Prostaglandin-F2 alpha levels in normal saline-induced mid-trimester abortions

In 20 mid-trimester abortion seekers induced by extra-amniotic instillation of normal saline, serial estimation of prostaglandin F2 alpha (PGF2 alpha) in the plasma and extra-ovular space were carried out. It was observed that PGF2 alpha was undetectable in both plasma and the extra-ovular space prior to the onset of induction, and was first detected in the extra-ovular fluid 2 hours after the onset of induction, prior to oxytocin infusion. In the subsequent samples, the prostaglandin concentration in plasma as well as in the extra-ovular fluid was found to rise, with levels in the latter showing a more significant rise with time as compared to the former. Thus, this study confirms the hypothesis that the mechanism of action of extra-ovular normal saline instillation in mid-trimester termination of pregnancy is the result of separation of fetal membranes from the uterine wall, leading to the release of prostaglandins which, in turn, causes uterine contractions leading to abortion.

A comparison of wet mount, culture and enzyme linked immunosorbent assay for the diagnosis of trichomoniasis in women

One thousand women in the child bearing age group, attending the Obstetrics and Gynaecology Outpatient Department, were investigated for the presence of Trichomonas vaginalis in their vaginal discharges. T. vaginalis was isolated in 68 patients (6.8%) by wet mount and/or culture. 55 cases (80.9%) were detected by wet mount examination and 67 (98.5%) by culture in TPS-I medium. Significant levels of antitrichomonal IgA antibody in the vaginal secretions by micro-ELISA technique were detected in 38 out of 50 subjects (76%) harbouring T. vaginalis in whom this assay was carried out. Culture was found to be the single most sensitive method for diagnosing trichomoniasis in women.

Anti-trichomonad IgA antibodies in trichomoniasis before and after treatment

Anti-trichomonad IgA antibodies were estimated by enzyme-linked immunosorbent assay (ELISA) in serum and vaginal secretions of 25 symptomatic and 25 asymptomatic Trichomonas vaginalis positive patients before and after treatment and in 25 age-matched controls. Significantly higher levels of antitrichomonad IgA antibodies were found in T. vaginalis positive patients when compared to control subjects, especially in vaginal secretions. In addition, a significant decrease in these antibodies was observed after treatment, which was more pronounced in vaginal secretions. It seems that anti-trichomonad IgA antibodies in serum and more so in vaginal secretions are directly related to and specific to the presence of T. vaginalis in the urogenital tract.

Studies of cardiovascular and arterial blood gas changes during carbon dioxide pneumoperitoneum for laparoscopic sterilization under general anaesthesia versus local anaesthesia

This study was conducted to evaluate the different change in arterial blood gases and cardiovascular system in 50 healthy females during laparoscopic sterilization procedure performed under general or local anaesthesia. Women who had laparoscopic sterilization under local anaesthesia, showed an increase in respiratory rate by 17% in response to hypercarbia produced by carbon dioxide insufflation. Subjects undergoing laparoscopic sterilization under general anaesthesia showed significant rise in pulse rate by 6% and systolic and diastolic blood pressure by 8% and 14%, respectively. Also arterial blood gas analysis showed increase in PaO2 by 22.7% which was highly significant. However, PaCO2, pH and base were maintained within normal limits as compared to the other group done under local anaesthesia, where no changes were observed.

Correlation of zymodeme patterns, virulence & drug sensitivity of Trichomonas vaginalis isolates from women

Characterization of T. vaginalis strains isolated from symptomatic and asymptomatic subjects was done by isoenzyme analysis. The pathogenicity of these isolates was checked in mouse model and in vivo drug susceptibility was determined. The isolates from symptomatic and asymptomatic individuals could not be grouped on the basis of isoenzyme analysis alone. All the strains except one, were pathogenic for mice, and metronidazole (50 mg/kg body weight) was effective in protecting the mice from T. vaginalis infection.

Macroscopic tuboplasty: reversal of female sterilization

Data is presented regarding 57 women who underwent reversal of sterilization procedure. In the majority (90%), the reason for request for reversal of procedure was loss of male child or more than one child. Thirteen subjects never came back for follow-up. Out of 39 subjects in whom follow-up is available for more than 3 months, in 35 (90%) the tubes are patent. There were 25 pregnancies in 21 subjects and incidence of viable pregnancy was 88% with only ectopic pregnancy (4%). In these 35 cases whose tubes were found to be patent post tuboplasty, 18 had laparoscopic ring application, 16 had abdominal tubal ligation and one had undergone vaginal tubal ligation. Thirteen subjects (62%) conceived within 6 months after reversal. In this series, no loupe or operating microscope was used.

Ultrasound guided intrauterine transfusion

Intrauterine transfusion was performed on 12 occasions in 9 Rh-sensitizedwomen. Under constant real-time ultrasound guidance, a 17G Touhy needle was negotiated through a placenta-free area and advanced into the foetal abdomen to reach the peritoneal cavity. After confirming the position of the needle, either by aspiration of foetal ascitic fluid or by injecting air into the peritoneal cavity, an epidural catheter was passed through the needle and the transfusion was accomplished. This procedure was successful in 11 (91%) of the 12 instances. In one patient the needle could not be placed in the foetal peritoneal cavity despite repeated. attempts; she developed pyrexia and went into spontaneous labour. The neonatal survival rate was 22% (2/9). The ultrasound guided technique not only eliminates the risk of radiation hazards, but also helps in precise placement of the needle in the uterus and foetal peritoneal cavity, which makes intrauterine transfusion safe.

Mesenteric arteritis

Four patients are presented with small bowel infarction secondary to a vascular arteritis. In three patients there was a history of rheumatoid arthritis. In each patient infarcted bowel was resected and a primary anastomosis performed. In one patient the anastomosis broke down and she subsequently died. One patient died from a disseminated rectal tumour three years later. The remaining patients remain well. If operated on early, intestinal infarction due to arteritis has a good prognosis.

A comparison of extra-amniotic physiological saline and ethacridine dye instillation for induction of mid-trimester abortion

In a prospective, randomized study of 209 patients, we induced mid-trimester abortion by instilling either normal saline (105cases) or ethacridine dye (Emcredil^®) (104cases) extra-amniotically. The mean induction-abortion interval for saline was 18 hours 25 minutes and for emcredil20 hours 12minutes. For a 'cut-off' time of30 hours there were 9 failures with normal saline and 7 failures with ethacridine but all women eventually aborted without surgical intervention. In the saline group the induction-abortion interval was longer in the more advanced than in the less advanced pregnancies. No difference was observed in bacteriological studies from samples collected before and 24 hours after instillation of the solution. We conclude that normal saline is a cheap, easily available and safe abortifacient.

Eosinophilic fasciitis without peripheral eosinophilia presenting as pyrexia of unknown origin

Eosinophilic fasciitis is a syndrome usually characterized by limb and joint pain, a raised sedimentation rate, hypergammaglobulinaemia, subcutaneous fasciitis and peripheral as well as tissue eosinophilia. We present a case with a positive tissue diagnosis, but who presented predominantly with marked nocturnal sweating and pyrexia.

Verapamil stimulates Ca(++)-uptake and Ca(++)-ATPase in plasma membrane vesicles of guinea pig spermatozoa

Verapamil, a potent calcium channel blocker, was administered orally at three different doses to guinea pigs for both short- (4 weeks) and long-term (12 weeks) effects. The drug treatment stimulated Ca(++)-transport and Ca(++)-activated ATPase in isolated plasma membrane vesicles of guinea pig spermatozoa. Ca(++)-uptake studies exhibited partial to complete restoration of stimulated Ca(++)-transport during recovery period, whereas the CA(++)-activated ATPase system remained stimulated even after 4 and 6 weeks of withdrawal of the drug treatment. The lack of inhibitory effect of verapamil on Ca(++)-uptake ruled out the involvement of calcium channels in spermatozoal calcium uptake in guinea pigs. The stimulatory effect of the drug on CA(++)-uptake, on the other hand, might indicate the possible capability of this lipophilic compound to induce favourable changes in the lipid microenvironment of the membrane, wherein the integral membrane proteins operate.

Effect of verapamil on different spermatozoal functions in guinea pigs--a preliminary study

Verapamil, a calcium channel blocker, was administered orally using three different doses to guinea pigs. Both short-term (4 weeks) and long-term (12 weeks) effects of the drug were observed. The drug administration resulted in a marked decrease in sperm density, sperm motility and cellular energy content (ATP). Zona pellucida penetration by the sperm obtained from drug-treated animals was significantly lower when compared with sperm from normal animals. Histopathological findings exhibited partial arrest of spermatogenesis. Partial to complete recovery was observed after 4 and 6 weeks of withdrawal of the drug treatment.

Spectrophotometric analysis of amniotic fluid in Rh immunised pregnancies

A total of 307 amniotic fluid analysis done in 344 Rh negative immunised mothers showed that 46, 83 and 178 delta OD values at 450 millimicrons fell in the upper, middle and lower zones of Liley's charts respectively. The correlation of spectrophotometric analysis with the condition of the baby at birth was about 95 per cent in the upper and lower zones. In the middle zone, however, it was about 75 per cent only. Also, in 7 women in whom the OD at 450 millimicrons fell in the middle zone, the babies were found to be Rh negative; in another baby, the OD difference fell in upper zone. In spite of these limitations amniotic fluid examination seems to be an important single guide to severity, being superior to other parameters like previous obstetric history, antibody titre alone and Liley's charts, which are still widely used.

A comparison of sucralfate and prednisolone enemas in the treatment of active distal ulcerative colitis

Sucralfate is well established in the treatment of upper gastrointestinal inflammation and ulceration, and preliminary evidence suggests it may be of benefit in active colitis. We have therefore undertaken a clinical trial to compare enemas of sucralfate (4 g) and prednisolone metasulphobenzoate (20 mg) in the treatment of active distal ulcerative colitis. Forty-four patients were entered into a 4-week study. Two patients were withdrawn because of non-compliance, and five were unable to complete the study: two developed constipation (both allocated to sucralfate) and three were unable to retain the enemas (two prednisolone and one sucralfate). Intention-to-treat analysis showed significant within-treatment improvement in rectal bleeding, sigmoidoscopic grade, and histologic grade in the prednisolone-treated group, and in stool frequency, rectal bleeding, and sigmoidoscopic grade in the sucralfate-treated group. Between-treatment comparisons, however, showed greater resolution of rectal bleeding and more marked improvements in histologic grade in patients treated with prednisolone metasulphobenzoate enemas. Further studies using higher doses of sucralfate would be useful.

Prevalence of hepatitis B surface antigen in pregnant mothers and its perinatal transmission

1000 pairs of maternal and cord blood samples were collected simultaneously at the time of delivery. 23 (2.3%) of the maternal samples were positive for HBsAg by enzyme-linked immunosorbent assay. HBeAg was detected in 11 (47%) of the 23 HBsAg positive mothers and anti-HBeAg was detected in another 5 samples. HBsAg and HBeAg were detected in 7 (30%) of the 23 cord blood samples from HBsAg-positive mothers, and anti-HBeAg was detected in one of these samples. At follow-up (6-18 months), antigenaemia had persisted in 17 (85%) of the 20 HBsAg-positive mothers and in 9 (45%) of 20 babies born to HBsAg-positive mothers. Seven of the 10 babies (70%) born to mothers positive for both HBsAg and HBeAg had persistent HBsAg in their blood, in contrast to 2 of the 10 babies (20%) born to mothers positive for HBsAg only. However, none of these mothers or their babies were found to have anti-HBeAg at follow-up. We conclude that the presence of HBeAg in mothers' blood enhances vertical transmission of hepatitis B virus infection to their babies.

Mid-trimester abortion by extraamniotic Emcredil versus normal saline

Data is presented for 40 mid-trimester abortions, induced by 0.1% Emcredil (Group 1--20 cases) and normal saline (Group 2--20 cases) by instillation in the extraamniotic space. It was observed that the 2 groups were comparable for age, parity and period of gestation. The mean induction-abortion interval was 18 hours 9 minutes in Group 1 and 19 hours 19 minutes in Group 2. Abortion was complete in 45% and 65% in Group 1 and Group 2, respectively. With a cutoff time of 30 hours, there were 3 failures, 1 in Group 1 and 2 in Group 2. The induction-abortion interval was significantly less in the more advanced pregnancies in the saline group. There was no complication in either of the 2 groups. It is hypothesized that normal saline also acts by damage of the decidual cells with liberation of prostaglandins locally. Also since normal saline is a cheap and easily available commodity with no contraindication for its use and no side-effects, it seems to hold a lot of promise for induction of mid-trimester abortion.

Laparoscopic removal of translocated intrauterine contraceptive devices

Data is presented regarding 20 translocated intrauterine contraceptive devices (IUCD). Successful laparoscopic removal was made in 13 (65%) cases though all these devices were Copper 'T' 200 model which tend to produce dense adhesions. Only when the IUCD was suspected to be partially or fully in the gut lumen or thick adhesions were present, or the device was not visualised, was laparotomy performed. Hence it is advocated that laparoscopy should be performed as a routine in patients with suspected translocated IUCD, as it obviates the need for laparotomy and thus decreases the duration of the hospital stay as well as preventing morbidity associated with laparotomy.

Electrohemostasis with endoscopic electrocoagulation in upper gastrointestinal bleed

Fifty patients who presented with upper gastrointestinal bleed were taken up for electrohemostasis with endoscopic electrocoagulation. Hemostasis was achieved in 32 patients at the first sitting, and in a second session in two of eight patients in whom it was attempted. No complications were encountered. EEC is an effective and safe method of achieving hemostasis in upper gastrointestinal bleed due to varied gastroduodenal lesions, and may help cut down the number of patients subjected to emergency surgery.

Asymptomatic salpingitis in intrauterine contraceptive device users

Serial histological sections of the fallopian tubes of 50 asymptomatic subjects undergoing voluntary tubal ligation were evaluated for morphological evidence of inflammation. Twenty-five subjects had history of IUD use (the study group) and the rest 25 had never used a device (the control group). Evidence of inflammation was found in 11 out of 25 subjects in the IUD users compared to only 2 out of 25 subjects in the non-users (p less than 0.001). The relative risk was 5.5 times. Both acute and chronic inflammation of the oviducts were observed more often in the IUD users, though clinically and at surgery there was no apparent evidence of pelvic inflammatory disease.

A family with Peutz-Jeghers syndrome

Three generations of a family with Peutz-Jeghers syndrome are described. The family chart is detailed.

Management of translocated and incarcerated intrauterine contraceptive devices

Thirty-seven consecutive patients who reported with absent or snapped strings and failed attempts at removal of intrauterine contraceptive devices (IUCD) by hooks or curette were posted for hysteroscopy/laparotomy following a plain X-ray of the pelvis to exclude unrecognized spontaneous expulsion. Direct visualization of the endometrial cavity was invaluable in locating and removing IUCDs, particularly the embedded and fragmented ones. Translocated medicated devices were associated with dense adhesions, suggesting the need for their prompt removal. There appears to be an increased risk of translocation in lactating women.

A model study of fecapentaenes: mutagens of bacterial origin with alkylating properties

Fecapentaene-14 and -12 are directly acting mutagens that do not require metabolic activation. Their unusual structure suggests a possible mechanism of action. A carbocation that is formed by the addition of an electrophilic species (such as a proton) to the enol ether is most probably the reactive species. A series of model enol ethers with conjugated systems of various lengths was prepared, and a correlation between mutagenicity and increasing reactivity of derived carbocations was found. The glycerol moiety does not play a crucial role in the overall reactivity of the fecapentaenes.

On distribution of different fecapentaenes, the fecal mutagens, in the human population

It has been shown by an HPLC analysis using a quarternary solvent mixture in an isocratic mode that human excretors of these fecal mutagens excrete both fecapentaene -12 and -14 but the ratios vary greatly between individuals. Since these mutagens are produced by the bacterial flora of the colon, this may indicate differences in the flora between these individuals or differences in the availability of different precursor molecules in their colons. Any relationship of these findings to the etiology of colonic cancer is not clear.

Aneurysm of the coronary sinus

Two patients, an adult and a baby, with an aneurysm of the coronary sinus are described. This unusual anomaly was detected in the baby during angiographic investigations for congenital heart disease. The aneurysm was an unexpected postmortem finding in the adult. Although the adult died suddenly, there was no evidence that this could be linked to the presence of the aneurysm.

Quadricyclane-norbornadiene isomerizations on alumina

Standard synthetic steps have been used to convert 7-methylenequadricyclane into the spiro-cyclopropene 1 and the allene 2. These (and other) quadricyclanes are cleanly isomerized on alumina to the respective bicyclo[2.2.1]hepta-2,5-dienes 3 and 4.

Giant cell tumour of the first metacarpal bone

A rare case of giant cell tumour of first metacarpal bone which was aggressive in its clinical behaviour but histologically benign, is reported in a thirty-one year old male. The tumour was excised en-bloc with disarticulation of the thumb and index finger with a gratifying result. The literature on giant-cell-tumour of the metacarpal bone is reviewed.

Hydrocolpos with peritonitis in the newborn

Two cases of hydrocolpos are described presenting soon after birth. One infant who died on the first day had an intrauterine peritonitis caused by compression of the caecum on the pelvic brim. The other surviving infant developed a caecal perforation secondary to Hirschsprung's disease. Neither infant had rectal atresia, which is the commonest cause of intestinal obstruction in these infants. The association of hydrocolpos with polydactyly in one of these cases may represent an autosomal recessive trait.