Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1*2 couples for every 1000 of the population. At

Traits presumed to reflect dopaminergic reward and prefrontal executive systems functioning were assessed in 100 clients undergoing residential treatment for substance dependence and a community sample of 107 social drinkers. All participants completed self-report measures of impulsivity, alexithymia, frontal systems dysfunction, sensitivity to rewards and punishments, dispositional mindfulness, alcohol use, illicit drug use, mood and demographic characteristics. The percentage of in-patients meeting the criterion for alexithymia was more than twice as high as in the community sample (p < .0001). Multivariate analysis of covariance controlling for age, education, head injury and gender revealed significant differences (p < .0001) between clinical and community samples such that clients scored higher on negative moods, frontal systems dysfunction, reward sensitivity, punishment sensitivity and impulsivity, and lower on dispositional mindfulness. Time in treatment was correlated only with negative mood, supporting the stability of the trait measures; controlling for negative mood eliminated group differences on punishment sensitivity and mindfulness only. Results are consistent with the notion that addiction is linked to reward sensitivity and frontal lobe deficits, with associated implications.

Summary. Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density <1 × 106/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4·7 (SE 3·8)% and without treatment was 6·6 (SE 3·9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.

One hundred and eighteen patients with unexplained infertility were treated with clomiphene (Clomid, Merrell) in a randomized placebo-controlled cross-over study lasting up to 3 months with each preparation. Compared with placebo, clomiphene led overall to a 66% increase in mid-luteal serum progesterone levels (from mean 43 nmol/l to 71 nmol/l, p less than 0.001) and a 53% rise in the 3-month cumulative conception rate (from 14.6% to 22.33%, p less than 0.05). The greatest relative increase in conception rates with clomiphene was in women with infertility lasting more than 3 years (3-month rates from 2.9% to 14.4%, p less than 0.05). Differences in conception rates were not related to the rises in progesterone, and there was no carryover effect of clomiphene into the following placebo cycles in terms of progesterone levels or conceptions. The findings suggest that couples with unexplained infertility of less than 3 years duration are essentially normal, but with more than 3 years duration there is often a subtle disorder of ovulation that is corrected by clomiphene therapy.

appearance of multiple cutaneous infections. Blood culture and culture from the pustules revealed haemolytic streptococci group A. The baby recovered after treatment with ampicillin.Disseminated intravascular coagulation has been found to occur in connexion with septic shock.4 Both thromboplastic material and fibrinolytic activators are most probably released as a oonsequence of endothelial damage to bacterial toxins.5 In most such cases therefore iboth the coagulation and fibrinolytic systems will be activated. In the present case the coagulation system was activated as shown by the decreased platelet count and the decreased levels of prothrombin, fibrinogen, antithrombin III, and a2-Macroglobulin. Soluble fibrin monomers were demonstrated and fibrin thrombi were found post mortem in the pulmonary and renal vessels. Extremely high levels cf AHF antigen have been found in conditions with severe tissue damage.6 A discrepancy between the antigen level and the AHF activity of the same degree as in the present case has been demonstrated in patients with signs of an activated coagulation system during pregnancy7 and has been proposed as an early sign of a pathologically activated coagulation system.The patient had, however, also signs of a markedly activa, ed filbrinolytic system with increased fibrinolysis, extremely high levels of fibrinogen degradation products of low molecular weight, indicating complete degradation of fibrinogen, and a very low facor V level. Alpha2-macroglobulin hinds both thrombin and plasmin, and very low levels are seen when both these proteolytic enzymes are present, as in this patient.Because the patient showed an activated fibrinolytic sys:em, no tranexamic acid was administered after the first dose. She was given dextran in order to prevent further platelet aggregation and fibrin deposition, and freshly frozen plasma and fresh blood were given to replace the coagulation factors.The vaginal flora in pregnant womnen sometimes contains hae.molytic streptocooci. These are usually commensals, but a few groups of streptococci are known to be able to cause malignant infections in puerperal and neonatal subjects. Group B streptococci are the most comnmonly encountered in the vagina, but the question whether pregnant carriers. should generally receive preventive penicillin treatment is not yet settled. On the other hand, during late pregnancy the presence in the birth canal of haemolytic streptococci of group A, which more consistentl'y occasion severe infections, is in our opinion of much graver significance. The finding of group A streptococci in women before parturition should be seriously considered as an invariable indication for proper preventive penicillin treatment.-We are, etc., G. GENNSER