severe intrauterine growth retardation. There were no differences even in the number of induced deliveries, let alone caesarean sections between the aspirin and the placebo groups. The mean gestational age and birthweight at delivery were over 39 weeks and greater than 3500 g in the placebo group. The number of babies with birthweight less than 2500 g were 3/43 and 4/43 in the aspirin and placebo groups, respectively. The authors do not report on the severity of hypertension in terms of how many women in each group required de novo anti-hypertensive medication in pregnancy (or an increase in pre-existing medication), nor do they report on the need for closer maternofetal monitoring or hospital admission. The study shows differences that are statistically significant and academically interesting, but which do not appear to be quite clinically relevant, a picture very similar to that shown in the study by Chappell et al. 1 , which extolled the benefits of anti-oxidant supplementation (vitamins C and E) in the reduction of the incidence of pre-eclampsia in a high risk population. Appropriately, Vainio et al. suggest that a larger, probably multicentre, trial would be required to assess the effect of aspirin on early-onset pre-eclampsia and intrauterine growth retardation, but the virtual absence of trends with regard to these endpoints in this study leaves room for scepticism. It would appear that aspirin, and perhaps vitamins, can modify the clinical course of hypertensive disease and pre-eclampsia in pregnancy slightly, but it is premature to suggest that they are effective in reducing significantly the important causes of maternal and fetal morbidity and mortality. Reference 1. Chappell LC, Seed PT, Briley AL, et al. Effects of anti oxidants in the occurrence of pre-eclampsia in women at increased risk: a randomised trial. Lancet 1999:354:810-816. John H. Smith St Mary's NHS Trust, London PII: S 1 4 7 0-0 3 2 8 (0 2) 0 2 8 0 9-4 Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms? Sir, I read the article by Robinson et al. 1 with interest. The authors should be congratulated in completing this study on a substantial sample of women. However, I would be grateful if one or two points in the results and the statistical analysis could be clarified. The important question is whether ultrasound measurements of bladder wall thickness can be adequately diagnostic. Central to this is: How much do these thickness measurements overlap between groups diagnosed urodynamically? The authors give results including those below, and conclude that 'Examination of the 95% CIs reveals no overlap in those women with a diagnosis of detrusor instability and in those with a diagnosis of GSI': This appears to be a non-sequitur. It is perfectly possible to have different means with non-overlapping confidence intervals, but still have so much overlap between the groups that many individual measurements will not be diagnostic. It is essential to distinguish between the 95% CI and the sprea...

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Diabetes mellitus (DM) has reached epidemic proportions world wide. Many chronic complications of DM, including neuropathy, retinopathy and nephropathy, have been well studied and although urologic complications have been recognized since 1935, little is known about DM as a pathophysiological risk factor for development of lower urinary tract symptoms (LUTS) in women. Diabetic nephropathy, a life-threatening condition, has received considerable attention in the last few years. Diabetic cystopathy, on the other hand, has received far less attention despite having a significant impact on quality of life, and with significant individual health risks. Initial studies suggested that long standing DM causes paralysis of the detrusor muscle leading to voiding difficulties and this has been the received wisdom regarding diabetic cystopathy for many years. In this review, we discuss what is currently known about lower urinary tract function and urinary incontinence in diabetic females, with a critical analysis of the available evidence and suggest areas for future research.

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