Outcome of IVF/ICSI referrals from the Royal Alexandra Hospital (level 2 infertility service) to Glasgow Royal Infirmary (level 3 infertility service).

In a 2-year period (2004 and 2005), 117 couples with infertility were referred from secondary care for IVF/ICSI treatment. This study describes the age, waiting times, diagnostic categories and outcomes for all couples referred. A total of 59% (69) of all couples referred conceived. Of these, 25% (29 couples) conceived spontaneously or as a result of simpler treatments and 34% (40 couples) conceived following IVF/ICSI treatment. The twin pregnancy rate following IVF/ICSI was 25% and the average waiting time from referral to treatment was 13-18 months. Couples with female factor infertility (excluding endometriosis) and couples with unexplained infertility experienced a higher spontaneous pregnancy rate while awaiting IVF/ICSI treatment, than those couples with male factor or combined infertility. However, couples with male factor or combined infertility achieved much higher success rates with IVF/ICSI treatment.

The water quality of the River Wear, north-east England

A 1-year detailed study of water quality in the River Wear in combination with longer (decadal) term Environment Agency data (Harmonised Monitoring Scheme) show the influences of historic lead-zinc and coal mining and sewage inputs. The water quality for many determinands, such as sodium, chloride, boron, nitrate, and soluble reactive phosphorus, varies seasonally due to changing flow conditions. For most dissolved determinands, concentrations decrease with increasing flow in response to dilution of point and diffuse sources by rainfall. However, concentrations increase with increasing flow for dissolved organic carbon, aluminium, lead, iron, yttrium, and the lanthanides and actinides. This increase probably reflects two processes. Firstly, trace element-enriched runoff occurs from the acidic moorland areas of the catchment when it wets up. Secondly, at high flows, increased production of transition metals bearing microparticulate material occurs; these pass through conventional filters used to separate dissolved from particulate materials. For the particulate components, iron, manganese, aluminium, and some trace transition metals are present above the analytical detection limits and concentrations increase with increasing flow in response to increasing suspended sediment levels. However, particulate metal concentrations are relatively low for the Wear compared to the other eastern UK rivers, even though historic lead-zinc mining activity in the upper portions of the Wear catchment has led to extensive spoil contamination of the land. This feature probably reflects the lack of a significant flood plain area, where trace contaminants can accumulate within the sediments. The importance of inputs of pumped water from former coalmines is highlighted; increased manganese and dissolved carbon dioxide concentrations and reduced pH result. Examination of the Harmonised Monitoring Scheme data indicate no clear long-term changes in water quality for all but one determinand, although analysis is hampered by changes in sampling frequency for all determinands and changes in detection limits for certain trace metals. The only clear long-term change is a reduction in the micro-organic insecticide, aldrin. Nonetheless, the long-term data, when plotted as a function of month, follow the same pattern as the LOIS data. For aldrin, the higher values during the early period of record occurred in the latter half of each year, presumably as a consequence of seasonal application and enhanced leaching during the autumn.

The neonatal consequences and neonatal cost of reducing the number of embryos transferred following IVF.

This clinical audit project examined the effects of change of policy between 1990 and 1993 transferring an average two (maximum three for particular cases) embryos to women undergoing IVF in the West of Scotland programme. All women who achieved clinical pregnancy in 1990 (92 women) and 1993 (93 women) as a result of the IVF programme were included in the study. The hospital records of women via the programme were analysed. The results of the study showed that there was a significant reduction in the rate of multiple pregnancy, preterm birth and low birth weight babies in the 1993 group (new policy). The cost of neonatal intensive care in 1993 for babies born following IVF was about nine times lower than that in 1990 (old policy). This study concluded that a policy of transferring two embryos (or three for particular cases) to women in an IVF programme, had improved the perinatal outcome and reduced the cost of the neonatal service for those babies.

Effects of in-vitro exposure to HCG on subsequent HCG-responsiveness of human granulosa cells obtained following treatment with GnRH analogue and gonadotrophins: an in-vitro model for luteal phase support.

The pregnancy rate in patients undergoing assisted conception treatment following pituitary desensitization with GnRH analogue and ovarian stimulation with gonadotrophins has been reported to be higher when ovarian function is supported in the luteal phase by exogenous human chorionic gonadotrophin (HCG). In the present study, we have examined the effects of culturing monolayers of granulosa cells, collected from such patients at oocyte retrieval, for various time intervals in the presence or absence of HCG on their subsequent ability to secrete progesterone (P4) either spontaneously or in response to further challenge with HCG. When cultured in the absence of HCG, granulosa cells demonstrated a rapid decline in both the spontaneous P4 secretion rate and the ability to secrete P4 in response to HCG. Maintenance in the presence of HCG inhibited the rapid decline in ability to secrete P4 spontaneously and also significantly enhanced the ability to respond to subsequent HCG stimulation. These results suggest that HCG support in the luteal phase in GnRH analogue-treated patients may have a cellular basis for its action both in maintenance of P4 secretion and also in rendering the corpus luteum more sensitive to rescue by conceptus-derived HCG.

How frequently need vaginal smears be taken after hysterectomy for cervical intraepithelial neoplasia?

A retrospective longitudinal review identified 341 women who had had a hysterectomy in association with CIN 3, in Tayside Region, during the years 1967-1977; 219 (64%) had completed 10 years of cytology follow-up and of 140 women eligible for 15-year smears 79 (56%) completed the 15-year follow-up. Eight (4%) of the 219 patients developed abnormal cytology, but in six, smears reverted to normal spontaneously. Two patients had persistently abnormal smears and vaginal intraepithelial neoplasia (VAIN) was diagnosed. Only one patient completing 15-year follow-up had an abnormal smear and VAIN later diagnosed. No patient over this 15-year period developed invasive vaginal carcinoma. Sixty vaginal carcinomas were identified during the period 1957-1987 from the gynaecology cancer register; only one was associated with a previous diagnosis of CIN 3 at hysterectomy. With such data we would propose screening 6-monthly during the first post-operative year and then at 2 years. If these smears were normal, the patient could then revert to the normal screening programme.

Eruption of the nevado del ruiz volcano, Colombia, on 13 november 1985: gas flux and fluid geochemistry.

The 13 November 1985 eruption of Nevado del Ruiz volcano, in Colombia, released a small volume of pyroclastic material and a disproportionately large volume of volcanic gas. Before the eruption, summit fumarole gases became less water-rich, and the sulfur/chlorine ratio increased. Remote measurements of sulfur dioxide flux after the eruption indicated active degassing at levels associated with eruptive or inter-eruptive stages of other volcanoes. Thermal water analyses revealed increases in magnesium, calcium, and potassium and an increase in the magnesium/chlorine ratio, suggesting that these elements may have been leached from new magma. Ash leachate data showed sulfate and chloride concentrations and ratios that would be expected for the late stages ofa major Plinian eruption. Water from the lahar contained high concentrations of sulfate and had a sulfur/chlorine ratio of 4.67, suggesting that water ejected from the crater lake and turbulent mixing of pyroclasts and glacial ice triggered the lahar. Microprobe analyses of pumice from this eruption and the most recent previous event showed similar mixed andesites. The uniform composition of the pumices and the unusually high ratio of gas to magma suggest that, although a new batch of magma triggered this eruption, the pumice that erupted may actually be old. Large volumes of new magma and glacial ice make the volcano dangerous and should stimulate development of an integrated long-term monitoring program to include Tolima volcano, 25 kilometers to the south.

Nuevos análisis de lavas y bombas del volcán Rincón de la Vieja, Costa Rica

En diversas visitas a la cima del volcán Rincón de la Vieja se recolectaron 5 muestras de productos eruptados y 7 muestras de productos de erupciones anteriores. Las 12 muestras andesitas porfiríticas, pilostaxísticas con fenocristales de plagioclasa, augita y magnetita. Aunque estas compreden un rango limitado en sus contenidos de sílica y magnesio, los análisis de las muestras sugieren cambios sistemáticos en el tiempo para algunos de los óxidos principales, elementos traza y en las razones de los elementos incompatibles, cuando se comparan las muestra entre sí. Las pocas muestras presentadas aquí sugieren que este centro volcánico puede ser adecuado pra examinar el desarrollo, en un tiempo largo, de un sistema magmático abierto (AU)