The postcoital test: a quantitative method.

A minor modification of the postcoital test (PCT) is made, which allows for a volumetric inspection of the cervical mucus with a standard clinical microscope. Homogeneously sized (40.3-microns) plastic microspheres are sprayed on the cervical mucus prior to placement of the coverslip, and these act as spacers to keep the slide-to-coverslip distance constant. As a result a known volume of cervical mucus is inspected with each microscope field of view and actual sperm concentrations can be calculated. Results from 20 patients are presented. Postcoital mucus samples were analyzed with and without spacer particles. Much of the variability in the microscopic portion (sperm concentration and motility) of the PCT test seems to be attributable to a factor controlled by the microparticles, presumably slide-to-coverslip distance. Variability in both sperm density and motility is decreased by the application of the microspheres.

Uterine prolapse after laparoscopic uterosacral transection. A case report.

Two cases of severe uterine prolapse are reported following laser uterosacral nerve ablation (LUNA). Both patients had a history of vaginal childbirth and subsequent development of secondary infertility and severe dysmenorrhea. It is suggested that this procedure be performed with caution on vaginally parous patients, and that it be reserved for use in patients who have adequate uterine support. Future studies are needed to determine the long-term incidence of uterine procidentia following this procedure.

Hypercalcemic crisis in pregnancy associated with excessive ingestion of calcium carbonate antacid (milk-alkali syndrome): successful treatment with hemodialysis.

Severe hypercalcemia, a potentially life-threatening condition, has been reported rarely during pregnancy. A patient with hypercalcemic crisis associated with excessive ingestion of absorbable calcium antacid was treated successfully with hemodialysis as well as other therapeutic measures, such as saline diuresis. This acute therapy resulted in long-term normalization of maternal calcium levels. The fetus, who exhibited a low biophysical score during the initial admission, was delivered a month later and had an uncomplicated neonatal course. Acute hemodialysis can be an effective, rapid, and safe method of lowering serum calcium levels in pregnant patients with severe hypercalcemia unresponsive to other medical therapies.

Vasa previa.

Diagnosis of vasa previa requires a high index of suspicion. Vasa previa must be included in the differential diagnosis of all cases of third trimester bleeding. When pulsatile vessels are palpated preceding the fetal vertex, vasa previa should be considered along with cord prolapse. Early diagnosis and intervention result in a favorable fetal outcome in this rare condition.

An in-depth study of accidents involving collisions with utility poles.

This paper summarizes the objectives, methodology, findings, and recommendations of a large-scale study of automobile crashes involving utility poles. In an 8-month survey of accidents, information on site characteristics and accident severity was obtained for a sample of 879 crashes. Randomly-selected samples of 795 sites and 627 vehicles provided control information. An accident-predictor model which identifies accident risk on the basis of site measurements has been derived. The model reveals a range of relative risks in the population of exposed poles of the order of 1000:1, and enables the identification of the relatively small proportion of poles which account for the majority of accidents. The model was used in conjunction with estimates of the costs of accidents to show that a number of remedial treatments are warranted. The hazardous effects of low tyre tread depths and improper tyre inflation pressures are also demonstrated.