The diagnostic performance of a new enzyme linked immunosorbent assay for the cardiac structural protein troponin T in the differential diagnosis of ischaemic cardiac damage was assessed. A well documented set of patients admitted to the coronary care unit of a district general hospital were studied. At a cutoff value of 0·2μ/L, troponin T measurements 12–24 h after admission or 12–16 to 24–48 h from onset of chest pain showed an overall efficiency of 97 · 6% for diagnosis of proven myocardial infarction. Troponin T was not detectable in patients when ischaemic heart disease could be excluded but was present in four patients with angina. Detectable troponin T in these angina patients was associated with subsequent cardiac events.
A group of oligomenorrhoeic women without obesity or hirsuties was investigated with high-resolution ultrasound, laparoscopy and biochemical parameters. In this series, polycystic ovaries (PCO), as defined by ultrasound and laparoscopy, are a common cause of oligomenorrhoea in women without the classic symptoms, and were strongly associated with an elevated free androgen index (FAI). Despite an elevated FAI, these women were not hirsute, It would seem reasonable to include a FAI in the investigation of the oligomenorrhoeic woman, along with the more 'standard' tests, such as thyroid function and a prolactin level.
SUMMARY. This paper reports on the provision of a clinical biochemistry service for serum oestradiol. The pathophysiology and recognised applications of oestradiol assays are discussed and the current availability of assay reagents and methodologies reviewed. Data are presented on the analytical performance of assays for serum oestradiol in the UK External Quality Assessment Scheme (UKEQAS) and general guidance is offered to laboratories providing a diagnostic service for this analyte.
SUMMARY. Eighty-five regularly cycling women with normal ovaries at laparoscopy, were studied to determine the factors that influence the free androgen index (FAl). It was found that body mass index (BMl), age of the patient and the phase of the menstrual cycle that the blood was collected can all affect the FAI. It is recommended that where possible, specimens should be collected in the early follicular phase to avoid misinterpretation of the result.
Polycystic ovaries (PCO), identified by ultrasonography, may be present in as many as 23% of otherwise normal women not manifesting any of the clinical signs of obesity, hirsutism and oligomenorrhoea.' Furthermore, a third of women being investigated for infertility in a recent study were shown to have PCO by laparocopy.^ Thus this condition would appear to be far more common than hitherto suspected, and could account for a large proportion of infertility cases. The condition is usually associated with elevated concentrations of LH and androgens, including testosterone,' but some indices such as free androgen index may be influenced by factors such as age and obesity4 and LH concentrations are not always raised.The ovaries and the adrenal glands are the main sources of androgens in women. Increased stimulation of the ovaries by LH during the follicular phase could account for raised androgen concentrations, in which case precursor progestogens should also be increased. Late onset congenital adrenal hyperplasia due to mild (subclinical) 2 1 a-hydroxylase deficiency might also result in increased concentrations of progesterone and I7a-hydroxyprogesterone, some of which would be converted to androgens. Since low dose progestogen pills can be used t o reduce fertility in normal women, it is possible that raised endogenous progestogen concentrations in women with PCO during the follicular phase could contribute to their infertility.We have compared serum progesterone, 17a-hydroxyprogesterone and various androgen indices during the early part of the follicular phase in women with PCO and in women with normal ovaries, since during this part of the cycle the concentrations of these steroids are normally low. METHODSSeventeen young female medical students initially volunteered to take part in the study which had Medical Ethical Committee approval. All the women underwent abdominal ultrasonography, and were subsequently classified as negative (n = 10) or positive (n = 7) for the presence of polycystic ovaries using the criteria of Adams et u I .~ A blood sample was taken between days 1-5 of the cycle from each subject and the steroid concentrations subsequently determined using standard radioimmunoassay techniques.The hormones measured were progesterone, 1 7a-hydroxyprogesterone, androstenedione, dehydroepiandrosterone sulphate and testosterone. In addition, sex hormone binding globulin (SHBG) concentrations were determined, and the ratio of testosterone to SHBG expressed as a percentage to give a value for the free androgen index (FAI). All samples for progesterone and 17a-hydroxyprogesterone were measured in the same batch. The within-assay coefficient of variation for progesterone at 1.039nmol/L was 12% while that for 17a-hydroxyprogesterone at 1.003 nmol/L was 24%.One woman, classified as having normal ovaries was subsequently found to have concentrations of hormones all well above those measured for the rest of the group. She was diagnosed as a probable late onset congenital adrenal hyperplasia and was not included i...
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