Direct booking colposcopy clinic -- the Portsmouth experience.

We present 2 years data on direct booking in our colposcopy clinic. The new booking system has improved our efficiency and helped us to achieve the national quality standards on clinic waiting time. The non-attendance (DNA) rate has also improved.

The effects of smoking on labour after uncomplicated pregnancy: a comparison between the progress and outcome of labour in 400 smokers and 400 matched non-smokers.

A comparison was made between the progress of labour and its outcome after an uncomplicated pregnancy, in 400 smokers and 400 non-smokers. Strict selection criteria were applied to eliminate, as far as possible, the variables which might have influenced labour in both groups and to ensure that the two groups of women were matched. The duration of labour was longer in smokers, who also had a higher incidence of caesarean sections. Smokers had a higher incidence of retained placenta and postpartum haemorrhage. The neonates of smokers had a higher incidence of problems in the immediate post-delivery period.

The impact of airport de-icing on a river: the case of the Ouseburn, Newcastle upon Tyne.

The damaging effects of airport de-icers to adjacent waterways have been suggested by a number of studies, but none have been able to demonstrate these effects in a field situation. The Ouseburn is a part-urban and partrural catchment of varied land-use and includes a tributary which drains the Newcastle International Airport. The tributary contributes only 3-5% of the river's average flow, yet it had a disproportionately adverse impact upon the river. This paper demonstrates how this was linked to the airport's winter application of urea salt de-icers. An integrated approach involving hydrological, chemical, bacteriological and macroinvertebrate sampling was used. During cold weather, higher levels of ammonia were recorded in the tributary and downstream, and concentrations peaked during runoff events. It is suggested that hydrolysis, facilitated by urea digesting bacteria, and surface runoff is the mechanism by which ammonia enters the stream. The airport tributary had a less diverse macroinvertebrate fauna than expected and had larger numbers of bacteria which were able to utilise urea. In-situ bioassay experiments found large deaths of Gammarus pulex (L.) and low biotic indices at a site downstream of the airport tributary confluence. Together with elevated ammonia levels this suggested that urea application adversely impacted on the main stream's water quality and ecology. The airport authorities have responded by changing to a less toxic de-icer.

Pericervical intrafallopian bupivacaine instillation to reduce postoperative pain after laparoscopic tubal sterilisation.

In a double-blind comparative study of 46 women undergoing laparoscopic tubal sterilization under general anesthesia using Falope ring bands, the group of women (study group, n=22) having 0.5% bupivacaine instilled paracervically had less pain than women given normal saline (control group, n=24) at 1 and 2 hours. The trial group also required narcotic analgesia significantly less often (6/22 vs 19.24) than the control group. The reduction in postoperative pain afforded by this method of administration of bupivacaine allows day case laparoscopic sterilization to be performed with greater confidence.

A randomized trial of the use of cocaine spray to provide pain relief during laser vaporization of the cervix.

In a double-blind trial, 50 patients undergoing laser vaporization of the cervix for cervical intraepithelial neoplasia were randomly allocated to one of two groups. One group had the cervix sprayed with 3-4 ml of a solution containing 10% cocaine, the other a placebo solution during the laser treatment. Women in the cocaine group had significantly less pain as assessed by a visual analogue scale (P less than 0.001) and by a verbal rating scale (P = 0.002). The cocaine group also had less blood loss (P = 0.001) as assessed subjectively by the operator.

A randomized trial of Citanest with Octapressin for relief of pain associated with laser vaporization of the cervix.

Fifty women undergoing laser vaporization of the cervix for cervical intraepithelial neoplasia were randomly allocated to one of two groups. In one group the patients received no anaesthesia, in the other the ectocervix was infiltrated with 2 ml of Citanest with Octapressin (prilocaine 3% with 0.03 i.u./ml. of felypressin) immediately before the procedure. The pain experienced by each group was assessed immediately after treatment by visual analogue and verbal rating scales. The pain experienced by those women receiving local anaesthesia was significantly reduced as assessed by the visual analogue scale (P = 0.011) and this reduction was not quite significant by the verbal rating scale (P = 0.06). The Citanest group had less troublesome bleeding but the difference in bleeding between the two groups was not significant.

Endocrine effects of danazol in the treatment of endometriosis.

The effects of danazol therapy on circulating gonadotrophins, oestradiol and sex hormone-binding globulin (SHBG) binding capacity have been studied in eight patients with endometriosis. There was a significant rise in luteinizing hormone (LH) in the first week of treatment with a fall in oestradiol levels. There was a marked fall in SHBG in the first week which continued up to 4 weeks. It is concluded that danazol is not 'anti-gonadotrophic' as frequently claimed and that its therapeutic actions, side effects and the endocrine changes could be explained by an effect on SHBG production. The rationale of its use in other conditions requires reconsideration.

Treatment of preinvasive disease of the cervix by cone biopsy.

During the years 1952--1977, 646 patients with abnormal cervical cytology underwent one biopsy (595) or ring biopsy of the cervix. The histological diagnoses were invasive carcinoma 20 (3%) microinvasive carcinoma 16 (2%), carcinoma in situ and severe dysplasia 418 (65%), other dysplasias 149 (23%). The remainder, 43 (7%) had no demonstrable abnormality. Following biopsy 41 (7%) patients with non-invasive disease had abnormal cytology within a year of biopsy. A further 12 (2%) developed abnormal cytology after one year. These recurrences occurred up to 12 years after the initial treatment, and in one patient invasive squamous carcinoma has developed.