Relaxin in human pregnancy serum measured with an homologous radioimmunoassay

This study reports serum levels of relaxin in normal and special-interest pregnancies using an homologous radioimmunoassay for human relaxin. The mean levels in uncomplicated antenatal patients were lower than those reported in studies using heterologous assays, but the trend in serum levels was similar. Serum levels peaked at ten weeks' gestation and decreased progressively to term. Relaxin was detectable in all pregnant subjects assessed at the time of the first missed menses. The mean relaxin levels in patients having in vitro fertilization and embryo transfer who subsequently delivered a single infant were significantly higher than those in normal antenatal patients at an equivalent gestational age. Patients with twin pregnancies after in vitro fertilization and embryo transfer generally had higher levels than patients with single pregnancies. Some pregnant patients who aborted after in vitro fertilization and embryo transfer had declining levels of relaxin before 40 days postlaparoscopy.

Predictive value of plasma human chorionic gonadotrophin beta subunit in diagnosing ectopic pregnancy after in vitro fertilisation and embryo transfer

A study was conducted aimed at establishing a range of plasma concentrations of the beta subunit of human chorionic gonadotrophin that might predict ectopic pregnancy after in vitro fertilisation and embryo transfer. From May 1984 to February 1986, 161 consecutive pregnancies at the Monash University in vitro fertilisation unit were analysed by determining plasma beta human chorionic gonadotrophin concentrations between two and 10 weeks after oocyte collection. Eighty eight ongoing singleton pregnancies, 25 multiple pregnancies, 27 first trimester spontaneous abortions, 12 anembryonic pregnancies, and nine ectopic pregnancies resulted from these conception cycles. When compared with values for ongoing singleton pregnancies two weeks after oocyte collection plasma beta human chorionic gonadotrophin concentrations in ectopic pregnancies were significantly lower (p less than 0.05; Wilcoxon rank sum test). Two weeks after oocyte collection all plasma beta human chorionic gonadotrophin concentrations in the set of ectopic pregnancies were below 30.6 IU/l, which corresponded to the lower quartile (25th percentile) of beta human chorionic gonadotrophin concentrations in ongoing singleton pregnancies. The beta human chorionic gonadotrophin concentration corresponding to the lower quartile of ongoing singleton pregnancies at each week of gestation was used to derive the predictive value of various statistics in detecting ectopic pregnancy in patients after in vitro fertilisation. The sensitivity, specificity, predictive value of a positive result, predictive value of a negative result, and efficiency of a single plasma beta human chorionic gonadotrophin concentration in predicting ectopic pregnancy were 100%, 68.1%, 16.7%, 100%, and 70%, respectively, two weeks after oocyte collection. These results suggest that a single determination of the plasma beta human chorionic gonadotrophin concentration beginning 14 days after oocyte collection is clinically useful in predicting the outcome of pregnancy achieved by in vitro fertilisation. Ectopic pregnancy after in vitro fertilisation is more likely when beta human chorionic gonadotrophin concentration is below the lower quartile of values in ongoing singleton pregnancies achieved by the technique.

Attitudes towards oocyte and embryo donation and disposal

The attitudes of In Vitro Fertilization (IVF) patients, their relatives, and their friends towards oocyte and embryo donation and disposal of frozen embryos were determined by questionnaire. The results obtained from a group of patients undergoing IVF treatment in the hospital were compared and some differences in attitudes were detected. Most respondents find embryo research and the creation of embryos, especially for research, acceptable under some circumstances and this contrasts with current Victorian legislation.

An analysis of plasma estradiol concentrations during clomiphene citrate-human menopausal gonadotropin stimulation in an in vitro fertilization-embryo transfer program

We report here a range of plasma estradiol (E2) concentrations suitable for use in an in vitro fertilization (IVF) program. This range was derived from nonparametric analysis of plasma E2 levels using plasma E2 measurements beginning 10 days before the anticipated day of the midcycle LH surge (midpoint), as calculated from each patient's six previous menstrual cycles, during which time the patients all received the same ovarian stimulation regimen. The regimen consisted of 100 mg clomiphene citrate/day for 5 days, beginning 10 days before the anticipated midpoint, plus 150 IU human menopausal gonadotropin, commencing the day after clomiphene. A consecutive series of 102 IVF conception cycles induced in this standardized fashion were analyzed in this study. The 5th-95 percentile envelope of plasma E2 concentrations was derived as a valid clinical indicator of satisfactory folliculogenesis during IVF treatment. Five women had plasma E2 concentrations below the 5th percentile of the E2 range on at least 3 consecutive days of ovarian stimulation, while six women had E2 levels above the 95th percentile of this range on at least 3 consecutive days. This plasma E2 range defined objectively the diagnoses of ovarian hyperstimulation and inadequate stimulation in an IVF program. These criteria should help clinicians in managing ovarian responses during IVF superovulation stimulation treatment.

Intragastric bacterial activity and nitrosation before, during, and after treatment with omeprazole

Ten healthy volunteers were studied before, during, and after treatment with omeprazole 30 mg daily for two weeks. On the 14th night mean nocturnal (2100-0700) intragastric acidity was significantly decreased by 75% (p less than 0.001). At 0700, 22 hours after the last dose of omeprazole, there were significant increases in the bacterial count and the nitrite and N-nitrosamine concentrations in the gastric juice (p less than 0.001). Three days later these changes had resolved. Short term treatment of healthy volunteers with omeprazole is associated with a short lived increase in the gastric bacterial flora, with endogenous production of N-nitroso compounds.

Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity

In a series of 59 experiments in nine duodenal ulcer patients, 24 hour intragastric acidity was measured before, during, and after treatment with daily oral omeprazole. Omeprazole 10, 20, and 30 mg/day for one week caused a 37, 90, and 97% decrease of 24 hour intragastric acidity, respectively. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses) there was a significant 26% decrease of 24 hour intragastric acidity, with full recovery seven weeks later. Fasting plasma gastrin concentration was significantly raised during treatment with all doses of omeprazole. Omeprazole 30 mg/day is the optimal dose for a maximal decrease of 24 hour intragastric acidity in duodenal ulcer patients.

Tearfulness: a psychoanalytic interpretation

In our view, the tearful feeling state is occasioned by the ego temporarily threatened with being inundated by complex memories and affects. For the moment, the ego cannot provide appropriate satisfying and integrated verbal expression. Words and verbal thinking are delayed. In this brief period, a controlled regression occurs during which the ego relates the current "precipitating experience" to temporally older conflictual experiences in the presence of the current object as a transference object and with a series of relationships so closely connected to that experience that they are interchanged in whole or part by the less selective, regressed, ego operations. The conscious experience may be sadness, gratitude, love, pride, or joy. But beneath these, there is the controlled regression, which interrupts verbal expression while the ego works through the earlier related conflicts,now remembered. The tearful feeling, a step in the direction of overt weeping, primitively expresses the frustration of an early wish for relief from pain, the pain of the imbalance of a complex conflict. The tearful feeling both expresses the wish for relief of pain and, at the same time, interrupts current verbal expression until the needed defense operations reduce the threat of ego disruption by working through old conflicts once again. Our thesis, then, is that within the analytic or psychotherapeutic hour the patient's feeling of tearfulness is a "too much" ego phenomenon that leads to a psychophysiological outlet.

Effect of daily oral omeprazole on 24 hour intragastric acidity

Twenty four hour intragastric acidity was measured in nine patients with duodenal ulcer before and after one week of treatment with oral omeprazole 30 mg daily, a drug that inhibits gastric secretion by inhibition of parietal cell H+K+ adenosinetriphosphatase (ATPase). Omeprazole virtually eliminated intragastric acidity in all patients: the median 24 hour intragastric pH rose from 1.4 to 5.3 and the mean hourly hydrogen ion activity fell from 38.50 to 1.95 mmol(mEq)/1 (p less than 0.001). This inhibition of 24 hour intragastric acidity is more profound than that previously reported with either cimetidine 1 g daily or ranitidine 300 mg daily.

T helper lymphocyte depression in early human pregnancy

Peripheral blood lymphocyte subclasses were determined in 60 women with normal pregnancies, 20 from each trimester, and in 20 controls using automated flow cytofluorimetry. The cells were stained with the monoclonal antibodies OKT3, OKT4 and OKT8 to stain total T cells, T helper and T suppressor-cytotoxic lymphocytes, respectively. A polyvalent rabbit anti-human Ig serum was used to stain B lymphocytes. Absolute numbers of T lymphocytes were significantly reduced in both the first and second trimesters. This was due to a significant decrease in T helper lymphocytes and a smaller, statistically not significant, reduction in the number of T suppressor lymphocytes. There was no significant change in lymphocyte subclasses during the third trimester. Total lymphocyte numbers were normal throughout pregnancy.

Responses of Australian patients with gynaecological disorders to the General Health Questionnaire: a factor analytic study

One hundred and twenty-seven out-patients attending a gynaecology clinic completed the General Health Questionnaire (GHQ, 60-item version) and a role problems checklist (RPCL). Principal factors analysis of the GHQ yielded 8 factors which were named: poor performance (which accounted for 63.3% of total variance), depression-anxiety, sleep-disturbance, anhedonia anergia, loss of confidence, general illness, social dysfunction and headache. These results were compared with previous principal components analyses of the GHQ (Goldberg, 1972; Goldberg et al. 1976). A multiple regression analysis indicated that age and 7 of the 8 factors were significantly related to the number of role problems reported by the patients. However, it appears that psychiatric distress (as measured by the GHQ) and role problems were only related to a small degree (multiple R2 = 12.69% only).

The morphological basis of embryonic movements in the light brown apple moth, Epiphyas postvittana (Walk) (Lepidoptera : Tortricidae)

A description is given of the morphological basis of the embryonic movements revealed in E. postvittana by time-lapse cinematography. The blastoderm gives rise to a broad germ band and serosal rudiment. The serosa spreads over the germ band, followed by the amnion. The germ band becomes cup-shaped, elongates, and turns on its side in the flattened egg before gastrulation begins. Only a small amount of the yolk of the egg is enclosed in the germ band. The remainder fills the amnioserosal space. As elongation continues, mainly through growth in the length of the abdomen, and segmentation takes place, the germ band becomes spirally coiled and convoluted within the flattened egg space. At the completion of elongation, the nervous system is well developed, segmental myoblasts are present, and the tubular stomodaeum and proctodaeum are linked by paired midgut strands. Shortening and dorsal closure eliminate the spiralling and convolution of the germ band and result in a tubular embryo with a large ganglionated nerve cord and large stomodaeum and proctodaeum, but with musculature still at the myoblast stage and midgut strands unchanged. Paired sheets of cardioblasts extending from the body wall to the midgut strands divide the ventral haemocoele from the dorsal haemocoele in the middle region of the body. A mesodermal sac covers the inner end of the stomodaeum and opens in the dorsal haemocoele. The tubular embryo now elongates, doubling its volume, reverses its position in the egg, and tucks the tail in beside the head. During elongation, the segmental myoblasts differentiate as muscle fibres. Towards the end of elongation and reversal, the midgut strands give rise to the midgut tube and the cardioblast sheets to the middorsal heart. When elongation and reversal are complete, the stomodaeal mesodermal sac is transformed into proventricular mesoderm. After further differentiation of striated muscle and secretion of the cuticle, the embryo ingests the yolk in the surrounding amnioserosal space and digests it before hatching takes place. Comparison of morphological structure with the movements displayed in the time-lapse record show that all elongation, rotation, spiralling, and convolution of the embryo before the onset of shortening is due to growth by cell proliferation and to accommodation of this growth within a fixed egg space of specific shape. In contrast, controlled muscular activity plays a major role in shortening and dorsal closure, in elongation and reversal of position, and in ingestion of excluded yolk. During shortening and dorsal closure, slow, generalized, possibly myogenic contractions are produced by the somatic myoblasts and appear to be responsible for the shape changes observed. During elongation and reversal, contractions are confined to the stomodaeal myoblast layer and result in rhythmic filling and emptying of the terminal stomodaeal sac. By this activity, fluid is transferred from the excluded yolk to the embryo and pumped along the dorsal haemocoelic channel, bringing about controlled elongation and reversal. In view of the coordination exhibited, and of the precocious development of the nervous system, it seems likely that this activity is neurogenic, even though the contractile units are still myoblasts. The final movement of reversal, tucking in of the tail, is due to somatic musculature, now differentiated as muscle fibres and showing twitches of probably neurogenic causation. Ingestion of excluded yolk is a precocious feeding activity, brought about by coordinated action of the larval feeding apparatus, and occurs only when the appropriate musculature has become differentiated as striated muscle. Although the morphogenetic movements of E. postvittana show modifications associated with the flattened form of the egg, they and their structural basis are, on comparative evidence, common to all lepidopteran embryos.