Laparoscopic assisted vaginal hysterectomy--190 cases: complications and training.

Laparoscopic assisted vaginal hysterectomy continues to gain popularity worldwide without evidence from any controlled trials of its superiority over existing techniques. There is some concern over complication rates particularly damage to the urinary tract and haemorrhage. The Royal College of Obstetricians and Gynaecologists has compiled a register of preceptors for advanced laparoscopic surgery, however there is nothing to prevent a surgeon without adequate training or experience from embarking upon any form of minimal access surgery. This series consists of 190 cases performed by one surgeon in a District General Hospital over the past five years. The mean operating time was 87 minutes and the mean hospital stay 2.7 days. There were nine failures. The incidence of late urinary tract damage was 1.6% and haemorrhage requiring transfusion 3.7%. Both the complication and failure rate fell slowly with experience, implying that the surgical learning period is significantly longer than with conventional surgery. With better selection it is felt that these figures can be further improved.

Safety of a single aerosol administration of escalating doses of the cationic lipid GL-67/DOPE/DMPE-PEG5000 formulation to the lungs of normal volunteers.

Several groups are assessing the use of cationic lipids for respiratory gene therapy. To date no human data are available regarding the safety of intra-pulmonary cationic lipid delivery. In preparation for a trial of pulmonary delivery of the CFTR gene, we have assessed the safety of nebulised lipid GL-67/DOPE/DMPE-PEG5000 (GL-67A), the cationic lipid formulation to be used in this study. Fifteen healthy volunteers were given incremental doses of GL-67A via a Pari LC Jet nebuliser; three volunteers in each of five dosing cohorts with a week interval between cohorts. Markers of safety included clinical assessment, measurement of lung function, chest CT scan, serological testing and analysis of induced sputum. Measurements were taken before administration and at intervals up to 21 days thereafter. No adverse clinical events were seen or any statistically significant changes in spirometry or gas transfer. There were no clinically significant changes in any of the blood parameters and no CT changes were seen. Comparisons of the cellular subpopulations (neutrophils, eosinophils, lymphocytes and macrophages) in induced sputum showed no significant alterations following administration of the GL-67A. This study suggests that a single application of aerosol formulation of GL-67A does not result in clinically detectable changes when given by nebulisation into the lungs of normal volunteers and provides an indication of a lipid dose tolerated in man.

Repeat administration of an adenovirus vector encoding cystic fibrosis transmembrane conductance regulator to the nasal epithelium of patients with cystic fibrosis.

Cystic fibrosis (CF) is a common autosomal recessive disease caused by mutations in the CF transmembrane conductance regulator gene. Recombinant adenoviruses have shown promise as vectors for transfer of CF transmembrane conductance regulator cDNA to airway epithelia and correction of the Cl- transport defect. However, because adenovirus-mediated gene transfer is transient, use of adenovirus as a vector for treatment of CF would require repeated administration. Therefore, we evaluated repeat administration of an adenovirus vector to the nasal epithelium of patients with CF with five escalating doses of up to 10(10) infectious units. There were no detectable adverse affects. All subjects were initially seropositive but developed additional humoral immune responses. The vector partially corrected the defect in airway epithelial Cl- transport in some subjects, although there was variability between subjects and there was less correction with subsequent administration, perhaps because the immune response limited gene transfer. Future work must focus on vectors with increased efficiency and with the ability to evade host defenses.

Use of portable real-time ultrasound scanner in district antenatal clinics.

A portable real-time ultrasound scanner was transported to nine district antenatal clinics up to 35 miles from the base hospital. A total of 100 patients was scanned. During a scanning time of five to ten minutes, measurements of biparietal diameters were obtained easily, and in most cases details of placental location, fetal movement and the fetal spine were obtained.

The clinical diagnosis of major congenital abnormalities of the fetal central nervous system.

During the ten years between 1965 and 1974, 207 infants with a major congenital abnormality of the central nervous system were born at Mill Road Maternity Hospital, Liverpool; open neural tube defects occurred in 92 per cent of cases. Only cases of anencephaly were frequently diagnosed clinically before labour and this was rarely so for spina bifida alone. Only 11 patients (5-3 per cent) had previously been delivered of an affected infant. The routine screening of pregnant patients is briefly discussed.