Rheumatic heart disease was the predominant type. Patients in NYHA class I/II had a better maternal and fetal outcome than those in NYHA class III/IV. Surgical correction of the cardiac lesion prior to pregnancy was associated with better pregnancy outcome. Pregnant women with prosthetic valves tolerated pregnancy well.

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Ormeloxifene is an effective and safe therapeutic option for the medical management of menorrhagia.

SUMMARY Liver ischaemia was induced by cross clamping the hilar pedicle for 30 minutes in groups of rats with or without treatment with the iron chelating agent desferrioxamine (deferoxamine, DFR). The groups included eight animals each and were divided into the following treatment categories: control; ischaemia alone; ischaemia with subsequent reperfusion; ischaemia preceded by DFR, 60 mg/kg body weight; and reperfusion preceded by 20, 40, or 60 mg/kg DFR. The drug was given intravenously five minutes before either ischaemia or reperfusion. Malondialdehyde (MDA), a product of lipid peroxidation, and histopathological changes of liver tissue samples were used as indicators of hepatocellular injury. Lipid peroxidation (MDA concentration in [imolkg liver tissue) was highest (4.76 (1P19)) after ischaemia without reperfusion and less pronounced (2-87 (0.34)) after reperfusion. Both concentrations, however, were significantly (p<005) higher than basal (control) values (1P78 (0.27)). At 60 mg/kg body weight, DFR treatment reduced MDA to basal or even lower concentrations in both situations (1.98 (0.08) and 1.26 (0.06), respectively) with a corresponding improvement in liver histopathology. Lower DFR doses were less protective. The data suggest that liver ischaemia is associated with free radical initiated, and apparently iron catalysed lipid peroxidation, which can be significantly decreased by iron chelation.The harmful effects of complete interruption of blood flow to an organ has long been a topic of intense interest. Complete interruption of blood flow to the liver is often necessary during surgical intervention for trauma or when extensive resection of a tumour is performed.' With the recent development of liver transplantation, the effects of temporary ischaemia on restoration of liver function are of even greater importance. Under these conditions, the harmful consequences of liver ischaemia and subsequent reflow on liver function are often related to injury at the cellular and subcellular level (membrane integrity, mitochondrial function, protein synthesis, DNA, etc).-4Damage to cell and organelle membranes is probably the critical lesion that precedes irreversible cell injury.' This has been largely attributed to peroxida-

Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.

Our purpose was to evaluate the pathologic features and outcome of pregnancies that were complicated with adnexal masses and were managed surgically. A review of patients who had persistent adnexal masses during pregnancy and needed surgical removal of tumours was performed from January 1998 to April 2001. There were 14 cases of persistent adnexal masses identified among 2000 deliveries. There were 13 patients who had surgical interventions: nine (69.2%) had surgery during ongoing pregnancy (at mean gestational age 17+/-3.7 weeks), two (15.3%) with caesarean section, one (7.6%) after evacuation of missed abortion and one (7.5%) after delivery. Out of 13, ten (76.9%) were benign [mature cystic teratoma, six (46.9%); serous cyst adenoma, two (15.3%); mucinous cyst adenoma, one (7.6%); paratubal cyst, one (7.6%)] and three (23%) were malignant (one immature teratoma, one papillary cyst adenocarcinoma and one krukenberg tumour]. Both patients operated on after 24 weeks had pre-term delivery. The worst outcome in the form of PPROM and preterm delivery at 28 weeks occurred in a patient who underwent emergency surgery. The incidence of malignancy was four- to fivefold greater in our series than reported in the literature. Ultrasound was unable to distinguish malignant cases. Pregnancy outcome was poorer if surgical intervention was done after >24 weeks and that, too, was done as emergency surgery.

Ultrasonographic measurement of fetal foot length, a new parameter, was correlated with the gestation age. One hundred and five ultrasonographic measurement of fetal foot length was performed between 13 and 42 weeks gestation. Comparison of linear regression of foot length versus gestational age demonstrated a strong correlation with an r2 value of 0.84 (P less than 0.001). Ninety-five percent confidence intervals at each week compared favorably with both biparietal diameter and femur length data. Mean foot lengths at each week of gestation compared favorably with data based on pathological specimens described in 1920 (Streeter GL: Weight, sitting height, head size, foot length and menstrual age of the human embryo. Contrib Embryol Carnegie Inst. 11: 143, 1920). Measurement of fetal foot length is of particular use when other parameters do not accurately predict gestational age, e.g. hydrocephalus, anencephaly, short limb dysplasia. It can also be used in conjunction with biparietal diameter and femur length in the management of patients with premature labor in order to patients with premature labor in order to accurately predict gestational age. Hence the present study demonstrates that the ultrasonographic measurement of foot length is a reliable indicator of gestational age.