SUMMARY A new chromatographic procedure for determining small amounts of pregnanediol in urine is described. The method involves (1) acid hydrolysis, (2) toluene extraction, (3) a new permanganate oxidation step, (4) chromatography on alumina columns, (5) acetylation, (6) further chromatography on alumina, and (7) colorimetry after developing a colour with sulphuric acid. The method is considered under the headings of specificity, sensitivity, accuracy and convenience. The significance of results obtained from male, proliferative phase female, and post-menopausal urine is discussed.

DiscussionMedazepam, a benzodiazepine, is being used in Europe increasingly for the symptomatic relief of neurotic anxiety, but there have been relatively few carefully controlled trials comparing it with established anti-anxiety drugs. The results of our initial investigation on inpatients confirm that it is effective in relieving anxiety. The optimum dose was 10 mg three times a day, and since there were no abnormalities in liver function or blood tests in this group the drug was considered to be safe for outpatient use.The results of a double-blind crossover comparison show that medazepam 10 mg three times a day is superior to amylobarbitone 60 mg three times a day for the relief of anxiety in outpatients (P<0-01). This was shown by the patients' responses to one or other of the drugs used in an attempt to relieve their presenting symptoms. This comparison might be criticized on the ground that the dose of amylobarbitone was too low. Higher doses are certainly more effective in relieving anxiety, but at the expense of increased drowsiness. Our own previous experience with amylcvbarbitone suggests that a 60 mg dose three times a day is probably the best dose for most outpatients. In addition to its overall superiority, medazepam was particularly useful for the relief of ruminations (P<0-05) and phobias (P<0-01). Drowsiness and ataxia were not major problems with medazepam, but we should add that this series contained no elderly patients, who seem to be most vulnerable to those side effects.A comparison of the results of this trial with a trial of chlordiazepoxide 20 mg three times a day and amylobarbitone 60mg three times a day (Jenner, Kerry, and Parkin, 1961) suggests that medazepam 10mg three times a day is at least as therapeutically effective as chlordiazepoxide 20 mg three times a day. In the present study 24 out of 29 patients (83 %) preferred medazepam, whereas the previous trial showed chlordiazepoxide to be preferred by 59 out of 77 patients (77%).A previous comparison of diazepam 5 mg three times a day and amylobarbitone 50 mg three times a day (Jenner and Kerry, 1967) showed that 15 out of 19 patients (7904) preferred diazepam for the relief of their anxiety. This suggests that 10 mg of medazepam three times a day also has about the same activity as 5 mg of diazepam three times a day.To evaluate a new tranquillizer is always difficult, and one would now like to see the results obtained by comparing medazepam with other established tranquillizers. The use of these drugs is often accompanied by initial enthusiasm, to be followed later by disappointment. Psychiatrists are often forced to use the available tranquillizers for the relief of anxiety when perhaps psychotherapy would be more appropriate. This was an outpatient trial and no attempt could be made to keep environmental factors uniform; indeed, it would not have been desirable to do so, since the purpose was to assess the drugs as used in daily practice. It seems that medazepam 10 mg three times a day might offer symptomic relief of anxiety to ...

In a prospective study of52 patients with ovarian malignancy followed up for 3-1 8 months the clinical significance of pre-operative serum CA 125 as ii tumour marker was assessed. In 41 patients with epithelial ovarian cancer. the level of CA 125 correlated wcll with tuniour load as indicated by F I G 0 stage. All epithelial histological types, including mucinous. released CA 125 although serouh and undifferentiated tuinours produced quantitatively more antigen. 'l'hcre was, however, no correlation between CA 125 concentration and histopathological grade. n o r did CA 125 level appear to be of any prognostic value in epithelial ovarian cancer. Elevated CA 125 levels were also found in patjcnts with sex cordistronial tumours, K r u k e n b e r g tumours. an ovarian sarcoma and a serous carcinoma of low malignant potential.

DURING recent years, there has been much interest in the possibility of assessing placental function by measurement of the metabolites of oestrogens and progesterone in urine. In order to recognize the abnormal it is necessary first to establish the patterns in normal pregnancy.Reliable methods of measuring pregnanediol, the chief urinary metabolite of progesterone, have been available for several years, and Shearman (1959) has published data which specify the average changes during the course of normal pregnancy, and the extent of variation around the means. There 'is, however, a considerable variation in pregnanediol output of the same subject from day to day, which much detracts from the value of estimations done on single 24-hour urines.The main urinary end-product of the oestrogens is oestriol, and many workers have been interested in the urinary output of this steroid during pregnancy. We have found 23 publications since 1951 on this subject (De