Chocolate cysts from ovarian follicles.

OBJECTIVE: To study the development of chocolate cysts by serial transvaginal ultrasonographic tracking of ovarian follicles. DESIGN: Retrospective study. SETTING: Department of Obstetrics and Gynaecology, Sunderland Royal Hospital, Sunderland, United Kingdom. PATIENT(S): We reviewed case notes of all patients who underwent laparoscopy for diathermy to endometriosis/ovarian diathermy/aspiration of ovarian cysts from 1989 to 1998. Twelve women with histories of infertility and proven chocolate cysts with documented ultrasonographic findings were included in the study. INTERVENTION(S): Serial ultrasonographic tracking of ovarian follicles in the cycle leading to the development of the chocolate cysts, followed by ultrasonographic tracking of cysts for 3 months and laparoscopy. MAIN OUTCOME MEASURE(S): Development and formation of chocolate cysts. RESULT(S): The diagnosis of chocolate cysts was confirmed laparoscopically in all patients and histopathologically in four. Ultrasound confirmed that they had all developed from follicles. CONCLUSION(S): Chocolate cysts can develop from ovarian follicles.

Female victims of rape and their genital injuries.

OBJECTIVE: A minority (some report < 10%) of women report sexual assault. Of those that negotiate the police process, only a minority will come to a court hearing. It is thought that the courts still rely upon medical evidence, in particular evidence of genital injury to 'prove' the rape. This study aimed to ascertain the incidence of genital injury in victims of alleged rape. DESIGN: Retrospective review of case records of women who reported they had had been raped, provided by women doctors on the Northumbrian Police Doctors scheme. SAMPLE: Case records from Newcastle, North and South Tyneside, Sunderland and Northumbria. METHODS: Analysis of records in the standardised booklet used by police surgeons to examine women reporting rape. MAIN OUTCOME MEASURES: Presence of genital injury, presence of other physical injuries. RESULTS: A minority of women had genital injuries (22/83); the majority had some form of physical injury (68/83), although most of these were minor. CONCLUSION: The study shows that only a minority of women examined by specifically trained police doctors show evidence of genital injury. The absence of genital injury does not exclude rape.

Poor perinatal outcome associated with maternal Brucella abortus infection.

BACKGROUND: Reports suggest that perinatal infection with Brucella abortus does not cause poor obstetric outcomes, because of protective mechanisms in the human, not seen in animal species. CASE: We report a case of maternal brucellosis resulting in preterm labor, chorioamnionitis, placental abruption, and delivery of a live-born infant at 25 weeks' gestational age. Both maternal blood cultures and amniotic fluid cultures were positive for B abortus species, and delivery occurred despite aggressive antibiotic and tocolytic therapy. CONCLUSION: Maternal infection with B abortus during pregnancy can lead to significant perinatal morbidity, casting doubt on reports that human pregnancy is resistant to such infection.

The results of tubal surgery in the treatment of infertility in two non-specialist hospitals.

The results of surgery for tubal damage, other than reversal of sterilization, were studied in two large hospitals. This is the first recent study from centres claiming no special expertise in this surgery. An unusually high follow-up rate was obtained. The term pregnancy rate for patients operated on for bilateral distal tubal occlusion was 4%. The success rate is lower than the lowest reported, overall success rates for each cycle of in vitro fertilization (IVF) and very much lower than cumulative term pregnancy rates for tubal surgery reported by most other authors. Patients with distal tubal occlusion but minimal adhesions had the best prognosis. Our results suggest that, provided in vitro fertilization is available, only those patients with good prognostic factors should undergo tubal surgery. These represent the minority of all patients with non-iatrogenic tubal blockage.

FiSBoG (fetal steroid binding glycoprotein) as a fetal function test.

FiSBoG is a recently described fetal protein. It can be detected in the cord blood. It can be identified in maternal serum in late pregnancy. In this study the values in maternal serum in late pregnancy in 31 normal pregnancies were compared with 23 abnormal pregnancies: 4 twin pregnancies, 4 stillbirth, 4 cases of pre-eclampsia, 4 who had a significant antepartum haemorrhage and 7 who were small-for-dates, to assess its potential as a test of fetal well-being. FiSBoG appeared to have no significant role as a test of fetal well-being.

Nasal absorption of progesterone in women.

Absorption profiles were obtained from women following the administration of ointment containing 20, 30 and 40 mg of progesterone to the nasal mucosa. There were no significant differences in area-under-curves between groups receiving the drug in one nostril but when 40 mg doses were divided between two nostrils there was a significantly greater area-under-curve suggesting that the area of mucosa applied with the drug is more important than dosage.

PIP: An ointment containing 20, 30, or 40 mg of progesterone was administered to the nasal mucosa of 18 female study subjects to assess whether progesterone is absorbed through this route. The women were studied in the follicular phase (days 5-12) of their menstrual cycle. 16 subjects were investigated during only 1 menstrual cycle and the remaining 2 subjects were tested in 2 nonconsecutive cycles, producing a total of 20 absorption curves. No clinically significant changes were noted in biochemical or hematological parameters. There were no significant differences in area-under-curve between the 20, 30, and 40 mg group receiving the drug in 1 nostril. However, the mean area-under-curve for the group receiving 40 mg divided between the 2 nostrils was significantly higher than the values obtained in either the 20 mg or the 30 mg groups dosed in 1 nostril. It appears that the speed of absorption and blood levels obtained are not dependent on dosage, although the amount of progesterone absorbed can be increased by application to a larger mucosal area. Nasal mucosa absorption profiles peak at a much earlier time than those for rectal and vaginal administration; moreover, the nasal route is likely to be more acceptable to patients. Study subjects reported only a few minor side effects, including a transient unpleasant taste in the mouth and slight stuffiness. Overall, the results of this preliminary investigation suggest that the nasal route of administration is relatively acceptable and capable of providing therapeutically effective levels of progesterone.

Fetal neuroblastoma and catecholamine-induced maternal hypertension.

A case of congenital neuroblastoma is presented. The interesting features are maternal symptomatology consistent with fetal production of catecholamines and the dilemmas of differential diagnosis. Observations are made on the frequency and diagnosis of fetal neoplasia. Antepartum detection of catecholamine metabolites may be the basis for the diagnosis of fetal neuroblastoma.

The effect of progesterone administration on sex hormone binding globulin binding capacity in women with severe premenstrual syndrome.

Thirty-one women with severe premenstrual syndrome had low sex hormone binding globulin (SHBG) binding capacities 30.2 +/- 9.4 nmol DHT bound/l. The SHBG binding capacities rose when they were treated with three different doses of progesterone. On 400 mg (17 women) SHBG level was 45.11 +/- 11.80. On 800 mg (8 women) SHBG binding capacity rose to 64.75 +/- 14.30 and on the six women who took 1200 mg progesterone daily SHBG binding capacity was 78.5 +/- 23.10. These results are discussed.

Sex hormone-binding globulin concentrations in women with severe premenstrual syndrome.

Sex hormone binding globulin (SHBG) binding capacity was measured in 50 women with severe premenstrual syndrome and 50 age-matched controls. The binding capacity was significantly lower (P = 0.001) in the patients. This finding suggests that the levels of SHBG binding capacity could be useful in the diagnosis and may help to explain the aetiology of the premenstrual syndrome.

Food intake before migraine attacks in children.

A questionnaire survey of 120 children with migraine showed an average age of onset of 5.15 years, an equal sex ratio under nine years, and a positive family history in 79 per cent. Eye symptoms (42 per cent) and headaches (32 per cent) heralded an attack, with abdominal pain and vomiting later and less frequent. Visual aura was not recognized under five years, but occurred in 52 per cent of the 13 to 15 year age group. Most attacks occurred on schooldays and 82 per cent were over within two days.The 24-hour food intake before an attack was compared with the food intake seven days later when no migraine occurred. This suggested that fasting (41 per cent) or specific foods (38 per cent) could have been responsible for many of the attacks.