Case reports of three patients who had fits as a consequence of hyponatremia are presented. Each patient was in spontaneous labor at term and received conventional doses of oxytocin for augmentation. The pathogenesis, diagnosis and treatment of this entirely iatrogenic condition are discussed. The differences between these and similar cases in the literature are stressed.

Adolescent↗

PubMedDate not supplied

Effect of nafarelin on uterine fibroids measured by ultrasound and magnetic resonance imaging.

Administration of the LHRH agonist, Nafarelin (D-(Nal2)6 GnRH), at a dosage of 200 micrograms twice daily intranasally in 13 patients with uterine leiomyomata resulted in a reduction in uterine volume to a mean of 55.1% at 3 months and 44.5% at 6 months as measured using ultrasound. Re-enlargement occurred on discontinuing therapy and the uterus was back to the original volume at three months. Magnetic resonance imaging (MRI) performed in five patients showed advantages over ultrasound in identification of fibroid number in two patients. Mean reduction in uterine area measured using MRI was 61.3%, and mean reduction of fibroid area 57%. Oestradiol was suppressed with treatment to a mean of 69 pmol/l.

Administration, Intranasal↗

PubMedDate not supplied

Hyperexpression in Escherichia coli, purification, and characterization of the metallo-beta-lactamase of Bacillus cereus 5/B/6.

We used site-directed mutagenesis to introduce both a NdeI restriction endonuclease site and an initiator codon at the junction of the leader and structural gene sequences of the metallo-beta-lactamase of Bacillus cereus 5/B/6. This construct allowed us to clone just the beta-lactamase structural gene sequence into an Escherichia coli expression vector. E. coli cells were transformed with the recombinant plasmid, the B. cereus beta-lactamase was expressed, and these E. coli cells were disrupted by sonic oscillation. When the resultant suspensions were clarified by ultracentrifugation, the B. cereus beta-lactamase represented 15% of the total protein in the supernatant. Subsequent gel filtration and ion-exchange chromatography allowed the first reported purification to homogeneity of the B. cereus beta-lactamase from E. coli with an 87% recovery and an overall yield of 17 mg of enzyme per liter of cell culture. The electrophoretic mobilities of the enzyme expressed in and purified from E. coli and the enzyme purified directly from B. cereus were identical in both native and sodium dodecyl sulfate gel electrophoreses. As with the B. cereus enzyme, Km and Vmax (using cephalosporin C as substrate) for the enzyme purified from E. coli were 0.39 mM and 1333 units/mg protein, respectively. Likewise, the Co(II)-reconstituted enzyme purified from E. coli, which retained 29% of the activity of the Zn(II) enzyme, had electronic absorption spectra with maxima at 347, 551, 617, and 646 nm with extinction coefficients of 900, 250, 173, and 150 M-1 cm-1, respectively.

Bacillus cereus↗

PubMedDate not supplied

Risk-benefit assessment of drugs used for the treatment of menstrual disorders.

This article considers the benign yet debilitating conditions of menorrhagia, dysmenorrhoea and irregular menstrual bleeding. Surprisingly little has been reported in the literature concerning these common ailments which can detract from the quality of female life during the reproduction years. Both dysmenorrhoea and menorrhagia are subjective complaints, but despite accurate means of measuring menstrual blood loss such quantification is rarely performed. This lack of diagnostic accuracy is a cause for concern, especially as both medical and surgical treatment are not without risk. The therapeutic alternatives which are commonly prescribed in an attempt to rectify such menstrual disorders are discussed. These include the nonsteroidal anti-inflammatory agents, the combined oral contraceptives, danazol, progestogens, antifibrinolytics, haemostatics, luteinising hormone releasing hormone analogues and clomiphene. The results of clinical trials which have utilised these various agents are considered in terms of both the effectiveness of treatment and its potential adverse effects.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMedDate not supplied

Sperm function and structure and seminal plasma prostanoid concentrations in men with IDDM.

Semen from 18 men with insulin-dependent diabetes mellitus (IDDM) aged 20-40 yr was compared with that from 15 age-matched control subjects. Although semen volume, sperm count, and spermatozoal motility were similar in the two groups, semen from diabetic men had significantly greater numbers of abnormal spermatozoa and significantly lower ability to penetrate hamster eggs. Concentrations of prostaglandins E2, F2 alpha, and I2 and thromboxane A2 were significantly elevated in the seminal plasma from semen of diabetic subjects compared with control subjects. These observations indicate the need for a careful assessment of fertility in diabetic men, the mechanisms underlying the abnormalities in spermatozoa, and the relationship of these abnormalities to the increase in prostanoid concentrations in diabetic men.

6-Ketoprostaglandin F1 alpha↗

PubMedDate not supplied

Effect of low-dose prednisolone on sperm fertilizing capacity in subfertile men with circulating antisperm antibodies.

To assess if low-dose prednisolone reduced circulating antisperm antibodies and improved sperm fertilizing capacity, the hamster oocyte penetration test (HOPT) was used to evaluate treatment in 36 males with significant serum antisperm antibodies, measured by the tray agglutination test (TAT). Prednisolone 5 mg three times a day for 3 months was used. Only couples in whom all tests in the female partner were normal were entered into the study. A significant increase in sperm density, normal morphology, and HOPT were noted after therapy (p < .001). A significant decrease in antisperm antibody titer was noted (p < .0001) and correlated with improvement of HOPT (p < .05). There were no significant side effects. Six pregnancies (17%) occurred. Three pregnancies (18%) occurred in partners of an untreated group of 17 men. Prednisolone therapy in this regime does not significantly improve pregnancy rates. The HOPT does not offer any additional information for predicting patients who will show an improvement in antibody titers or achieve pregnancy after steroids.

Adult↗