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ULTRASOUND MONITORING OF OVULATION SIR,-Ultrasound has been used to monitor pre-ovulatory follicle growth.1-3 We have been examining the relation between ovulation-time, as estimated by basal body temperaand ultrasound estimates of follicle diameter. Ten women were studied for a total of 11 cycles. They were volunteers from 24 to 28 years of age who were not using oral contraceptives, had no gynecological problems, and had regular cycles ranging from 24 to 32 days. Every day basal body temperature was measured at 7 A.M. and an echographic test was carried out between 5 and 7 P.M. The temperature curves were read without knowledge of echographic findings and after the women’s curves had been mixed with those of other gynxcological patients. The days of the cycle were numbered, beginning with day 0 (DO), the last day on which a low temperature was observed preceding a phase of temperature elevation. For three curves DO could not be determined. ture curve,

FOLLICULAR DIAMETER

(mm) ACCORDING TO DAY OF CYCLE AS

ESTIMATED BY BASAL BODY TEMPERATURE

for diagnosing Hirschsprung’s disease, obviating radiological and manometric methods. Nevertheless, a reliable biochemical method for measuring AChE activity in rectal-biopsy specimens would be a valuable adjunct to the subjective, qualitative methods and might become the method of choice for routine

diagnosis. We are assessing the value of a biochemical method similar that of Dr Dale and his colleagues (Feb. 17, p. 347), making use of samples taken from the same biopsy for both histochemical diagnosis and biochemical assay. So far, 128 biopsy samples have been studied blind and the levels of enzyme activity were similar to those recorded by Dale et al. 11 samples had raised levels of enzyme activity, and 10 of these corresponded with the 10 that had been scored histochemically as diagnostic of Hirschsprung’s disease. The remaining biopsy had been scored as not diagnostic of Hirschsprung’s disease. These preliminary results support the suggestion of Dale et al. regarding the value of their method in the diagnosis of Hirschsprung’s disease. to

L. L. SMITH

Department of Pathology, Royal Hospital for Sick Children, Edinburgh EH9 1LF *Present address:

G. T. N. BESLEY W. J.

Department of Pathology, Royal Hospital for

A. PATRICK*

Sick

Children,

Yorkhill, Glasgow.

ERYTHROCYTE

SODIUM/POTASSIUM FLUXES IN HYPERTENSION

The results of follicle diameter measurements by echography (table) showed that the follicle disappeared between D-2 and D-1 in one case, between D-1 and DO in two cases, and between DO and D+1in five cases. There was no evidence of follicle disappearance after D+1-1.e., 36 h after the last low temperature reading. In case 4 the follicle diameter was 20 mm on DO at 7 P.M., 26 mm on D+1 at 10 A.M., and 33 mm on D+at 3 P.M.; the follicle had disappeared at D+at 7 P.M. It was thus possible with this non-invasive approach to demonstrate rapid growth of the follicle in the hours preceding ovulation and to estimate the time of ovulation. The mean follicle diameter on the day before disappearance was 25-3±4-0 mm, a result which accords with the estimation of follicle diameter by volume measurements of follicular liquid.4 This echographic technique has permitted us to demonstrate a close relationship between DO and the actual time of ovulation. It may be possible to predict the day of ovulation if an equation for the echographic growth curve of the preovulatory follicle can be established.

Gynæcology and Obstetric Service,

R. RENAUD I. DERVAIN

C.M.C.O.,

J. MACLER

Schiltigheim 67300, France

C. EHRET

Statistical Research Unit,

I.N.S.E.R.M., Villejuif 94800,

A. SPIRA

France

ACETYLCHOLINESTERASE IN HIRSCHSPRUNG’S DISEASE

SiR-In our experience, a qualitative, histochemical method for the identification of acetylcholinesterase (AChE) activity in rectal-biopsy material has provided a rapid, reliable method 1. Rönnberg, L., and others Lancet, 1978, i, 669. 2. Hackelöer, B.-J. ibid. p. 941.

3. Macler, J., Jacquetin, B., Ehret, C., Dervam, I., Renaud, R. J. Gynec. Obstet. Biol. Reprod. 1978, 7, 746. 4. Bomsel-Helmrich, O., Gougeon, A., Thebault, A., Saltrarelli, D., Milgrom, E., Frydman, R., Papiernik, E., J. clin. Endocr. Metab. (in the press).

SiR,—The results reported by Dr Garay and Professor Meyer (Feb. 17, p. 349) add to the increasing body of evidence to indicate that there is an important abnormality of sodium transport across cell membranes in hypertension. However, the unphysiological nature of their experiments makes it difficult be certain how the results should be related to the homoeostasis of sodium in vivo. 2,5-p-chlormercuribenzenesulphonate (P.C.M.B.S.) induces a temporary severe leak for both sodium and potassium so that intracellular concentrations of both approach those found in the extracellular fluid. After removal of the P.C.M.B.s. and the restoration of membrane sulphydryl groups the process of re-establishing normal electrochemical gradients can be studied. As Garay and Meyer point out rather obliquely this process of recovery does not primarily utilise ouabain-sensitive pathways-i.e., it does not depend mainly upon the sodium pump. Their results are therefore largely concerned with mechanisms which are quantitatively less important than the sodium pump in the normal cell. Nevertheless they do demonstrate that the rate of net sodium efflux was slower in cells derived from patients with essential hypertension. In moderate hypertension net potassium influx was greater than in the controls, thus further suggesting that pathways other than the sodium pump are important. Contrary to the impression conveyed by Garay and Meyer leucocyte flux studies were performed by Edmondson et al.’ under conditions where intracellular sodium and potassium concentrations were steady and net transport was not occurring. Under these circumstances a reduction in the ouabainsensitive rate constant for sodium efflux was found together with an increased intracellular sodium concentration. The unidirectional flux of sodium was similar to that of controls. Thus it may be possible for intracellular sodium to increase because of a change in the behaviour of the sodium pump, as in our studies, or because of alterations in ouabain-insensitive efflux pathways, as suggested by the study of Garay and Meyer, or because of increased membrane permeability as postulated by other workers.2,3 The important common factor to

1. Edmondson, R. P. S., Thomas, R. D., Hilton, P. J., Patrick, J., Jones, N. F. Lancet, 1975, i, 1003. 2. Jones, A. W. Fedn Proc. 1974, 33, 133. 3. Friedman, S. M., Nakashima, M., McIndoe, R. A., Friedman, C. L. Experientia, 1976, 32, 257.

Ultrasound monitoring of ovulation.

665 ULTRASOUND MONITORING OF OVULATION SIR,-Ultrasound has been used to monitor pre-ovulatory follicle growth.1-3 We have been examining the relation...
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