Male contraception: past, present and future.

Male contraception research has yielded a number of promising leads over the past 50 years. Yet, little is known by the public due to lack of institutional support and funding. This is unfortunate since, apart from condom and vasectomy, there are many male methods which may be safer, more effective and easier to use. This paper explores male contraception which has been used in the past and the present and discusses some of its potential developments.

Pathophysiology of transient cranial diabetes insipidus during pregnancy.

OBJECTIVE: We investigated the possible mechanisms underlying transient cranial diabetes insipidus during pregnancy. DESIGN AND PATIENTS: A woman who developed clinical diabetes insipidus during the third trimester of pregnancy was studied through a total of three pregnancies and postpartum. MEASUREMENTS: Plasma AVP, urine and plasma osmolality, urine volume and specific gravity were measured during water deprivation tests and hypertonic saline infusion. Plasma and urine osmolality were measured after subcutaneous injection of AVP. The water deprivation and AVP test were repeated after proven inhibition of urinary PGE2 with aspirin. Serum vasopressinase activity was measured during one of the pregnancies affected with diabetes insipidus and compared with that obtained between 26 and 38 weeks from 13 normal pregnancies. RESULTS: The patient was found to have cranial diabetes insipidus which responded to low dose intranasal 1-desamino-8-D-arginine vasopressin. Inhibition of PGE2 with aspirin did not enhance urine concentrating ability or the response to a test dose of subcutaneous AVP. Plasma levels of vasopressinase remained within the physiological range for normal pregnancy. CONCLUSIONS: These studies indicate that subclinical cranial diabetes insipidus may be unmasked in late pregnancy. This effect is not related to AVP resistance resulting from PGE2 production or excessive vasopressinase activity, but may be due to a combination of physiological vasopressinase secretion with reduced AVP secretory capacity and reduction in the thirst threshold that accompanies normal pregnancy. We relate these findings to a previously described group of women with transient diabetes insipidus during pregnancy who had impaired liver function.

Outcome of gestational diabetes in Bengali Asians living in an east London health district.

The characteristics and outcome of pregnancy complicated by gestational glucose intolerance are described in a consecutive series of 69 Bengali Asian patients and a parallel group of 22 Caucasian patients. The Bengali patients were older and of higher parity than the Caucasians and more frequently required insulin therapy. However, the outcome of pregnancy was similar in terms of antenatal clinic attendance, the number of antenatal hospital admissions, glycaemic control, birthweight and mode of delivery. Of those patients who attended for postnatal glucose tolerance test, 20% of the Bengali population demonstrated persisting abnormality of glucose tolerance, whereas no abnormalities were evident in the Caucasian group. These findings are consistent with the high prevalence and early age of onset of non-insulin-dependent diabetes in Asian populations. The World Health Organisation (WHO) criteria for the diagnosis of impaired glucose tolerance proved insufficiently sensitive for the diagnosis of gestational diabetes. This was particularly demonstrated by four patients with apparently normal glucose tolerance by WHO criteria who subsequently required insulin therapy.

Female genital actinomycosis.

Four cases of female genital actinomycosis are added to the reported total of about 300. The relationship of the disease to the normal microbial flora, intrauterine contraceptive device usage and pelvic sepsis is explored. It is suggested that the disease may be more frequent than hitherto realized.

PIP: Actinomycosis of the female genital tract is the subject of this brief review article, which adds 4 new cases to 300 previously reported. The problem of delayed diagnosis because of the nonspecific nature of the symptoms is emphasized, and at present no definitive tests for the disease exist, furthering the likelihood of serious complications. Clinical grounds are the only means of diagnosis, and if actinomycosis is suspected clinically, a careful examination of a cervical smear or endometrial biopsy may let the physician prescribe antibiotics before laparotomy (or removal of an IUD, if present). Penicillin in large doses is recommended, but the organism is sensitive to many antibiotics. Recently, lincomycin and clindamycin have been used because of their better penetration into the circumscribed fibrotic abscess cavities which develop during actinomycosis, in addition to being effective against the secondary organims present. Abscess drainage and pelvic toilet at laparotomy are therapeutic, and at least 3 months of effective antibiotic treatment are required. The frequency of this pelvic infection is rising at an alarming rate, since doctors are now more likely to diagnose the condition.