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Notes: Objective To ascertain whether metronidazole treatment of women with a heavy growth of Gardnerella vaginalis during mid-pregnancy would reduce the risk of spontaneous preterm birth.Design A multicentre, randomised, placebo-controlled trialSetting Four metropolitan hospitals.Participants Eight hundred and seventy-nine singleton women with a heavy growth of G. vaginalis or Gram stain indicative of bacterial vaginosis at 19 weeks of gestation.Interventions Oral metronidazole (400 mg) or placebo twice daily for two days at 24 weeks of gestation, and at 29 weeks if G. vaginalis found in test-of-cure swab four weeks after treatment.Main outcome measures Spontaneous preterm birth less than 37 weeks.Results Intention-to-treat analysis showed no difference between metronidazole and placebo groups in overall preterm birth (31/429 [7.2%] vs 32/428 [7.5%]) or spontaneous preterm birth (20/429 [4.7%] vs 24/428 [5.6%]). Among the 480 women with bacterial vaginosis, treatment had no effect on spontaneous preterm birth (11/242 [4.5%] vs 15/238 [6.3%]). In the subset of 46 women with a previous preterm birth, women in the metronidazole group showed a significant reduction in spontaneous preterm birth (2/22 [9.1%] vs 10/24 [41.7%], OR 0.14, 95%CI 0.01–0.84). A treatment effect was also found in compliant women with a previous preterm birth and bacterial vaginosis (0/14 [0%] vs 6/17 [35.3%], OR 0.0,95%CI 0.0–0.94).Conclusion Metronidazole treatment of women with a heavy growth of G. vaginalis or bacterial vaginosis did not reduce the preterm birth rate. Among women with a previous preterm birth, treatment reduced the risk of spontaneous preterm birth. Further studies are required to confirm these findings.

Notes: We studied 11 glomus tumours immunohistochemically, with a panel of connective tissue and epithelial markers. Most tumours contained small nerve fibres located in connective tissue septae between groups of glomus cells, thus accounting for the frequent occurrence of pain associated with glomus tumours. All tumours stained positively for muscle-specific actin and vimentin. Immunostaining for high and low molecular weight cytokeratins, desmin, myoglobin, S-100 protein, neurofilaments and Factor VIII related antigen was negative. Our findings confirm and amplify the proposed smooth muscle histogenesis of glomus tumours. This immunohistochemical profile may be of diagnostic value in the differential diagnosis of atypical glomus tumours.

Notes: Dedifferentiated chondrosarcoma is a biphasic tumour, comprising well-differentiated chondrosarcoma and an anaplastic non-cartilaginous sarcoma juxtaposed but distinct from each other. Two cases of dedifferentiated chondrosarcoma, one primary and one recurrent, demonstrated muscle differentiation when studied with monoclonal antibodies to muscle specific actin, desmin and myoglobin. One of the tumours was also positive for cytokeratin, identified by AE1/AE3 and CAM 5.2 antibodies. Our findings are consistent with the concept that these tumours are capable of diverse patterns of morphological and immunophenotypic differentiation.

Notes: The objective of this study was to compare the biological and economic efficiency of a seasonal pasture-based spring calving system of milk production on a high-rainfall, heavy-clay soil [Kilmaley (KMY)] to that on a lower-rainfall free-draining soil [Moorepark (MPN)] in Ireland. The physical performance data were obtained from a 3-year study (1998–2000) carried out at both sites. Analysis of the system of milk production at the two sites was undertaken using the Moorepark Dairy System Model. Herbage dry-matter production was greater at the MPN site with a greater proportion being produced between 1 September and 1 May. On average, over the 3 years, the system of milk production at the MPN site had a higher stocking rate (2·34 vs. 1·89 cows ha−1), higher milk production per cow (6421 vs. 5781 kg per cow), longer grazing season (250 vs. 149 d) and a higher proportion of the diet of the herd from grazed grass (0·70 vs. 0·40) than at KMY. Economic analysis showed that, in a 468 100 kg European Union milk quota scenario, the profitability at the MPN site was €28 417 greater than at the KMY site. At similar milk production per cow it was €19 138 greater. Monte Carlo simulation showed that the MPN site was stochastically dominant over the KMY site. Sensitivity analyses showed that farm profit was most sensitive to changes in milk price. The results also indicated that milk production in the future may not be sustainable economically on high-rainfall, heavy-clay soils in Ireland.

Notes: Objective To study the vaginal flora of pregnant women at 22–28 weeks gestation to determine whether the presence of specific micro-organisms is significantly associated with preterm birth and prelabour rupture of the membranes.Design A comprehensive descriptive prospective study of the vaginal micro-flora of women between 22–28 weeks gestation comparing those who gave birth preterm (〈37 weeks) with those who gave birth at term. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Tri-chomonas vaginalis. Multiple logistic regression analysis was used to account for confounding obstetric and demographic variables.Setting The Queen Victoria Hospital, Adelaide, South Australia.Subjects 135 women who gave birth preterm compared to 651 women who gave birth at term.Main outcome measure Preterm birth and preterm prelabour rupture of membranes (PROM)Results The prevalence of Gardnerella vaginalis between 22–28 weeks was significantly higher in women who gave birth preterm compared to women who gave birth at term (23%vs 15%; multiple logistic regression odds ratio (OR) 1.8, 95% confidence intervals (CI) 1.01–3.2, P〈0.05. Ureaplasma urealyticum was also found in a higher proportion of women who gave birth preterm (49% vs 32% OR 1.7, 95% CI 1.1–2.6, P〈0.0005). Preterm PROM occurred in 42% of whom 60% were carriers of U. urealyticum between 22–28 weeks, compared with 32% in the term group (OR 3.2, CI 1.7–6.1, f〈0.0005). When women who received antibiotics between the mid-trimester swab and labour were excluded, G. vaginalis was also significantly associated with preterm PROM (OR 2.7, CI 1.1–6.5, P〈0.05). The presence of vaginal enteropharyngeal bacteria (E. coli, Klebsiella spp., Haemophilus spp., Staph. aureus) in the midtrimester was not predictive of preterm birth, but when these organisms were found in labour, they appeared to have been acquired later in the pregnancy.Conclusion Women carrying G. vaginalis or U. urealyticum during the midtrimester had nearly twice the risk of preterm birth, while women positive for U. urealyticum had more than a threefold risk of preterm PROM.

Notes: Objective— To study the vaginal flora of women in preterm labour (PTL) and determine whether the presence of specific vaginal microflora is significantly associated with onset of PTL.Design— A comprehensive prospective study of the vaginal microflora of women in early labour comparing women in PTL with term controls. Microbiological assessment included cultures for aerobic and anaerobic bacteria, yeasts, genital mycoplasmas and Trichomonas vaginalis. Multiple logistic regression analysis was used to adjust for confounding obstetric and demographic variables.Setting— The Queen Victoria Hospital, Adelaide.Patients— 428 Women in PTL compared to 568 women in labour at term.Main outcome measure— PTL and preterm prelabour rupture of membranes (PPROM) in relation to specific vaginal microflora.Results— After multiple logistic regression analysis, two distinct bacteriological groupings were associated with PTL 〈37 weeks gestation, namely, the bacterial vaginosis group of organisms, Gardnerella vaginalis and Bacteroides spp., and a group of enteropharyngeal organisms, E. coli, Klebsiella spp., Haemophilus spp. and S. aureus. G. vaginalis was found in 12% of women in PTL compared to 6% at term [regression odds ratio (ROR) 1.8, 95% confidence intervals (CI) 1.1–3.1] whereas Bacteroides spp. were detected in 45% of women in PTL compared with 35% at term (ROR 1.6, CI 1.2–2.1). The prevalence of G. vaginalis (17%) and Bacteroides spp. (50%) was even higher in women in PTL 〈34 weeks gestation. The enteropharyngeal group of organisms were more commonly present in women in PTL 〈37 weeks (E. coli 10% vs 6%, ROR 1.4, CI 0.8–2.4; Klebsiella spp. 3% vs 〈1%, ROR 5.4, CI 1.1–26.7; Haemophilus spp. 2% vs 〈1%, ROR 5.5, CI 1.1–28.6; aureus 6% vs 4%, ROR 1.8, CI 0.9–3.3) and were isolated even more frequently in women in PTL 〈34 weeks (E. coli 15%; Klebsiella spp. 4%; S. aureus 7%). Bacteroides spp., Klebsiella spp., and Haemophilus spp. were all found to be associated with PPROM.Conclusion— There are two distinct bacteriological groupings commonly found in women in PTL, especially in PTL 〈34 weeks gestation. These bacteriological groups are women with bacterial vaginosis in pregnancy and women who demonstrate enteropharyngeal bacteria in the vagina.