Clinics in general practice. A case for the gynaecologist?

PIP: The case of a 31-year-old female patient with 2 children who was sterilized 7 years ago at age 24 years and has a 3-year history of low bilateral abdominal pain is discussed. The patient was investigated at the surgical outpatient department and has been recommended to a gynecologist. The symptoms lack suggestion of gynecological disease. Some of the questions to be asked are why she was sterilized, why not her husband, and what method was used. Were there any complications in sterilization operations 7 years ago that resulted in abdominal pain? Whoever takes on the case should question what the quality of the woman's life was before the operation and how it has since changed. It would be helpful to know if she would have liked a 3rd child and if her sexual feelings have changed. At the time she was sterilized, it was unusual for a woman to be sterilized at the age of 24 years with 2 children. There were probably strong medical or psychiatric indications then. One suspects either tubal disease after sterilization or chronic pelvic inflammatory disease as the likely diagnosis. If it becomes apparent that she wants another baby perhaps tubal reanastomosis could be accomplished.^ieng

Immunity to attenuated influenza virus WRL 105 infection induced by heterologous, inactivated influenza A virus vaccines.

Groups of student volunteers were immunized with one of five different inactivated influenza virus vaccines. The concentration of virus in the various vaccines differed by both the international unitage test and by the concentration of haemagglutinin, as measured by the single radial diffusion test; the results of the two methods of standardization showed no correlation. The serum HI response to immunization was variable; volunteers given A/England/72 showed a 16.6-fold increase in homologous serum antibody titre whilst volunteers given A/Hong Kong/68 vaccine showed a 4.2-fold increase. The variable response of volunteers to immunization could not be explained by the varied concentration of virus in the vaccines, as measured by either test, the titres of serum HI antibody present before immunization, or a combination of these two factors.The ability to infect volunteers with WRL 105 virus 4 weeks after immunization with heterologous, inactivated virus vaccine was directly related to the degree of cross-reactivity between the haemagglutinins of this vaccine virus and WRL 105 virus. Thus, the greatest number of infections by the challenge virus were seen in volunteers given A/Hong Kong/68 vaccine, less were observed in volunteers given A/England/72 vaccine, and least were found in groups given A/Port Chalmers/73 or A/Scotland/74 vaccine. However, compared with the incidence of infection in volunteers given B/Hong Kong/73 vaccine, all the heterologous influenza A vaccine gave some immunity to challenge infection.