The Ornstein-Uhlenbeck third-order Gaussian process (OUGP) applied directly to the un-resampled heart rate variability (HRV) tachogram for detrending and low-pass filtering.

The heart rate variability signal derived from the ECG is a beat-to-beat record of RR-intervals and is, as a time series, irregularly sampled. It is common engineering practice to resample this record, typically at 4 Hz, onto a regular time axis for conventional analysis using IIR and FIR filters, and power spectral estimators, in the time and frequency domain, respectively. However, such interpolative resampling introduces noise into the signal and the information quality is compromised. Here, the Ornstein-Uhlenbeck third-order band-pass filter is presented which operates on data sampled at arbitrary time and preserves fidelity. The algorithm is available as open source code for MATLAB(®) (MathWorks™ Inc.) and supported by an interactive website at http://clinengnhs.liv.ac.uk/OUGP.htm.

An efficient time-varying filter for detrending and bandwidth limiting the heart rate variability tachogram without resampling: MATLAB open-source code and Internet web-based implementation.

The heart rate variability (HRV) signal derived from the ECG is a beat-to-beat record of RR intervals and is, as a time series, irregularly sampled. It is common engineering practice to resample this record, typically at 4 Hz, onto a regular time axis for analysis in advance of time domain filtering and spectral analysis based on the DFT. However, it is recognised that resampling introduces noise and frequency bias. The present work describes the implementation of a time-varying filter using a smoothing priors approach based on a Gaussian process model, which does not require data to be regular in time. Its output is directly compatible with the Lomb-Scargle algorithm for power density estimation. A web-based demonstration is available over the Internet for exemplar data. The MATLAB (MathWorks Inc.) code can be downloaded as open source.

Spironolactone in the treatment of hirsutism.

Spironolactone (100 mg) for 25 days in each menstrual cycle was assessed over 6 months for treatment of hirsutism in 35 patients. Five patients withdrew due to either nausea or polymenorrhea. the latter problem was encountered in 16 patients. Of the 30 remaining patients, 17 had a significant reduction in hair growth as assessed by Ferriman and Gallwey hair scores (p less than 0.05). The only significant change in endocrine parameters was a reduction in serum testosterone (p less than 0.05). Treatment with spironolactone alone was inferior to our previous experience with the cyproterone acetate--estrogen combination.

Human amnion in the treatment of vaginal malformations.

Vaginoplasty using human amnion has been performed in 27 patients aged from 13 to 28 years. Excellent epithelialization occurred with good functional results; the technique appears to be preferable to other surgical methods.

Spironolactone in combination with an oral contraceptive: an alternative treatment for hirsutism.

The clinical efficacy of a combination of spironolactone and an oral contraceptive pill (Conova 30) was assessed in 23 patients presenting with hirsutism of whom 20 completed 6 months of treatment. Of the 20 patients, 16 showed improvement on objective (Ferriman & Gallwey hair score) and subjective assessment. Serum levels of androgens (testosterone, androstenedione and 17-hydroxy progesterone) were suppressed and sex hormone binding globulins were elevated. Nausea was the only significant side effect.

Effect of cyproterone acetate-ethinyl oestradiol treatment on adrenal function in hirsute women.

Pituitary adrenal suppression has been assessed in twenty-two patients receiving cyproterone acetate (100 mg) and ethinyl oestradiol (30 micrograms) for the treatment of hirsutism. Cortisol responsiveness to ACTH and to insulin induced hypoglycaemia, and diurnal variations of plasma cortisol levels were measured before and after 6 months of treatment. There was no evidence that adrenal suppression is a significant problem in this group of patients.

Sperm/cervical-mucus crossed hostility testing and antisperm antibodies in the husband.

The behaviour of sperms has been investigated in preovulatory cervical mucus in 44 infertile couples. In 22 couples, immobilising and agglutinating autoantibodies were detected in the husband's sera in high titres. In 10 couples, antisperm antibodies were detected in the husbands by indirect immunofluorescent testing. In 12 couples, no evidence of antisperm antibodies was found in either husbands or wives. The results obtained with husband and wife were compared with the behaviour of the husband's sperms in cervical mucus from fertile donors, and with the behaviour of sperms from fertile donors in the wives' mucus. This crossed hostility test indicated that high tires of immobilising and agglutinating antisperm antibodies in the husband effectively prevented the sperms from penetrating the cervical mucus, even though the sperms appeared normal on seminal analysis. Antibodies detected by indirect immunofluorescence did not have this effect. Poor penetration was also observed with low sperm motility or poor cervical mucus. It is concluded that this test, taken with the postcoital test, could provide a useful screen for immunological causes of infertility and an accurate test for the clinical relevance of antisperm antibody tests.

The treatment of hirsutism with cyproterone acetate (an anti-androgen).

The rationale of anti-androgen treatment for hirsutism is explained. The results are presented of treatment with cyproterone acetate of idiopathic hirsutism or hirsutism associated with polycystic ovarian disease. Ten out of 14 patients showed a good response after six months treatment. The response was dramatic in two patients.

Inhibition of puerperal lactation. A double blind study of bromocriptine and placebo.

Bromocriptine and placebo were randomly allocated for three weeks to 52 postpartum patients requiring lactation suppression. Bromocriptine significantly lowered plasma prolactin levels and suppressed breast milk, breast pain and engorgement quicker than placebo. No side-effects were noted and rebound lactation did not occur. Menstruation appeared to re-start sooner when Bromocriptine was given.

Recognizing the fetus at risk.

Impairment of either fetal growth potential or placental growth support may cause fetal growth retardation. Impaired growth potential is associated with a number of congenital abnormalities. Awareness of the increased possibility of fetal anomaly comes from the obstetric patient's reproductive history or family history more than from anything else. In general, if the likelihood of fetal anomaly seems increased, investigation in the form of amniocentesis, ultrasonic monitoring of fetal growth, radiologic study, or all three may be required. More common than poor growth potential is poor placental growth support. Here, historical evidence of maternal hypertension or toxemic disorders, among other abnormal clinical findings, is an indication for fetal monitoring.

Using ultrasound to assess the fetus at risk.

In early pregnancy, ultrasonic scanning is valuable if the patient's menstrual history is unreliable or if uterine size is less than expected. The crown-rump length of the embryo can be measured from the sixth week of gestation, and pulsation of the heart detected from the seventh. The crown-rump length of the early embryo gives precise information about maturity. Somewhat later in pregnancy, fetal maturity and growth rate can be assessed accurately by measurement of the biparietal diameter. The head circumference and the fetal upper abdominal circumference together give the head-abdomen ratio, which can be helpful in assessing fetal nutrition. The abdominal circumference also may be used to predict fetal weight.

Vaginoplasty at the Chelsea hospital for women: a comparison of two techniques.

The results have been compared of 37 McIndoe-Read operations and 39 Williams' operations carried out at the Chelsea Hospital for Women. The McIndoe-Read procedures comprised 28 primary operations for congentital absence of the vagina, five repeat procedures and four operations for other conditions; the Williams' procedures comprised 27 primary operations, four operations following the previous vaginoplasty and eight operations following other procedures. The results favoured the Williams' vulvovaginoplasty. Special mention must be made of the dangers of repeating the McIndoe-Read procedure and of the fact that the vagina constructed by the Williams' technique showed no tendency to contract if intercourse did not occur.

Replacement hormone therapy in gonadal dysgenesis.

Curettage carried out during the third week of treatment of ethinyl oestradiol in 14 patients with gonadal dysgenesis showed cystic glandular hyperplasia in seven patients developed a large endometrial polyp and in one atypical changes were found in the hyperplastic endometrium. In seven patients treated by an oestrogen-progestogen combination normal secretory endometrium was seen in five, proliferative change only in one (thought to be due to incorrect timing of the curettage) and a small proliferative polyp in association with secretory endometrium elsewhere in the uterus in the seventh. In view of these changes and report of adenocarcinoma of the endometrium in patients with gonadal dysgenesis treated with oestrogens alone it is suggested that a regime of low dose oestrogen therapy for 21 days accompanied by a progestogen on days 15 to 21 is preferable to oestrogens alone.

The resistant ovary syndrome.

A patient is described with primary amenorrhoea, raised FSH and LH levels and ovaries containing many primary follicles. These features were characteristic of the "resistant ovary syndrome". After ovarian wedge resection the patient began to menstruate.