Crohn's disease of the vulva--two further cases.

Crohn's disease of the vulva is a rare disease, only eight cases having been described in the literature (Parks, Morson & Pegum, 1965; Mountain, 1970; Ansell & Hogbin, 1973; Devroede et al., 1975; Kao, Paulson & Askin, 1975; Levine, Barton & Grier, 1982). Two additional cases are presented, one of whom is the sixth reported with metastatic Crohn's disease of the vulva.

HLA tissue typing and chronic vulval dystrophy.

Tissue typing was performed on 25 patients who attended the Royal Victoria Hospital with chronic vulval dystrophy (CVD). Age-matched control groups who had pernicious anaemia only and achlorhydria only were also tissue typed as these conditions had been found more frequently in our patients with CVD. When these three groups were compared with age-matched control groups of blood donors and patients with gynaecological disorders other than CVD, no specific tissue type was found in patients with CVD nor in those with pernicious anaemia or achlorhydria only.

Associations between pelvic anatomy, height and year of birth of men and women in Belfast.

Standardized radiological pelvimetry was used to examine 242 male and 314 female adults attending the out-patient departments of the Royal Victoria Hospital, Belfast, Seven indices of pelvic size and shape were measured from X-rays on each individual together with social and biological factors including age, height and year of birth. The aims were to quantify any differences in pelvic anatomy between the sexes and to measure correlations between these pelvic indices and selected biosocial factors. Pelvic indices for men and women of similar stature were significantly different, with the exception of the brim index, and these anatomical changes were correlated with year of birth. The similarity of the findings in both sexes suggests common environmental factors such as nutrition are the most likely causes, rather than factors specifically associated with pregnancy and childbirth.

The prognostic value in threatened abortion of plasma progesterone values and the cornification index of vaginal smears.

The predictive values of plasma progesterone levels in 70 patients threatening to abort was investigated. It was found that no patient aborted whosed plasma progesterone level remanined above 35 nmol/l between 7 and 16 weeks of pregnancy, whereas if the plasma progesterone level was less than this, subsequent abortion always occurred. The predictive value of cornification index in vaginal smears was also examined: many smears were unsatisfactory for assessment and in patients with threatened abortion there was a 14 per cent incidence of falsely optimistic and 29 per cent of falsely pessimistic predictions.

A randomized controlled trial of selective planned delivery.

A prospective randomized controlled trial designed to investigate selective planned delivery is reported: 264 obstetrically normal women in the 38th week of pregnancy were admitted to this trial and 184 completed it. The infants of mothers in the planned delivery group had higher serum bilirubin levels on the fifth day post partum than control infants but no baby required treatment for hyperbilirubinaemia. Mothers in the planned delivery group required significantly greater amounts of pethidine while control mothers had a significantly higher incidence of meconium staining of the amniotic fluid. However, the infants in the two groups had similar Apgar scores at birth. There was one stillbirth in the control group; this was due to unrecognized fetal hypoxia during labour induced at 42 weeks for postmaturity.

Selective planned induction in conditions of civil strife.

Selective planned induction may be defined as the initiation of labour by artificial means for reasons not strictly medical. Where the indications are merely social or for conveniencewhether patient's, hospital's, or doctor'sit is doubtful that the procedure is acceptable until we have more detailed knowledge of its effects on the mother and fetus. However, the civil strife that occurred in Belfast in 1972 provided conditions in which the present study of the technique seemed justified. The results suggest that, provided the selection criteria are sufficiently rigorous and meticulously applied, there are no serious maternal risks. The main fetal risk is of unexpected prematurity; this can be avoided, but the precautions applied in this preliminary study reduced significantly the number of patients for whom the method could be used. A second series, with controls and using less rigorous selection criteria, is at present being studied.