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Notes: Objective To investigate the effect of the gonadotrophin releasing hormone (GnRH)-agonist goserelin, given by monthly subcutaneous injection for three months prior to total abdominal hysterectomy for uterine leiomyomata, on the pre-operative symptoms, difficulty of operation and operative blood loss.Design Randomised placebo-controlled study.Setting Patients were recruited from the gynaecological outpatient departments from hospitals in Edinburgh, Glasgow and Newcastle.Subjects Seventy-one premenopausal women with uterine leiomyomata who were on the waiting list for hysterectomy.Interventions After the presence of leiomyomata was confirmed using ultrasonography, the women were randomised to receive either the GnRH-agonist goserelin by monthly subcutaneous injection or a sham injection for three months prior to operation. At the monthly visits, patients were asked about treatment related symptoms, fibroid related symptoms, and their bleeding patterns. Blood was taken for haematological assessment.Main outcome measures Haemoglobin concentrations at recruitment, at operation and post-operatively, pre-operative symptoms, operative difficulty and blood loss and post-operative complications.Results Treatment with goserelin induced amenorrhoea in over 80% of the women, and this was associated with a significant rise in haemoglobin level. At the time of operation, fibroid related symptoms were less in the goserelin group than in the placebo group. The hysterectomy was technically easier and the median (range) operative blood loss was significantly lower in the goserelin group compared with the placebo group (187 (60–600) ml vs 308 (118–1000) ml respectively; P 〈 0.05, Wilcoxon signed rank test). There was no difference between the two groups in the duration of hospital stay or the frequency of post-operative complications. The fibroids were smaller at the time of operation in the goserelin group, and more women treated with goserelin were able to have their operations through a transverse incision.Conclusions This study demonstrates the benefits of goserelin in women having total abdominal hysterectomy for uterine leiomyomata.

Notes: Summary. Five infertile women, with normal menstrual rhythm who had been investigated previously by daily hormone analyses throughout at least one complete menstrual cycle and had shown poor luteal-phase steroid-hormone profiles were treated by a new approach. They were rendered hypogonadotrophic with large doses of a luteinizing hormone releasing-hormone analogue (Hoe 766) and were then treated with exogenous gonadotrophins to induce follicular growth and ovulation. Progesterone production after ovulation in all cases was superior to that observed in the individual patients’ without treatment. One patient conceived in her first conception cycle and another in her fourth. This regimen offers a systematic approach to the treatment of unexplained infertility in women with deficient luteal-phase steroid-hormone profiles.

Notes: Six infertile patients had been studied previously (Dodson et al., 1975b) and were shown to produce inefficient corpora lutea which appeared to be predetermined by ovulation of “poorly grown” follicles. In a second cycle these infertile patients were treated with 50 mg of clomiphene per day for five days. The resulting plasma sex steroid and gonadotrophin profiles were compared with those found before treatment and with the profiles in normal patients (Dodson et al., 1975a). Treatment with clomiphene appeared to produce increased follicular growth and more active corpora lutea.Thanks are due to Dr. Philip England, Research Department, Glasgow Royal Maternity Hospital, who supervised the LH assays; Mr. Alan Craig, Searle Scientific Services, who supervised the FSH assays; Dr. P. D. G. Dean for a gift of oestradiol antiserum; Mr. W. McNally, Department of Obstetrics and Gynaecology, for art work and the Medical Research Council for financial support (MRC 971/222/C).

Notes: Total urinary oestrogens (UE), plasma oestradiol-17β (PE2), plasma progesterone and urinary pregnanediol values were estimated during 28 cycles of treatment with human menopausal gonadotrophins (HMG) and human chorionic gonadotrophin (HCG) in seven patients with primary or secondary amenorrhoea who complained of infertility. Ovulation occurred in 23 courses of treatment and three patients became pregnant. PE2 estimations gave a more accurate day to day assessment of the response of patients to treatment than UE values. Monitoring of treatment with PE2 values should reduce any tendency to overstimulation with HMG and allow more accurate timing of the first HCG injection which is critical for a successful ovulatory response. The first HCG dose is an effective stimulus to ovulation when administered on the day of the UE peak which is the day after the PE2 peak. The first HCG dose appeared to be an ineffective stimulus to ovulation if given subsequent to this time or more than two days after the last HMG stimulation.

Notes: We have investigated the collisionally induced line shapes corresponding to the 1S0→1D2 4575-A(ring) electric quadropole transition in neutral calcium for a variety of rare-gas perturber species. We interpret our results in terms of molecular potentials.

Notes: We present results on experiments probing the effect of collisions on forbidden lines. Two contrasting lines are investigated—a spin-forbidden dipolar transition and a spin-allowed electric quadrupole transition. We explain our results in terms of straightforward physical models.

Notes: Instability mechanisms discussed to date are unable to account for the behavior of long-pulse self-sustained discharge-pumped XeCl devices. We develop theoretical arguments supporting the concept that halogen donor depletion during the discharge pulse is the principal cause of discharge collapse and the termination of lasing. The theoretical prediction that the duration of the glow phase should vary as the inverse square of the initial halogen donor concentration is verified by experimental results furnished by a study of a resistively stabilized long-pulse xenon chloride laser.

Notes: Sensitive and specific displacement analysis methods for the assay of steroid hormones in small volumes of plasma are described. Plasma sex steroid and gonadotrophin hormone patterns were determined throughout a number of normal menstrual cycles. The mean cycles showed patterns which were similar to those described by other workers. However, examination of individual cycles provided information which may contribute to our understanding of menstrual cycle regulation with particular reference to the pattern of 17a-hydroxyprogesterone and steroid-gonadotrophin interactions.

Notes: Abnormalities of in-vitro sperm-mucus penetration, ovarian hormone deficiency, specifically poor progesterone surge, and luteal cyst formation were assessed prospectively in 95 couples with fully investigated primary infertility of 3·3 years duration. Abnormal spermmucus penetration was found in 22, half of whom could have been identified on semen assessment alone. Ten other males had recurrent oligospernia but with normal motility and mucus penetration. Twentyone patients had a poor progesterone surge and seven of them demonstrated retained luteal phase cysts. Endocrine and mucus penetration abnormalities did not coincide, demonstrating that they are distinct and unrelated phenomena. A significant number of couples were found for whom the term‘unexplained infertility’was no longer applicable and appropriate management could be considered.

Notes: Summary. Fourteen infertile women with normal menstrual rhythm were investigated; each provided daily blood samples throughout two menstrual cycles: one control cycle and another on therapy with clomiphene (50 mg/day) given either from days 1 to 5 (n=7; group I) or from days 5 to 9 (n=7; group II) of the cycle. The effects of this empirical clomiphene therapy on the menstrual cycles were assessed by reference to the delay from termination of clomiphene therapy to ovulation (day after the LH peak) and by comparing pre-ovulatory oestradiol levels and luteal phase progesterone indices (total progesterone levels from days 4 to 8 post LH peak) in patients' control and treated cycles. No differences were observed in the effects of the treatment on the two groups of women except that the clomiphene to ovulation delay was greater in those treated earlier in the cycle (group I). Clomiphene caused increased follicular development as indicated by elevated pre-ovulatory oestradiol levels but this was not followed by improved progesterone indices. Ovarian ultrasonography indicated that the increased follicular development was in terms of numbers of follicles and not in maturity or oestrogen biosynthetic capacity of individual follicles. The lack of increased luteal progesterone levels thereafter indicated that mean luteal progesterone production per luteinized follicle was reduced. Clomiphene therapy as given in this study was therefore not successful in stimulating increased follicular/luteal hormone production from the dominant follicle/corpus luteum in such patients.