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A case of metastasis from squamous carcinoma stage 1B of the cervix to a borderline cystadenoma of the ovary is described. In addition, the patient had atypical endometrial hyperplasia. The patient underwent a radical hysterectomy with no adjuvant postoperative treatment and has resumed work, with no sign of recurrence one year postoperatively. The aspects of the metastasis to the ovary, multiple tumors in the genital tract and tumor-to-tumor metastasis are discussed. Reports on ovarian metastasis in low-stage squamous carcinoma of the cervix are few and it still seems justified to spare the ovaries at surgery in the young patient.

As saliva is an easily accessible biological material, compared with 24-hour urine and blood, the salivary concentration of estriol was studied from the 30th to the 41st week of gestation in 268 samples from 124 normal pregnancies. At the same time, venous blood samples were drawn and analyzed for total and unconjugated estriol. The mean values for the concentration of total estriol in saliva in the 30th and 41st weeks were 2.8 and 7.2 nmol/l respectively. The salivary estriol concentration appears to increase in perfect conformity with its serum concentration in the course of gestation. If estriol in saliva also reflects low serum values and an impaired function of the feto-placental unit, analyses of the saliva may be applicable as a screening procedure in high-risk pregnancies.

An investigation made in 1966-67 of 2 122 pregnant women revealed 182 (8.6%) with significant asymptomatic bacteriuria, of whom 127 could be located in 1983. In 182 non-bacteriuric controls from the same investigation 105 could be located. Eight bacteriuric and 1 non-bacteriuric patient had died, all from causes of death unrelated to urinary tract infections. Data were collected by questionnaires, together with a urine specimen from approximately 73% of the survivors. No differences could be found between the initial bacteriuric and non-bacteriuric group concerning the number and complications of later pregnancies, urinary tract infections requiring hospitalization, or recognized arterial hypertension. In 1983, more of the initially bacteriuric women had experienced urinary tract infections not demanding hospitalization and more were bacteriuric (≥105 col/ml), compared with the controls: 36.5% and 28.8%, respectively. These high rates probably indicate some contamination due to self-sampling. B. anitratum was a new bacteria emerging, compared with the original study.

A one-stage ultrasound screening program was evaluated, using a pregnancy/perinatal database containing information from 2766 pregnancies and deliveries. Among women who did not have a second-trimester ultrasound examination, labor was induced for presumed post-term pregnancy in 4.0% versus 1.6% of pregnancies in the screening group (p = 0.007). In the group with second-trimester ultrasound scanning other than screening, the frequency was 3.2%. Of women with spontaneous labor or who were induced for presumed post-term pregnancy, 3.8% in a screening group and 8.0% in a group with other second-trimester ultrasound examination were post-term according to BPD measurements (p = 0.0003).In the screening group, 6.2% of liveborn singletons were small for gestational age(less than the 10th percentile) compared with 8.5% in the non-screening group (p<0.05).A subset of 365 screened women with optimal menstrual history had spontaneous labor or were induced for presumed post-term pregnancy. According to menstrual history and ultrasound examination, 7.4% and 3.8% of these were post-term, respectively (p = 0.04).It is concluded that the main value of screening lies in a more accurate dating of pregnancy, even when menstrual history is optimal, with a lower incidence of induced labor for believed post-term pregnancies. In addition, there may be an improvement in the obstetric management of pregnancy, reflected in our study as a lower incidence of small for gestational age infants.

With a view to establishing some of the factors responsible for an increased risk of neoplasia in the vagina following primary hysterectomy for dysplasia or carcinoma in situ of the cervix, 63 surgical specimens from patients with subsequent neoplasia in the vagina have been compared with specimens from 40 patients without subsequent neoplasia.We found the frequency of neoplasia in the vagina to be greater when dysplasia or carcinoma in situ could be demonstrated in the vaginal margin. Neither the degree of endo-cervical glandular involvement, the number of mitoses, nor the inflammatory response of the connective tissue appeared to be significant in this respect.No significant connection was found between the severity of the preinvasive lesion of the cervix and the subsequent neoplasia in the vagina.

Hemodynamic changes during the first and third trimester in pregnancy and in the first week of puerperium were evaluated by non-invasive measurements of Systolic Time Intervals (STI) in supine and left lateral position. the Pre-ejection Period (PEP) was found to shorten significantly in pregnancy and the puerperium due to the increased blood volume. the electro-mechanical systole (QS2) and left ventricular ejection time (LVET) were shortened too, while PEP/LVET-ratio was increased in the third trimester due to the mechanical compression of the gravid uterus on the inferior vena cava. A lengthening of QS2 and LVET and a decreased PEP and P/L-ratio were demonstrated in the third trimester in lateral position when the pressure of the enlarged uterus was eliminated. Heart rate (HR) increased in late pregnancy as well as after delivery, while arterial blood pressure (BP) only underwent minor changes. Employment of the STI seems to provide more useful information about the changes in cardiac function during gestation than HR and BP does. the measurements of STI can be repeated without any risk or inconvenience to the patients.

To investigate developments in perinatal care, all fetal and neonatal deaths among those born after at least 24 weeks of gestation at the University Hospital of Tromsø, Norway from 1976 to 1989, were subjected to medical audit. A decrease in total mortality rate was found when based on maturity (≥24 weeks; 19.9-13.4%; p<0.01), and/or birth weight (≥500 g; 19.2-13.4%; p<0.05). This was mainly due to a decrease in fetal deaths (14.8-6.6%; p<0.0001). Deaths during labor (5.4-1.1%; p<0.001), and deaths before the onset of labour (9.4-5.5%; p<0.05) declined. The neonatal death rate remained virtually constant (5.2-6.8%). The incidence of conditions affecting the placenta and the umbilical cord, causing asphyxia and intra-uterine growth retardation, declined, from 9.2 to 5.0% (p<0.01), as did that caused by immaturity (2.8-1.3%; p<0.05). The rates of death caused by cerebral hemorrhage, respiratory distress syndrome, infections, and malformations did not change. There was no significant proportional change in the causes of death from the first to the last period. The rate of fetal death following suboptimal care declined (2.4-0.4%; p<0.01), while the corresponding neonatal death rate remained unchanged (0.9-1.1%). The proportions of both fetal and neonatal deaths occurring after suboptimal care were low (fetal: 16.2, 8.8, and 5.6%; neonatal: 17.1, 23.5, and 16.2%). These differences did not reach statistical significance. The ratio of neonatal to fetal deaths increased from the first (26.1%) to the last period (50.7%; p<0.01), due mainly to a significant shift from fetal to neonatal death among those weighing 500-999 g (19.6-56.0%; p<0.01). It is concluded that prophylactic efforts to avoid preterm birth and IUGR, and further therapeutic efforts in neonatal intensive care are needed to bring down mortality rates at our hospital in the future.

The computerized records of 3074 women who were delivered during the period 1987-1990 were analysed. We studied possible relations of birth weight and gestational age to maternal first- and second-trimester hemoglobin levels. Birth weight and gestational age were taken as outcome variables in a multiple stepwise regression analysis, including factors that might interact with hemoglobin levels. A strong independent inverse correlation between the lowest second-trimester hemoglobin and birth weight was observed. First-trimester hemoglobin levels explained little with regard to birth weight, but had a small negative correlation to gestational age. For gestational age > 259 days we found a strong positive correlation between the first- to second-trimester decrease in hemoglobin and birth weight.

Background. Vasopressin seems to be an important etiological factor for the myometrial hyperactivity and reduced blood flow in primary dysmenorrea. Substances which block the action of vasopressin on the uterus are therefore of interest.Methods. The effect of an orally active, non-peptide vasopressin V1a receptor antagonist, SR 49059, as well as its enantiomer, SR 49770, which is 50 to 100 fold less potent in binding studies, were tested in vitro on myometrium from 14 subjects. Two doses of the compounds, 2 nmol/L and 10 nmol/L, were used for counteracting the contractile effect of arginine vasopressin in a concentration of 0.7 nmol/L.Results. SR 49059, in the lower concentration, significally decreased the response to arginine vasopressin, measured as area under the recording curve, to 48 per cent of that to the agonist alone, and in the higher dose to 28 per cent. SR 49770 was much less potent in reducing the response to vasopressin.Conclusion. The myometrial action of arginine vasopressin is exerted via V1a receptors. The potent stereospecific inhibitory effect of SR 49059 on arginine vasopressin-induced myometrial activity indicates that the compound acts specifically through V1a receptors and may have a therapeutic potential in primary dysmenorrea.

Study objective To study national secular trends in Norway of perinatal mortality and case fatality due to placental abruption (PA) and associations with cesarean section (CS).Design A population based cohort study.Setting The Medical Birth Registry of Norway.Patients 9,592 cases of placental abruption (PA) of a total of 1,446,154 births notified in Norway 1967-1991.Main measures Comprehensive perinatal mortality (all stillbirths ≥ 16 weeks of gestation and early neonatal deaths) and standard perinatal mortality (all stillbirths ≥ 28 weeks of gestation and all early neonatal deaths). Case fatality rate.Main results From 1967 through 1991, the standard perinatal mortality rate due to placental abruption (PA) in Norway decreased from 2.5 per 1000 births (13.5% of all deaths) in 1967 to 0.9 (13.2%) in 1991. The comprehensive perinatal mortality rate decreased from 3.2 to 1.7 per 1000. The proportion of all perinatal deaths due to PA increased from 11.4% in 1967-1971 to 13.9 in 1987-1991. The case fatality rate decreased from 470.8 per 1000 cases in 1967-71 to 217.0 in 1987-91 and decreased in all gestational age categories. Case fatality in PA with cesarean section (CS) was generally lower than in PA without CS, regardless of gestational age.Conclusions Placental abruption is an important cause of perinatal mortality in Norway. Our results are in favor of an active approach with frequent use of cesarean section, also at lower gestational ages. The decreasing case fatality rate by year of birth in all gestational age groups may be attributed to improved obstetric and perinatal care.

Study objective To study secular trends of placental abruption (PA), the effects of demographic variables and the use of cesarean section (CS) associated with PA.Design A population based cohort study.Setting The Medical Birth Registry of Norway.Patients 9.592 cases of PA of a total of 1.446,154 births notified, i.e. all births in Norway 1967-1991.Main results The PA proportion was 6.6 per 1000 births of a gestational age of 16 weeks or more, ranging from 5.3 in 1971 to 9.1 in 1990. Birth order two had the lowest proportion and it increased by maternal age. The PA proportion decreased by gestational age from 86.4 per 1000 below 28 weeks to 3.4 in term pregnancies. The PA proportion per 10,000 pregnancies at risk increased from 1.3 in the 28th week to 14.1 in the 42nd week. A secular trend of a decreasing but still high relative risk of PA in SGA-births (< the 10 birthweight percentiles) and larger infants in PA-cases was noted. To an increasing extent, PA-cases in university hospitals were referred cases. The CS rates in PA-births at any gestational age increased from 1967 through 1991. The relative risk of PA of Apgar score <7 after five mintues, adjusted for gestational age, was 7.8.Conclusions Inspite of an increasing CS rate, an increasing proportion of PA was noted from 1967 through 1991. The proportion was lowest for birth order two and increased by maternal age. To an increasing extent. PA births were centralised. SGA. prematurity and asphyxia were major problems associated with PA. A tendency towards larger infants and a decreasing relative risk of PA in SGA-births might be attributable to improvements in antenatal care.

During the period 1973-83, metroplasty for infertility was performed in 20 cases of symmetric uterine malformation. Apart from a vaginal septum in 2 cases, no other genital malformations were noted. A modified Jones & Jones technique was performed in 16 cases. 3 were unified a.m. Tompkins and 1 a.m. Strassman. No operative complications were noted. Prior to operation, 19 of the 20 women were pregnant, 46 times in all. Of these, 40 ended in spontaneous abortion, 5 in preterm birth, of which 2 infants survived, and 1 in birth at term. Postoperatively, 17 of the 20 women became pregnant, 22 times in all, and of these, 3 ended in spontaneous abortion and 19 with live infants born at term. The metroplasty changed the fetal survival rate from 6.5% prior to operation, to 86.4% after the operation. Pregnancy occurred 15 months, on average, after the operation. Only a few minor complications occurred during the pregnancies. Cesarean section was performed electively in 13 cases and acutely in 3 cases. A vaginal delivery occurred in the last 3 cases. There were only a few abnormal presentations and all the infants were born at term with a mean weight of 3400 g. Metroplasty seems to be an operation which clearly improves fetal survival rate in women with both symmetric uterine malformations and a history of habitual abortions and/or preterm births. Subsequent pregnancies are not associated with any increased risk of complications.

Serum angiotensin-converting enzyme (SACE) levels were determined in normotensive pregnant subjects and patients with pre-eclampsia in the third trimester of pregnancy and 5 days, 3 and 6 months after parturition, and also in the first and second trimester in the normotensive group. SACE levels were reduced during pregnancy and 5 days after delivery in the normotensive subjects compared with the levels 3 and 6 months after delivery and to the non-pregnant control subjects. After correction for plasma volume expansion, SACE was reduced in first and second trimester only. In pre-eclampsia both SACE and corrected SACE were significantly lower in third trimester and 5 days after parturition than 3 and 6 months after delivery and in non-pregnant control subjects. The reason for the reduced level of SACE in first and second trimester during normal pregnancy is not known. The low SACE levels in pre-eclampsia may be a secondary phenomenon due to a decreased placental synthesis without primary importance for the blood pressure regulation.

From 1st March, 1980 and up to 29th February 1984 a multicenter serum α-fetoprotein (S-AFP) screening project was carried out for the detection of severe fetal malformations. S-AFP was determined by a radio-immunoas-say in 28062 pregnant women between the 16th and 20th week of gestation. Patients with elevated S-AFP values, e.g. above 95 percentile, were examined further with a second S-AFP and by ultrasound scan. 244 amniocenteses (0.9%) were carried out to detect 62 malformations (21 anen-cephalies, 14 spina bifidas, 2 encephaloceles, 7 omphaloceles, 5 gastroschises, 4 chromosome abnormalities and 9 other malformations). Fifteen of the 16 cases of spina bifida could not be verified by ultrasound scan, whereas all other malformations except chromosome abnormalities were confirmed by ultrasonography. Two cases of spina bifida and one case of skin-covered encephalocele had normal S-AFP concentrations and were therefore not detected. There were no definitive false-positives, e.g. therapeutic abortion of a normal fetus. Our conclusion is that a nationwide S-AFP screening should be recommended.

Aim. To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. Methods. Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency.Results. Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p<0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies >2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies >2.0 milliseconds (odds ratio 2.18, p<0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuumextraction could not be related to either fecal incontinence or pudendal nerve function.Conclusion. The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.

The computerized records of a population of 7214 women who were delivered during the period 1987-1991 were analysed. We studied the possible relationship of the duration of the first and second stages of labor to maternal age. In para 0, para 1 and para 2+ mothers we found an independent positive correlation between the second stage duration and maternal age. By multiple stepwise regression analysis maternal age turns out to be one of the most influential maternal characteristics of the second stage of labor. No correlation was found between maternal age and the duration of the first stage.

Vaginal repair has been recommended in cases of stress urinary incontinence and posterior bladder suspension defect diagnosed by colpocysto-urethrography. Thirty-eight women with stress urinary incontinence and posterior suspension defect have been treated. First, 19 women underwent a vaginal repair. In a second period, another 19 consecutive patients had a colposuspension a.m. Burch. The patients have been evaluated 6 months postoperatively and at a long-term follow-up. No significant difference was found postoperatively in the frequency of symptoms and signs of stress incontinence, either after 6 months or at the long-term follow-up. A significantly smaller frequency of genital prolapse was found in the colposuspension group at long-term follow-up. No side effects such as frequency, urgency or bacteriuria were evident in the group treated by colposuspension. With reservation to the non-randomized allocation, it may be concluded that a radiographic distinction between anterior and posterior bladder suspension defects in choosing the surgical approach is unnecessary.

Study objective: To determine the concentration of 5-aminosalicylic acid (5-ASA) and the metabolite N-acetyl-5-aminosalicylic acid (Ac-5-ASA) in the maternal and fetal plasma at delivery aid in the maternal milk post partum.Design and study subjects. Pregnant and lactating women with chronic inflammatory bowel disease, treated with different pure 5-ASA preparations participated in the study. At delivery, samples (if fetal and maternal plasma were obtained from nine women. The excretion in milk was measured and the time of medicine intake was registered during a 24 h period 2-4 weeks after delivery in 13 women.Results. Concentrations of 5-ASA in the fetal plasma were lower than in maternal plasma. Plasma concentrations of Ac-5-ASA were detectable in all the nine samples and similar levels in the mother and the fetus were found at the time of delivery. In three women 5-ASA was detected in the milk in low concentrations. The concentration af Ac-5-ASA in the milk varied considerably during the 24 h collection period, and also between individuals; its concentration tended tcr be higher than in the plasma. No time relation between medicine intake and maximal concentration in the milk was found. Based on the maximal Ac-5-ASA concentration and a milk intake of one liter/daily. the newborn receives less than 15 mg Ac-5-ASA daily.Conclusiotr. The study indicates that treatment with pure 5-ASA preparations in conventional doses is uithout risk to the fetus and the newborn.

The value of colpo-cysto-urethrography (CCU) in female stress- and urge incontinence was measured. in a prospective series of 172 consecutive females with stress- or urge incontinence, CCU was performed and assessed with regard to 1. no suspension defects, 2. anterior defects, or 3. posterior defects, respectively. Six months following operative repair for stress incontinence, CCU was repeated in 97 patients and compared with operative success. CCU was of minor value in the differentiation between stress- and urge incontinence. in stress incontinence, CCU was of greater value for the preoperative planning of operative technique, vaginal or abdominal, but could be omitted when pelvic examination did not disclose genital prolapse, as this excluded posterior suspension defects at CCU. Postoperative CCU was of minor value, and poorly correlated to operative success or failure. Stress incontinence with anterior suspension defects was best treated by abdominal colposuspension, even when complicated by genital prolapse. with no suspension defect at CCU, vaginal and abdominal repair were equally good alternatives. Posterior suspension defects had the lowest cure rate.

Preoperatively a collaboration between gynecologists, urologists and radiologists is essential for the diagnostic accuracy of urinary incontinence especially to isolate stress incontinence for surgical treatment. the aim of this study was to estimate the value of these combined efforts.212 women referred for urinary incontinence were assessed by history of micturition, pelvic examination, cystoscopy, cystometry, stress test for urine loss, uroflowmetry and colpo-cysto-urethrography. a final diagnosis obtained on this basis classified the patients in stress incontinence (130), urgeincontinence (47), neuromuscular dysfunction (6), uncertain type (10), other disease (8) and no incontinence (11).According to calculations of predictive values of positive and negative tests, respectively, each single test in the preoperative investigation programme was evaluated regarding the final diagnosis stress incontinence. It was assumed that the symptom stress incontinence, the pelvic examination and the colpo-cysto-urethrography were of minor or no importance for the diagnosis stress incontinence but might have been for the choice of surgical treatment. Cystoscopy and uroflowmetry had no place in daily routine. in contrast normal cystometry and especially the sign stress incontinence deserved consideration of refinements.

In 22 healthy women the non-haeme iron absorption (bone-marrow smears and haematological parameters) was studied at the 12th, the 24th and the 36th week of gestation and two months after delivery.In eight non-pregnant women and in seven pregnant women (at the 36th week of gestation) the absorption of food iron was measured from different types of meals. The iron absorption was measured from radioironlabelled test meals using a whole-body counter with a very high sensitivity.During pregnancy the non-haeme iron absorption increased continuously from Less than 1 % in early pregnancy to almost 15 % in late pregnancy. Calculations indicated that the amount of iron absorbed from the diet covered only about half of the demands.The increasing absorption of food iron during pregnancy seems to be related to the still more increasing demands. However, the very low absorption values in early pregnancy was quite unexpected. The amount of iron absorbed was actually below the basal demands, which means that even in early pregnancy, for reasons unknown, there is a negative iron balance. Further studies are necessary to elucidate the significance of this finding.Two months after delivery the absorption of iron from the diet was increased compared to in non-pregnant women and exceeded the demands at that phase thus indieating that a positive iron balance was achieved.

So far no information is available as to whether a relationship exists between the concentration on the maternal plasma oestrogens and the birth weight of the newborn and its sex. Using a gaschroma-tographic method (5) the maternal plasma concentrations of oestriol, oestrone and 17β-oestradiol were measured in normal pregnancies. From their values the regression line for each oestrogen was calculated in the individual case. the hormone value on the regression line corresponding to the 40th week of pregnancy is correlated to the birth weight and the sex of the infant. the series comprises 20 normal pregnant women delivering 20 normal infants with birth weights ranging between 2700-4100 g. As far as oestriol is concerned the series include a further 10 pregnancies, where nine of the babies born were small for dates. the correlation between plasma oestriol and birth weight is not statistically significant (0.10 > P >0.05). the relationship of plasma oestrone and 17β-oestradiol to birth weight is far from being significantly correlated. Concerning the sex of the infants, the mean values of plasma oestriol and 17β-oestradiol of 10 women with female fetuses do not differ from the mean values of 10 women with male fetuses. the mean value of plasma oestrone in the first group, however, is twice the value in the second group, yet the difference is not statistically significant (0.10 > P > 0.05).

Following therapeutic abortion in 280 patients prior to the 12th week of gestation, the amount of tissue aspirated was investigated. Measurement of the amount of tissue removed by vacuum suction after dilatation of the cervical canal showed a definite relationship between tissue quantity and gestational age. However, there was a wide range of tissue quantity in the various gestational age groups.The amount of blood lost during the procedure also depended upon gestational age. In 71% of the patients less than 100 ml was lost. There was no difference in the amount of blood lost between primigravidae and multigravidae when regard is paid to gestational age.No case of ectopic pregnancy was found.Re-evacuation was performed in 9 cases. The amount of tissue then recovered was small, in 7 cases 10 ml or less. Placental tissue was removed at re-evacuation in only one of these patients, decidua in all the others.It is concluded that measurement of the amount of tissue removed does not permit assessment of whether the uterine cavity has been adequately evacuated.

Ninety-two patients with preoperative sterile urine undergoing colposuspension or vaginal repair operation for stress urinary incontinence and/or genital descensus were randomized to either suprapubic or transurethral postoperative catheter drainage. The prevalence of significant bac-teriuria on the fifth postoperative day was statistically significantly lower when using suprapubic catheter (20.8%) than with transurethral catheter drainage (45.5%). This applied especially to colposuspension. The rate of postoperatively impaired bladder emptying also tended to be reduced when using suprapubic catheter. At follow-up after one year, postoperative bacteriuria was closely correlated to increased rates of both clinical cystitis and asymptomatic significant bacteriuria. Thus it is recommended to use suprapubic bladder drainage not only after colposuspension but also after vaginal repair in an effort to avoid an increased risk of urinary infections.

This study aimed at providing a detailed anam-nestic, clinical, and mammographical characterization of 109 patients with fibrocystic breast disease, who were selected on the basis of pronounced mastodynia, prominent palpable structure and mammographical confirmation of the clinical diagnosis. Since these patients were selected for subsequent therapy, and most of them also underwent various hormonal investigations, accurate differential diagnosis was considered essential. Therefore, X-ray mammography was supplemented as required with adenography, galactography, and aspiration of cysts followed by aerography. Additionally, the results for most study variables were recorded by means of standardized scoring systems.On the basis of this characterization, three diagnostic sub-groups of fibrocystic disease could be distinguished: 20 patients with prominent glandular structure but no visible cysts (group A), 43 patients with prominent glandular structure as well as small (<1 cm) cysts (group B), and 46 patients with both small and large (≥ 1 cm) cysts. The three groups differ significantly in mean age (33.1±5.5 (SD), 39.2±4.9, and 43.7±4.6 years in groups A, B, and C, respectively). There was a significant trend towards increasing duration of breast complaints, and patients with a history of >5 years account for 45, 65, and 74% in groups A, B, and C, respectively. Moreover, most of the study variables, viz. mastodynia, palpable structure, amount of glandular tissue, non-cystic nodularity, small cysts, duct ectasia, nipple discharge, and fibrosis, also tended to increase significantly in intensity and/or frequency from group A to B to C.These findings strongly support the view that fibrocystic breast disease is a benign progressive process and that the three diagnostic sub-groups represent different stages of this condition.

The purpose of the investigation was to study various aspects of danazol treatment in patients with fibro-cystic breast disease and pronounced mastodynia. To qualify for inclusion, the patients in this study had to have a mammographically confirmed prominent glandular structure and/or severe cystic breast disease, associated with pronounced cyclical mastodynia lasting at least one week per menstrual bycle for more than 6 months. They also had to be premenopausal and not undergoing hormonal therapy.Of 109 patients with a mean age of 40±6.2 (SD) years, who completed 6 months' treatment with danazol, 65% had a pre-treatment history of more than 5 years. According to detailed mammographic characterization, only 18% of the patients had no visible cysts. Of the 82% with visible cysts, half presented with both small (< 1 cm) and large cysts. The patients were treated in two consecutive groups, 55 patients receiving 400 mg a day and 54 patients 200 mg a day.The therapeutic response was similar following both dosages. Mastodynia responded rapidly and total elimination was noted in about 90% of cases. A marked decrease in prominence of palpable structure was observed in virtually all patients. Mammographically, a decrease in the amount of glandular tissue was observed. These changes during treatment were statistically highly significant (p<0.001), irrespective of dose or category of patient. Non-cystic nodularities gradually decreased in 85% and resolved completely in 58% of the cases, but the degree of resolution in the groups of patients with no or only small (< 1 cm) visible cysts was significantly greater (p < 0.02 or less) than in the group which also had large cysts and which included the most severe and intractable cases.The mammographical visualization of cysts, ductal system, and fibrous tissue increased initially due to the marked regression of obscuring glandular tissue. Thereafter, a decrease in the number and spread of small cysts was observed in a significant proportion of patients and in some cases a reduction in duct diameter could be demonstrated by means of galactography. Nipple discharge also decreased. The extent of fibrosis appeared to be unaffected by therapy. In the 46 patients with large cysts and, in most cases, a documented history of repeated cyst formation, danazol treatment was found to arrest the development of new cysts and to, Fibrocystic breast disease, mammographic evaluation of treatment, cyst formation, post-treatment relapse, danazol treatment was found to arrest the development of new cysts and to prevent recurrence for a considerable time thereafter. Within 2½ years of treatment, only 9 patients had recurrence of large cysts and even in these cases the rate of cyst formation was less than half of the pre-treatment rate.Menstrual irregularities or amenorrhea were noted in 66 and 85010 during danazol treatment with 200 and 400 mg, respectively. A moderate weight gain of approximately 2 kg was the most common side effect. Other side effects were not infrequent, but usually well tolerated, particularly at the 200 mg daily dose. In no case was there any need to stop treatment on medical grounds and laboratory safety monitoring did not reveal consistent changes.During a post-treatment observation period of up to 3 years, the patients were followed with regard to symptomatic relapse, defined as recurrent mastodynia of similar intensity as before treatment in still premenopausal women. In patients treated with 200 mg, the cumulative relapse rate was 67% during a mean observation period of 18.2 months, with a mean interval to relapse of 9.2 months. In patients treated with 400 mg, the cumulative relapse rate was 52% within a mean period of 27. I months and a mean interval to relapse of 12.2 months.Clinical and, in particular, mammographic findings point to an involution and apparent inactivation of glandular tissue as the key to the therapeutic action of danazol in the treatment of fibrocystic breast disease, affecting not only subjective symptoms, but also causing profound changes in mammographic structure and activity, as evidenced by arrested cyst formation.

Thirty premenopausal women with recurrent, pronounced cyclical mastodynia associated with mammographically confirmed fibrocystic disease were studied. All patients had long-standing symptoms, had undergone one previous course of treatment with danazol, and were recruited during long-term follow-up after original treatment, when cyclical mastodynia had again reached similar severity as before the original treatment (mean interval between treatments 9.5±3.9 (SD) months). Fifteen patients each were randomly allocated to double-blind treatment with either danazol or placebo. During the first month, 2 capsules a day (each containing danazol 100 mg or placebo) were given, thereafter one capsule a day up to 6 months.Danazol caused a marked and sustained decrease in mastodynia, according to the clinician's assessment and according to each patient's self-rating on a visual analogue scale. The response to danazol was fairly uniform and statistically significant (p < 0.005 or less), whereas the response to placebo was inconsistent and not statistically significant (p>0.10). Danazol proved significantly more effective than placebo (p<0.05 or less). Changes in palpatory and/or mammographic findings were also found more consistently after danazol treatment than after placebo.During treatment, there was a modest weight increase, which was statistically significant in the danazol group (p <0.01) but not in the placebo group. A greater frequency in menstrual irregularities was observed in the danazol group than in the placebo group, but not to an extent that would have caused 'unblinding' of the study. Other side effects were virtually the same in both groups with regard to type of complaint, total number of complaints (16 on danazol, 18 on placebo) and proportions of patients reporting one or more complaints (10/15 on danazol, 9/15 on placebo).Thus, unlike placebo, danazol largely abolished the cyclicity and periodicity of breast symptomatology and produced, in most cases, a sustained suppression of mastodynia, which was associated with a decrease in palpable structure and mammographic densityhpread of glandular tissue. These findings demonstrate the therapeutic efficacy of danazol even at these low doses, compared with placebo.However, a comparison of the response to danazol in this study and the response in the same patients during the original treatment course suggests that the dose of 100 mg a day is not as effective as 200 or 400 mg a day in severe cases.

The number of foetal erythrocytes in maternal blood is determined by adding yeast cells to the sample before preparation of the smear, extraction and staining. 25-1100 foetal erythrocytes per μ1 blood, corresponding to a foeto-maternal transfusion of about 20-900 μ1 are recovered with an average coefficient of variation of 20%. The clinical application of the method is demonstrated by following the rate of disappearance of the foetal erythrocytes from the maternal blood after a foetomaternal transfusion.

Plasma oestriol concentrations were studied in 48 women with prolonged pregnancies. In all, 177 studies were made from the 40th to 46th weeks. There was a significant fall in plasma concentration from the 40th to 46th weeks contrasting with the significant rise from the 24th to 42nd weeks of normal pregnancy. There was a correlation between the plasma concentration and urinary excretion of oestriol, as there is in normal pregnancy from the 24th to 42nd weeks, but there was a significant difference in the correlations (at these two stages) pointing to an increased renal clearance of oestriol during prolonged pregnancy. It is postulated that this phenomenon might depend on a proportionate increase in the production of the conjugate oestriol-16-glucosiduronate, which is more rapidly excreted by the kidneys than oestriol-3-sulphate, and which reflects a reduced metabolic activity. Urinary oestriol excretion, however, falls during prolonged pregnancy, despite the postulated increased clearance. It is concluded, therefore, that oestriol production, which reflects the function of the feto-placental unit, is, in fact, reduced during prolonged pregnancy. Plasma oestriol studies would appear, therefore, to give a better physiological control of prolonged pregnancy than urinary oestriol studies.

Oestriol, oestrone, and oestradiol-17β concentrations in plasma were studied in a series of “high risk” pregnancies. A gas chromatographic method of measurement was used. Plasma determinations have an advantage over urine determinations, because the collection of 24 h urine specimens is ledious and particularly liable to error. Low and subnormal plasma oestriol values were found to be correlated with the subsequent occurrence of fetal asphyxia or intrauterine death. Plasma oestriol values well within normal limits, or increasing, indicated that fetuses were not at risk of the more severe grades of asphyxia, or of intrauterine death. An exception was observed when the mothers had impaired renal function. Oestrogen clearance is reduced and, therefore, apparently normal values are not significant. Low oestrogen concentrations may not be significant when patients are on (halogenated) steroid therapy. Plasma oestrone and oestradiol-17β values in the asphyxia group showed a similar pattern to those of oestriol, but gave no additional information. In the groups without asphyxia, especially oestradiol-17β values lay low in the normal range with many subnormal values. In many of these cases, there was also the discrepancy that plasma oestriol values were normal, while urine oestriol values were subnormal. The plasma analysis will probably become a valuable guide to care in the obstetrical clinic.

A caw of total puerperal rupture of the pubic symphysis during non-operative delivery is rcportcd and the literature reviewed. The patient in our case was successfully treated by external skeletal fixation. In agreement with the literature the authors recommend external skeletal fixation when lesions are unstable, when inadequate reduction is achieved. or when the diastasis is more than 40 mm.

A report of two cases of recurrent stromal endometriosis, both the patients having positive estrogen receptors in the tumor tissue. They were first treated with tamoxifen, which failed to halt growth of the tumor. After a month's subsequent treatment with progesterone the tumor regressed and the patients' condition improved.

Tumors originating from the blood vessels seldom occur in the ovaries, and primary hemangiopericytoma localized to the ovaries has not previously been described. In the case reported here a bilateral ovarian tumor was found, with one metastasis to the terminal ileum. It was not possible to perform a radical operation, and the patient was after-treated with external irradiation therapy and chemotherapy. For 9½ months the tumor receded, whereafter it appeared to be stationary for 13 months, to the death of the patient. At autopsy the tumor was in evident regression and there were no signs of metastases.

Malignant transformation occurs in about 2% only of ovarian dermoid cysts. The clinical and histopathological findings in a rare case of primary ovarian malignant melanoma of amclanotic type are presented.

Small cell carcinoma of the ovary is a rare malignancy affecting young women. We report the first case of small cell carcinoma of the ovary and coincident pregnancy. The patient died of the disease 23 months after the initial diagnosis.

In 7 pregnant women, treated prophylactically with salazosulfapyridine (SASP) 3 day, amniotic fluid (16th week, n=4, maternal and cord plasma (n=S) and breast milk (n=3) were analysed for SASP and the metabolites sulfapyridine (SP), acetyl sulfapyridine (Ac-SP), 5-aminosalicylic acid (5-ASA) and acetyl 5-aminosalicylic acid (Ac-5-ASA). Amniotic fluid contained concentrations of SASP, SP and Ac-SP and partly also Ac-5-ASA comparable to those previously found by others, whereas 5-ASA concentrations were very low. The ratios of maternal to cord plasma for all SASP metabolites were about 1:1-1:2, except for 5-ASA, cord plasma being extremely low. In breast milk, only traces of S-ASA were detected, while Ac-S-ASA was above the plasma level. Only negligible amounts of S-ASA are thus transferred to the fetushewborn, which is of significance for the future use of the new non-sulfa-containing S-ASA preparations during and after pregnancy.

Following kidney transplantation, 20 women gave birth to 24 infants after the 28th gestational week. All babies were singletons, alive, and free from malformations. the mean weight was 2 595 g (range 1 420-3 200 g) and the mean gestational age was 37.8 weeks (range 32-40 weeks). the cesarean section rate was 75%. On dividing the patients into low- and high-risk groups, the rate of pre-eclampsia, prematurity, and intra-uterine growth retardation was 2-3 times as high in the high-risk as in the low-risk group. No patients experienced graft rejection during the pregnancy but, within 3 months after delivery, two rejection episodes occurred. Later, a further 5 patients experienced graft rejection. All infants developed normally. We conclude that pregnancy following renal transplantation generally has a normal outcome and that the function of the transplanted kidney is unaffected by the pregnancy.