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A 29 year old expectant mother was critically ill at 27 weeks gestation with disseminated metastatic malignant melanoma and was treated with dacarbazine. A dramatic remission was induced and at 38 weeks gestation she went into labour spontaneously and delivered a healthy infant. She relapsed and died eight weeks post partum. This is the first reported use of dacarbazine in pregnancy.

With improvement in the medical management of diverticular disease, perforation has become the most common indication for surgical intervention. It is a source of considerable morbidity and mortality and consequently has provoked a considerable and controversial challenge for surgeons. We are proposing that all patients found to have purulent peritonitis secondary to perforating diverticulitis at laparatomy, should be managed initially by a defunctioning transverse colostomy, drainage and the administration of appropriate antibiotics. Subsequent management should consist of simple closure of the colostomy following a check barium enema and the commencement of a high fibre diet. We substantiate this by reporting 20 cases from Dudley Road Hospital and 20 others mentioned in the current literature.

Continuous wave Doppler ultrasound was used together with B-mode real time ultrasound to study feto-placental blood flow in utero. The results of 887 examinations on 221 patients are presented. The fetal heart rate acceleration slope and pulsatility index (P.I.) of the audiofrequency ultrasound display were analysed. There was a significant reduction in fetal heart rate (P less than 0.001) and P.I. (P less than 0.001) with advancing gestational age in normal pregnancy. In contrast, in retarded intrauterine growth a significant increase in P.I. values was observed in 77% of patients.

A combination of pulsed echo and continuous wave Doppler ultrasound was used to obtain blood flow velocity signals from the umbilical arteries of 18 normal patients from the 16th until the 40th week of pregnancy. Audio frequency analysis of these signals yielded fetal blood velocity waveforms. Analysis of these waveforms demonstrated that the placenta is an organ of low vascular resistance and that placental resistance to blood flow declines with advancing gestational age in normal pregnancy.

Two otherwise comparable groups of patients, 27 of whom were non-smokers and 20 of whom smoked in excess of ten cigarettes per day, had serial fetal biparietal diameter measurements taken throughout pregnancy; from 21 weeks onwards, the fetal biparietal diameters increased significantly more slowly (p < 0.01) in mothers who smoked.

Continuous wave Doppler ultrasound has seldom been applied to the evaluation of the cerebral circulation of the newborn infant. Twenty-five term infants were studied and records taken from the common carotid and anterior cerebral arteries during the first week of life using a bidirectional Doppler instrument. The best Doppler signals obtained were audiofrequency analysed and sonagrams recorded. Analysis of the carotid sonagrams revealed a mean Pulsatility Index (PI) on the first day of life of 0.98 compared to 0.88 on Day 2 (p less than 0.001). An unexpected finding was the absence of continuous carotid blood flow in the majority of infants in the first hours of life. The PI on subsequent days did not differ significantly from Day 2. The PI of the anterior cerebral arteries on Day 1 was significantly elevated (p less than 0.001) compared to Day 2 and subsequent days. The significance of these findings and their importance in the further evaluation of pathological cerebral states in the neonate, especially birth asphyxia and intracranial haemorrhage are discussed.

The fetal crown-rump length (CRL) was measured by means of pulsed ultrasound, and the normal values between 47 and 101 days from the onset of the last menstrual period were determined from cross-sectional data in 253 patients. For any given CRL, the range was found to be within three days of the menstrual age with a maximum variation for a given occasion of three days. Detailed statistical analysis showed that the acceleration in the rate of change in the CRL was a constant and that the intrapatient variability, where measured, was low. A close correlation between the measurement and the date of ovulation was demonstrated in a further 40 patients.

A combination of pulsed echo and continuous wave Doppler ultrasound was used to obtain blood flow velocity signals from the umbilical arteries of 10 patients during uncomplicated spontaneous labour. Audio frequency analysis of these signals yielded fetal blood velocity waveforms. Analysis of these waveforms demonstrated that placental vascular resistance to feto-placental blood flow is not altered by uterine contractions, artificial rupture of the membranes, the infusion of oxytocin nor the administration of analgesia during uncomplicated labour.

We combined two ultrasound techniques to develop a safe, non-invasive, transcutaneous method of observing the circulation in the umbilical arteries and vein in the fetus. The umbilical cord can be located by standard echo ultrasound procedures, and this information can be used to direct a Doppler ultrasound beam on to the vessels in the cord. The signals can be heard through audio headphones or recorded on a tape recorded and spectrum-analysed. The method was successful in each of 20 patients examined, whose pregnancies ranged from 12 to 40 weeks' gestational age, and was suitable for outpatient use. It should be useful in assessing such conditions as pre-eclampsia and intrauterine growth retardation.

The ultrasonic measurement of the fetal crown-rump lenght (CRL) in early pregnancy was utilized to predict the date of delivery in 220 patients with reliable menstrucal histories and in 186 patients with unreliable menstrual dates who began labour spontaneously; Ninety-five per cent and 96.2 per cent respectively were delivered within 12 days of the predicted date. The CRL was found to be better than biparietal diameter measurements (p greater than 0.001) and as good as a reliable menstrual history (p greater than 0.5) in predicting the time fo spontaneous onset of labour.

To assess the effect of biliary diversion on gastric colonization by Campylobacter pylori, we undertook a retrospective histologic study of 24 patients with symptomatic bile reflux after peptic ulcer surgery, who had endoscopic gastric biopsies performed before and after a Roux-en-Y operation. The time interval between the preoperative and postoperative endoscopic examinations ranged from 0.8 to 9.8 yr (mean 4.7 yr). The partial gastrectomy specimen, which had been resected at the initial operation, was available for assessment in 12 patients (50%). Biopsy specimens were assessed for the presence of C. pylori and scored for severity of reflux gastritis by the use of a histologic grading system. Ten of the 12 partial gastrectomy specimens (83%) were C. pylori-positive. Only 13 of the 24 patients (54%) were C. pylori-positive before the Roux-en-Y operation, rising to 22 (92%) after biliary diversion (p = 0.008). The median reflux score was 6 in the partial gastrectomy specimens; it rose to 11 before the Roux-en-Y operation and fell again to 6 after biliary diversion (p less than 0.001). These results suggest that C. pylori may recolonize the gastric remnant after biliary diversion.