazards to the population in the investigated areas.

Measurements of activity concentrations of naturally occurring radionuclides in soil samples from Punjab province of Pakistan and assessment of radiological hazards.

The natural level of radioactivity in soil is one of the major causes of external gamma rays exposure. It was considered imperative to measure gamma-ray activity concentrations due to naturally occurring, potentially hazardous radionuclides from 232Th, 226Ra and 40K in soil samples from Punjab, the most populated province of Pakistan. The activity concentrations were measured in soil samples collected from all 34 district headquarters of Punjab province using a P-type coaxial high purity germanium (HPGe)-based gamma-ray spectrometer having a relative efficiency of 60%. The mean activity concentrations for 232Th, 226Ra and 40K were found to be 41 +/- 8, 35 +/- 7 and 615 +/- 143 Bq kg(-1), respectively in soil samples from all 34 district headquarters of Punjab. The mean values of radium equivalent index (Ra(eq)) and total annual external gamma radiation dose were found to be 141 +/- 27 Bq kg(-1)and 0.38 mSv, respectively. Since these estimated radiological impact assessment factors are lower than the recommended values there seems to be no potential radiological health hazard associated with the soils from the district headquarters in the Punjab province of Pakistan. Geological studies show that most of the soils in Punjab have developed on the extensive fluviatile deposits of five rivers and a stable ratio of natural activity concentrations is observed in soil samples of the areas under study.

Determination of natural radioactivity in building materials used in the Rawalpindi/Islamabad area by gamma-ray spectrometry and instrumental neutron activation analysis.

Samples of sand and manufactured building materials collected from the Rawalpindi/Islamabad area have been analyzed for the primordial natural radionuclides 238U, 232Th and 40K using gamma-ray spectrometry. The uranium and thorium contents have also been determined by instrumental neutron activation analysis (INAA). The specific activities of these radionuclides in the samples are compared with those of the world averages for soil. The comparison shows that, of the nine samples analyzed, only the three brick samples have higher activities than the world averages for soil. The specific activities in these materials, having a radium equivalent activity of less than 370 Bq kg-1, when evaluated for radiological effects show that all materials meet the external gamma-ray dose limitation of 1.5 mSv y-1. The gamma-spectrometric and INAA techniques complemented each other well in this study.

Blood flow changes in the ovarian and uterine arteries in women with polycystic ovary syndrome who respond to clomiphene citrate: correlation with serum hormone concentrations.

OBJECTIVE: Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels in women with polycystic ovary syndrome (PCOS) and to relate the vascular changes to hormonal indices. METHODS: Six women with a history of previous anovulatory cycles and/or oligomenorrhea and/or elevated serum luteinizing hormone concentrations in addition to polycystic ovaries underwent induction of ovulation with clomiphene citrate. Serial transvaginal ultrasonography was performed on menstrual cycle day 2, daily from the estimated day of ovulation minus 6, 6-hourly from the estimated day of ovulation minus 2 or when the mean follicular diameter was greater than 16 mm (whichever was earlier) until 6 h after follicular rupture, and once 7 days after follicular rupture. At each scan, uterine and intraovarian blood flow was assessed by transvaginal color Doppler ultrasound, and serum concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone were assessed by fluoroimmunoassay. RESULTS: All six women demonstrated ultrasonographic features of ovulation. Follicular peak systolic blood flow velocity (Vmax) and ovarian stromal Vmax in the dominant ovary increased during the follicular phase of the menstrual cycle and reached a peak at 36 and 42 h after the onset of the LH surge of 30.7 +/- 4.6 cm/s and 37.0 +/- 3.9 cm/s, respectively. There was no significant change in the ovarian stromal Vmax of the non-dominant ovary. There was no significant change in the pulsatility index (PI) in either the follicular or the ovarian stromal vessels during the menstrual cycle. The changes in follicular Vmax correlated significantly with changes in serum concentrations of FSH, LH and progesterone. Uterine artery time-averaged maximum velocity (TAMX) declined to its lowest levels at LH surge minus 6 days, and thereafter increased. In contrast, the PI increased during the follicular phase of the cycle, reaching a peak at LH surge minus 4 days, and thereafter declined. The changes in uterine artery PI correlated inversely with serum estradiol and serum progesterone concentrations. CONCLUSIONS: Women with PCOS have significant differences in intraovarian and uterine artery hemodynamics, both at the baseline ultrasound scan and during the clomiphene-induced menstrual cycle, compared with women with normal ovaries. The intraovarian and uterine artery vascular differences are likely to be due to a primary disorder within the polycystic ovary and their different hormonal status. Clomiphene citrate may have an effect on uterine artery blood flow.

Relationship of ovarian stromal volume to serum androgen concentrations in patients with polycystic ovary syndrome.

The aim of this study was to investigate of the relationship of ovarian stromal volume, measured using three-dimensional ultrasound, to serum androgen concentrations in patients with polycystic ovaries. Serum gonadotrophin, oestradiol and androgen concentrations and ovarian volume measurements were obtained in the early follicular phase from 100 women undergoing assisted conception treatment cycles. Group 1 contained 50 women with regular menstrual cycles and normal ovarian morphology, group 2 contained 24 women with regular menstrual cycles and polycystic ovaries seen on ultrasound scan and group 3 contained 26 women with polycystic ovary syndrome. Statistical analysis included analysis of variance, Scheffé's procedure and Pearson's correlation. Total ovarian volume (15.7-16.1 versus 11 ml, P < 0.05), stromal volume (14.5 versus 9.4 ml, P < 0.05) and thecal steroid concentrations were significantly greater in groups 2 and 3. Stromal volume was positively correlated with serum androstenedione concentrations (r = 0.45, P = 0.0019 in group 3) but was not correlated with any other endocrine parameter. It was concluded that polycystic ovaries are characterized by increased ovarian stroma with associated overproduction of theca-derived steroids, particularly androstenedione.

Unexpected effect of a nitric oxide donor on uterine artery Doppler velocimetry in oligomenorrheic women with polycystic ovaries.

We compared uterine artery vascular responses following administration of the nitric oxide donor glyceryl trinitrate to ten women with oligomenorrhea and ultrasound evidence of polycystic ovaries with those of nine women with a normal menstrual cycle and ultrasonically normal ovaries. Mean arterial blood pressure, pulse rate and uterine artery flow velocity waveforms were recorded before and 60-75 min after glyceryl trinitrate patch application. The pulsatility index and resistance index were calculated to describe changes in impedance to flow in the uterine artery. Peak systolic and time-averaged velocities were also measured. Pretreatment median arterial pressure was higher in women with polycystic ovaries (90 mmHg) compared to those with regular cycles (80 mmHg) (p < 0.05). No differences were found in pulse rate and uterine artery blood flow indices between the two groups. After glyceryl trinitrate patch administration, there was no change in blood pressure or pulse rate in either group. In women with polycystic ovaries, there was an increase in uterine artery resistance index (0.93 to 1.00; p < 0.05) and pulsatility index (3.77 to 4.99; p < 0.05) and a decrease in peak systolic (36.8 to 32.3 cm/s; p < 0.05) and time-averaged maximum (8.5 to 5.0 cm/s; p < 0.05) velocities. Uterine artery Doppler parameters remained unchanged in women with normal cycles. Uterine artery vascular responses to the nitric oxide donor glyceryl trinitrate are different in women with normal cycles compared to oligomenorrheic women with polycystic ovaries. This may be relevant to an understanding of the pathophysiology underlying the higher risk of cardiovascular morbidity and mortality associated with polycystic ovarian syndrome.

Transvaginal three-dimensional ultrasound: reproducibility of ovarian and endometrial volume measurements.

OBJECTIVE: To assess the reproducibility of ovarian and endometrial volume measurements obtained using transvaginal three-dimensional (3D) ultrasound (US). DESIGN: Prospective clinical study. SETTING: A tertiary referral center for assisted reproduction. PATIENTS: Forty women undergoing ovarian stimulation for IVF-ET using the long protocol of GnRH agonist. INTERVENTION: Three observers independently measured 20 stored ovarian scanned volumes and 20 endometrial volumes. Also, ovarian volume was calculated from three diameters obtained by two-dimensional (2D) US. MAIN OUTCOME MEASURE: Analysis of variance, the paired Student's t-test, and calculation of intraclass and interclass correlation coefficients were used for statistical analysis. RESULTS: Three-dimensional ovarian volume measurements were not significantly different from ovarian volume calculated from three diameters (7.98 versus 7.58 mL). The mean endometrial volume measurement was 3.56 mL. The intraobserver coefficient of variation for both ovarian and endometrial volume was 8%. The interobserver coefficient of variation was 9% for ovarian volume and 11% for endometrial volume. Intraclass and interclass correlation coefficients were 0.95 and 0.95 for ovarian volume and 0.90 and 0.82, respectively, for endometrial volume. CONCLUSION: Transvaginal 3D US produces highly reproducible ovarian and endometrial volume measurements.

Relationship of ovarian stromal blood flow at the baseline ultrasound scan to subsequent follicular response in an in vitro fertilization program.

OBJECTIVE: To assess whether Doppler indices of intraovarian blood flow are related to the subsequent follicular response in an in vitro fertilization (IVF) program. METHODS: One hundred five women underwent ultrasonographic assessment of ovarian morphology, transvaginal color Doppler measurement of intraovarian blood flow and immunoassay of serum FSH during the early follicular phase of an IVF cycle. The subsequent follicular response was related to the Doppler data. RESULTS: Mean ovarian stromal peak systolic blood flow velocity was significantly correlated with the follicular response (P = .001), even after adjusting for the age of patient, type of ovary (polycystic or normal), total number of human menopausal gonadotropin ampules used, and serum FSH. Mean ovarian stromal pulsatility index was not related to the follicular response. Mean ovarian stromal peak systolic blood flow velocity was significantly lower (P = .007) in the poor-response group. The adjusted odds of a poor response increased significantly by an estimated 22% per cm/second decrease in velocity (P = .02). CONCLUSION: Ovarian stromal blood flow at the baseline ultrasound scan is correlated with subsequent follicular response and may be a new indicator for predicting ovarian responsiveness in an IVF program.

Blood flow changes in the ovarian and uterine arteries during the normal menstrual cycle.

OBJECTIVE: Our purpose was to study the hemodynamic changes in the uterine and intraovarian vessels during the normal menstrual cycle and to relate the vascular changes to hormonal index values. STUDY DESIGN: Seven women who had bilateral tubal patency, a normal pelvis on laparoscopy, and regular ovulatory cycles underwent serial transvaginal ultrasonography on menstrual cycle day 2, daily from estimated day of ovulation-6, hourly from estimated day of ovulation-2, or when the mean follicular diameter was > 16 mm (whichever was earlier) until 6 hours after follicular rupture and once 7 days after follicular rupture. At each scan uterine and intraovarian blood flow was assessed with transvaginal color Doppler ultrasonography and serum concentrations of follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone assessed by fluoroimmunoassay. RESULTS: In one case there was evidence of a luteinized unruptured follicle and the patient was therefore excluded from analysis. In the other six women there was spontaneous ovulation at a mean of 39 hours after the onset of the luteinizing hormone surge. On the side with the dominant follicle, follicular and ovarian stromal peak systolic blood flow velocity rose significantly during the menstrual cycle with no significant change in pulsatility index. The changes in blood flow velocity correlated significantly with changes in serum follicle-stimulating hormone, luteinizing hormone and progesterone concentrations. There were no significant changes in either blood flow velocity or pulsatility index in the contralateral ovary. Uterine artery time-averaged maximum velocity on the side of the developing ovarian follicle increased during the menstrual cycle with no significant change in the contralateral vessel. Uterine artery pulsatility index on the side of the developing follicle declined during the midluteal phase and was significantly lower than on the contralateral side. The changes in time-averaged maximum velocity correlated with the changes in serum estradiol and progesterone concentrations. CONCLUSION: The vascular changes in the wall of the dominant ovarian follicle and ovarian stroma during the menstrual cycle are consistent with activity of angiogenic-like factors. The decline in uterine artery resistance during the midluteal phase may reflect optimal vascularity for implantation of the blastocyst.

Advances in the use of ultrasound in infertility management.

Over the past year a number of interesting studies using colour Doppler ultrasound have emerged in the field of infertility. Although they have increased our knowledge of physiological changes, prospective randomized studies are still awaited. The development of three-dimensional ultrasound systems is likely to provide improved spatial evaluation of pelvic organs and improve diagnosis of the polycystic ovary.

Elective cryopreservation of all embryos in women at risk of developing ovarian hyperstimulation syndrome may not prevent the condition but reduces the live birth rate.

OBJECTIVE: Our goal was to evaluate the use of elective cryopreservation of all embryos to prevent the development of ovarian hyperstimulation syndrome in patients at risk while undergoing in vitro fertilization treatment. DESIGN: We analyzed 117 treatment cycles in which the serum E2 concentration on the day of hCG administration was > 10,000 pM and in whom > or = 15 oocytes were retrieved at ultrasound-directed follicle aspiration. The incidence of ovarian hyperstimulation syndrome, pregnancy, and live birth in 65 patients who had elective cryopreservation of all embryos and 52 patients who had fresh embryo transfer were compared. Independent t test and chi-square test (with Yates' correction) was used as appropriate. RESULTS: The clinical pregnancy (35 vs 17%; P < 0.03) and the live birth (27 vs 12%; P < 0.05) rates in patients receiving fresh embryo transfer was significantly higher than in those who had elective cryopreservation of all embryos. The incidence of moderate and severe ovarian hyperstimulation syndrome was similar in both groups (3.8 and 6.2%). CONCLUSIONS: Elective cryopreservation of all embryos does not reliably protect against the development of ovarian hyperstimulation syndrome but may reduce the clinical pregnancy and live birth rate.

Acute and chronic respiratory complications of toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a rare disease resulting in bullous necrosis of the epidermis with partial-thickness loss of skin and mucous membranes. Previous reports of TEN have not focused on respiratory complications. During a 6-year period, 12 patients with biopsy-proven TEN were referred to a regional burn unit at the Wellesley Hospital, Toronto. Five patients required mechanical ventilatory support, and nine showed roentgenographic evidence of respiratory complications that had developed. Intensive therapy in a critical care burn unit resulted in a 75% survival rate. The four nonsurvivors had severe preexisting multisystem disease. Four survivors were observed prospectively, with 3 monthly pulmonary function testings performed. The four survivors tested, even if they did not require mechanical ventilatory support, showed evidence of respiratory involvement. Three patients demonstrated a persistent reduction in carbon monoxide diffusing capacity of up to 35% to 40% below normal. From our case series we suggest that TEN, although primarily a dermatologic condition, may result in life-threatening acute respiratory decompensation requiring ventilatory support and long-term pulmonary function abnormalities. Patients with TEN should be closely monitored for pulmonary complications.