Peripheral plasma met-enkephalin levels in ovulatory and anovulatory human menstrual cycles.

OBJECTIVE: To test the hypothesis that met-enkephalin has a role in human ovulation and that plasma levels may differ between ovulatory and anovulatory ovarian cycles. DESIGN: This is a descriptive study comparing levels of plasma met-enkephalin, gonadotropins, and ovarian steroids in 12 ultrasonically confirmed ovulatory cycles and 12 anovulatory cycles. SETTING: The study took place in the infertility clinic of a large teaching hospital receiving primary and tertiary referrals of both private and public sector patients. PATIENTS: All patients (n = 16) had infertility greater than or equal to 3 years and normal findings on previous investigation including evidence of ovulation. INTERVENTIONS: Ovarian cycles were defined using transabdominal ultrasound scanning. Biochemical analyses were by radioimmunoassay. MAIN OUTCOME MEASURES: The differences between plasma met-enkephalin levels in the two groups of cycles were compared. RESULTS: Met-enkephalin levels are significantly higher in ovulatory cycles with a significant peak in the 2 postovulatory days (Duncan's multiple range test; P less than 0.05). CONCLUSION: Human ovulation is associated with cyclic elevation of plasma met-enkephalin. Further studies are required to elucidate causality.

Intra-operative diagnosis of lymph node metastases in gynaecological practice using imprint cytology.

The technique of imprint cytology has been described for the assessment of malignancy and correlates well with histology. Despite the simplicity, speed and excellent cellular detail the technique has still not been fully appreciated. We describe the value of the technique applied to intra-operative diagnosis of lymph node metastases in gynaecological malignancy. Four hundred and seventy five lymph nodes were examined using imprint cytology followed by routine histology. The technique of imprint cytology was found to have a zero false negative rate, 0.6% false positive rate and an accuracy of 99.3%. We advocate the consideration of this technique for the evaluation of cases with gynaecological malignancy as an alternative to frozen section histology.

Subsequent obstetric performance related to primary mode of delivery.

OBJECTIVE: To relate subsequent obstetric performance with primary mode of delivery. DESIGN: Postal questionnaire survey of women who delivered their first child five years ago. SETTING: Huddersfield Royal Infirmary. POPULATION: Women who were delivered of their first baby in 1991: 250 by normal vaginal delivery; 250 by instrumental vaginal delivery; and 250 by caesarean section. MAIN OUTCOME MEASURES: Answers to fixed choice questions on fear of future childbirth, number of subsequent children and reasons for no further children. RESULTS: The response rate was 64%. Overall, 222 (46.6%) women were initially frightened about future childbirth. According to mode of delivery: 93 (57.1%) after instrumental vaginal; 79 (47.9%) after caesarean section; and 50 (33.8%) after normal vaginal delivery. Five years after the primary delivery, 99 women (20.8%) were still frightened about future childbirth: instrumental vaginal group 41 (25.2%); caesarean section group 43 (26.1%); and normal vaginal group 15 (10.1%). In the group of women who were delivered by caesarean section 13% more women had not had a second child after five years compared with the normal vaginal delivery group ((P < 0.03, relative risk 1.46 (1.07-1.99)). In the group of women who had a vaginal instrumental delivery 6% more had not had a second child after five years compared with normal vaginal delivery group. Of the women who had no further children, 30% who had caesarean section and 28% vaginal instrumental delivery had involuntary infertility. CONCLUSIONS: Caesarean section or vaginal instrumental delivery leaves many mothers frightened about future childbirth. Primary caesarean section and to some extent vaginal instrumental delivery is associated with an increased risk of voluntary and involuntary infertility.

Surviving hepatic rupture in pregnancy--a literature review with an illustrative case report.

Spontaneous hepatic rupture in pregnancy is a rare condition associated with significant maternal and perinatal mortality. Patients developing pre-eclampsia and especially HELLP syndrome require close monitoring for prompt diagnosis of hepatic rupture. However, the presenting symptoms and signs, e.g. epigastric pain, shoulder pain, nausea and vomiting, are common. Thus a high index of suspicion and early evaluation with imaging is vitally important. The important lesson to be learnt is that a Pfannenstiel incision does not allow for adequate assessment of the liver. If hepatic rupture is suspected a second upper abdominal incision should be performed. Improved survival can be achieved through early recognition and a multidisciplinary approach.

Immunohistological characterization of endometrial gland epithelium and extravillous fetal trophoblast in third trimester human placental bed tissues.

The distribution, morphology and antigen expression of endometrial glands, uterine vessels and fetal trophoblast have been studied in third trimester placental bed tissues with a panel of monoclonal antibodies in immunohistochemical techniques. Residual endometrial glands were numerous but often were attenuated or compressed and could only be identified clearly with epithelial cell markers. These glands must be clearly distinguished from vessels and trophoblast in immunological studies of cells in the placental bed. The changing pattern of antigen expression of both maternal glands and fetal trophoblast in placental bed tissues may indicate a form of local regulation of gene expression.