Detection of alpha-fetoprotein by supplementation counterimmunoelectrophoresis (CIE).

A simple, inexpensive and sensitive method of detecting alpha-fetoprotein (AFP) by supplementation CIE assay is described. The method detects AFP at concentrations in the region of 20 ng/ml.

Comparison of various assays for detection of AFP in differentiating patients with primary hepatocellular carcinoma from controls.

Four assays for the detection of alphafetoprotein (AFP) in the diagnosis of primary hepatocellular carcinoma (HCC) were evaluated. The frequency of AFP detection was compared in 89 HCC patients and in 71 patients with chronic active hepatitis/cirrhosis. Of the four assays, immunodiffusion, counterimmunoelectrophoresis (CIE), supplement CIE, and radioimmunoassay, the best for differentiating patients with HCC from those with chronic active hepatitis and cirrhosis was CIE.

A comparative study of the metabolic effects of injectable and oral contraceptives.

The metabolic effects of an injectable contraceptive, Depo-provera (medroxyprogesterone acetate), an oral contraceptive pill containing 50 micrograms ethinyl estradiol and 500 micrograms norgestrel and a control group (not on contraceptives) were compared in 3 groups, each comprising 32 women. The subjects were matched for race, age and parity. Mean duration of treatment was 41.7 +/- 18.3 months for Depo-provera and 59.6 +/- 29.0 months for the pill group. Glucose tolerance was impaired in both treatment groups. The combination pill showed more changes in both glucose tolerance and insulin response. Lipid levels remained unchanged in both treatment groups.

The credibility of the Breast Cancer Risk Assessment (BCRA) tool for Asians.

This paper presents an overview of the Breast Cancer Risk Assessment (BCRA) Tool, assessing the credibility of the BCRA tool in estimating the risk of developing breast cancer for Asians and the carrying out of tests to identify the changes in the risks that follow with changes in one or more risk factors of the tool. It is essential to increase the awareness of women of their risk of developing breast cancer, as it is not surprising that some women may not even be conscious of the individual factors that might contribute to the increase of their risk of developing breast cancer. On the other hand, relatively accurate means of determining increases in relative risks of developing breast cancer due to changes in some of the risk factors are also important. This is done so that unnecessary worry due to an overestimation of an individual's risk of developing breast cancer can be avoided. Due to the origin of the BCRA tool which is used in this study, it is important to verify the validity of the tool on Asians and to identify, as far as possible, the effect that each risk factor has on individuals. The effect that a specific risk factor has on a white woman may not be exactly the same for that of an Asian woman. As the above-mentioned tool has been arrived at using the statistics and databases of white women, in this work, tests have been carried out to determine the suitability of the tool on Asian women. On top of that, various tests are also carried out to determine the effects of the change of certain risk factors on a woman's risk of developing breast cancer. These factors include age, number of breast biopsies and number of first-degree relatives with breast cancer. Five-year risks and lifetime risks are also looked into separately with the change of each of these factors.

Failed induction of labour.

Over a 15-month period 1,057 consecutive inductions of labour were performed representing a 10% induction rate; 174 (16.5%) of these patients were delivered by Caesarean section of which 74 (7.0%) were for failed induction of labour, 58 (5.5%) for fetal distress, 19 (1.8%) for cephalopelvic disproportion, 6 for malposition and 17 for other reasons. The mean cervical score at induction of labour was 5.7 and 5.5 for cephalopelvic disproportion (CPD) and malposition respectively but was 4.0 for failed induction. The mean cervical dilatation at the time of Caesarean section was 5.7 cm and 6.6 cm for CPD and malposition respectively whereas it was 3.5 cm for failed induction. Mean maximum dose of oxytocin was 19.2 milliunits per minute (mu/min) and 22.5 mu/min for CPD and malposition respectively whereas it was 24.7 mu/min for cases of failed induction. Nulliparas with a cervical score of 3 or less had a 65.4% Caesarean section rate of which more than two-thirds were for failed induction of labour. Analysis of indications for induction of labour revealed that a fair number of inductions had debatable obstetric indications. Tailoring induction of labour to the cervical score and indication might reduce the Caesarean section rate for failed induction of labour. Rational management to ensure an adequate dose of oxytocin and sufficient time in the first stage of labour is important. Failed induction of labour may be differentiated from failure of labour progress due to CPD or malposition.

Total uterine activity in induced labour--an index of cervical and pelvic tissue resistance.

Uterine activity was studied during labour induced using an automatic infusion system (AIS) or a peristaltic infusion pump (IVAC) to administer oxytocin. In the 110 patients who achieved vaginal delivery the total uterine activity required to effect full dilatation of the uterine cervix was found to vary according to parity and cervical score but not according to mode of oxytocin infusion. Irrespective of whether the uterine activity level per 15 min was maintained at between 700 and 1500 kPas or at between 1500 and 2000 kPas, the total uterine activity was similar the lower levels being compensated for by a longer duration. Fetal outcome, in terms of 1- and 5-min Apgar scores and umbilical vein blood pH, was unaffected by the level of uterine activity. The cervical and pelvic tissue resistance varies according to parity and cervical score and the uterus has to achieve a certain total uterine activity in induced labour which is best achieved by maintaining optimal uterine activity levels of 1500-2000 kPas/15 min to effect vaginal delivery of the baby in good condition in optimal time.

The effect of parity on uterine activity in labour.

Uterine activity was studied in 40 multiparous Singapore women of Chinese origin who were in normal labour and had a normal delivery. A catheter tip pressure transducer coupled with a uterine activity integrator was used to quantify uterine activity. Normal labour progress was defined as labour progressing within 2 h to the right of a line drawn on the partogram at 1 cm/h in the active phase of labour. A wide range of activity was observed. The median level of uterine activity rose from 815 kPas/15 min at 3 cm dilatation to 1731 kPas/15 min at 9 cm dilatation with an overall median level of 1130 kPas/15 min. The 10th centile value rose from 430 kPas/15 min at 3 cm dilatation to 923 kPas/15 min at 9 cm dilatation. Profiles of dilatation-specific activity values were constructed. These values were significantly lower than in a comparative group of nulliparous patients. The parous uterus requires to expend significantly less effort to effect normal vaginal delivery than its nulliparous counterpart.

A randomized comparative trial of the Lippes Loop D, Gravigard and TCu 220C IUDs.

This randomized prospective trial compared the use-effectiveness and pregnancy rates in 3 IUDs following immediate postabortal insertion in 199 women over 3107 months of use. At 24 months the Gravgard (Cu 7) was not significantly different from either of the other 2 devices. However, the Lippes Loop D when compared with the TCu 220C had a higher expulsion rate (P less than 0.05) and a higher use-related termination rate (P less than 0.001). Further details of accidental pregnancies, removal for incomplete abortion or pelvic inflammatory disease and within 48 hours after insertion are presented.