Search

Respiratory frequency, tidal volume, minute ventilation, oxygen consumption, carbon dioxide production, and end-tidal carbon dioxide tension were measured longitudinally during pregnancy and post partum in 20 normal subjects with a computer-assisted mass spectrometer. Resting tidal volume, minute ventilation, oxygen consumption, and carbon dioxide production increased during pregnancy. End-tidal carbon dioxide tension fell progressively during pregnancy. Respiratory exchange ratio was 0.9 at 36 to 39 weeks' gestation and 0.8 at 5-13 weeks post partum. Respiratory frequency did not change during pregnancy. The increase in minute ventilation is in excess of the increase of carbon dioxide production and the resultant fall in end-tidal carbon dioxide tension reflects a fall in systemic arterial blood carbon dioxide tension. The greater respiratory exchange ratio during late pregnancy as compared with post partum also reflects this hyperventilation during pregnancy. Fourteen subjects with pregnancy-induced hypertension studied cross-sectionally failed to show any difference in the respiratory variables measured when compared with normotensive subjects at a similar length of gestation.

Specific binding of oxytocin to high affinity sites in endometrial membrane preparations has previously been shown in sheep. Endometrial tissue preparations from 27 'normal' women of proven fertility were incubated with tritiated oxytocin and the existence of significant binding sites in human endometrium was shown. Furthermore, the level of binding sites underwent a cyclical variation with the highest concentration of binding at midcycle. A cyclical pattern of binding site concentration not unlike that found in the normal women was shown in 19 subfertile patients taking clomiphene. However, in 20 subfertile patients not taking clomiphene, no cyclical pattern emerged with significantly lower levels of binding sites in the mid-portion of the cycle (P less than 0.02) and significantly higher levels in the mid-late luteal phase (P less than 0.01), as compared to the normal women. In the mid-portion of the cycle levels were significantly lower in the subfertile patients not taking clomiphene (P less than 0.03) as compared to those taking clomiphene. No significant differences were shown between the normal women and those patients taking clomiphene.

We have demonstrated that echo-planar imaging can be used to produce high-quality snapshot images of the human fetus in utero in a fraction of a second. These images are free of motional artifact or blurring and allow detailed depiction of fetal structures in normal and pathological pregnancies.

1. The intracellular free calcium concentration ([Ca2+]i) in washed human platelets was measured using the fluorescent indicator, fura-2, in a cross-sectional study of 36 normotensive, primigravid volunteers, 12 in each trimester of pregnancy and a further 12 at 6 weeks post partum. The results were compared with those obtained from 30 normal female volunteers not using oral contraception. 2. The mean basal [Ca2+]i in the platelets of the pregnant women in the first two trimesters (115.6 +/- 6.7 and 120.1 +/- 5.7 nmol/l, respectively) was not shown to differ significantly from that of normal non-pregnant volunteers (112.3 +/- 2.9 nmol/l). However, during the third trimester a significant increase in [Ca2+]i was noted (134.0 +/- 4.9 nmol/l; P less than 0.05), with a return to normal values in the post-partum period (108.2 +/- 6.1 nmol/l). 3. [Ca2+]i was also measured in the platelets of a group of 12 primigravid pregnant women in the third trimester whose pregnancies were complicated by gestational hypertension (pregnancy-induced hypertension and pre-eclampsia). A significant rise in basal [Ca2+]i was noted in the platelets of primigravidae whose pregnancies were complicated by pre-eclampsia (163.6 +/- 8.8 nmol/l) as compared with normotensive, third-trimester primigravidae (P less than 0.02). However, no correlation could be demonstrated between [Ca2+]i and systemic blood pressure.

1. The effect of doubling doses of angiotensin II on maternal systemic blood pressure and arcuate and fetal umbilical artery Doppler velocity profiles has been investigated in 10 women in first- and 10 in second-trimester pregnancy. Ten non-pregnant women were also studied. 2. A progressive decrease in the pressor response to angiotensin II in early pregnancy as previously described was confirmed. 3. Angiotensin II induced a significant dose-dependent increase in the pulsatility index (a measure of downstream resistance) in the umbilical artery in both first- and second-trimester patients. There was an apparent increase in the threshold response of the pulsatility index to angiotensin II in the umbilical artery as pregnancy progressed. There was also a significant correlation between changes in maternal systolic or diastolic pressure and change in umbilical artery pulsatility index, but this did not differ between the two trimesters. This suggests that the increase in pulsatility index is related to blood pressure rather than angiotensin II. This is consistent with reports that angiotensin II does not cross the haemomonochorial placenta. 4. Basal pulsatility index in the arcuate artery fell with increasing gestation. There was a significant inverse association between the evoked change in maternal systemic blood pressure and the change in arcuate artery pulsatility index, suggesting local vasodilatation. 5. We conclude that acutely increasing maternal blood pressure leads to increased vascular resistance on the fetal side of the circulation.

Eighteen patients with suspected primary or recurrent ovarian carcinoma have been investigated in each case by the assay of serum levels of the antigen CA125, immunoscintigraphy using 131I-OC125 antibody and magnetic resonance imaging using a 0.15 Tesla system. The final diagnosis was confirmed by laparotomy or laparoscopy. Serum levels of CA125 ranged between 5 and 780 units/ml (normal range less than 35). Antibody images and MRI were truly positive in 11 patients, 2 of whom were subsequently found to have bowel tumours. MRI showed greater detail of smaller lesions whilst immunoscintigraphy was more suited to the detection of distant metastases. In 7 patients the antibody images were positive whilst the serum marker levels were normal. This pilot study provides a preliminary comparison of the more recent techniques currently being evaluated for the detection of ovarian carcinoma.

Low implantation of the placenta may protect against the development of pregnancy-induced hypertension (PIH) and is associated with improved values in tests of placental function. PIH occurred in six of 201 (3%) consecutive patients with placenta praevia managed at the City Hospital, Nottingham, from 1 April 1973 to 30 June 1981. None of the six patients developed associated proteinuria. Of the total number of 24,549 patients delivered in the same hospital for the years 1974-1978, 3744 (15%) developed PIH. Of the patients with placenta praevia, 52% had serum levels of human placental lactogen above the 95th centile and 25% had 24-h urinary oestriol levels above the 95th centile. The birthweight distribution was not different from that of the total live births at the City Hospital, Nottingham (based on 1975-1976 deliveries).

Plasma angiotensin-converting enzyme (ACE) has been measured prospectively throughout pregnancy, at delivery and in the puerperium in 18 normotensive primigravidae and their infants. Plasma ACE was consistently lower during pregnancy than in comparable, non-pregnant controls, but rose progressively from about 30 weeks to term. At vaginal delivery maternal and fetal ACE levels did not differ significantly. There was a steady increase in maternal ACE activity up to 6 weeks post partum, when the levels were not significantly different from non-pregnant controls. No correlation could be found between plasma ACE and plasma renin activity or concentration, or plasma AII. Plasma aldosterone increased in parallel with ACE during the last ten weeks of pregnancy.

A real-time computer system was employed to monitor continuously the fetal electrocardiogram (ECG) during labour. Signals from a scalp electrode were amplified, filtered and passed through an interface system to a digital computer. From 110 patients studied, 37 were selected by rigid criteria which fulfilled a strict definition of normal fetal condition in labour and delivery. The mean values and the range of the various parameters of the fetal ECG complex were defined. As a large amount of data was generated by the system, a method was developed to display the short and long-term dynamic behaviour of the fetal ECG during labour in the form of labour profiles. By further averaging of these labour profiles, the pattern of normal behaviour was established. Certain changes in the fetal ECG, previously thought to be characteristic of fetal distress, occurred in normal patients. The P-R interval was up to 10 per cent shorter during contractions towards the end of labour and there was a long-term trend towards the end of labour for the P-R interval to fall by 7 per cent. The P wave amplitude fell by 30 per cent over the last hour. These trends were statistically significant. The QRS complex was found to lengthen slightly towards the end of labour, but the R-T interval and ST segment displacement displayed no significant changes.

An angiotensin I-like substance has been detected in media after incubation of human chorion-decidua in vitro. The substance was identified as angiotensin I by gel filtration, ion exchange chromatography, and a specific antiserum to angiotensin I. The presence of angiotensin I in these incubates indicates that renin substrate may be either stored or synthesized by the tissue. The levels of angiotensin I produced during incubation were greater than could be explained by the action of renin on plasma substrate since the major part of the chorion-decidua is avascular. Previously chorion-decidua has been shown to contain large amounts of renin and to be capable of synthesizing both active and inactive forms of the enzyme in vitro; however, renin substrate has not been described in this tissue.

Fifty-eight of a consecutive series of 75 pregnancies in women with insulin-dependent diabetes went into the third trimester. Diabetes was managed by home blood glucose monitoring and women were not routinely admitted at any stage before delivery. The mean number of in-patient days before delivery was 15 for the whole series but has been reduced to 9 during the past four years. Each woman performed an average of 171 blood glucose measurements during her pregnancy. Mean blood glucose (including post-prandial levels) fell significantly from 7.9 mmol/l in the first trimester to 7.3 in the second and 6.4 in the third. Mean percentage of haemoglobin A1 was within the normal range in the second and third trimesters. The cesarean section rate was high at 66% but there were no perinatal deaths. Three infants had congenital abnormalities. We conclude that home blood glucose monitoring is a safe and effective way of managing pregnant diabetic women as out-patients. The cost of meters and sticks is repaid many times over in the saving of hospital costs. In addition, home blood glucose monitoring is popular with the patients and many choose to continue it after delivery.

Twelve patients with suspected primary and recurrent carcinoma of the ovary have undergone immunoscintigraphy with an antitumour monoclonal antibody in order to assess the impact of the technique on patient management. Consistent tumour uptake of radiolabelled antibody was visualized in malignant tumours after subtraction of the blood background activity. Eight patients were imaged before surgery and in all of these the sites of uptake visualized on the images agreed with the surgical findings. In one patient with recurrent disease the imaging information was used as an aid for establishing the extent of external beam radiotherapy. A repeat study in this patient 6 months later revealed a reduction in the size of the tumour, which still concentrated labelled antibody and confirmed the viability of repeat investigations. Immunoscintigraphy was capable of providing diagnostic information which may offer an alternative to second-look surgery in these patients.

The outcome of 140 pregnancies complicated by unexplained abdominal pain was compared with that in a comparison group of 280 women who gave birth at the same time. The two groups were comparable for maternal age and parity but the study group contained a significantly higher proportion of smokers, unmarried women, and women whose partners were unemployed (P less than 0.001). All the pregnancies resulted in livebirths. There were no statistically significant differences in birthweight, gestational age at delivery or mode of delivery between the two groups.

In the largest survey of smoking in pregnancy to date in the United Kingdom, 3882 women attending the two antenatal clinics in Nottingham during July and August 1986, were asked about their smoking habits. Thirty-seven per cent of pregnant women were smoking and only one in four of these was successful at stopping at some point during pregnancy. However, 55 per cent of the mothers who smoked at the start of pregnancy claimed to smoke less during pregnancy. No change was reported in the habits of one-quarter of the mothers who smoked during pregnancy and this proportion may represent an 'irreducible minimum'. Mothers were more likely to continue to smoke if younger (14-20 years), single, living with a partner who smoked, who left school at 16 years and were from manual working families. Those who succeeded in giving up smoking during pregnancy were more likely to be from professional and managerial families. Antenatal booklets about the dangers of smoking were the source of information cited most frequently. Half of the smoking mothers claimed not to have received advice from their family practitioners about the hazards of smoking nor information about how to give up the habit. Even fewer received such advice from hospital doctors, or midwives. This represents a major challenge to professional training in health education.

Tissues from the fetoplacental unit were incubated in medium E 199 at 0 degrees C and following removal of the tissue were incubated at 37 degrees C. Compared to control tissues held at 0 degrees C, large quantities of angiotensin I, measured by means of specific radioimmunoassay, were detected in the media from both amnion and chorion-decidua while only small amounts were found in the media from placenta and umbilical cord. Following prior incubation with antirenin, the generation of angiotensin I was abolished in all tissues. These results indicate that both renin and its substrate are released into the media during incubation at 0 degrees C and suggest the existence of a locally functioning renin-angiotensin system in certain tissues of the human female genital tract.

1. A radioimmunoassay for the measurement of angiotensin II in 1 ml of plasma has been developed and used to measure angiotensin II in maternal peripheral, cord venous and cord arterial blood in 45 patients at delivery. 2. In babies delivered vaginally, cord venous and cord arterial concentrations of angiotensin II were significantly higher than maternal venous blood concentrations. There was a significant relationship between both cord venous and cord arterial concentrations and maternal concentrations of angiotensin II. 3. Cord venous concentrations of angiotensin II were significantly greater than those in cord arterial blood in babies delivered vaginally but not in those delivered by lower-segment Caesarean section. This suggests the possibility that, during labour, the placenta may contribute to foetal concentrations of angiotensin II. 4. Maternal and cord venous concentrations of angiotensin II were significantly higher in patients with hypertensive disease of pregnancy than in those who had remained normotensive throughout pregnancy. 5. Cord venous concentrations of angiotensin II increased significantly with increasing duration of the second stage of labour.

The application of nuclear magnetic resonance imaging to the diagnosis of ovarian tumours has been studied in a group of seven patients with ovarian masses and several healthy volunteers who provided examples of normal pelvic anatomy. In three patients, benign unilocular ovarian cysts were demonstrated and in three patients, recurrent ovarian tumours were identified and the extent of the tumours defined. One patient with bilateral ovarian endometriomas was imaged. Endometrial cysts, like masses in other systems which contain blood or lipid-rich material, show high-density images whereas malignant tumours show tissue densities closer to those of normal tissues. The potential value of this technique in the assessment of pelvic disease is discussed.

The effect of aminophylline on renin release from human chorion was investigated by perfusing the tissue with various concentrations of the drug. Buffer containing aminophylline (2 X 10(-6) mol/l) doubled the rate of active and total renin secretion, but a more concentrated solution (10(-5) mol/l) released proportionately less active and total renin although the result was statistically significant. Renin secretion was not altered by aminophylline (5 X 10(-5) mol/l). The pattern of renin release was modulated by concentrations of aminophylline which were at least a 100-fold lower than those required to inhibit cyclic adenosine 3',5'-monophosphate phosphodiesterase. However, as the methylxanthines are potent adenosine receptor antagonists, we suggest that in the human chorion adenosine is a mediator of renin release.

An examination of the biokinetics and biodistribution of i.p. administered 131I- or 111In-labelled 791T/36 antibody (1 mg) has been carried out in five patients with stage III/IV ovarian cancer. Blood kinetics and urinary excretion of the radiolabels were assayed. Scintigraphy was performed immediately following administration and before and after peritoneal lavage at 48 h. Blood levels of both preparations rose over the first 20-40 h reaching 8-14% of the administered dose in the circulation and then declined (T1/2 of 40 h). Circulating radiolabel was still attached partially to antibody as shown by precipitation with anti-mouse IgG antiserum. The rapid appearance of radiolabel in the bloodstream meant that any tumour localization could be from circulating antibody rather than local infiltration. Interpretation of the images was difficult and the distribution of the tracer was different from that previously observed using i.v. administration of antibody. In some cases the images were confusing and the uptake of activity did not fit in with the clinical knowledge of the disease or the findings from laparoscopy. Tumour specimens resected at 4-5 days showed up to 0.02% of the dose g-1.

Five women with complete and partial hydatidiform mole were examined by magnetic resonance imaging (MRI). Spin-echo pulse sequences (T2 weighted) were found to provide excellent resolution, while inversion-recovery pulse sequences (T1 weighted) gave better pathological detail. The myometrium was clearly seen on each patient and no invasion by the tumour detected. This corresponded to the histological findings. The potential uses of magnetic resonance in the diagnosis of primary and recurrent trophoblastic disease and its role in management are discussed.

Admission to hospital is usually recommended to achieve the best possible diabetic control during pregnancy. We have used blood glucose monitoring at home to find out if patients can achieve equally good control outside hospital. Twenty-five consecutive diabetic patients were studied, of whom 20 had taken insulin before pregnancy. Six of their 14 previous pregnancies had ended in perinatal death. The 25 women performed 4247 blood glucose measurements during their pregnancies. Overall the mean blood glucose concentration was 7.1 mmol/l (128 mg/100 ml); before meals the mean was 6.5 mmol/l (117 mg/100 ml). Mean concentrations were lower in the third trimester, but at no stage was control in hospital significantly better than at home. The mean hospital stay before delivery was 22 days, and all patients had live babies. Monitoring blood glucose concentrations at home produces greater understanding and motivation among patients, improves control early in pregnancy, and shortens time spent in hospital.

The progesterone concentration in the umbilical venous and arterial plasma has been measured by radioimmunoassay. In 35 normal spontaneous vaginal deliveries the concentration in the umbilical venous plasma was highly correlated with the difference between venous and arterial plasma concentrations. There was no correlation of progesterone levels with infant birth weight or placental weight, but slightly higher amounts were found in samples taken from women with female fetuses than those with male fetuses. There was also a significant correlation of venous progesterone concentration with duration of labour. In 14 subjects where forceps were used to assist delivery because of prolonged second stage labour, progesterone levels were found to be elevated, whereas in nine cases of elective Caesarean section they were reduced. It is suggested that the fetus may stimulate progesterone secretion by the placenta in response to stress and that there may also be a fetal sex-related response.

Plasma renin and angiotensin II levels were measured in nine patients immediately before and at half-hourly intervals in the four hours following therapeutic termination of pregnancy. There was a small fall in renin and angiotensin II levels over the first 1 to 2 hours, followed by a slight increase. The magnitude of these effects was much smaller than those previously seen following normal delivery. It is concluded that in early pregnancy maternal, rather than feto-placental, factors are controlling the renin-angiotensin system.

Maternal and fetal blood samples were obtained from 10 normotensive primigravidae and 10 primigravidae with pregnancies complicated by hypertension and proteinuria. Measurements were performed of plasma renin activity (PRA), plasma renin concentration (PRC) and plasma renin substrate (PRS). PRA and PRC were significantly higher in cord artery and cord vein blood than in maternal venous blood in normotensive women, and PRS was significantly lower. PRS levels were lower in maternal plasma of hypertensive women, and, although PRC and PRA were lower in the cord blood of infants born to hypertensive women, these differences did not achieve statistical significance.

Factors which influence levels of plasma AII in late pregnancy have been studied in 50 primigravidas and 53 multigravidas. A highly significant relationship has been shown between diastolic blood pressure and plasma AII (r = 0.4190 p less than 0.005) in primigravidas but not in multigravidas (r = 0.205; p less than 0.3). Multiple regression analysis and analysis of covariance have been applied to a series of independent variables with plasma AII as the dependent variable. The single most important variable related to AII levels in primigravidas was diastolic blood pressure whereas in multigravidas it was proteinuria. Rhesus blood group was shown to have a significant effect in both parity groups, Rh-negative primigravid women exhibiting higher values of AII.

The occurrence of renin and renin substrate has been described in human seminal plasma. Mean levels of active and total renin were higher in seminal plasma than in normal male plasma (7.1 compared to 3.8 and 38.5 compared to 24.6 ng/ml/hr, respectively). The differences were not statistically significant. Renin substrate concentrations were very low compared to male plasma levels, which suggests that renin may function either in tissues of the male genital tract prior to secretion into the seminal plasma or may be important following ejaculation in the female genital tract.

Spironlactone was given to 28 women in a double blind cross over trial during four menstrual cycles. Hormonal profiles were measured during the first two cycles. Plasma aldosterone was elevated in the premenstrual phase of the cycles but there was no significant difference between symptomatic and asymptomatic groups. The rise in serum progesterone was higher in the symptomatic group during the postovulatory phase. The administration of spironolactone reduced weight and relieved psychological symptoms in more than 80 per cent of the symptomatic group.

The obstetrical policy during labor at two University clinics in Nottingham (United Kingdom) and Nijmegen (The Netherlands) was investigated prospectively and simultaneously during a period of three months (1984). At the University of Nijmegen the obstetrical population tended to be more 'pathologic', and less intervention during labor was observed for early amniotomy, pain relief, induction and augmentation of labor. The pH in umbilical arterial blood was as a mean 0.01 unit lower in Nijmegen than in Nottingham. The validity of electronic fetal monitoring appeared to be higher in Nijmegen. It is concluded that data on the neonate probably cannot give an answer in favor of one of these policies. Parenthood information could give more conclusive evidence.

Concentrations of plasma angiotensin II (AII) have been measured in the second stage of labour or before delivery by elective Caesarean section in 134 women and some factors influencing the levels have been assessed. Plasma AII concentrations in the second stage of labour were higher than levels previously observed before the onset of labour in both primigravid and multiparous women. Markedly lower levels were found following delivery by elective Caesarean section than following vaginal delivery. Multiparae had higher AII concentrations than primigravidae both before the onset of labour and at delivery. Epidural analgesia was associated with significantly lower AII concentrations; in primigravidae receiving such analgesia a statistically significant relation was found between AII concentration and diastolic blood pressure at delivery. A similar relation was found in the nonproteinuric patients delivered by Caesarean section. The estimated duration of the second stage of labour was the major factor affecting AII concentration in normal multiparae. In both primigravid and multiparous women, AII concentrations were markedly raised in association with proteinuria.

Forty-one patients with 45 pelvic mass lesions were assessed by magnetic resonance imaging (MRI). All lesions were initially considered to be benign ovarian masses with this diagnosis confirmed in 36 lesions. The characteristics on MRI are analysed and features useful in predicting histological type identified. Our results indicate that a high, though not absolute, level of diagnostic specificity should be obtainable in identification of ovarian pathology.

To investigate the ability of steroid hormones to interact with endometrium, particularly in cases of unexplained subfertility, intact cells were incubated with tritiated progesterone and oestradiol and their uptake into the nuclei was measured. Samples were taken at dilatation and curettage from 23 fertile women, 14 women with unexplained primary subfertility, and 9 patients whose primary subfertility could be explained. Serum oestradiol and progesterone levels were not significantly different between the three groups, nor were values of 3H-oestradiol uptake. However, low (below 5 pmol/mg DNA) values for nuclear 3H-progesterone uptake were present in most samples from women with unexplained subfertility but in only about half of the women in the other two groups. This biochemical defect may be the cause of some cases of unexplained subfertility.

Pre- and post-operative ovarian cancer patients' sera were examined for the presence or circulating immune complexes using a variety of assay procedures. In contrast to findings with breast cancer patients' sera, sera from patients with other gynaecological tumours or with preclinical disease diagnosed by cytology, no evidence was obtained to indicate that circulating immune complexes were associated with ovarian cancer.

Nuclear magnetic resonance (NMR) techniques have been used to produce images of the pregnant and nonpregnant human uterus. A series of pictures is presented showing the normal nonpregnant uterus and pelvic organs, the uterus and its contents in pregnancy at 17, 30, and 40 weeks' gestation, and the pelvic organs in the early puerperium. In early pregnancy the uterus and placenta are clearly seen and the dimensions and configuration of the pelvis can be readily assessed. Because of the relatively long scan time of 2 minutes, better images of the fetus were obtained in the third trimester when movement is more restricted. The potential value of this technique in obstetrics is discussed.

Serial blood samples were obtained throughout pregnancy from 11 women with essential hypertension (EHT). Seven were treated with labetalol (Trandate) and 4 with alpha -methyl dopa (Aldomet). Nine patients were well-controlled throughout pregnancy. Their mean plasma renin concentrations (PRC) followed the profile determined in 18 normal patients studied serially. They remained in the upper normal range until the last month, when both treatment groups showed a fall in PRC. Mean plasma aldosterone (ALD) also followed a normal profile until late gestation when it too showed a sharp fall. Of the two patients who developed superimposed PIH, one, who received labetalol, developed severe hypertension at 35 weeks, requiring delivery. Although PRC increased early in this pregnancy, ALD did not, remaining low throughout. Serum potassium [K+] measurements were also very low in this patient. The second patient only became hypertensive at 40 weeks and had PRC and ALD profiles resembling those in the successfully treated EHTs. There was a strong positive correlation throughout between serum potassium and ALD measurements (p less than 0.001) but none between PRC and ALD. This latter agrees with the known lack of correlation between PRC and ALD in normal pregnancy and may suggest that changes in electrolyte balance are more important stimuli to ALD secretion during pregnancy.

Sections of human chorion were perfused with an aerated buffer for 5 hours. Samples were collected every 20 minutes and the concentration of active and total renin in the perfusate was measured. Substitution of the initial bicarbonate buffer (281 mosm/L) with a buffer of 251 mosm/L doubled the rate at which active and inactive renin were released into the perfusate. When the osmolarity of the solution was reduced by 60 mosm/L, a threefold rise in the concentration of active renin and a sixfold rise in that of total renin was seen. However, these effects were transient, and renin secretion decreased before osmolarity was raised to the previous value.

Sera from patients with ovarian tumours were assayed for circulating immune complexes (CIC) by four well established assays based on the interaction of immune complexes with components of the complement system. There was no difference in control, pre- or post-operative or BCG-treated patients' sera. Levels were also unchanged in sera in antigen excess. In patients with ovarian tumours therefore the measurement of CIC would appear to be of little value as a screening test, as a guide to the extent of disease, prognosis or therapy. In a small pilot therapy-trial there was no difference in the survival rate between patients with stage III and IV ovarian cancer treated with cyclophosphamide plus BCG and those who received only cyclophosphamide. Treatment with BCG was associated with postoperative pyrexia and a prolonged hospital stay.

A human semen bank has been established in Nottingham for artificial insemination using donor semen (AID). Frozen semen has been used for all inseminations. The introduction and organization of such a programme within the National Health Service is described. Six pregnancies have so far been confirmed and two normal infants have been delivered.

Paired maternal venous (MV) before (P1) and after (P2) general anesthesia, cord venous (CV) and cord arterial (CA) blood was taken from two groups of primagravid women, one delivered vaginally and the other by elective lower segment Caesarian section (ELSCS). ACTH, Cortisol (CoSol) Aldosterone (Aldo) Plasma Renin Activity (PRA) Plasma Renin Concentration (PRC) Angiotensin II (AII) Solium (N alpha) and Potassium [K]+ were measured in both study groups. Of the various hormones studied, all but cortisol were raised in the P2 sample with only ACTH and AII achieving significant increase. A number of significant positive correlations was found between P1 and P2 samples as well as between the hormones themselves. Four of the vaginally delivered group received epidural analgesia and demonstrated significantly higher levels of ACTH and CoSol in the CV sample. A comparison of the studied variables between the two groups showed a significant decrease in the ELSCS group of ACTH and CoSol in the MV sample, of ACTH, CoSol, PRC in the CV sample, and of CoSol in the CA sample. Of all the parameters, studied, only [K]+ together with Aldo was found to be elevated in the CV sample of the ELSCS group but only [K]+ achieved significant increase.