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OBJECTIVE To evaluate the clinical usefulness of Doppler analysis of the uterine artery velocity waveform in the prediction of pre-eclampsia and its associated complications of intrauterine growth retardation and perinatal death. DESIGN Quantitative systematic review of observational diagnostic studies using online searching of the MEDLINE database coupled with scanning of the bibliographies of primary and review articles including known unpublished studies. MATERIAL Twenty-seven studies involving 12,994 subjects stratified into population subgroups at low and high risk of developing pre-eclampsia and its complications. OUTCOME MEASURES The outcome measures studied were: 1. the development of pre-eclampsia; 2. intrauterine growth retardation; and 3. perinatal death. The main meta-analyses were the flow velocity waveform ratio +/- diastolic notch derived by transabdominal Doppler ultrasound as the measurement parameter. The analyses were conducted using likelihood ratio as a measure of diagnostic accuracy. A likelihood ratio of 1 indicates that the test has no predictive value for the outcome. Prediction for the outcome event is considered conclusive with likelihood ratios of > 10 or < 0 x 1 for a positive and negative test result, respectively. Moderate prediction can be achieved with likelihood ratios of 5-10 and 0 x 1-0 x 2 whereas likelihood ratios values of 1-5 and 0 x 2-1 would generate only minimal prediction. RESULTS In the low risk population a positive test result, predicted pre-eclampsia with a pooled likelihood ratio of 6 x 4 (95% CI 5 x 7-7 x 1), while a negative test result had a pooled likelihood ratio of 0 x 7 (95% CI 0 x 6-0 x 8). For intrauterine growth retardation the pooled likelihood ratio was 3 x 6 (95% CI 3 x 2-4 x 0) for a positive test result and 0 x 8 (95% CI 0 x 8-0 x 9) for a negative test result. Using perinatal death as outcome measure, the pooled likelihood ratio was 1 x 8 (95% CI 1 x 2-2 x 9) for a positive test result and 0 x 9 (95% CI 0 x 8-1 x 1) for a negative test result. In the high risk population a positive test result predicted pre-eclampsia with a pooled likelihood ratio of 2 x 8 (95% CI 2 x 3-3 x 4), while a negative test had a likelihood ratio of 0 x 8 (95% CI 0 x 7-0 x 9). For intrauterine growth retardation the pooled likelihood ratio was 2 x 7 (95% CI 2 x 1-3 x 4) for a positive test result and 0 x 7 (95% CI 0 x 6-0 x 9) for a negative result. For perinatal death the pooled likelihood ratio was 4 x 0 (95% CI 2 x 4-6 x 6) for a positive test result and 0 x 6 (95% CI 0 x 4-0 x 9) for a negative result. CONCLUSION Uterine artery Doppler flow velocity has limited diagnostic accuracy in predicting pre-eclampsia, intrauterine growth retardation and perinatal death.

To determine whether fetal growth velocity derived from two antenatal ultrasound measurements in the third trimester, 28 days apart, can identify infants born with anthropometric features of intrauterine growth retardation.Prospective observational study.Department of obstetric ultrasound, Ninewells Hospital, Dundee.Two hundred and seventy four low risk women participating in a longitudinal study of serial fortnightly ultrasound in pregnancy.Growth velocities of the fetal abdominal area and bi-parietal diameter were calculated from the third from last and last measurements prior to delivery. Receiver Operator Characteristics curves were employed to determine an optimal cutoff point for velocity to predict intrauterine malnourishment.Likelihood ratios for fetal abdominal area and bi-parietal diameter growth velocity in the prediction of growth retarded infants with skinfold thickness10th centile; ponderal index25th centile, or mid-arm circumference to occipito-frontal circumference ratio (MAC:OFC ratio) of less than -1 SD. A likelihood ratio of10 generates significant changes in the pre-test probability of growth retardation, whereas a likelihood ratio of 5 to 10 generates only moderate changes.Fetal abdominal area velocity predicted growth retardation with likelihood ratio 10.4 (95% CI 3.9 to 26) for skinfold thickness; likelihood ratio 9.5 (95% CI 4.6 to 19) for ponderal index; a likelihood ratio 4.7 (2.3 to 8.4) for MAC:OFC. Bi-parietal diameter velocity predicted growth retardation with likelihood ratio 6.5 (95% CI 1.9 to 20) for skinfold thickness but did not predict low ponderal index or MAC:OFC ratio.Fetal abdominal area velocity is useful in identifying infants with reduced skinfold thickness or low ponderal index. Prospective evaluation of serial ultrasound and velocity calculation in a selected population at increased risk of growth failure and a clearer understanding of the relative significance of the different neonatal anthropometric measures of impaired growth achievement is necessary before the estimation of growth velocity can be recommended in clinical practice.

Objective To evaluate and compare third trimester ultrasound measurements of fetal size and growth velocity in the prediction of intrapartum operative delivery for fetal distress and admission to the special care baby unit in a low risk antenatal population undergoing labour at term. Design Retrospective analysis of prospectively collected ultrasound data. Setting Ninewells Hospital, Dundee, Scotland. Population Three hundred and ninety-eight women previously enrolled in a longitudinal study of intrauterine volume undergoing labour at a gestational age of > 37 weeks. Method Fetal abdominal area (FAA) standard deviation scores (Z scores) were calculated for size at 32 and 36 weeks of gestation together with the growth velocity Z scores between these two gestational ages. Receiver–operator characteristics were calculated for fetal abdominal area Z scores at 32, 36 weeks and velocity Z scores in the prediction of caesarean section for fetal distress and/or admission to the special care baby unit. Main outcome measures Intrapartum caesarean section for fetal distress and admission to the special care baby unit with a diagnosis of perinatal hypoxia. Results Pregnancies ending in caesarean section for fetal distress or admission to the special care baby unit (n= 17) had significantly lower fetal abdominal area Z scores at 36 weeks of gestation (mean Z score −0.71 vs−0.18) and lower fetal abdominal area growth velocity (mean Z score −1.31 vs−0.01). Taking a cutoff Z score of −1.2 derived from the receiver–operator characteristic curve, fetal abdominal area velocity has a sensitivity of 65% and specificity 75% for caesarean section for fetal distress and/or admission to the special care baby unit. Conclusion Growth velocity of the fetal abdominal area in the third trimester is superior to a single measurement of the fetal abdominal area at either a mean of 32 or 36 weeks of gestation in the prediction of caesarean section for fetal distress and admission to the special care baby unit in low-risk women labouring at term. These results support the hypothesis that in the third trimester at least, growth rate in utero is more relevant to intrapartum performance and immediate perinatal outcome than estimates of fetal size alone.

Summary A retrospective review of all women diagnosed with endometrial adenocarcinoma over a 5-year period was performed. One hundred and eleven women had not defaulted from follow-up and were thought to be disease-free following primary treatment. Seventeen (15.3%) of this group of women developed recurrent disease; four of these being detected in asymptomatic patients at routine follow-up visits. Women with asymptomatic recurrences had a significantly better survival than those presenting with symptoms (25% vs. 8%, P = 0.048). On the basis of previous findings, a limited hospital surveillance protocol was applied retrospectively to these patients with an estimated financial saving of over 2500 per annum. However, as one asymptomatic recurrence was detected by vault cytology during the 2 years after primary treatment, it may be worthwhile continuing to perform vault cytology during this period.

Publisher Summary The synthetic chemokines have been employed for investigations of their functions, structure- activity relationships, and three-dimensional structure. These studies have demonstrated that chemical synthesis is a straightforward route to chemokines and novel analogs. This chapter describes the rationale and procedures that have developed based on experience with the synthesis of chemokines. The first and foremost requirement for the study of a particular chemokine is obtaining sufficient pure material for the experiments, Furthermore, the study of structure-activity relationships involves building conclusions from the results of multiple analogs. This requires the generation of large numbers of analogs, so the methods chosen must be capable of fulfilling this need. Natural sources are not useful because the amounts that can be derived are very low, and it is not possible to modify the sequence. Both the chemical and DNA approaches can provide native chemokines and analogs with specific changes. The two approaches are fundamentally different, with the synthesis method being less known, and therefore some comparisons are useful.

Second-generation endometrial ablation techniques provide an effective surgical treatment option for women with menorrhagia. Their ease of use might result in inappropriate surgical treatment without previous medical therapy. We sought to establish local compliance with national guidelines following the recent introduction of second generation ablation techniques into routine practice. We collected data at the time of ablation on the preceding medical management of women undergoing either microwave endometrial ablation or thermal balloon ablation. One hundred and thirty-two consecutive women underwent second-generation endometrial ablation. At least one medical treatment (range 1 – 5) was used before ablation in 86% of women. The majority (86%) of women undergoing a second-generation endometrial ablation technique received at least one effective medical therapy before surgical intervention, indicating a high level of compliance with published guidelines.

The aims of this paper were (1) to determine the value of third trimester customised estimated fetal weight centile ranking in the prediction of infants born with anthropometric features of IUGR and (2) to compare the performance of customised centiles with ultrasound fetal growth velocity in the prediction of IUGR. Two-hundred and seventy women with low-risk pregnancies participated in a longitudinal study of fetal biometry. Third trimester customised estimated fetal weight centiles (cEFW) were obtained after adjustment for gestational age at the time of ultrasound, birth order and gender, maternal weight, height and ethnic origin (www.wmpi.net). Fetal growth velocity was calculated using the increment in the fetal abdominal area (FAA) over a mean 28-day interval with reference to published standards. IUGR was defined as neonatal ponderal index (PI)

The intracellular domain of human protein tyrosine phosphatase beta (HPTP beta) (44 kDa) was expressed in bacteria, purified using epitope ‘tagging’ immunoaffinity chromatography, and characterized with respect to kinetic profile, substrate specificity and potential modulators of enzyme activity. A chromogenic assay based on the Malachite Green method was employed for the detection of inorganic phosphate (Pi) released from phosphopeptides by HPTP beta. This assay, modified so as to improve its sensitivity, was adapted to a 96-well microtitre plate format, and provided linear detection between 50 and 1000 pmol of Pi. The cytoplasmic domain of HPTP beta was strongly inhibited by vanadate, molybdate, heparin, poly(Glu, Tyr) (4:1) and zinc ions. In order to explore the substrate preferences of this PTPase, we generated 13-residue synthetic phosphotyrosine-containing peptides that corresponded to sites of physiological tyrosine phosphorylation. HPTP beta demonstrated kcat. values between 76 and 258 s-1 using four different phosphopeptides. The substrate preference of HPTP beta was in the order srcTyr-527 > PDGF-RTyr-740 > ERK1Tyr-204 >> CSF-1RTyr-708 with Km values ranging from 140 microM to greater than 10 mM. The variations in affinity were probably due to differences among the four phosphopeptides compared, particularly with respect to the character of the charged amino acids flanking the phosphotyrosine residue.

SummaryIntroductionMifepristone is a progesterone antagonist at receptors in the endometrium and myometrium. One action is to sensitise the uterus to exogenous prostaglandins (Bygdeman and Swahn, 1985) and has been demonstrated to shorten the induction-abortion interval compared with prostaglandin administration alone (Rodger and Baird, 1990).

(2003). Management of late intrauterine death using a combination of mifepristone and misoprostol. Journal of Obstetrics and Gynaecology: Vol. 23, No. sup1, pp. S55-S55.

The magnitude of the duodenal loop in patients with a variety of pancreas-associated disease has been accurately measured and compared with those values encountered in a series of normal subjects in order to assess if any widening had occurred. Using a Student's t -test all the patients with pancreatic disease were indistinguishable from the control subjects at the 5% level, and the validity of this effect as a diagnostic tool is questioned.

The radiological signs of common bile duct obstruction have been analysed in a series of 146 Chiba needle percutaneous cholangiograms. The upward pointing convexity was the most reliable sign, indicating impacted stones in all cases. The least reliable sign was the biconcave caudal cut-off. An inter-observer variation study of the signs indicated that a knowledge of the clinical history did not improve the diagnostic accuracy of film reading.

In a controlled study of barium swallow radiographs in systemic sclerosis, longitudinal oesophageal mucosal folds were absent in eight of 30 patients and in one of 30 control subjects (P less than 0.03). Patients without mucosal folds developed Raynaud's phenomenon at an earlier age than those who retained their mucosal folds (P less than 0.05). A loss of oesophageal mucosal folds did not necessarily signify more severe visceral or cutaneous disease.

Summary. Between August 1973 and May 1979, 18 patients suffering from severe haemophilia A underwent synovectomy for recurrent haemarthroses, resistant to medical management. A total of 23 joints (11 knees and 12 elbows) were subjected to operation, five patients undergoing two synovectomies on different joints. Post-operative follow-up period ranged from 12 to 58 months for elbow synovectomy and from 29 to 76 months for knee synovectomy. All patients experienced fewer haemarthroses, the average number of bleeding episodes per joint over a 12 month period being reduced from 19 to 3 for knee joints, and from 24 to 3 for elbow joints. This improvement was apparent in the immediate post-operative year and maintained thereafter. Over the same follow-up period nine of the 11 knee joints were found to have lost an average 42° mobility. Following elbow synovectomy five out of 12 patients lost an average of 28° mobility; six patients gained an average 11° mobility. The post-operative complication rate was high for knee synovectomy, 54% suffering haemorrhage despite haemostatic factor VIII levels. For elbow synovectomy the rate was much lower, 75% of operations being uncomplicated. The average in-patient time for knee operation was 75 d, and for the elbow 19 d. We conclude that synovectomy of the knee joint is to be avoided when other means of reducing bleeding episodes are available, whereas elbow synovectomy retains a useful role in the treatment of recurrent haemarthroses which do not respond to clotting factor prophylaxis.