折叠式人工晶状体临床应用观察

目的:探讨白内障超声乳化摘除联合折叠式人工晶状体植入术的临床应用效果。方法:对109例(147只眼)白内障行超声乳化吸除术联合折叠式人工晶状体植入术,分别植入人工晶状体CANON STAARAQ-110NV型53眼、AMO S140NB型43眼、Pharmacia Ceeon 911型32眼、Alcon Acrysof型20眼。对术后视力、术前术后角膜散光、术后前房反应、人工晶状体位置、手术并发症进行观察。结果:术后6个月。矫正视力≥0.5眼数分别为94.3％、93.0％、90.6％、90.0％;术后6个月,AQ-110NV型和S140NB型、CeeOn 911型和Alcon Actysof型间角膜平均散光度数无显著差异,AQ-110NV型和S140NB型与Ceeon 911型和Alcon Acrysof型有显著差异(P<0.05);术后前房反应轻微;角膜水肿、后囊破裂、后囊混浊、人工晶状体破损,发生率分别为6.1％、4.1％、10.9％、3.9％;未发现人工晶体状体明显移位者。结论:各种材料的折叠式人工晶状体在临床上的应用都是有效的,推注式人工晶状体(AQ-110NV、S140NB型)植入术无须扩大切口,容易掌握,术后反应轻,并发症少,手术疗效满意。     

In-the-Bag Intraocular Lens Placement via Secondary Capsulorhexis with Radiofrequency Diathermy in Pediatric Aphakic Eyes

Pediatric ophthalmologists increasingly recognize that the ideal site for intraocular lens (IOL) implantation is in the bag for aphakic eyes, but it is always very difficult via conventional technique. We conducted a prospective case series study to investigate the success rate and clinical outcomes of capsular bag reestablishment and in-the-bag IOL implantation via secondary capsulorhexis with radiofrequency diathermy (RFD) in pediatric aphakic eyes, in which twenty-two consecutive aphakic pediatric patients (43 aphakic eyes) enrolled in the Childhood Cataract Program of the Chinese Ministry of Health were included. The included children underwent either our novel technique for secondary IOL implantation (with RFD) or the conventional technique (with a bent needle or forceps), depending on the type of preoperative proliferative capsular bag present. In total, secondary capsulorhexis with RFD was successfully applied in 32 eyes (32/43, 74.4%, age 5.6±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved in 30 eyes (30/43, 70.0%), but in the remaining 2 eyes (2/32, 6.2%) the IOLs were implanted in the sulcus with a capsular bag that was too small. Secondary capsulorhexis with conventional technique was applied in the other 11 eyes (11/43, 25.6%, age 6.9±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes(3/43, 7.0%), and the IOLs were implanted in the sulcus in the remaining 8 eyes. A doughnut-like proliferative capsular bag with an extensive Soemmering ring (32/43, 74.4%) was the main success factor for secondary capsulorhexis with RFD, and a sufficient capsular bag size (33/43, 76.7%) was an additional factor in successful in-the-bag IOL implantation. In conclusion, RFD secondary capsulorhexis technique has 70% success rate in the capsular bag reestablishment and in-the-bag IOL implantation in pediatric aphakic eyes, particularly effective in cases with a doughnut-like, extensively proliferative Soemmering ring.     

Blue light filtering intraocular lenses in phacoemulsification cataract surgery

Blue light can damage retina and cause age related macular degeneration. After cataract surgery and lens removal retina stays unprotected. Blue light filtering intraocular lenses (IOL) increase protection of the retina. In our prospective study we investigated clinical results after bilateral implantation of Acrysof Natural IOL to 30 patients (N = 60 eyes). In a control group (N = 60 eyes, 30 patients), standard acrysof IOL was implanted bilaterally. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and Nd YAG laser capsulotomy rate were measured and compared with control group. Subjective patient's satisfaction and subjective colour perception were also investigated. There was no significant difference in UCVA, BCVA and Nd YAG laser capsulotomy rate between the two groups. High patient's satisfaction was noticed (96.7% of patients would implant Acrysof Natural IOL again). Acrysof Natural IOL enables good visual acuity VA, low rate of Nd YAG laser capsulotomy and high patient's satisfaction without colour perception disturbances.     

Nd:YAG激光治疗人工晶体植入术后后囊膜混浊的临床应用

目的：总结Nd：YAG激光治疗人工晶体(intraocular lens,IOL)植入术后后囊膜混浊(posterioc rcapsular opacification,PCO)的疗效和并发症,探讨此类手术临床应用的技巧与适用范围。方法：在不散瞳的条件下,应用Nd：YAG激光切开瞳孔区后囊膜混浊。结果：患者术后视力改善显著,术后并发症有眼压升高、AI晶体损伤、出血及玻璃体疝形成。结论：Nd：YAG激光治疗人工晶体植入术后晶体后囊膜混浊效果显著,严格掌握适应症以及熟练的手术技巧是获得最佳疗效的关键。     

无缝线巩膜隧道瓣小梁切除联合白内障超声乳化人工晶体植入术治疗青光眼合并白内障的临床疗效

目的:探讨无缝线巩膜隧道瓣小梁切除术与白内障超声乳化人工晶体(IOL)植入术联合治疗青光眼伴白内障患者的疗效。方法:将88例青光眼伴白内障患者,随机分为观察组与对照组,44例每组。观察组行无缝线巩膜隧道瓣小梁切除术+白内障超声乳化摘除术+IOL植入术,对照组行经典小梁切除术+白内障超声乳化摘除术+IOL植入术,对比两组的疗效。结果:术后6个月,观察组视力提高率为86.36%,视力0.5率为81.82%,显著高于对照组的72.73%、68.18%(P0.05);观察组术后眼压和散光度显著低于对照组(P0.05);观察组的功能滤泡形成率为84.09%,显著高于对照组的70.45%(P0.05);观察组术后角膜内皮细胞丢失率为4.629%,显著低于对照组的14.760%(P0.05);观察组的并发症发生率为4.55%,显著低于对照组的22.73%(P0.05)。结论:无缝线巩膜隧道瓣小梁切除术与白内障超声乳化IOL植入术联合治疗青光眼伴白内障较经典三联术式具有更好的疗效,可有效改善视力、降低眼压、保护角膜内皮、降低术后并发症,值得推广应用。     

低能氮离子注入西瓜胚芽的存活率的初步研究

以西瓜胚芽为材料 ,研究了低能氮离子注入植物活体组织的存活率和二甲亚砜 (DMSO)预处理对存活率的影响。结果表明 ,真空冰冻对存活率有一定影响 ,离子注入损伤是植物活组织在离子注入时存活率降低的主要原因 ;在能量为 2 5 ke V,总剂量为 3.9× 10 1 6ions/ cm2 ,脉冲剂量为 1.3× 10 1 4 ions/ cm2 的注入参数下 ,1%的 DMSO预处理 2 5～ 35分钟可以降低失水率并大大提高胚芽的存活率。由此讨论了进一步扩大低能离子注入的应用范围 ,以及在果树、花卉和无性繁殖的作物上进行诱变育种或遗传转化的可能性。     

超声乳化联合房角分离治疗急性闭角型青光眼的临床观察

目的:观察和比较白内障超声乳化吸除人工晶状体植入术联合前房角分离术或小梁切除术治疗原发性急性闭角型青光眼合并白内障的临床疗效。方法:选择哈尔滨医科大学附属第一医院眼科医院2017年1月～2017年11月收治的原发性急性闭角型青光眼合并白内障患者62例,根据手术方式不同将其随机分为A、B两组,A组(31例,行Phaco+IOL联合前房角分离术);B组(31例,行Phaco+IOL联合小梁切除术)。分别观察两组患者术前术后最佳矫正视力(BCVA)、眼压(IOP)、前房深度(ACD)、角膜内皮细胞密度(ECD)的变化。结果:两组患者术后3天、3个月BCVA及IOP和术前比较均明显提高(P0.05),IOP控制至正常范围。且术后1周,A组视力恢复及眼压控制均优于B组(P0.05)。两组患者术后3月,ACD及ECD均较术前明显变化,ACD加深,ECD减少(P0.05),且A组ACD明显高于B组(P0.05)。结论:Phaco+IOL联合前房角分离术治疗急性闭角型青光眼合并白内障患者能有效降低眼压,在早期即可获得较好的临床效果。     

Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute,India

Purpose

To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India.

Methods

The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1–3 weeks and 4–11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.

Results

Mean age was 61.8 years (SD: 8.9 years) and 1,133 (55.3%) surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%). The most common procedure was small incision cataract surgery (SICS) with intraocular lens (IOL) implantation (91.8%). Intraoperative complications were seen in 29 eyes (1.4%). At the 4–11 weeks follow-up visit, based on presenting visual acuity (PVA), 61.8% had a good outcome and based on best-corrected visual acuity (BCVA), 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30), in females (OR 1.58; 95% CI 1.04, 2.41), those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57), with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04), eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25) and those undergoing extracapsular cataract extraction (OR 9.39; 95% CI 1.18, 74.78).

Conclusions

This study demonstrates that quality cataract surgeries can be achieved at rural SCs. The concept of the LVPEI SCs can be applied to other developing countries, allowing rural patients to attain better vision through cataract surgery. Despite improvements in quality of cataract surgery, gender discrimination in terms of outcome continues to be an issue and needs further investigation.     

超声乳化联合小梁切除术治疗闭角型青光眼合并白内障的临床研究

目的:探讨超声乳化白内障吸除术(Phaco)、人工晶状体植入术(IOL)联合小梁切除术(TBL)治疗原发性闭角型青光眼(PACG)伴厚晶状体白内障的临床疗效和安全性。方法:将82例(98眼)原发性闭角型青光眼伴厚晶状体白内障患者随机分为A组(41例52眼)和B组(41例46眼),A组行Phaco+IOL+TBL治疗,B组单纯行TBL治疗,比较两组的手术前后眼压、最佳矫正视力、中央前房深度(ACD)、小梁虹膜角(TIA)、房角开放距离500(AOD500)及小梁睫状体距离(TCPD)的变化、视力提高率及并发症的发生情况。结果:两组术后眼压均较术前显著降低,且A组的降低幅度显著高于B组(P0.05);两组术后最佳矫正视力均显著提高,且A组显著高于B组(P0.05);A组术后视力提高率为86.54%,显著高于B组的32.61%(P0.05);两组术后ACD、TIA、AOD500及TCPD均显著提高,且A组显著高于B组(P0.05);A组手术并发症发生率为5.77%,显著低于B组的17.39%(P0.05)。结论:超声乳化白内障摘除术、人工晶状体植入术联合小梁切除术治疗PACG伴厚晶状体白内障的疗效较单用小梁切除术更好,且安全性更高。     

Cataract surgery and intraocular lens implantation in children with juvenile rheumatoid arthritis associated uveitis

Clinical records of 6 children (7 eyes) with juvenile rheumatoid arthritis (JRA) who underwent cataract surgery with IOL implantation between January 1998 and December 2002 were reviewed. The median age at the time of cataract surgery was 8 years (range 5-14 years). The median follow up was 48 months (range 26 to 60 months). Five of six children (6 eyes) were on systemic immunosuppressive or anti-inflammatory therapy. Glaucoma was present in three eyes before surgery, and all three eyes underwent combined cataract surgery and trabeculectomy with mitomycin C. A final best corrected visual acuity of 0.5 or better was achieved in all eyes Postoperative complications included posterior capsule opacification (n = 5), glaucoma (n = 1), and cystoid macular edema (n = 1). Intraocular lens implantation in children with control of preoperative and postoperative ocular inflammation could lead to favorable visual results.     

Penetrating keratoplasty and Verisyse iris-claw lens--is it safe for corneal graft?

The loss of the corneal endothelial cells, especially in a first postoperative year, has been observed in patients who underwent penetrating keratoplasty (PK). The implantation of new generation of "iris claw" phakic IOL (Verisyse) in refractive cases has been shown to cause clinicaly insignificant endothelial cell loss. In our prospective case series we investigated the endothelial cell loss and clinical outcome in patients that either underwent PK and implantation of PCIOL or PK and implantation of Verisyse IOL. In the first group of 9 patients scheduled for PK, implantation of Verisyse was performed due to the absence of the posterior capsule support. 2 of these patients had angle supported ACIOL, 4 patients were aphakic and 3 had posttraumatic cataract with ruptured posterior capsule. The second group of 12 patients had standard "triple" procedure (PK + ECCE + PCIOL). BCVA of both groups of patients prior the operation was hand movement in 12 patients, light perception in 7 patients and 0.05 in 3 patients. The preoperative endothelial cell count of the donor grafts obtained from the eye bank was 2800 cells/mm2 on average. The follow up was 6-10 months. Six months after the operation all "Verysise" patients maintained transparent graft. Postoperative visual acuity improvement was recorded in 18 out of 21 eyes (85.7%). Best spectacle corrected visual acuity of > or = 0.3 was achived in 55.5% in the Verisyse group and in 50.0% of "triple procedure" group. The endothelial cell count and morphology were estimated on the specular microscope on a monthly basis. Mean endothelial cells loss in patients with PK and Verysise was 40 +/- 8% and in patients with "triple" procedure was 42 +/- 12% at 10 postoperative months. There was no significant difference in the endothelial cell loss and clinical outcome between the group of patients who had PK and Verysise as compared to those with implanted PCIOL.     

A Survey of Hospital Infection in a Pediatric Hospital: Part I. Description of Hospital,Organization of Survey,Population Studied and Some General Findings

Of 17,836 children admitted in 1959, 6.5% developed infection following admission; most of these seemed to be hospital-acquired. Respiratory infections were commonest (2.7%), then gastroenteritis (1.3%), staphylococcal infections including miscellaneous and postoperative wounds (1.1%), pyrexias (0.5%), miscellaneous and post-operative wound infections due to other bacteria (0.4%), “communicable” diseases (0.3%) and monilial infections (0.2%). Incidences were highest in infants and on certain wards incapable of segregating all infected cases. Only 14.3% of infections were severe. They contributed to 16 deaths but not as the sole cause. Hospital infections made over 2070 extra patient-days necessary. Wound infection followed 3.1% of 5052 surgical operations-2.1% when considering only clean sites. Seventy per cent were staphylococcal; antibiograms suggested that some were not of hospital origin. Staphylococcal disease, present on admission or hospital-acquired, occurred in 2.6% of patients. None of these incidences seemed unduly high. Many varied factors underlie hospital infections, and complete control is unlikely with present knowledge and facilities.     

Results of intracoronary stenting made in different periods after diagnostic coronary angiography

The high cost of tools and expendable materials and its associated necessity of solving organizational issues force to delay the implementation of stenting for nonmedical reasons in many cases. This gives a convenient way to evaluate how much effective and safe stenting would be made just after coronary angiography or delayed intervention would be performed and at the same time to consider the way delay in stenting may affect its clinical and angiographic results. The study covered 136 patients with coronary heart disease who had been implanted an intracoronary stent. All this patients were divided into 3 groups. Group 1 included 16 patients who had undergone stent implantation just after diagnostic coronary angiography, Group 2 comprised 42 patients who had the similar procedure no later than a month after coronary angiography, and Group 3 consisted of 78 patients who had it a month or later following angiography. The angiographic success rates of stenting was 100% in Group 1, 97.6% in Group 2, and 92.3% in Group 3. The causes of poor results were evolving myocardial infarction (2.4%) and technical failure (2.4%) in Group 2; evolving myocardial infarction (2.6%), emergency aortocoronary bypass surgery (1.3%), and technical failure (3.8%) in Group 3. In Group 2, 4.8% cases of those undergone delayed stenting showed more significant stenosis than those having diagnostic intervention. In Group 3, there was more progressive stenosis in 16.7% and a transition of stenosis to occlusion in 7.8%. There were no complications (such as hemorrhage, retroperitoneal hematoma, etc.) at the site of puncture in Group 1, but in Group 2 and 3 they were 3.8 and 6.5%, respectively. Delayed stenting frequently adversely affects the outcomes of endovascular treatment due to the higher incidence of complication and to the increasing technical sophistication of the procedure no late than a month after diagnostic coronary angiography.     

利用离子束提高水生植物对富营养化水体修复功能的初步研究

Ion beams have been widely usedinthe semiconduc-tor industryand appliedfor surface modificationof materi-als since the1970s,while nobody had discussed howthese ion beams could be used in genetic modification inbiological science,evenfewpeople paid attentionto bio-logical effects induced byion beamandtheir possible usein genetics.In1986,Yu et al.have discovered the ge-netic effects in rice mediated by low energy ions[1—5].Since thenion beamradiation has been widely usedtoim-prove crops and the performance of...     

Stent implantation in acute myocardial infarction using a heparin-coated stent: a pilot study as a preamble to a randomized trial comparing balloon angioplasty and stenting

Preliminary experience with primary stenting in myocardial infarction has suggested a greater benefit in clinical outcome than has been obtained with direct balloon angioplasty. However, subacute thrombosis (SAT) remains a limitation for this new mode of therapy. In the BENESTENT II Pilot and main trials, the incidence of SAT with the heparin-coated Palmaz-Schatz stent was only 0.15%. Therefore, as a preamble to a large randomized trial, the feasibility and safety of the use of the Heparin-Coated Palmaz-Schatz trade mark Stent in Acute Myocardial Infarction (AMI) was tested in 101 patients enrolled between April and September 1996 in 18 clinical centres. In 101 stent-eligible AMI patients, as dictated by protocol, a heparin-coated stent was implanted. The primary objectives were to determine the in-hospital incidence of major adverse cardiac events (MACE: death, MI, target lesion revascularization) and bleeding complications, while the secondary objectives were the procedural success rate and the MACE, the restenosis and reocclusion rates at 6.5 months. Stent implantation (n 3 129 stents) was successful in 97 patients of the 101 who were included in this trial. During their hospital stay, two patients died and no patient experienced re-infarction, ischaemia prompting re-PTCA or CABG. Four patients suffered a bleeding complication, three major and one minor, of whom three required surgical repair. At 210 days follow-up, 81% of the patients were event free. At 6.5 months restenosis was documented in 18% of the 88 patients who underwent follow-up angiography, including three total occlusions. The results, both with respect to QCA and the occurrence of MACE, compare favourably with studies using elective stenting in both stable and unstable angina patients. As a result of this pilot study, a large randomized trial comparing direct balloon angioplasty with direct stenting in 900 patients with AMI was initiated in December 1996.     

N+离子注入对大豆种子活力及其幼苗的抗氧化酶活性影响

本文研究了用25keV N+注入丰豆103的种子后,N+离子对其种子的活力及子叶伸展后48小时和96小时的幼苗内蛋白质含量、谷胱甘肽巯基转移酶(GSH-Ts)、谷胱甘肽过氧化酶(GSH-Px)、抗坏血酸过氧化物酶(ASA-POD)活性的影响.结果表明当N+注量在2.6×1016N+/cm2～5.2×1016N+/cm2时,种子的发芽率、发芽指数、活力指数都明显提高;幼苗的可溶性蛋白含量高于对照.在6.5×1016N+/cm2～10.4×1016N+/cm2注量时,幼苗的可溶性蛋白含量低于对照,96小时幼苗可溶性蛋白的含量高于48小时,说明辐射引起的损伤可随生长时间的增加而有所恢复.高注量可引起幼苗内一些抗氧化酶活性的升高,且随注量的增加酶的活性升高也越明显,96小时幼苗的GSH-Px和ASA-POD活性高于48小时幼苗,GSH-Ts活性略有下降.而低注量(1.3×1016N+/cm2～5.2×1016N+/cm2)的上述酶指标升幅不大.说明经N+离子处理后可通过诱导这些抗氧化酶活性的升高起到减轻伤害的作用.     

A survey on the prevalence of gastrointestinal parasites of dogs in the area of Thessaloniki, Greece

Faecal specimens randomly taken from 232 healthy dogs living in the area of Thessaloniki were screened for internal parasites. In 39.2% of the examined dogs excretion of Sarcocystis bovicanis (1.3%), Isospora ohioensis/burrowsi (3.9%), Giardia lamblia (0.8%), Hammondia heydorni (0.4%), Dicrocoelium dendriticum (0.8%) Diplopylidium nolleri (0.4%), Joyeuxiella pasqualei (0.8%), taeniids (0.4%), Toxocara canis (22.4%), Toxascaris leonina (1.3%), Uncinaria stenocephala (3.0%), Trichuris vulpis (2.6%), Spirocerca lupi (0.4%), or Linguatula serrata (0.4%) was detected. The overall rate of infection did not show any significant difference concerning sex or age. T. canis, however, was significantly more often found in the youngest age group (1-3 months).     

Clinical experience with Ex-press Mini Glaucoma Shunt implantation

In this prospective study we wanted to report our experience and to evaluate the efficacy and safety of Ex-press Mini-Glaucoma Shunt implantation under a superficial scleral flap, as a newly and improved surgical technology in a treatment of POAG (Primary open-angle glaucoma) and refractory glaucoma. 44 eyes (35 patients) underwent an implantation of Ex-Press Mini Glaucoma Shunt. We had 21 patients with POAG (60%) and 14 patients with PEXG-pseudoexfoliation glaucoma (40%). The follow-up period was 8.62 + 7.48 months (range 2-22 months). Main outcome measures included postoperative IOP control, postoperative medications and early postoperative complications. The IOP was measured in the following postoperative time-points of 1 day, 1 week, 1, 3, 6, 9 and 12 months. The mean IOP values 1 year postoperatively were reduced for 52.8% compared to preoperative values and the use of medications were reduced for 77%. We had complications like postoperative hypotony (3.5%), choroidal ablation (7%), intraocular hemorrhage (3.5%) and postoperative shunt closure (3.5%). The Ex PRESS Mini Glaucoma Shunt implanted under a superficial scleral flap is relatively safe and effective surgical procedure and provides satisfactory IOP control and medication reduction. However, device related complications remain still a problem.     

Enterobacteriaceae, coliforms, faecal coliforms and salmonellas in raw ewes' milk

Thirty-nine samples of freshly drawn ewes' milk collected at 13 farms, and 120 samples of raw ewes' milk collected on arrival at a dairy were examined. Farm samples had geometric mean counts of 4.4 X 10(2) Enterobacteriaceae/ml, 3.9 X 10(2) coliforms/ml and 2.0 X 10(2) faecal coliforms/ml, whereas the respective mean counts were 6.2 X 10(3)/ml, 5.4 X 10(3)/ml and 1.3 X 10(3)/ml for dairy samples. Salmonellas were not detected by enrichment procedures in any of the 159 samples examined. Escherichia coli (47.5% strains), Enterobacter cloacae (17.7%), Ent. agglomerans (11.3%), Hafnia alvei (6.5%) and Klebsiella oxytoca (6.0%) were the predominant species in 434 Enterobacteriaceae strains isolated from farm samples. Levels and species of Enterobacteriaceae found in the present work in raw ewes' milk imply a considerable risk of early blowing in cheese-making from unpasteurized milk.     

Studies on the growth of the fetal sheep. The effects of reduction of placental size on hormone concentration in fetal plasma

Intrauterine growth retardation was induced in sheep by removal of endometrial caruncles before pregnancy. At a second operation catheters were implanted into the ewe and fetus at 105-135 days of pregnancy. Three groups of fetuses: low birthweight-for-dates (small caruncle) normal birthweight-for dates (normal sized caruncle) and controls have been compared. The concentration of ACTH (60 +/- 6.9 pg/ml) in the normal-sized caruncle fetuses were lower in the controls (144 +/- 4.7 pg/ml) or small caruncle fetuses (142 +/- 53 pg/ml). Basal cortisol concentrations were similar in the controls (7.3 +/- 1.2 ng/ml) and normal-sized caruncle fetuses (6.5 +/- 0.5 ng/ml) but those in the small caruncle fetuses were significantly higher (12.7 +/- 1.0 ng/ml, P less than 0.001). The concentration of insulin correlated with plasma glucose and the mean concentrations were 19.2 +/- 1.6 mu units/ml (controls), 8.4 +/- 2.6 mu units/ml (normal-sized caruncle) and 3.9 +/- 1.6 mu units/ml (controls), 8.4 +/- 2.6 mu units/ml (normal-sized caruncle) and 3.9 +/- 1.6 mu units/ml (small caruncle). Prolactin was significantly lower in the small caruncle fetuses (2.1 +/- 0.3 ng/ml) compared to the controls (66.6 19.4 ng/ml) or normal-sized caruncles (76.1 +/- 38 ng/ml) but growth hormone concentrations in the small caruncle.