Current trends in management of ectopic pregnancy in the United Kingdom

The potential advantages of laparoscopic management of ectopic pregnancy include lower morbidity, faster return to work, and less impact on reproductive health. This study aimed to investigate the current management of ectopic pregnancy in the United Kingdom. Thirty-five per cent of ectopic pregnancies are currently managed laparoscopically. Units that tended to operate laparoscopically were more likely to attempt to preserve the fallopian tube at surgery. Ninety per cent of units in the UK feel that they potentially could manage ectopic pregnancies laparoscopically but in practice only 60% managed any of the last three ectopic pregnancies by this technique.

Intraductal papillary mucinous tumor of the pancreas (IPMT): follow-up of twelve cases

INTRODUCTION

Intraductal papillary mucinous tumours (IPMT) were described as a distinct entity in I982. The extent of surgical resection for this disease remains controversial.

METHODS

Twelve patients with a diagnosis of IPMT were included in the present retrospective study.

RESULTS

Ten out of twelve patients had symptoms suggesting chronic pancreatitis. Two patients were not operated on due to biopsy-verified metastases in the liver. Nine patients were treated with a total pancreatectomy and one with a pancreaticoduodenectomy. In the ten patients operated on for IPMT, histological examination showed eight non-invasive- and two invasive carcinomas. In six cases, multifocal extensive intraductal changes were found, affecting either most of or the whole pancreas. There was no perioperative mortality. Six patients were alive at follow-up without recurrence and four patients were dead, two of them with recurrence.

CONCLUSION

IPMTs represent a subgroup of pancreatic neoplasms with a favourable prognosis, and the resection should aim at removing all dysplastic foci. In cases with diffuse dilatation of the main pancreatic duct, widespread tumour involvement of the duct system can be expected and total pancreatectomy should be the operation of choice.

Direct fabrication of terahertz optical devices on low-absorption polymer substrates

We have fabricated terahertz wire grid polarizer and terahertz bandpass filter devices on high-density polyethylene substrates using simple photolithographic fabrication techniques. The performance of the fabricated devices was measured using a Fourier transform IR spectrometer. Both devices showed good performance in the terahertz frequency range up to 5 THz, in agreement with rigorous coupled-wave analysis (polarizer) and finite-difference time-domain (filter) simulations. Our results successfully demonstrate the use of standard fabrication techniques to produce large-aperture free-standing terahertz optical devices on low-absorption polymer materials with the advantage of low cost using a simple fabrication process. The fabricated polarizer had better than 30 dB extinction ratio at 3 THz. Bandpass filters were demonstrated at three different center frequencies (1.5, 1.8, 2.9 THz) with a 3 dB insertion loss and 2<or=Q<or=7.

Biodegradation potential of pure and mixed bacterial cultures for removal of 4-nitroaniline from textile dye wastewater

Environmentally toxic aromatic amines including nitroanilines are commonly generated in dye contaminated wastewater in which azo dyes undergo degradation under anaerobic conditions. The aim of this study was to develop a process for biological treatment of 4-nitroaniline. Three bacteria identified as Acinetobacter sp., Citrobacter freundii and Klebsiella oxytoca were isolated from enrichment cultures of activated sludge on 4-nitroaniline, after which the isolates and the mixed culture were studied to determine optimal conditions for biodegradation. HPLC analyses showed the mixed culture was capable of complete removal of 100micromol/L of 4-nitroaniline within 72h under aerobic conditions. There was an inverse linear relationship (R(2)=0.96) between the rate of degradation (V) and 4-nitraoaniline concentrations [S] over 100-1000micromol/L. The bacterial culture was also capable of decolorizing structurally different azo dyes (Acid Red-88, Reactive Black-5, Direct Red-81, and Disperse Orange-3) and also degraded nitrobenzene. Our findings show that enrichment cultures from activated sludge can be effective for the removal of dyes and their toxic intermediates, and that treatment may best be accomplished using an anaerobic-aerobic process.

A simple method to screen for azo-dye-degrading bacteria

A stab-culture method was adapted to screen for azo dyes-decolorizing bacteria from soil and water samples. Decolorized azo dye in the lower portion of the solid media indicates the presence of anaerobic azo dyes-decolorizing bacteria, while aerobic decolorizing bacteria decolorizes the surface portion of the solid media. Of twenty soil samples tested, one soil sample shows positive results for the decolourisation of two azo dyes; Biebrich scarlet (BS) and Direct blue 71 (DB) under anaerobic conditions. A gram negative and oxidase negative bacterial isolate was found to be the principal azo dyes degrader The isolate was identified by using the Biolog identification system as Serratia marcescens.

Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience

BACKGROUND AND STUDY AIMS

Solid pseudopapillary tumors of the pancreas are rare, low-grade, epithelial neoplasms that are usually discovered incidentally in young women. Distinguishing solid pseudopapillary tumors from other pancreatic tumors, especially pancreatic endocrine tumors, can be challenging. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in this context remains unclear. The purpose of this study was to describe the endoscopic ultrasound features of solid pseudopapillary tumors and the role of EUS-FNA in the preoperative diagnosis of these tumors.

PATIENTS AND METHODS

Patients from five tertiary referral centers with surgically confirmed solid pseudopapillary tumors who had undergone preoperative EUS-FNA were included. The endoscopic ultrasound findings, cytologic descriptions, immunostaining results, operative records, surgical pathology, and results of the most recent clinical follow-up were reviewed.

RESULTS

A total of 28 patients were identified (four men [14 %], 24 women [86 %], mean age +/- standard deviation [SD] 35 +/- 10 years). Solid pseudopapillary tumors had been found as incidental findings on cross-sectional imaging in 50 % of cases. The mean tumor size +/- SD was 42 +/- 19.5 mm and the majority were located in the pancreatic body and tail. The endoscopic ultrasound report described a well-defined, echo-poor mass in 86 %; the tumors were solid in 14 patients (50 %), mixed solid and cystic in 11 patients (39 %), and cystic in three patients (11 %). A preoperative diagnosis of solid pseudopapillary tumor was made in 21 patients (75 %) on the basis of EUS-FNA cytology. Surgical resection was performed in all cases. Laparoscopic resection was performed in eight of these patients (29 %).

CONCLUSIONS

A solid pseudopapillary tumor should be included in the differential diagnosis of any well-demarcated, echo-poor, solid or mixed solid/cystic pancreatic lesion seen during endoscopic ultrasound, particularly in young women. The diagnostic accuracy of EUS-FNA for solid pseudopapillary tumors was 75 % in this study. A definitive preoperative diagnosis can guide the surgical approach in selected cases.

Rosiglitazone treatment improves cardiac efficiency in hearts from diabetic mice

Isolated perfused hearts from type 2 diabetic (db/db) mice show impaired ventricular function, as well as altered cardiac metabolism. Assessment of the relationship between myocardial oxygen consumption (MVO(2)) and ventricular pressure-volume area (PVA) has also demonstrated reduced cardiac efficiency in db/db hearts. We hypothesized that lowering the plasma fatty acid supply and subsequent normalization of altered cardiac metabolism by chronic treatment with a peroxisome proliferator-activated receptor-gamma (PPARgamma) agonist will improve cardiac efficiency in db/db hearts. Rosiglitazone (23 mg/kg body weight/day) was administered as a food admixture to db/db mice for five weeks. Ventricular function and PVA were assessed using a miniaturized (1.4 Fr) pressure-volume catheter; MVO(2) was measured using a fibre-optic oxygen sensor. Chronic rosiglitazone treatment of db/db mice normalized plasma glucose and lipid concentrations, restored rates of cardiac glucose and fatty acid oxidation, and improved cardiac efficiency. The improved cardiac efficiency was due to a significant decrease in unloaded MVO(2), while contractile efficiency was unchanged. Rosiglitazone treatment also improved functional recovery after low-flow ischemia. In conclusion, the present study demonstrates that in vivo PPARgamma-treatment restores cardiac efficiency and improves ventricular function in perfused hearts from type 2 diabetic mice.

Differential response of etiolated pea seedlings to inoculation with rhizobacteria capable of utilizing 1-aminocyclopropane-1-carboxylate or L-methionine

The majority of soil microorganisms can derive ethylene from L-methionine (L-MET), while some rhizobacteria can hydrolyze 1-aminocyclopropane-1-carboxylate (ACC) due to their ACC-deaminase activity. In this study, three strains having either ACC-deaminase activity (Pseudomonas putida biotype A, A7), or the ability to produce ethylene from L-MET (Acinetobacter calcoaceticus, M9) or both (Pseudomonas fluorescens, AM3) were used for inoculation. The highly ethylene specific bioassay of a classical "triple" response in pea seedlings was used to investigate the effect of the inoculation with the rhizobacteria in the presence of 10 mM ACC or L-MET. The exogenous application of ACC had a concentration-dependent effect on the etiolated pea seedlings in creating the classical "triple" response. The inoculation with P. putida diluted the effect of ACC, which was most likely due to its ACC-deaminase activity. Similarly, the application of Co2+ reduced the ACC-imposed effect on etiolated pea seedlings. In contrast, the inoculation of A. calcoaceticus or P. fluorescens in the presence of L-MET caused a stronger classical "triple" response in etiolated pea seedlings; most likely by producing ethylene from L-MET. This is the first study, to our knowledge, reporting on the comparative effect of rhizobacteria capable of utilizing ACC vs L-MET on etiolated pea seedlings.

Biodegradation of α- and β-endosulfan by soil bacteria

Extensive applications of persistent organochlorine pesticides like endosulfan on cotton have led to the contamination of soil and water environments at several sites in Pakistan. Microbial degradation offers an effective approach to remove such toxicants from the environment. This study reports the isolation of highly efficient endosulfan degrading bacterial strains from soil. A total of 29 bacterial strains were isolated through enrichment technique from 15 specific sites using endosulfan as sole sulfur source. The strains differed substantially in their potential to degrade endosulfan in vitro ranging from 40 to 93% of the spiked amount (100 mg l(-1)). During the initial 3 days of incubation, there was very little degradation but it got accelerated as the incubation period proceeded. Biodegradation of endosulfan by these bacteria also resulted in substantial decrease in pH of the broth from 8.2 to 3.7 within 14 days of incubation. The utilization of endosulfan was accompanied by increased optical densities (OD(595)) of the broth ranging from 0.511 to 0.890. High performance liquid chromatography analyses revealed that endosulfan diol and endosulfan ether were among the products of endosulfan metabolism by these bacterial strains while endosulfan sulfate, a persistent and toxic metabolite of endosulfan, was not detected in any case. The presence of endosulfan diol and endosulfan ether in the bacterial metabolites was further confirmed by GC-MS. Abiotic degradation contributed up to 21% of the spiked amount. The three bacterial strains, Pseudomonas spinosa, P. aeruginosa, and Burkholderia cepacia, were the most efficient degraders of both alpha- and beta-endosulfan as they consumed more than 90% of the spiked amount (100 mg l(-1)) in the broth within 14 days of incubation. Maximum biodegradation by these three selected efficient bacterial strains was observed at an initial pH of 8.0 and at an incubation temperature of 30 degrees C. The results of this study may imply that these bacterial strains could be employed for bioremediation of endosulfan polluted soil and water environments.

Impact of the availability of sonography in the acute gynecology unit

OBJECTIVE

The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient.

METHODS

This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital. Women were assessed in the routine manner by history-taking and clinical examination and questionnaires were completed by the doctors, including details of the intention to treat. Transvaginal ultrasound examinations were then performed and a second diagnosis and management plan were made utilizing the extra information from the scan. The plans for clinical management before and after the ultrasound examination were compared.

RESULTS

We originally recruited 1000 consecutive women to the study. The mean age was 31.1 (SD, 9.81) years. Complete data were available for 920 (92%). 84 (9.1%) women did not require a scan. Of the 521 women with a positive pregnancy test, 75.6% were reassured immediately that their pregnancy was intrauterine. 143 women (27.4%) were given the diagnosis of a suspected ectopic pregnancy before sonography, compared with 29 (5.6%) after. Following the ultrasound examination there was a change in clinical management in 54.1% of the women with a positive pregnancy test and a reduction in admissions (including inpatient theater admissions) (from 40.3% to 17.1%) and outpatient follow-up examinations (from 41.1% to 35.5%). In 90 (23.8%) non-pregnant women a significant ovarian cyst (> 5 cm) was suspected clinically; 28/90 (31.1%) were confirmed on sonography. Following the ultrasound examination there was a change in clinical management for 38.1% of non-pregnant women and a reduction in admissions (from 37.1% to 19.4%) and outpatient follow-up examinations (from 25.7% to 18.1%).

CONCLUSION

It appears that the availability of transvaginal sonography at the time of initial assessment of emergency gynecology patients improves diagnostic accuracy and reduces unnecessary admissions and follow-up examinations.

A 93 year old man with the PRSS1 R122H mutation, low SPINK1 expression, and no pancreatitis: insights into phenotypic non-penetrance

BACKGROUND

The cationic trypsinogen (PRSS1) R122H mutation causes autosomal dominant hereditary pancreatitis (HP) with multiple attacks of acute pancreatitis, but the penetrance, frequency, and severity of attacks are highly variable. HP twins study suggests that modifier genes influence severity but not penetrance.

AIM

To investigate potential trypsin associated factors in subjects with the PRSS1 R122H mutation and phenotypic non-penetrance.

METHODS

Two subjects from HP families (including a 93 year old subject with PRSS1 R122H without pancreatitis), one with chronic pancreatitis and one with a normal pancreas, were studied. Relative expression of: (a) the PRSS1 R122 and H122 alleles; and (b) the PRSS1 and SPINK1 genes in pancreatitis were determined using complementary methods.

RESULTS

PRSS1 wild-type (R122) and mutant (H122) allele expression was equivalent in multiple (> 3) samples from the phenotypically affected and non-penetrant subjects with R122H genotypes using allele specific quantitative reverse transcription-polymerase chain reaction (RT-PCR) and intron spanning nested RT-PCR followed by cDNA sequencing. Compared with PRSS1 mRNA levels, SPINK1 mRNA levels were low in normal appearing tissue but markedly increased in samples with chronic inflammation, independent of PRSS1 genotype.

CONCLUSION

Attacks of acute pancreatitis in HP subjects appear to be independent of the relative expression of the mutant PRSS1 H122 allele or SPINK1 gene expression. The marked increase in SPINK1 gene expression with inflammation is consistent with its regulation as an acute phase protein.

The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain-can we reduce the need for laparoscopy?

OBJECTIVE

To assess the accuracy of new transvaginal ultrasound-scan-based markers and to compare them to conventional ultrasound methods used in the detection of common pelvic pathology in women with chronic pelvic pain (CPP).

DESIGN

A prospective observational study.

SETTING

Teaching hospital.

POPULATION

A total of 120 consecutive women with CPP undergoing transvaginal ultrasonography before either diagnostic or operative laparoscopy.

METHODS

Anatomical abnormalities, e.g. endometrioma or hydrosalpinx (hard markers), were documented. The woman was then assessed for the presence or absence of 'soft markers' (reduced ovarian mobility and site-specific pelvic tenderness).

MAIN OUTCOME MEASURE

Presence or absence of pelvic pathology noted during laparoscopy.

RESULTS

Seventy women had pelvic pathology, of whom 51 had endometriosis alone, 7 both endometriosis and pelvic adhesions, 6 pelvic adhesions, 1 hydrosalpinx with endometriosis and 5 hydrosalpinx and pelvic adhesions. The likelihood ratio for the hard markers was infinity (specificity was 100%), for the soft makers 1.9 (95% CI 1.2-3.1) and for a 'normal' ultrasound 0.18 (0.09-0.34). The pre-test probability of pelvic disease in our population of women with CPP was 58%, and this probability of disease was raised to 100% with the presence of hard markers and to 73% with the presence of soft markers. The pre-test probability of 58% fell to 20% when ultrasound finding was found to be normal.

CONCLUSION

This new approach improves the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.

[Effect of substrate-dependent microbialy produced ethylene on plant growth]

Various compounds have been identified as precursors/substrates for the synthesis of ethylene (C2H4) in soil. This study was designed to compare the efficiency of four substrates, namely L-methionine (L-MET), 2-keto-4-methylthiobutyric acid (KMBA), 1-aminocyclopropane-1-carboxylic acid (ACC), and calcium carbide (CaC2) for ethylene biosynthesis in a sandy clay loam soil by gas chromatography. The classic "triple" response in etiolated pea seedling was employed as a bioassay to demonstrate the effect of substrate-dependent microbialy produced ethylene on plant growth. Results revealed that an amendment with L-MET, KMBA, ACC (up to 0.10 g/kg soil) and CaC2 (0.20 g/kg soil) significantly stimulated ethylene biosynthesis in soil. Overall, ACC proved to be the most effective substrate for ethylene production (1434 nmol/kg soil), followed by KMBA, L-MET, and CaC2 in descending order. Results further revealed that ethylene accumulation in soil released from these substrates created a classic "triple" response in etiolated pea seedlings with different degrees of efficacy. A more obvious classic "triple" response was observed at 0.15, 0.10, and 0.20 g/kg soil of L-MET, KMBA/ACC, and CaC2, respectively. Similarly, direct exposure of etiolated pea seedlings to commercial ethylene gas also modified the growth pattern in the same way. A significant direct correlation (r = 0.86 to 0.97) between substrate-derived [C2H4] and the classic triple response in etiolated pea seedlings was observed. This study demonstrated that the presence of substrate(s) in soil may lead to increased ethylene concentration in the air of the soil, which may affect plant growth in a desired direction.

Do we need to follow up complete miscarriages with serum human chorionic gonadotrophin levels?

Despite a history of heavy vaginal bleeding with clots, a proportion of women diagnosed with complete miscarriage, using transvaginal sonography (TVS), have an underlying ectopic pregnancy (EP). We evaluated the need for hormonal follow up in women with history and scan findings suggestive of complete miscarriage. One hundred and fifty-two consecutive women with findings suggesting complete miscarriage at presentation based on their history and TVS were presented to the Early Pregnancy Unit. Serum human chorionic gonadotrophin (hCG) levels were taken at presentation and 48 hours. All women were followed up until hCG was <5 u/L or a pregnancy was visualised on TVS either inside or outside the uterus. Overall, 9 (5.9%) of 152 women with an apparent complete miscarriage had an underlying EP. A diagnosis of complete miscarriage based on history and scan findings alone is unreliable. These women should be managed as 'pregnancies of unknown location' with serum hCG follow up.

A prospective evaluation of a single-visit strategy to manage pregnancies of unknown location

BACKGROUND

The aim was to assess whether women with a pregnancy of unknown location (PUL) can be safely excluded from potentially unnecessary multiple clinic visits.

METHODS

A single-visit protocol was developed based upon data from 200 consecutive PULs. PULs were divided into groups according to the probable risk of ectopic pregnancy. Those PULs with an initial serum progesterone < or =10 nmol/l or a serum HCG of < or =25 U/l were deemed to be at low risk and classified as resolving or failing PULs. Those PULs with an initial serum progesterone of >50 nmol/l, regardless of serum HCG, were thought to be a probable intra-uterine pregnancy (IUP) and were also classified as being low risk. Those PULs with an initial serum progesterone of 10-50 nmol/l and a serum HCG of >25 U/l were classified as being at high risk. This protocol was then tested prospectively on 318 consecutive PULs. Management was based solely on the basis of an initial transvaginal ultrasound scan (TVS) and a single measurement of HCG and progesterone taken at the time of initial consultation.

RESULTS

A total of 5544 consecutive women were scanned, of which 560 (10.1%) women were classified as PULs. Forty-two were lost to follow-up and therefore 518 (9.34%) were analysed. In the training set of 200 PULs, there were 111 (55.5%) failing PULs, 67 (33.5%) IUPs and 22 (11%) ectopic pregnancies. In the test set of 318, there were 189 (59.4%) failing PULs, 114 (35.8%) IUPs and 15 (4.7%) ectopic pregnancies. For the training group, the sensitivity and specificity of a single visit to detect low-risk PULs were 77 and 82%, respectively. The positive (PPV) and negative predictive values (NPV) were 97 and 31%, respectively. For the test group of 318 PULs, the sensitivity and specificity were 84 and 33%, respectively. The PPV and NPV were 96 and 9.4%, respectively.

CONCLUSIONS

A single-visit strategy based on commonly used criteria eliminates 84% of non-ectopic pregnancies correctly from the system. However, as 67% of ectopic pregnancies are discharged without adequate follow-up, a single-visit strategy should not be used as an alternative to the current multi-visit strategy used in most units.

In vitro assessment of anti - cutaneous leishmaniasis activity of some Sudanese plants

Examination of crude methanol extracts of four Sudanese plants (Azadirachta indica, Acacia nilotica, Balanites aegyptiaca and Allium sativa) revealed that only three species had a considerable in-vitro anti-leishmanial activity on Leishmania major promastigotes. The plants Azadrachta indica, Allium sativa, and Acacia nilotica gave a LC50 of 10.2, 4.94, and 89.38 microg/ml, respectively. Extracts of Balanites aegyptiaca had a moderate biological activity on L major promastigotes.

Use of microsatellite marker loss of heterozygosity in accurate diagnosis of pancreaticobiliary malignancy from brush cytology samples

BACKGROUND

Brush cytology of biliary strictures to diagnose pancreaticobiliary malignancy suffers from poor sensitivity.

AIM

To improve the diagnostic yield of pancreaticobiliary brush cytology through analysis of tumour suppressor gene linked microsatellite marker loss of heterozygosity (LOH) and k-ras codon 12 mutation detection.

METHODS

Twenty six patients with biliary strictures underwent endoscopic retrograde cholangiography with brush cytology. A panel of 12 polymorphic microsatellite markers linked to six tumour suppressor genes was developed. Genomic DNA from cell clusters acquired from brush cytology specimens and microdissected surgical malignant and normal tissue underwent polymerase chain amplification reaction (PCR). PCR products were compared for LOH and k-ras codon 12 mutations.

RESULTS

Seventeen patients were confirmed to have pancreaticobiliary adenocarcinoma. Nine patients had benign strictures (eight proven surgically, one by follow up). Cytomorphological interpretation was positive for malignancy (n = 8), indeterminate (n = 10), and negative for malignancy (n = 8). Selected malignant appearing cytological cell clusters and microdissected histological samples from cancer showed abundant LOH characteristic of malignancy while brushings from nine cases without cancer carried no LOH (p<0.001). LOH and k-ras mutations profile of the cytological specimens was almost always concordant with the tissue samples. Presence of k-ras mutation predicted malignancy of pancreatic origin (p<0.001).

CONCLUSION

LOH and k-ras codon 12 mutation analysis of PCR amplified DNA from biliary brush cytology discriminates reactive from malignant cells, with 100% sensitivity, specificity, and accuracy. Minor variations in LOH in brushings and in different sites within the same tumour likely reflect intratumoral mutational heterogeneity during clonal expansion of pre- and neoplastic lineages.

Kinetics and effects of trace elements and electron complexes on 2-keto-4-methylthiobutyric acid-dependent biosynthesis of ethylene in soil

AIMS

2-Keto-4-methylthiobutyric acid (KMBA) is an established intermediate in microbial biosynthesis of ethylene from methionine. This study demonstrates the kinetics and effects of trace elements and electron complexes on substrate (KMBA)-derived C2H4 biosynthesis in soil.

METHODS AND RESULTS

We have previously reported KMBA-dependent C2H4 production in soil. We studied the kinetics and effects of various trace elements and electron complexes on KMBA-derived C2H4 biosynthesis in soil by gas chromatography. Kinetic analysis revealed that ethylene forming enzyme (EFE) reaction was linear (R2 = 0.9448) when velocity of reaction (V) was plotted against substrate [S] over the range from 2.5 to 10 mmol l(-1) and thus followed a first order reaction. Application of three linear transformations of the Michaelis-Menten equation indicated high affinity of EFE for the substrate because Km values ranged between 5.4 and 6.67 mmol l(-1) and Vmax of reaction was between 22.4 and 35.7 nmol kg(-1) soil 120 cm(-1). Most of the trace elements exhibited positive effects on KMBA-dependent C2H4 production in soil. Maximum stimulatory effect on C2H4 biosynthesis was observed in response to Co(II) application, while Fe(III) inhibited the biotransformation of KMBA into C2H4. Contrarily, most of the tested electron complexes inhibited KMBA-derived C2H4 biosynthesis in the soil. However, lower concentrations (1.0 mmol l(-1)) of mannitol and hydroquinone were stimulatory to C2H4 production in soil compared with controls (substrate only).

CONCLUSIONS

The results revealed that both kind and concentration of trace elements and electron complexes affected the substrate-dependent production of C2H4 in soil with different degrees of efficacy.

SIGNIFICANCE AND IMPACT OF THE STUDY

The C2H4 in the root environment could be physiologically active even at low concentrations, so knowledge regarding various factors which regulate C2H4 biosynthesis in soil could be of significance for plant growth and development.

Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first-trimester sonography

OBJECTIVE

To assess the prevalence and natural history of ovarian pathology in pregnancy.

METHODS

Three thousand consecutive pregnant women presenting before 14 weeks' gestation at the early pregnancy unit at St George's Hospital, London, underwent ultrasound examination during which both ovaries were visualized. Women found to have a simple ovarian cyst with a minimum diameter > or =25 mm or a complex ovarian cyst of any size were included in the study. They were followed up with ultrasound scans every 4-6 weeks until either resolution of the ovarian cyst occurred, intervention was required or the pregnancy was concluded. If the cyst persisted at 20 weeks' gestation, these women were rescanned 6 weeks after conclusion of the pregnancy. Women were managed expectantly throughout their pregnancy.

RESULTS

One hundred and sixty one women with a total of 166 cysts were included for analysis. At presentation, 43.7% of the women were asymptomatic and 56.3% had pain and/or vaginal bleeding. The mean gestational age at presentation was 53 (range, 28-98) days, the mean maternal age was 30 (range, 17-42) years, and the mean ovarian cyst diameter was 48 (range, 12-115) mm. The first-trimester pregnancy diagnoses were 106 intrauterine pregnancies, 40 miscarriages, five ectopic pregnancies, three pregnancies of unknown location and seven terminations of pregnancy. The sonographic features of the ovarian cysts included: 117 simple and anechoic, 21 hemorrhagic, 16 with mixed echogenicity, seven with a ground-glass appearance, three solid/cystic with papillary projections and two with low-level echoes. One hundred and nineteen (71.7%) of the cysts resolved spontaneously and were presumed to be physiological, 40 (24.1%) persisted and seven (4.2%) required intervention, four of these as an emergency because of pain. There was one case of borderline malignancy and no cases of malignancy. Five (3.0%) of the cysts underwent torsion. Only 0.13% (4/3000) of all women who initially presented to our unit required acute intervention during their pregnancy.

CONCLUSIONS

The majority of cysts detected in early pregnancy are physiological and resolve. Very few persist and intervention during the pregnancy is rarely indicated. The expectant management of ovarian cysts detected in the first trimester is safe and should be encouraged. Examining the ovaries in the first trimester is of limited value.