Mortality among women participating in the Oxford/Family Planning Association contraceptive study

43 deaths are known to have occurred among the 17 032 participants in the Oxford/Family Planning Association contraceptive study up to the end of April, 1977. 9 deaths from cardiovascular causes have been observed among the women in the oral-contraceptive entry group (49 681 woman-years of observation) while no such deaths have been observed among the women who entered the study while using a diaphragm or an intrauterine device (39 146 woman-years of observation). These findings are consistent with the results presented in the accompanying report from the Royal College of General Practitioners Oral Contraception Study.

The care of oral contraceptive users by general practitioners in Oxfordshire

A questionnaire was circulated to a sample of general practitioners in Oxfordshire enquiring about the supervision of women taking oral contraceptives. A high standard of care was being offered and the doctors believed that there was a wide range of conditions that should influence the prescription of oral contraceptives. We conclude that while suitably trained paramedical staff could provide the same standard of care as the general practitioners, this could not be achieved through the use of a package insert listing possible contraindications.

A long-term follow-up study of women using different methods of contraception--an interim report

In 1968, a prospective study was started in collaboration with the Family Planning Association to try to provide a balanced view of the beneficial and harmful effects of different methods of contraception. This investigation is now in progress at seventeen clinics and over 17,000 women are under observation. At the time of recruitment, all these women were married white British subjects, aged 25–39 years, who voluntarily agreed to participate. Fifty-six per cent were using oral contraceptives, 25% were using a diaphragm and 19% were using an intrauterine device (IUD). During follow-up each woman is questioned at return visits to the clinic and a record of pregnancies and their outcome, hospital referrals (inpatient or outpatient), changes in contraceptive methods and the results of cervical smears, is accumulated. Women who default are sent a postal questionnaire and, if this is not returned, are telephoned or visited in their homes to collect the necessary information.

So far, data obtained during 56,000 woman-years of observation are available for analysis. Follow-up has been maintained with an annual lapse rate of about 0.3%due to withdrawal of co-operation or loss of contact; adherence to the method of contraception in use at recruitment has been reasonably good, and the reporting of pregnancies and hospital admissions appears to have been both reliable and unbiased.

The present data include only 24 deaths, so the mortality associated with different contraceptive methods cannot yet be estimated. With regard to morbidity, however, our preliminary results closely resemble those obtained in the prospective study carried out by the Royal College of General Practitioners (1974) and in the principal retrospective studies carried out in Britain and the United States. Women who used oral contraceptives at the start of the study experienced adeficiencyof hospital referrals for cancer, benign lesions of the breast, menstrual disorders other than amenorrhoea, duodenal ulcer, and retention cysts of the ovary; they showed anexcessof referrals for cerebrovascular disease, cervical erosion, skin disorders, self-poisoning, migraine, venous thrombosis and embolism, hayfever, gallbladder disease, amenorrhoea, and sterility. Women who used a diaphragm showed adeficiencyof hospital referrals for carcinoma-in-situ and dysplastic lesions of the cervix uteri and accidental injury; and anexcessof referrals for haemorrhoids and cystitis. Women who used an IUD experienced anexcessof hospital referrals for anaemia, varicose veins and salpingitis. About half of these differences (12 out of 23) were predicted from other studies while some suggestive evidence already existed for a further five. Of the remaining six, some probably reflect the influence of selective factors or chance.

Multiple pregnancies, stillbirths, malformations, the sex ratio and birthweight showed no consistent relationship to method of contraception. The outcome of unplanned pregnancies occurring in women using an IUD, however, was remarkably unfavourable both in terms of ectopic gestation and miscarriage.

Clear evidence was found of impairment of fertility after discontinuation of oral contraceptives. Whether this is likely to lead to permanent sterility in some women is uncertain.

The study has provided data on the efficacy of a wide variety of contraceptive methods. In general the failure rates are in keeping with those obtained in other large-scale studies, save that those for the diaphragm and the sheath are much lower than those usually quoted.

The available evidence does not yet allow a final balance to be struck between the benefits and risks associated with the new methods of contraception that have become widely used during the last two decades. It seems clear, however, that there are no material risks associated with the use of the diaphragm apart from the risk of pregnancy and that there may be some unintended benefits.

Jamaican vomiting sickness. Biochemical investigation of two cases

We identified methylenecyclopropylacetic acid, a known metabolite of hypoglycin A, in the urine of two patients with Jamaican vomiting sickness. Excretion of unusual dicarboxylic acids such as 2-ethylmalonic, 2-methylsuccinic, glutaric, adipic and dicarboxylic acids with eight and 10 carbon chains were also detected in both patients. The amounts of these dicarboxylic acids were 70 to 1000 times higher than normal. These metabolites have also been identified in urine of hypoglycin-treated rats. This evidence links hypoglycin A to Jamaican vomiting sickness as its causative agent. Urinary excretion of short-chain fatty acids was also increased up to 300 times higher than normal. These results indicate that, despite their clinical and histologic similarities, the cause and biochemical mechanisms of Jamaican vomiting sickness differ distinctly from those of Reye's syndrome in which these abnormal urinary metabolites are not appreciably increased.

Identification of ethylmalonic acid in urine of two patients with the vomitting sickness of Jamaica

Large amounts of ethylmalonic acid have been identified in urines from two patients with the vomitting sickness of Jamaica. The amounts were 178 and 882 mug per mg creatinine which are 70 and 350 times, respectively, over control values. Other short and medium chain dicarboxylic acids including glutaric and adipic acids and those with eight and ten carbon chain, saturated and cis-unsaturated, were also detected in large quantities as in the case of hypoglycin treated rats; urine. However, the large increase of urinary ethylmalonic acid in these two human cases is in a sharp contrast to the findings in hypoglycin treated rats in which urinary ethylmalonic acid increased only 3 times over control. It appears that ethylmalonic acid is produced in the cases with the vomiting sickness of Jamaica by carboxylation of n-butyryl-CoA which is not oxidized further due to the inhibition by hypoglycin A. In case of hypoglycin-treated rats, n-butyryl-CoA is mainly conjugated with glycine or deacylated to free butyric acid.

Accumulation of replicative DNA intermediates in Tetrahymena after excision-repairable damage to DNA

Inhibition of DNA synthesis in the eukaryotic organism Tetrahymena pyriformis by thymine starvation results in the formation and accumulation of a distinct class of DNA during the first hour after re-initiation of the synthesis. This DNA, when synthesized in the presence of 5-bromodeoxyuridine (BrdUrd), bands as a distinct peak at an intermediate density of (see article) in a neutral CsCl buoyant density gradient. Following short pulses of BrdUrd, the DNA of intermediate density accounts for up to 90% of the newly synthesized DNA and binding assays on nitrocellulose filters show the presence of single-stranded regions. Alkaline buoyant density and alkaline velocity gradients clearly demonstrate the presence of non-covalently linked newly synthesized fragments with an average length shorter than that of the parental strands. Pulse experiments show that the DNA of intermediate density is progressively converted to fully hybrid (light - heavy) DNA molecules. It is therefore suggested that in response to damage caused by thymine starvation, a replicative DNA intermediate accumulates at the growing point. A similar phenomenon has also been observed after irridation with ultraviolet light. The effect of the protein synthesis inhibitor cycloheximide on the formation on the intermediate and the fully hybrid material is also described.

The amino acid pool of Hansenula holstil: characterisation, and changes mediated by environment

Amino acid pools extracted from Hansenula holstii grown in continuous culture with either ammonia or nitrate as sole source of nitrogen, under a variety of substrate limitations, were characterised and quantified. Pools from corresponding cultures were shown to be similar in size and composition, regardless of whether ammonia or nitrate was the nitrogen source. Large changes in pools (both quantitative and qualitative) occurred when cultures were grown under different substrate limitations. Such changes were particularly large in glutamate, glutamine, alanine, lysine and arginine; the possible significance of such environment-mediated changes is discussed.

Septic abortion in women using intrauterine devices

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Clinical testing of the hypothalamic-pituitary-adrenocortical system in states of hypo- and hypercortisolism

Cortisol production is appropriately maintained by a complex control system which involves primarily the hypothalamus, the pituitary, and the adrenal cortices. Very small quantities of ACTH stimulate cortisol production, and maximum stimulation occurs with serum concentrations of only 3 mU/100 ML. Under normal circumstances, cortisol is secreted in bursts about ten times each day and circulates predominately bound to a specific binding protein which is rather completely saturated. Radioimmunoassay of plasma cortisol is now generally available and is the assay method of choice, but because of the episodic nature of its secretion, random values of plasma cortisol must be interpreted with great reservation, and even the comparison of morning and evening values in assessing circadian rhythmicity is not often helpful. Urinary free cortisol determinations provide excellent discrimination between normal function and all forms of hypercortisolism. Although the response of the adrenal cortices to ACTH may be evaluated in a number of different ways, the simplest but most definitive procedure involves continuous intravenous administration over a 48-hr period. Of the various tests which indirectly assess the potential for ACTH secretion, the use of metyrapone is most helpful. In the test of greatest utility, plasma cortisol and 11-desoxycortisol are determined the morning after a single midnight oral dose of 30 mg/kg. The detection of all forms of pathologic hypercortisolism is still best accomplished by the oral administration of dexamethasone. Plasma cortisol can be determined the morning after a single midnight dose of 1 mg, or urinary 17-hydroxycorticosteroids can be determined after 2 days in which 0.5 mg is given at 6-hr intervals. Patients with hypercortisolism of hypothalamic-pituitary origin usually evidence appropriate suppression of urinary steroids if the dose is increased to 2.0 mg every 6 hr for another 48 hr. In patients who do not suppress on this or even higher doses of dexamethasone, the distinction between those with adrenal tumor and those with the ectopic ACTH syndrome can be accomplished most definitively by the assay of plasma ACTH where this determination is available.

Reversion studies with exrB in Escherichia coli

exrBderivatives of H/r30 and WP2 are sensitive to ultraviolet radiation (UV), methylmethane sulphonate (MMS) and will not form colonies at 42 °C. Revertants to wild type were selected by plating on either nutrient plates containing MMS or nutrient plates incubated at 42 °C. Revertants selected for MMS resistance were temperature- and UV-resistant, and all revertants selected for temperature resistance were MMS and UV resistant. The frequency with which revertants appeared on MMS plates was about eight times as high as it was at 42 °C, and the variance in frequency of revertants among cultures started with small inocula was higher on selection at 42 °C than on MMS. The spontaneous frequency was estimated to be 10−6to 10−7, sufficiently low to suggest a single mutational event. Among wild-type revertants selected at 42 °C there was a stable and an unstable class.exrB+could be co-transduced withmalB+from stable revertants to anexrBstrain, but could not from unstable revertants. None of the revertants could support the growth of amber or ochre mutants of phage T4, nor were amber and ochre suppressedexrBstrains wild type with regards MMS and temperature resistance. The presence of a polarity suppressor in anexrBstrain did not modify resistance to UV or temperature. Neither UV or MMS was able to induce mutations in anexrBstrain.

Accuracy of recall of histories of oral contraceptive use

Published retrospective studies of the relationship between the use of oral contraceptives and disease have assumed that women are able to recall their oral contraceptive histories with reasonable accuracy. The validity of this assumption has been investigated by comparing oral contraceptive histories obtained from 75 women attending family planning clinics with the information contained in the clinic records. It is concluded that simple measures of oral contraceptive use, such as whether the preparations have ever or never been used, whether they are in current use, and the total duration of use, are likely to be remembered with adequate accuracy.

The synthesis of esters of bilirubin

1-Alkyl-3-p-tolytriazenes were used to synthesize the methyl, ethyl, isopropyl and benzyl esters of bilirubin. Treatment of a chloroform solution of bilirubin with the triazene at room temperature gave high yields of the corresponding esters. These were identified by n.m.r. and mass spectroscopy together with elemental analysis. N.m.r. studies also suggest that bilirubin dimethyl ester is in the lactam rather than the lactim form.

Metal complexes of bilirubin in aprotic solvents

Bilirubin reacts with zinc acetate, cadmium acetate or cobaltous acetate in dry dipolar aprotic solvents to form highly coloured complexes. The complex formed in NN-dimethylformamide can be isolated as a solid with bilirubin:zinc:acetate:NN-dimethylformamide molar proportions of 1:3:2:2. Water will decompose these complexes, with the regeneration of bilirubin.