Summary. Bone marrow graft rejection following HLA‐matched bone marrow transplantation (BMT) for leukaemia has been a rare problem. However, with the introduction of T‐lymphocyte depleted BMT, graft rejection is recognized as a new complication. At the Royal Free Hospital (RFH) in London T‐depletion is achieved using two monoclonal antibodies with complement mediated lysis. The methodology was extended to other centres and in total 56 patients have received T‐depleted, HLA matched BMT. Twelve of 56 patients have had graft rejection. At the RFH three of 41 (7%) patients have had rejection whereas at collaborating centres nine of 15 (60%) patients have had rejection. We have investigated these rejections in order to identify factor(s) responsible. Rejection was not restricted by patient or donor characteristics, nor disease status. Patient management, chemotherapy conditioning, efficiency of T‐depletion, graft versus host disease (GvHD), and infection post BMT, were not consistently implicated. The major difference between the RFH and all other centres was in the radiotherapy (RT) conditioning: The RFH prescribed a single fraction of 7‐5 Gy total body irradiation (TBI) whilst collaborating centres gave 10 or 12 Gy fractionated TBI. We conclude that the different incidence of rejection (7% v. 60%) relates primarily to the RT conditioning although the mechanisms(s) of rejection remain unknown. We conclude that where T‐depleted BMT is used, compensation by more intensive RT conditioning is required in order to avert graft rejection.

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In order to detcrmine the most effective regimen for the prevention of infection after clectivc hysterectomy, 300 patients were randomly assigned to rcceivc thrce perioperativc doses of either amoxycillin-clavulanic acid (1.2 g intravenous) or metronidazole (1 g suppository). Of the 280 patients who were assessable 138 were given amoxycillin-clavulanic acid and 142 received metronidazole; 268 underwent abdominal hysterectomy and li 2 had vaginal hysterectomy. Patients in the amoxycillin-clavulanic acid group had significantly less infectious morbidity (13.8%) than those in the metronidazole group (33.1?&). There were also statistically significant differences in favour of amoxycillin-clavulanic acid with respect to operative site infection, duration of hospital stay, need for postoperative antimicrobials, and surgery for operative site infection. But for one isolate of Bacreroides frqilis, all pathogens isolated from wound infections in the metronidazole group were aerobes. No anaerobes were isolated from patients in the amoxycillin-clavulanic acid group. The results suggest that prophylaxis for hysterectomy should consist of an agent, or combination of agents, with activity against both aerobic and anaerobic bacteria. Amoxycillin-clavulanic acid fulfils this criterion and appears to bc effective and safe.Infections following elective major gynaecological wrgcry such a5 abdominal and vaginal hyv

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Women have historically taken part in sports for many centuries. The first recorded female game competitions were the Herean Games in approximately 1,000 BC, named after the Goddess Hera. Held at Olympia in Greece, these games were for women alone and were thought to have originated as part of ancient fertility rights. Historically there is evidence of sporting activities involving women, but nothing of significance until after the 1948 summer Olympic Games, when 385 female athletes participated. Over the last six decades there has been a noted rise in the number of female athletes, reaching its maximum with the 2008 Beijing Olympics, where over 42% of the 11,028 athletes were women. Similarly in 2006, at the Turin Winter Olympics in Italy, 40% of the 2,500 athletes were females. In the 2012 Olympics, the Olympic Committee anticipates that approximately 44% of all athletes participating will be female. Despite there being a significant rise in the number of elite athletes in the UK, there appears to be an overall decrease in the amount and intensity of physical exercise undertaken by teenage girls. This is considered to be due to the fact that physical education is no longer an integral part of the school curriculum in the UK. There is, however, a small but significant group of elite athletes who start to train at a very early age (9-10 years old) especially in gymnastics, skating, swimming and athletics.