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Evaluation .pdf


Nom original: Evaluation.pdf
Titre: PII: 014067369090600A

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122

85% of the

175 Dundee sera and 82% of the 141
from atopic donors (total IgE more than 250
U/ml). The frequency of RAST positivity to oilseed rape pollen was
higher in Dundee (26-3%) than in Glasgow (7-8%) (p<0-005).
Positivity to mixed moulds was 16-9% and 12-1 %, respectively. In
both series positive RAST scores were 1 or 2 in most instances

Glasgow

original

sera came

(91% Dundee, 82% Glasgow).
Month by month the frequency of oilseed rape and mixed mould
positivity in Glasgow remained low and reasonably constant while
there were peaks in July for the Tayside sera. In July oilseed rape
pollen positivity in Tayside was the most common abnormality
(43%), ahead of Dpteronyssinus (30%), cat dander (27%), and dog
dander (20%).
These results indicate that individuals are frequently sensitised to
the pollen of oilseed rape-ie, the growing of this crop in large
amounts has introduced a new antigenic hazard (which may be a
greater hazard if sensitivity to moulds is confirmed). Of the few
positive sera (11) from Glasgow, 8 had "rural" addresses (in
Dumfriesshire and Lanarkshire) and could therefore have been
from persons exposed to this crop. The nature of our investigation
did not allow us to determine whether the sensitisation seen was
responsible for symptoms, a task which is urgently required.
Our findings support the general public concern that oilseed rape
is a potent source of sensitisation. We are now looking at the
question of whether such sensitisation leads to symptoms.
We recognise the assistance and helpful comments of many of our colleagues,
particularly those in the Scottish Allergy Group. We thank Mr L. Cameron,
director of environmental health, Angus District, for background
information, interest, and support.

University Department
of Medical Microbiology,
Ninewells Hospital and Medical School,
Dundee DD1 9SY, UK

D. PARRATT
G. THOMSON
CAROLE SAUNDERS

Department of Bacteriology and Immunology,
University of Glasgow,
Western Infirmary, Glasgow

C. MCSHARRY
SUSAN COBB

1.

Medwing
1985;

B. Immediate

hypersensitivity

to

mustard and rape. Contact Dermatitis

13: 121-22.

Clinical method for evaluating progress in
first stage of labour
SIR,-It has been suggested that there is a clinical sign which will
indicate the progress of the first stage of labour without vaginal
examination (Sr H. Lake, personal communication). This sign is a
line of red/purple discolouration seen to arise from the anal margin
and extend cranially between the buttocks; the onset of second stage
is indicated when it reaches the nape of the buttocks.
To test this provocative but potentially useful sign we
investigated forty-eight women in spontaneous labour with a
singleton cephalic fetus. With the patient in the left lateral position
the midwife examined between the patient’s buttocks. The line’s
length was noted in tenths of the total distance between the anal
margin and the nape of the buttocks, and then vaginal examination
was done. The cervical dilatation and station of the fetal head
relative to the ischial spines was also recorded. All observations were
made by the same midwife for each patient and continued until
second stage. 102 observations were made by a total of eighteen
midwives. The red line was seen on 91 (89%) occasions, and was
completely absent in five (10-4%) women and initially absent in
three (6-25%). The figure shows the relation betwen cervical
dilatation and red line length (r=0-72; SEM=6’8, p<0-001).
There was a significant correlation between the station of the fetal
head and red line length (r = 0 59, SEM =6-72; p < 0 001). ).
To our knowledge this is the first report of this red line. We
believe that it represents a clinical sign which is easy to recognise and
which may offer valuable additional information in obstetric
management. The line may arise because of vasocongestion at the
base of the sacrum. It blanches when firm pressure is applied and

Correlation between red-line

length and cervical dilatation.

slowly recolours when pressure is withdrawn. This congestion
possibly occurs because of increasing intrapelvic pressure as the
fetal head descends, which would account for the correlation
between station of the fetal head and red line length. The correlation
with cervical dilatation can be explained only indirectly by its
dependence on station of the fetal head. We postulate that increase
in intrapelvic pressure causes congestion in the basivertebral and
intervertebral veins around the sacrum,Z which, in conjunction with
the lack of subcutaneous tissue over the sacrum, results in this line of
red purple discolouration. We accept that our observation will not
replace vaginal examination in labour but believe it is a useful
adjunct where such examination is refused or is distressing.
Department of Obstetrics and Gynaecology,
United Medical and Dental Schools,
St Thomas’ Campus,
London

DOMINIC L. BYRNE

Queen Charlotte’s and Chelsea Hospital,
London

D. K. EDMONDS

1. Lindgren L. Biodynamics of the cervix during pregnancy and labour. In: Blandau RJ,
Moghissi K, eds. Chicago: Chicago Press, 1973: 402.
2. Last RJ. Anatomy regional and applied. 7th ed. Edinburgh: Churchill Livingstone,
1985: 496.

CORRECTIONS
HIV-associated immune thrombocytopema. The second author of this
letter (Aug 19, p 459) is J. M. (not J. H.) Pena.
Antibiotics for

cholangitis. In this letter by Prof G. L. French and
colleagues (Nov 25, p 1271) the first sentence of the third paragraph should
have read "... several times the peak serum level", and the second sentence of
the fourth paragraph should have read "... 1000 mg/l for cefoperazone ...’’
Gut reactions. The price of this book, reviewed on Dec 16 (p 1427), is$22.95
not

22.95.


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