The impact of maternal serum alpha fetoprotein screening on open neural tube defect births in north-east Scotland.

Over the three years period 1980-1982, 18 256 pregnancies in the Grampian Region of N-E Scotland including the islands of Orkney and Shetland were screened for raised levels of maternal serum alpha fetoprotein (MSAFP) in the second trimester. Thirty six cases of fetal open neural tube defect in singletons were detected (18 anencephaly and 18 spina bifida). Four additional cases of open spina bifida were associated with normal MSAFP levels although two of these were detected by amniotic fluid AFP measurement when amniocentesis was carried out because of previous NTD history. A further three cases of open spina bifida and two of anencephaly occurred in unscreened pregnancies. The MSAFP screening programme alone was thus instrumental in reducing the birth incidence of open neural tube defects by 36 out of 45 cases (80 per cent) in singletons.

The renal clearance of oestriol in late human pregnancy.

The renal clearance of unconjugated oestriol, oestriol glucosiduronate and oestriol sulphate by the kidney in late human pregnancy has been compared with simultaneous measurements of inulin clearance. The results for the fractions not bound to protein indicate that after glomerular filtration, unconjugated oestriol is completely reabsorbed, oestriol glucosiduronate is both filtered and excreted actively by the tubules, and that oestriol sulphate is filtered but not excreted or absorbed by the tubules; the administration of probenecid confirms these observations on tubular handling. The possibility of using endogenous oestril sulphate as a means of measuring the glomerular filtration rate in pregnancy is suggested.

Cardiovascular effects of peritoneal insufflation of carbon dioxide for laparoscopy.

We have investigated, in 13 artificially ventilated and anaesthetized patients, the cardiovascular effects of peritoneal insufflation of carbon dioxide preparatory to laparoscopy. Stepwise increases of intra-abdominal pressure up to a maximum of 25 cm H(2)O were accompanied by increases of airway pressure, intrathoracic pressure, central venous pressure, and femoral venous pressure and by signs of cardiovascular stimulation with mild tachycardia and hypertension. End-tidal carbon dioxide tension rose only slightly. The anaesthetic technique used provided good surgical conditions; our results suggest that it does not impose undue strain on the homoeostatic ability of the patient's cardiovascular system.