Paraovarian cystic endosalpingiosis in association with tamoxifen therapy.

This report describes a case of macroscopically visible cystic endosalpingiosis involving the paraovarian region in a woman who had been taking tamoxifen for breast cancer. A 2.5 cm multicystic lesion was seen on the external surface of the right ovary and histological examination showed a mass of dilated glands lined by ciliated tubal-type epithelium and set in a fibrovascular stroma. Cystic endosalpingiosis resulting in a tumour-like mass is a rarely described entity which is probably not well recognised by histopathologists. Although unlikely to be mistaken for malignancy, the lesion may result in diagnostic confusion. The role of tamoxifen in the development of the lesion in the present case is not clear but the oestrogenic effects of this drug may have contributed to its formation.

Acute fatty liver of pregnancy and diagnosis by computed tomography.

A 39 year old woman was admitted to a maternity unit at 34 weeks' gestation with nausea, vomiting, and jaundice. Her condition deteriorated, and she was transferred to hospital, deeply unconscious and hypotensive. The diagnosis of acute fatty liver of pregnancy was initially suggested by the typical history of prodromal malaise and vomiting and the rapid onset of hepatic encephalopathy with profound hypoglycaemia and only small increases in transaminase activities. Computed tomography was performed: there was no enlargement of the liver or spleen, but the attenuation value over the liver indicated appreciable fatty infiltration of the liver, establishing the diagnosis of acute fatty liver of pregnancy. Computed tomography is of value in the diagnosis of liver disease of late pregnancy, and this technique may become the method of choice for the investigation of acute fatty liver of pregnancy.

Histocompatibility antigens and intrauterine fetal growth retardation.

Maternal-fetal antigen compatibility adversely affects fetal and placental weights in animal experiments and is associated with recurrent spontaneous abortion and preeclampsia in human reproduction. HLA A and B types of the mother, father and infant were determined in 30 pregnancies complicated by intrauterine fetal growth retardation (IUGR) and in 32 normal pregnancies. The frequency and degree of antigenic compatibility between the parents and the mothers and their infants were compared between the groups. There was no evidence that IUGR was associated with a significant degree of HLA A and B antigenic compatibility.

Immunofluorescent studies of the uteroplacental arteries in normal pregnancy.

Immunofluorescent studies were performed on placental bed biopsies from 27 normal pregnancies. Uteroplacental arteries were present in 26 of the 27 biopsies and all showed deposition of fibrin in relation to the fibrinoid layer within the vessel wall; 12 also showed deposition of C3. Interstitial fibrinoid deposits also stained positively with fibrin. There was no deposition of immunoglobulins within the arterial changes nor in association with intramural or interstitial trophoblast. This study indicates that fibrin is a significant contributor to the fibrinoid layer within the uteroplacental arteries, and suggests that the presence of bound C3 is due to the activation of the complement system by fibrinogenesis. There was no evidence that the humoral immune response was involved in the aetiology of the physiological changes in the uteroplacental arteries.

Birth before arrival in hospital.

In a series of 35,466 booked patients, the incidence of birth before arrival in hospital (BBA) was one in 695 (0.14%). These labours were usually precipitate (71%), and 51% of them occurred in the patient's first or second pregnancy. Most BBAs were avoidable (65%) had the patients attempted to reach hospital at the onset of labour. A patient need not be concerned about the possibility of BBA if she presents for assessment when she believes that labour has begun.

Acute polyhydramnios--a complication of monozygous twin pregnancy.

Eight patients with acute polyhydramnios were encountered in 31 103 pregnancies, an incidence of 1 in 3888. All patients with acute polyhydramnios had monozygous twin pregnancies and 14 of the 16 infants were normal. The condition occurred in the second trimester and usually ended in premature delivery within a few days. The perinatal mortality was 100 per cent and accounted for 14.9 per cent of the perinatal mortality in twins.