No abstract

17 Horwitz W, ed. Official methods of analysis of the Association of Official Analytical Chemists. 12th ed. Washington, DC: AOFAC, 1975:7. 18 Holaday CE, Lansden J. Rapid Screening method for aflatoxins in a number of products.

Summary. Conventional and telemetric monitoring of labour were compared in a randomized study of 200 patients to assess the effect on the pattern of labour, outcome and attitude of the patients. All the telemetry patients had the option of mobility, but only 45% elected to get out of bed, and then often only for short periods. No clear physical benefits accrued from voluntary mobility. Ambulant patients who had spontaneous deliveries had a longer second stage and more of their babies were slow to establish regular respiration. Quantitative subjective assessments of pain, anxiety and comfort were made. Primigravidae with telemetric monitoring who chose to get out of bed had higher pain scores than primigravidae monitored conventionally, but anxiety scores were highest among primigravidae with telemetry who elected to stay in bed. There was a significant bias towards increased anxiety in the lower social classes. Primigravidae gained more reassurance from monitoring than did multigravidae, but there were no differences resulting from whether or not the recording apparatus was within the patient's view. Multigravidae who had experienced both forms of monitoring preferred telemetry because they felt less restricted and less anxious.

Objectives  To compare transvaginal ultrasound measurements of endometrial thickness with direct anatomical measurements and consider the implications of these findings on clinical practice. Design  Prospective observational study using two modalities blinded to each other's findings. Setting  Singleton Hospital, Swansea, a medium‐sized District General Hospital. Sample  Forty‐seven women admitted for hysterectomy. Methods  All women underwent transvaginal ultrasound scan to measure the endometrial thickness within 16 hours of surgery. Anatomical measurement of the fresh specimen was carried out immediately after surgery. Main outcome measures  Agreement between ultrasound and anatomical measurements of the endometrial thickness. Results  No ultrasound measurement was possible in 15% of patients. When both values were obtained, transvaginal ultrasound measurements were >2 mm different from the ruler measurement in 13/40 (33%) with an obvious tendency of the ultrasound scan to over‐estimate the endometrial thickness. The mean difference between the two measurements was −0.8 mm (limits of agreement −7.1 to +5.5 mm). The discrepancy was greater in women with endometrial thickness ≤5 mm (−1.6 mm, limits of agreement −5.7 to +2.6 mm) compared with that in women with endometrial thickness >5 mm (−0.2 mm, limits of agreement −7.6 to +7.2 mm). Kappa statistics showed good agreement between the two measurements in discriminating between thin and thick endometrium in 77% (κ= 0.55). Transvaginal ultrasound misdiagnosed a thick endometrium as thin in 3/40 (8%) and misdiagnosed a thin endometrium as thick in 6/40 (15%). Conclusions  Transvaginal ultrasonography is of limited value as a screening test for abnormal endometrium in patients with postmenopausal bleeding if the only parameter of normality is an endometrial thickness of 5 mm or less.

Nitrosamines are carcinogenic substances found in cigarette smoke, and it is known that female smokers have an increased risk of cervical carcinoma and premalignant change. Nitrosamines may also be formed due to the combination of amines and nitrites in an acidic medium. This study has shown a statistically significant association between anaerobic vaginosis which produce amines and cervical intraepithelial neoplasia 2 and 3. In addition nitrate reducing organisms are found in the acidic lower genital tract in a significant number of cases. It is therefore theoretically possible that nitrosamines may be an important agent in the development of premalignant disease of the cervix.