Endocrinology of in-vitro fertilization pregnancies during the first trimester

The endocrine function of the corpus luteum and placenta andthe inter-relationships between ovarian steroids and the placentalproteins in pregnancies achieved following ovarian stimulation,in-vitro fertilization and embryo transfer (IVF-ET) have beeninvestigated. The serum concentrations of human chorionic gonadotrophin(HCG), Schwangerschaft protein-1 (SP-1), pregnancy-associatedplasma protein A (PAPP-A), progesterone and oestradiol weremeasured at weekly intervals between the 4th (ET plus 2 weeks)and 14th week of gestation in 86 pregnancies. The mean concentrationsof the placental proteins and oestradiol were significantlyhigher in twin than in singleton pregnancies from as early as5 weeks gestation, but the mean concentrations of progesteronewere significantly higher only at the end of the first trimester.Ranking, as demonstrated by the presence of statistically significantcorrelations between serum levels of each substance analysedin week 13 with those of preceding weeks, was established forprogesterone and SP-1 from the 5th week, for oestradiol andPAPP-A from the 7th week and for HCG from the 8th week of gestation.The presence of statistically significant correlations betweeneach substance analysed suggests that the placenta becomes thedominant source of oestradiol from 8 weeks gestation and ofprogesterone not until 12 weeks gestation, and that the placentalsynthesis of HCG, SP-1, PAPP-A, oestradiol and progesteroneappear to be linked. There were no statistically significantcorrelations between the serum concentrations of HCG and eitherprogesterone or oestradiol until the production of each hadbecome predominantly placental.     

Thymic cysts in mediastinal Hodgkin disease

Three cases of proved thymic cysts associated with mediastinal Hodgkin disease are presented. Two illustrate regression of lymphoma with chemotherapy but persistence of thymic cysts. The third case demonstrates a thymic cyst in untreated Hodgkin disease. These cases suggest that such cysts are probably neither coincidental with nor a consequence of therapy but are probably related to initial thymic involvement by Hodgkin disease.     

In-vitro activity of pefloxacin compared to enoxacin, norfloxacin, gentamicin and new beta-lactams

The in-vitro activity of pefloxacin was compared with that of norfloxacin, enoxacin, nalidixic acid, gentamicin, cefotaxime, ceftazidime and, where appropriate, other beta-lactams against a total of 363 recent clinical isolates. An agar dilution procedure was used to determine MICs and two inocula (10(4) and 10(6) cfu) were used throughout. Pefloxacin inhibited 90% of isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, indole-positive Proteus spp., Enterobacter spp., Shigella sonnei, Salmonella typhi, Campylobacter jejuni, Staphylococcus aureus and Haemophilus influenzae at less than or equal to 0.5 mg/l. Serratia marcescens and Providencia stuartii were somewhat more resistant, 2 mg/l of pefloxacin being required to inhibit 90% of isolates of these species. Pefloxacin inhibited 90% of isolates of Pseudomonas aeruginosa at 4 mg/l and 90% of isolates of the Bacteroides fragilis group at 16 mg/l. The activity of enoxacin was similar to that of pefloxacin, with enoxacin being four-fold less active against Staph. aureus, two-fold less active against the Bacteroides fragilis group and most species of the Enterobacteriaceae, and two-fold more active against Ps. aeruginosa. Pefloxacin showed good activity against gentamicin-resistant Ps. aeruginosa and Enterobacteriaceae and against methicillin-resistant Staph. aureus. Strains with decreased susceptibility to norfloxacin tended to be less susceptible to both pefloxacin and enoxacin.     

A combined ultrasonic linear array scanner and pulsed Doppler velocimeter for the estimation of blood flow in the foetus and adult abdomen--I: Technical aspects

A method is proposed for estimating the volume blood flow of deep lying vessels in the foetus and in adult portal vein and renal vessels. The equipment combines a 3.5 MHz linear array scanner with a 2 or 4 MHz pulsed Doppler. The pulsed Doppler tranducer is connected to the linear array by two movable arms. A real time spectrum analyser is used to process the Doppler signals. A water bath was used to perform an in vitro calibration of the complete system and to adjust the registration of the Doppler sample volume with the echo picture. Several possible inaccuracies in vessel diameter measurement are discussed and the mean of several caliper measurements described by Eik-Ness (1982) is used. Time Motion is thought to be the better method but is more complicated in practice.     

Training medical students in HIV/AIDS test counselling: results of a randomized trial

The study assessed the effectiveness of a programme aimed at increasing medical students' skills in counselling patients presenting for HIV testing/AIDS information. Senior medical students were randomly assigned to receive a short course in pre- and post-test counselling, or to a control group which received the usual curriculum. The students' performance in counselling simulated patients was videotaped at baseline and after 3 months. A subsample was also assessed at 12 months. Students receiving the programme showed significantly greater improvement in pre- and post-test counselling skills over 3 months than did the controls. For the subsample continuing to 12 months, a significant effect over time was found; however, there was no significant difference between the groups. This may have been influenced by the small sample sizes used for the 12-month assessment. General interactional skills improved for the overall sample over 3 and 12 months, but again there were no significant differences between groups. Those exposed to the programme did not show significantly greater changes in either knowledge or attitude scores over either time frame, compared with controls. When taught in addition to the usual undergraduate curriculum at Newcastle University, this short interactional skills course significantly enhanced students' ability to provide pre- or post-test counselling for HIV/AIDS.     

Congenital lobar emphysema in congenital cytomegalovirus infection

We report a case of congenital lobar emphysema diagnosed antenatally in an infant of 32 weeks’ gestation. Histology and serology confirmed infection with cytomegalovirus (CMV). CMV pneumonitis leading to inflammation and obstruction in the bronchial tree may have resulted in the development of congenital lobar emphysema.