Dumbbell ganglioneuroma mimicking lumbar neurofibroma: a case report and review of the literature.

Spinal ganglioneuromas may grow in a dumbbell fashion. We report the first case of an intradural, extramedullary ganglioneuroma in the lumbar spine and review the pertinent literature. Although rare, we propose that ganglioneuroma be considered a differential diagnosis in patients presenting with a large mass occupying both intraspinal and extraspinal compartments.

Outcome of 441 breech singleton deliveries at the Catholic Hospital, Oluyoro, Ibadan.

Breech presentation at delivery occurred in 441 of 21,243 deliveries giving an incidence of 2.1% in Oluyoro Catholic Hospital, Ibadan. The fresh stillbirth rate was 7.8% and this was six times the cephalic (1.2%) fresh stillbirth rate for the same period. The incidence of breech presentation was lowest between parity 1 and 3, and rose above parity 5. Majority of the stillbirths occurred in primigravidae and grandmultiparous patients. Caesarean section was performed in 15.7% of breech singleton, while 79% were delivered by assisted breech delivery. The commonest indication for caesarean section was fetal distress. Low birth weight (2.5 kg) or less breech singleton occurred in 22% cases, and accounted for 45% of all breech stillbirths. The lowest risk to the fetus was between 3kg and 4kg birth weights. Congenital abnormalities of the Central Nervous System occurred in 2.7% of breech babies as compared to 0.2% in cephalic presentation. Low birth weight, prematurity, primigravidity and grandmultiparity were the identified factors associated with stillbirths. Early identification and management of these factors will reduce the high incidence of perinatal deaths in breech deliveries. We advocate the use of symphysiotomy in the management of the entrapped aftercoming head of the breech.

Efficacy of large loop excision of the transformation zone for cervical intraepithelial neoplasia.

This study showed the efficacy of large loop excision of the transformation zone (LLETZ) in the management of cervical intraepithelial neoplasia (CIN). Eighty-three women with abnormal cervical cytology were recruited. Colposcopic examination and directed punch biopsy were performed and the women had LLETZ therapy as an outpatient procedure. There were 2 cases of microinvasive cervical carcinoma that were missed by directed punch biopsy, the diagnosis being made after the patients underwent LLETZ treatment. There was a large disparity in the histological analysis between directed punch biopsy and LLETZ specimen. This disparity would not have been detected if the women were treated by ablative methods. In women with cervical dysplasia, LLETZ procedure is preferred as the whole excised lesion can be examined histologically and diagnostic error is reduced.

Superiority of end-diastolic volume and ejection fraction measurements over wedge pressures in evaluating cardiac function during aortic reconstruction.

Marked changes occur in cardiac function during aortic reconstruction. Numerous factors (primarily compliance changes) limit the currently used pressure-based pulmonary artery catheters' ability to reflect these changes accurately. A new pulmonary artery catheter was used in 26 patients undergoing aortic reconstruction (7 patients with abdominal aortic aneurysms and 19 with occlusive disease) that directly measures right ventricular (RV) volumes and ejection fractions. The extent of coronary artery disease (CAD) was evaluated before surgery, and the patients were divided into three classes. The greatest changes in cardiac function were noted immediately after aortic cross-clamping. Cardiac output significantly decreased in patients with mild or moderate CAD (p less than 0.01 and p less than 0.001) but not in patients with no CAD (p less than 0.5). This correlated well with RV end-diastolic volume (RV-EDV) and stroke volume (RV-SV) measurements in the groups with mild (p less than 0.05) and moderate CAD (p less than 0.01) but not in the group with no CAD (p greater than 0.5). Wedge pressure showed poor correlation, with no significant change noted in any group (p greater than 0.5). Measurements taken later in the procedure documented a significant trend toward baseline in mild and moderate groups. At the opening of the second limb of the graft, the compensated values (CO, RV-EDV, and RV-SV) did not change significantly in the groups with mild and no CAD (p greater than 0.2) but approached significance in the group with moderate CAD (p less than 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

Testicular volume and seminal fluid profile in fertile and infertile males in Ilorin, Nigeria.

Total testicular volume (TTV) measured with a metric tape and vernier calliper in 20 men whose wives were 12-20 weeks gestation, and in 48 infertile men was correlated with the height, weight, Ponderal Index (PI), sperm density, and total sperm in the ejaculate. There was a good correlation between TTV by tape and calliper (r = 0.96, P less than 0.001). There was a positive linear correlation between TTV and height but not with the other parameters. Giant head spermatozoa were more common in fertile Nigerian males than in fertile Asian or caucasian males (P less than 0.001). Giant head sperm and sperm with tail defects occurred in 6.25%, 11.1% fertile and 37.1%, 47.4% infertile men respectively. Spontaneous abortion due to blighted ova were more prevalent in wives whose husbands has greater than 8% giant head sperm (P less than 0.02).

Effect of bromocriptine on menstrual cycle length.

Forty-seven women with regular ovulatory menstrual cycles and normal plasma prolactin levels were treated with different doses of bromocriptine, and changes in follicular and luteal phase length determined by daily estimation of plasma gonadotrophin concentration. Follicular phase length was highly significantly reduced from a median duration of 12.7 days in the basal cycle to 11.7 days in the first treatment cycle, and to 10.7 days during the second treatment cycles. The length of the luteal phase was unaltered by treatment with bromocriptine. Reduction of follicular phase length was not influenced by the dose of bromocriptine used, and it is concluded that this effect is a consequence of the reduction of plasma prolactin concentration.

Plasma prolactin concentrations during conception and the first ten weeks of human pregnancy.

Plasma prolactin concentrations were measured daily throughout 20 cycles in which conception occurred and for several weeks during early pregnancy. Thirteen of the pregnancies were 'spontaneous' (i.e. without exogenous pharmacological stimulation) and 7 occurred during either clomiphene or bromocriptine treatment. Prolactin concentrations were fairly stable throughout the conception cycles until shortly after the time of the first missed menses. From this time concentrations rose gradually to reach a mean concentration of 1250 mU/l 60 days after ovulation. However, there were marked fluctuations from day to day within individuals and considerable variation in the magnitude of the prolactin rise between subjects. Three subjects were mildly hyperprolactinaemic and although prolactin levels remained slightly elevated throughout the study period, this did not affect the outcome of pregnancies.

The human menstrual cycle: plasma concentrations of prolactin, LH, FSH, oestradiol and progesterone in conceiving and non-conceiving women.

Hormonal profiles were obtained throughout 26 conception cycles and 27 non-conception control cycles. The pregnancies followed treatment (clomiphene or bromocriptine) in 12 women but were spontaneous in the remaining 14. No sustained significant difference between the various types of conception cycle was found for LH, FSH, oestradiol or progesterone concentrations. Prolactin concentrations varied widely, suggesting that mean cycle prolactin concentrations ranging from 45 to 760 mi.u./l are compatible with conception. Although there were no significant differences in progesterone secretion within the conception cycles, there were highly significant differences between the conception cycles and the non-pregnant control cycles. Mean progesterone concentrations in the conception group were higher (P less than 0.005) than those in the control women over Days 3-8 following the LH peak. This difference could only be partly accounted for by heterogeneity within the control group (15-20% of the control cycles had low progesterone concentrations and were probably subfertile. It is suggested that the higher conception cycle progesterone concentrations during the early part of the luteal phase may constitute a preimplantation component of the maternal recognition of pregnancy in women.

Prolactin concentrations in normal menstrual cycles and conception cycles.

Plasma prolactin concentrations were measured daily throughout twenty-three menstrual cycles from regularly ovulating women. In five of the cycles conception occurred spontaneously. The frequency distribution of prolactin concentrations was calculated and an appropriate linear transform obtained. Means and 95% confidence limits were determined by inspection of the logarithmic probability plots and these gave mean concentrations (and ranges) of 302 (106-871) mU/1 for the nonconception cycles and 178 (58-550) mU/1 for the conception cycles. Distribution of prolactin concentrations was log-normal in all cases, although the population containing the conception cycles was distinct from the population of non-conception cycles. It is suggested that the normal range found in ovulating women is 80-800 mU/1 but that for conception to occur levels should be slightly lower and approximate to the range 60-600 mU/1. Thus the lower limit of normal is about 60 mU/1 and the upper limit about 800 mU/1. Any concentration over 800 mU/1 should be designated as hyperprolactinaemia.

Comparison of plasma steroid and gonadotrophin profiles in spontaneous cycles in which conception did and did not occur.

Luteinizing hormone (LH), follicle stimulating hormone (FSH), oestradiol and progesterone were measured in plasma from blood samples obtained daily throughout 23 menstrual cycles in a total of 18 normal women. Eight of these women were trying to conceive at the time of investigation and five succeeded. The subjects were divided into those who were not exposed to pregnancy (Group I), those who became pregnant (Group II) and those who were trying to become pregnant but failed to do so (Group III). The mean profiles of each of the four hormones were similar for the three groups studied. Statistical comparisons (using 't' tests) between Groups II and III showed that FSH concentrations were significantly lower (P less than 0.01) in the late follicular phase (Days -7 to -3 before the LH peak) in Group III. Similarly, progresterone concentrations were significantly lower (P less than 0.05) during the early luteal phase (Days +3 to +7 after the LH peak) in Group III.

Prolactin concentrations in ovulatory but infertile women: treatment with bromocriptine.

We measured basal plasma prolactin concentrations (in samples obtained during the early follicular phase) in 25 normal (control) women and in a similar group of 40 patients with a long-standing history of infertility. The infertile patients were all ovulating regularly, and had been unsuccessfully treated with clomiphene and in some cases dydrogesterone and human menopausal gonadotrophin. Although none of the patients had plasma prolactin concentrations greater than 1000 muU/ml, 47.5% of the estimations were greater than 1 standard deviation (SD) above the mean established for our control group. This difference was highly significant (P less than 0.001). Treatment with various bromocriptine regimens effectively reduced prolactin concentrations to below normal in all cases, and 16 pregnancies followed-13 during bromocriptine treatment and three in the first post-treatment cycle. The cumulative conception rate was 63.4% after 10 months' treatment.

Circulating levels of pregnancy-specific beta1-glycoprotein in early pregnancy.

Circulating levels of pregnancy-specific beta1-glycoprotein (SP1 or PSbetaG), luteinizing hormone (LH) and human chorionic gonadotrophin (HCG) were measured serially in 9 subjects immediately after conception. Ovulation occurred spontaneously in 3 subjects, or followed administration of clomiphene citrate (2 subjects) or bromocriptine (4 subjects). The timing of ovulation was determined by the appearance of the LH surge. Levels of HCG were detected 10 to 16 days, and SP1, 18 to 23 days after ovulation. These findings suggest that the measurement of plasma levels of SP1 may provide valuable additional biochemical evidence of pregnancy.