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This study compared the physiological and economical effects of laparoscopic and open surgery. The laparoscopic minimally invasive technique reduced the trauma of the tissue, the homeostasis of the organism was less damaged, therefore the metabolic and inflammatory responses were reduced, the respiration and blood gas values were nearer to the normal ones than at laparotomy. These results can explain that laparoscopic surgery leads to less pain and quicker postoperative recovery than conventional surgery. The cost of laparoscopic operations on the adnexa and laparoscopic hysterectomy was compared with the cost of the same open operations. According to USA and British data after laparoscopic surgery hospital stay was reduced by 6-8 days, less drugs, blood and infusion were used, the duration of the sick leave and pay was shorter by 20-30 days. The laparoscopic method is not an unnecessary luxury. Today reliable data attest to values of operative laparoscopy.

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OBJECTIVE: To assess the outcome of a modified laparoscopic-assisted Doderlein hysterectomy. DEFINE: A prospective clinical study. SETTING: Women's Endoscopic Laser Foundation, South Cleveland Hospital, Middlesbrough, Cleveland. SUBJECTS: Twenty consecutive women with indications for hysterectomy and unsuitable for vaginal approach. INTERVENTION: Laparoscopic-assisted Doderlein hysterectomy with modification to make the technique cost effective. MAIN OUTCOME MEASURES: Operative time, uterine weight, blood loss, hospital stay, intra-operative complications and post-operative complications. RESULTS: The median operative time was 93 minutes, the uterine weight was 168 g, blood loss minimal. The median hospital stay was three days. There were no intra-operative complications and minimal post-operative complications. CONCLUSIONS: The modified laparoscopic-assisted Doderlein hysterectomy is a safe, rapid procedure which allows the patient to achieve all the benefits of laparoscopic surgery with simple and inexpensive laparoscopic and vaginal techniques.

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Transcervical fallopian tube catheterization has been evaluated on a group of patent tubes in both a model of the human uterotubal complex and during hysterosalpingography. The technique appears to be unreliable and tubal catheterization occurs infrequently.

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The authors compared the serum DHAS and cortisol level in 53 vaginal deliveries with those of 21 caesarean sections prior to the onset of labour at the 28th to 36th weeks. They also compared 18 vaginal deliveries with 16 elective caesarean sections at the 40th week. The serum hormone concentrations were measured in the maternal vein, the umbilical vein and the umbilical artery. The results indicate that the serum DHAS and cortisol level was higher after vaginal delivery than after caesarean section in the maternal vein, umbilical vein and umbilical artery at the 28th to 36th and also at the 40th week. The authors suggest that, although the role of the fetal adrenal cortex is not so definitive as in the case of some species in the onset of labour, it may be presumed that the increase in adrenal cortical activity cannot be explained exclusively by maternal stress.

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K cell activity was measured in the enzyme-like kinetic model of cytotoxicity against O, Rh (D) positive erythrocytes in 127 patients with carcinoma of the uterine cervix, 55 with carcinoma of the corpus uteri and 30 with malignant tumors of the ovary. The control groups included 62 healthy age matched women and 39 patients with benign tumor of the ovary. The cytotoxic activity was measured in a number of cases before any treatment and after irradiation and surgery in patients with cervical and endometrial cancer. The target cells were obtained from the same donor. ADCC activity of cervical and ovarian tumor patients enhanced depends on the stage of the disease. K cell activity of endometrial carcinoma patients was similar to the controls. ADCC activity of patients with carcinoma of the uterine cervix was increased, with carcinoma of the uterine corpus was indicated an increasing tendency following irradiation. There was connection with the dose of the irradiation and K cell activity. On the contrary, operation did not influence ADCC activity.

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There are a great deal of data concerning the role of testosterone in the formation of the sex of the fetus. The synthesis of the testosterone is influenced by the hypophysis and the fetoplacental unit. In this study the authors conferred the progesterone, DHAS, cortisol, oestradiol, oestriol, prolactin and HPL levels of male and female newborns in the maternal vein and in the umbilical vein and artery in the 28th-32th weeks (31 parturients, 15 male and 16 female fetuses), in the 33rd-36th weeks (43 parturients, 20 male and 23 female fetuses) and in the 40th week (34 parturients, 11 male and 23 female fetuses) of pregnancy. The determination of serum hormone concentration was carried out with the RIA method in 2084 samples. There was no significant difference between the serum hormone concentrations of the male and female sex in the 28th-40th weeks of pregnancy. They assume that in the 28th-40th weeks there is no difference in the activity of steroid and peptide hormone secretion caused by the sex of the fetus.

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The authors measured the serum levels of dehydroepiandrosterone sulfate (DHAS) in the maternal vein (MV), the umbilical vein (UV) and the umbilical artery (UA) during the 28th-36th weeks of pregnancy (n = 74) and in the 40th week (n = 34), to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found: (1) The DHAS concentration increased significantly in MV, up to twice the concentration from the 28th-32nd weeks to the 33rd-36th weeks (p less than 0.01). From the 33rd-36th weeks to the 40th week it decreased significantly to one third of this value (p less than 0.01). DHAS levels revealed a decreasing tendency in the UA and UV serum from the 28th-32nd weeks to the 33rd-36th weeks, and there was a tendency to rise from the 33rd-36th weeks to the 40th week. (2) The serum DHAS values were found to be higher than in the MV, the UA-UV difference was not significant; however, the 'UA/UV X 100' value remained higher than 100% during the 28th-40th weeks. (3) The MV DHAS value showed slight correlation with the UV and UA DHAS concentration (r = 0.2951, p less than 0.01, n = 106; r = 0.2930, p less than 0.01, n = 100). There was a close correlation between the UV and UA serum DHAS levels (r = 0.8432, p less than 0.01, n = 98). The authors consider that the adrenal activity increases independently of the maternal adrenal cortex at term.

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The role of the maternal-fetoplacental hormonal system in the maintenance of pregnancy and in the onset of labor was studied by measuring the serum progesterone level in the maternal vein, the umbilical vein and artery at term (n = 34) and in the case of premature births (n = 74). Our results show: 1) During the 28th-40th weeks the serum progesterone concentration in the umbilical vein is greater than in the maternal vein (p less than 0.01) and in the umbilical artery (p less than 0.01), and greater in the umbilical artery then in the maternal vein (p less than 0.01). 2) No correlation was found between the serum progesterone concentration in the maternal and fetal vessels, whereas a close correlation was found between the serum concentration in the umbilical vein and artery. 3) The progesterone concentration of the maternal serum increased during the 28th-40th weeks, but increased only during 28th-36th week in the umbilical vein and artery and fell significantly by the 40th week. From this it appears that the maternal and the fetal progesterone concentrations are interdependent. The progesterone concentration of the umbilical vessels falls before term but it is not an essential factor in the onset of labor.

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K cell activity of 18 mature, healthy newborns was measured against O,Rh(D)-positive erythrocytes, sensitized by anti-D antibodies, in cord and venous blood (later obtained 3-4 days after delivery). 53 healthy women served as controls. Activity was determined as a function of target cell number in the enzyme-like kinetic model of cytotoxicity. It was low in cord blood, increased in venous blood by days 3-4 but it did not reach the level of adults. While cytotoxic activity of male infants increased significantly from birth to the 3rd-4th day of life, it did not change in female infants. No correlation was found between the weight and K cell activity of newborns.

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The serum level of unconjugated 17 beta-oestradiol (E2) and oestriol (E3) in the maternal vein (MV), the umbilical vein (UV) and artery (UA) immediately after term (n = 34) and preterm (n = 74) labour was measured to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found. (1) The level of E2 and E3 increased equally in the MV, UV and UA serum from the 28th-32nd week to the 33rd-36th week of pregnancy. From the 33rd-36th week to the 40th week there was no change in the MV, but the value of E2 and E3 decreased significantly in the UV and UA serum. (2) The serum level of E2 in the MV was significantly higher than that in the UV and UA during every gestational period. In contrast, the serum concentration of E3 in the MV was significantly lower than that in the UV and UA. (3) The value of 'UA/UV X 100' of E2 and E3 was about 30% during the 28th-40th week. (4) A weak correlation was found between the MV serum level of E2 and E3 and UA serum concentrations. A strong correlation was found between the UV and UA serum levels of E2 and E3. The authors suggest that though there is a close connection between the fetal and the maternal organism, the fetus is still capable of maintaining its hormonal environment independently.

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A method for obtaining trophoblastic cell cultures from first-trimester human placental villi is described. The essential feature of the method is the use of serum from a pregnant woman in the culture medium. Using this technique, pure cultures of trophoblastic cells are produced in 88 per cent of cases.

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The authors examined the possible role of HPL in the onset of labour. The HPL level of the maternal vein, the umbilical cord vein and artery was compared in vaginal mature (n = 16) and premature (n = 52) deliveries. The HPL concentration was also examined in mature (n = 18) and premature (n = 18) deliveries performed by caesarean section prior to the onset of labour. The results showed that: the serum HPL level in the maternal vein, the umbilical cord vein and artery was lower during the 33rd-36th and the 40th weeks in cases of vaginal delivery compared to elective caesarean section; The artery/vein ratio decreases during labour (A/V X 100 value), indicating that HPL metabolism in the fetus decreases during regular labour pains; The onset of premature labour and delivery was associated with lower HPL levels compared to normal pregnancy. The authors assume that the lower HPL level found in cases of vaginal delivery may be due to reduced placental perfusion, but they do not exclude the possible association of lower HPL concentrations in cases of premature delivery.

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The concentration of steroid and peptide hormones in the development of the respiratory distress syndrome of the newborn has been investigated. Serum progesterone, dehydroandrostenedione sulphate (DHAS) oestradiol, oestriol, cortisol, prolactin and human placental lactogen (HPL) concentrations were measured by radioimmune assay (RIA) in samples obtained from the maternal vein and the premature newborn's umbilical artery and vein. The results were grouped according to gestational age into two groups, 28-32 and 33-36 weeks. Serum cortisol level was lower in maternal blood and both the umbilical vein and artery if the newborn subsequently developed RDS. No deviations from healthy values were encountered with any other hormone. These observations and data in the literature suggest that maturation of the fetal lung is influenced not only by maternal glucocorticoid secretion but also by the activity of the fetal adrenal cortex.

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Serum prolactin concentration was determined in blood samples taken from the maternal cubital vein, the umbilical vein and artery between the 28th-40th weeks of pregnancy from 108 parturients, of whom 74 gave birth prematurely and 34 gave birth at term. Results indicated that during this period the prolactin level rose in the umbilical vein and artery but not in the maternal vein. Correlative analysis showed a significant positive correlation between gestational age and the serum prolactin concentration of umbilical arterial and venous blood, but no correlation was found in the case of maternal blood. During the 28th-32nd weeks the prolactin level of maternal blood was found to be higher than that of umbilical blood while during the 33rd-36th weeks and at the 40th week the prolactin level was higher in the umbilical vein and artery. No correlation was found between the prolactin concentration of maternal and umbilical blood. On the basis of these results the authors conclude that fetal prolactin concentration changes occur independently of the maternal organism and increases during the 28th-40th weeks of pregnancy.

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Changes in the serum cortisol level of maternal venous, umbilical venous and umbilical arterial blood were studied separately between the 28th-36th weeks in cases of preterm deliveries (n = 74) and in the 40th week in cases of term delivery (n = 34). Results indicate that between the 28th-40th weeks of pregnancy the cortisol concentration increased only in the serum of the umbilical artery; the "umbilical arterial/umbilical venous concentration X100" quotient rose from a value of 86% measured at 28th-32nd weeks to 103% in the 40th week of pregnancy. Positive correlation was found between the cortisol concentration of the three samples. On the basis of these results the authors believe that fetal adreno-cortical activity increases before birth.

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Anti-D antibody-dependent cellular cytotoxicity of peripheral blood mononuclear cells was measured against O, Rh (D)-positive erythrocytes in 20 healthy pregnant women (chosen from all trimesters), and in 16 toxemic patients; it was then compared to the cytotoxic activities of 20 women 3 months after parturition and to that of 42 nonpregnant women. The application of an enzyme-like kinetic model for measurement of maximal cytotoxic function has permitted sensitive determination of the K cell function. It was found that during normal pregnancy maternal K cell activity did not change, whereas it was significantly decreased in preeclampsia.

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The cytotoxic activity of killer (K)-cells was measured against O Rh(D)-positive human erythrocytes sensitized by anti-D antibodies, in 14 women during normal labor and compared with the K-cell activity of 20 pregnant women (in the 37-40th week of pregnancy) and 42 non-pregnant female controls. K-cell activity was determined by the enzyme-like kinetic cytotoxic model, which measured the maximum of killing capacity. Cytotoxic activity was found to be significantly higher intrapartum. Data are compatible with the possibility that immunologic mechanism(s) are contributing to the onset of parturition.

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