The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey.

BACKGROUND: A prospective epidemiology study evaluated the role of specific social and psychological variables in the prediction of depressive symptomatology and disorders following childbirth in a community sample. Measures of social support used previously in clinically depressed populations facilitated further comparison. METHODS: Nulliparous pregnant women (N = 507) were interviewed during pregnancy with the Interview Measure of Social Relationships (IMSR) and a contextual assessment of pregnancy-related support and adversity and 427 were followed up at 3 months postpartum with the 30-item GHQ, including six depression items. To establish the clinical representativeness of the GHQ, high GHQ scorers and a random subsample of low scorers were interviewed using the SCAN. Regression models were developed using the GHQ Depression scale (GHQ-D), the IMSR and other risk factor data. RESULTS: GHQ-D after childbirth was predicted by lack of perceived support from members of the woman's primary group and lack of support in relation to the event becoming pregnant; this held even after controlling for antenatal depression, neuroticism, family and personal psychiatric history and adversity. Informant-rated deficits in provision of social support also predicted later depression. The size of the primary social network group previously found to be related to depression in women, did not predict depressive symptom development. CONCLUSION: Predictors of depressive symptom development differ from predictors of recovery from clinical depression in women. Interventions should be designed to reduce specific deficits in social support observed in particular study populations.

Prechemotherapy serum CA125 level as a predictor of survival outcome in epithelial carcinoma of the ovary.

A total of 55 patients with epithelial ovarian carcinoma treated with platinum-based chemotherapy were followed for a minimum period of 2 years. Of these 22 patients had a prechemotherapy serum CA125 level of less than 50 ku/l and 33 patients had a serum CA125 level of greater than or equal to 50 ku/l. The 5-year actuarial survival of the two groups were 75% and 10% respectively. Prechemotherapy CA125 level taken 4 weeks after debulking surgery may predict the eventual survival outcome in epithelial ovarian cancer patients who undergo chemotherapy treatment.

Long-term survival after chemotherapy with cisplatinum, adriamycin and cyclophosphamide for carcinoma of the ovary.

Forty six patients with FIGO Stage II, III, and IV ovarian cancer received treatment with cisplatinum, adriamycin and cyclophosphamide. After a minimum follow-up time of 60 months 13 patients remain free of recurrence. The overall 5-year survival is 39% and the median survival is 39 months. The 5-year survival for Stages II, III, and IV is 64%, 40% and 0% respectively. The 5-year actuarial survival for those who had less than 2 cm residual disease (including those with complete debulking) is 72%, while for those who had greater than 2 cm residual disease (including those who had biopsy only) is 15%. None of the patients have developed any second neoplasm.

Development and validation of a radioimmunoassay for human secretory 'pregnancy-associated endometrial alpha 2-globulin' (alpha 2-PEG) and detection in serum during pregnancy.

A specific and sensitive radioimmunoassay has been developed for pregnancy-associated endometrial alpha 2-globulin (alpha 2-PEG), the major secretory protein of the human endometrium during the mid- to late-luteal phase of the menstrual cycle and first trimester of pregnancy. This assay enabled alpha 2-PEG to be measured in the cytosolic extracts of endometrium, amniotic fluid, seminal plasma and in pregnancy sera. The concentration of alpha 2-PEG in cytosols prepared from mid-secretory endometrium was 44-fold higher than in those from proliferative endometrium and a further 30-fold increase during the first trimester in comparison with mid-secretory endometrium. Levels of alpha 2-PEG in amniotic fluid (15-20 weeks) and seminal plasma were 15 +/- 4 and 55 +/- 7 micrograms/ml, respectively. With the exception of sera, where alpha 2-PEG was undetectable using rocket immunoelectrophoresis, estimates of alpha 2-PEG levels in these compartments, measured by rocket immunoelectrophoretic and RIA assays were comparable, although for seminal plasma 2.5-fold higher estimates were obtained by RIA. Detectable levels of alpha 2-PEG were obtained in 253 of 275 (92%) pregnancy sera tested. During pregnancy, peak levels were detected between weeks 6 and 11 but these represented only 2% of the levels detected in amniotic fluid. These observations support evidence from in vitro studies that alpha 2-PEG is a product of the secretory glandular epithelium, a tissue prominent in the first trimester and whose principal secretory route during pregnancy is into the amniotic fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Amniotic fluid concentrations of secreted pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG).

The levels of pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG), the two major proteins synthesized and secreted by the endometrium in vitro, have been assayed in 210 amniotic fluid specimens obtained at termination of pregnancy or by amniocentesis, or at delivery. alpha 1-PEG was undetectable until week 10 and thereafter rose to peak levels between weeks 20 and 24. Levels fell 15-fold by week 35 but substantial amounts were still present at parturition. alpha 2-PEG was present at highest levels during early pregnancy, at weeks 6-15, but thereafter levels rapidly fell until during weeks 31-42 alpha 2-PEG was detectable in only 3 of 25 specimens. During weeks 15-20, when alpha 2-PEG levels fell and alpha 1-PEG levels rose, a high correlation was observed between the week of gestation and the log of the ratios of the concentration of these proteins. These observations provide the opportunity to assess the role of endometrial and decidual dysfunction in the aetiology of pregnancy disorders.

The role of second-look laparotomy in the management of patients with stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide.

Twenty-eight patients underwent a second-look laparotomy on completing triple agent chemotherapy with cisplatin, adriamycin and cyclophosphamide. The adequacy of the primary debulking procedure and the stage of tumour were the most significant factors associated with a good prognosis. Grade and histological type of tumour had no effect on survival rates. Eighteen patients were surgically free of disease at the second-look procedure and of these, all are alive and disease free with a mean survival time of 39 months. Of the 10 patients with positive second-look procedures, four are dead. The mean survival for patients with positive second look laparotomies was 30.7 months. Second-look laparotomy may contribute to increased survival if pelvic clearance was not attempted at initial staging laparotomy but should primarily be used to assess new agents and new combinations of chemotherapeutic agents and to define the optimum number of courses of chemotherapy.

Protein synthesis and secretion by the human endometrium during the menstrual cycle and the effect of progesterone in vitro.

To identify markers of endometrial differentiation specimens of endometrium from the menstrual cycle were incubated in vitro with [35S]methionine, in the absence or presence of progesterone, and protein synthesis and secretion were studied by fluorographic analysis of one dimensional SDS/gradient polyacrylamide gels. Changes were demonstrated in the rate of synthesis and secretion of a number of endometrial proteins (EP) during the cycle and in response to progesterone. Endometrial proteins were classified into three groups: Group I-synthesized and secreted throughout the menstrual cycle and unaffected by progesterone exposure; Group II-synthesis and secretion associated with histological type of endometrium and unaffected by progesterone exposure, e.g. EP 13 (Mr 33,000) with proliferative, EP 15 (Mr 28,000) with secretory and EP 14 (Mr 32,000) with late secretory endometrium; Group III-synthesis and secretion regulated by progesterone exposure irrespective of source of endometrium, e.g. EP 9 (Mr 54,000) and 11 (Mr 45,000). The Group II proteins EP 14 and 15 were also the major secretory protein products of endometrium from first and second trimester pregnancy respectively, the native forms referred to as pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG). We conclude that EP 15 (alpha 2-PEG) represents a human analogue of uteroglobin.

A study of cryosurgery and the CO2 laser in treatment of carcinoma in situ (CIN III) of the uterine cervix.

The results of laser and cryosurgical treatment in 106 patients with histologically proven carcinoma in situ of the uterine cervix (CIN III) are presented. Seventy-one patients were treated with the laser and in 63 of these further follow-up with colposcopy and cytology failed to show any abnormality. This represents an initial success rate of 89%. In 8 patients (11%) initial treatment was considered to have failed because of persistent dyskaryotic smears and histological evidence of cervical intraepithelial neoplasia (CIN II-III). Six of these patients were treated successfully with a further laser application and two patients had conization. The overall success rate for the laser was 97%. Thirty-five patients were treated with cryosurgery and subsequent follow-up was negative in 29 of these patients (83%). The 6 treatment failures (17%) were subsequently successfully treated with local destructive therapy (4 with cryosurgery, 1 with laser, and 1 with needle diathermy). The overall success rate for cryofreezing was 94.2%. In cases of CIN III the laser is more likely to achieve eradication of the lesion with a single application than cryofreezing.

Protein synthesis and secretion by the human endometrium and decidua during early pregnancy.

To investigate the role of the endometrium in sustaining early pregnancy, specimens of endometrium from early pregnancy were incubated in vitro with radiolabelled amino acids, and protein synthesis and secretion were studied by subsequent fluorographic analysis of one-and two-dimensional polyacrylamide gels. Seventeen secreted endometrial proteins (EP) were identified. Changes were demonstrated in the rate of synthesis and/or secretion of a number of these proteins during early pregnancy. Two proteins, EP 14 and EP 15, are the principal secretory proteins of pregnancy endometrium. EP 14 (subunit mol. wt 32 000) is associated with decidualized endometrium and its rate of synthesis/secretion increases during early pregnancy. EP 15 (subunit mol. wt 28 000) is also synthesized and secreted by the secretory endometrium during the menstrual cycle, and during early pregnancy, but its secretion declines to undetectable levels by week 15-16. These proteins may provide useful markers of endometrial function and differentiation during the menstrual cycle and pregnancy.

Immunochemical detection and characterization of pregnancy-associated endometrial alpha 1- and alpha 2-globulins secreted by human endometrium and decidua.

Antisera raised against the soluble antigens of the endometrium of early pregnancy detected two antigenic proteins of alpha 1 and alpha 2 mobility in extracts of this tissue and were termed antigens A and B. Neither antigen was detected in pregnancy sera or extracts of proliferative endometrium, but antigen B was detected in extracts of secretory endometrium and both were present in amniotic fluid and medium from in-vitro incubations of pregnancy endometrium. Fractionation of radiolabelled medium on ion-exchange chromatography demonstrated that antigens A and B co-eluted with the proteins from which EP14 and EP15 were derived and which were the major secretory polypeptides of pregnancy endometrium in vitro. Further biochemical purification revealed that EP14 (Mr 32 000) was derived from a protein of native molecular weight 36 000 which existed in two forms, whereas EP15 (Mr 28 000) was derived from a dimeric glycoprotein of native molecular weight 56 000. Immunochemical studies demonstrated that antigens A and B are identical to these two secretory proteins and have been termed pregnancy-associated endometrial alpha 1- and alpha 2-globulins (alpha 1- and alpha 2-PEG).