Premenstrual syndrome: diagnosis and treatment experiences

We sought to examine the diagnosis and treatment experiences of women in the United States who reported having been diagnosed with premenstrual syndrome (PMS) by a physician. A survey of 220 women, randomly selected, ages 26-56, who subscribed to a woman's health newsletter and reported being given a diagnosis of PMS by a physician was conducted. Subjects reported (1) they sought medical help for 5.33 +/- 6.23 years before receiving a diagnosis, (2) they sought help from 3.75 +/- 3.22 physicians for PMS symptoms, (3) they thought the majority (71%) of physicians they used were not adequately informed to diagnose and treat them, (4) only a minority (23%) of physicians used a symptom chart, currently the only way to confirm a PMS diagnosis, when determining their diagnosis, and (5) only approximately 1 in 4 (26%) physicians provided them with a helpful treatment. Seventy-six percent of subjects reported that a PMS diagnosis resulted from their own suggestion, with an agreement by the physician. Eighty-one percent reported that the initial suggestion of PMS came from a non-medical source. The most commonly recommended and used treatments were vitamins, exercise, and diet modification. Current treatment satisfaction was 15.6% not very satisfied, 48.8% somewhat satisfied, and 35% very satisfied. Satisfaction was higher if natural progesterone or hysterectomy with oophorectomy was included as a treatment, although a high percentage of satisfaction was seen with several treatments. Data indicate that physicians from whom most of the women sought care between 1974 and 1994 failed to recognize, diagnose, or treat their PMS using the standards and protocols published in the medical literature.     

Idiopathic fibrosing pancreatitis: a rare cause of obstructive jaundice in children

AIMS: To analyse the significance of antibodies to p53 protein as a serological marker for changes in p53 gene expression in patients with hepatocellular carcinoma. METHODS: Thirty eight patients with hepatocellular carcinoma, 19 showing accumulation of p53 protein by immunohistochemistry and 19 having no accumulation, were studied. The presence of anti-p53 was tested using a novel ELISA utilising a recombinant p53 protein as a capture system and verified by western blotting. p53 gene mutations were sought by single strand conformational polymorphism and DNA sequencing analyses. RESULTS: Of 19 patients with p53 protein accumulation in tumour tissue, 10 (52%) had antibodies to p53 in serum by ELISA. Four patients with p53 negative immunohistochemistry also had detectable anti-p53. Western blot analysis confirmed the specificity of the ELISA positive serum samples. The presence of anti-p53 was independent of serum alpha-fetoprotein and was detected in 50% of small tumours while only 8% were alpha-fetoprotein positive. Mutations affecting exons 5 and 6 seem to be more frequently associated with development of anti-p53, than mutations in exons 7 or 8. CONCLUSIONS: The ELISA for anti-p53 is a convenient and specific tet for the detection of humoral response to alterations in p53 gene expression and could be of value in the diagnosis and characterisation of patients with hepatocellular carcinoma.     

Computed tomography screens stable patients at risk for penetrating cardiac injury

OBJECTIVE: To determine the accuracy of CT of the chest in diagnosing the presence of cardiac injury in stable patients with penetrating chest injuries. METHODS: A retrospective chart review of a convenience sample of stable patients with penetrating thoracic wounds evaluated for hemopericardium using chest CT at an urban level I trauma center. RESULTS: 60 stable patients with penetrating wounds in proximity to the heart underwent CT. Three patients had radiographic evidence of pericardial fluid, and 1 had an equivocal study. These 4 patients underwent subxiphoid pericardial window exploration: 2 had only clear fluid present, the other 2 had hemopericardium. The latter patients had a total of 3 cardiac and 1 diaphragmatic injuries, which were repaired at subsequent sternotomy. None of the 56 patients who had negative CTs had further clinical evidence of cardiac injury. The sensitivity, specificity, and accuracy of CT in this setting for hemopericardium are 100% (95% CI 18-100%), 96.6% (95% CI 88-100%), and 96.7% (95% CI 89-100%), respectively. CONCLUSION: Chest CT may be a useful test for diagnosing the presence of hemopericardium in the setting of penetrating thoracic injury. With the caveat that the patient must be removed from a closely monitored environment, the authors the use of CT in stable patients with penetrating chest wounds whenever echocardiography is unavailable.     

Simplified functional splinting after extensor tenorrhaphy

The economic assessment of liver transplantation is complex and involves the cost of the transplant procedure, the cost of alternative treatments and the positive economic contribution of successful outcomes. The one-year survival rates are currently in the order of 80-90% for elective transplants and 60-75% for emergency transplantation. The average cost of a liver transplant operation in the UK is between pounds 32,000 and pounds 45,000. Factors which have a major influence on costs are aetiology, patient status at the time of transplantation, retransplantation and duration of hospital stay. Rejection episodes, renal impairment and surgical complications are of intermediate importance. The cost of transplantation must be balanced against the cost of alternative treatments that would be required if the patient were not transplanted and the positive economic benefit derived from excellent rehabilitation in the majority of recipients.     

alpha-difluoromethylornithine ototoxicity. Chemoprevention clinical trial results

Bioassay-directed fractionation of the methyl ethyl ketone extract of Chiloscyphus rivularis yielded five new sesquiterpenes, 12-hydroxychiloscyphone (2), chiloscypha-2,7-dione (3), 12-hydroxychiloscypha-2,7-dione (4), chiloscypha-2,7,9-trione (5), and rivulalactone (6) in addition to the known sesquiterpenes, 4-hydroxyoppositan-7-one (7), chiloscyphone (1), and isointermedeol (8). The structure and stereochemistry of rivulalactone, a novel trinorsesquiterpene, was confirmed by its synthesis starting from 1. Compound 2 showed selective bioactivity in our yeast-based DNA-damaging assay and cytotoxicity to human lung carcinoma cells.     

Homogeneous immunoconjugates for boron neutron-capture therapy: design, synthesis, and preliminary characterization

The application of immunoprotein-based targeting strategies to the boron neutron-capture therapy of cancer poses an exceptional challenge, because viable boron neutron-capture therapy by this method will require the efficient delivery of 10(3) boron-10 atoms by each antigen-binding protein. Our recent investigations in this area have been focused on the development of efficient methods for the assembly of homogeneous immunoprotein conjugates containing the requisite boron load. In this regard, engineered immunoproteins fitted with unique, exposed cysteine residues provide attractive vehicles for site-specific modification. Additionally, homogeneous oligomeric boron-rich phosphodiesters (oligophosphates) have been identified as promising conjugation reagents. The coupling of two such boron-rich oligophosphates to sulfhydryls introduced to the CH2 domain of a chimeric IgG3 has been demonstrated. The resulting boron-rich immunoconjugates are formed efficiently, are readily purified, and have promising in vitro and in vivo characteristics. Encouragingly, these studies showed subtle differences in the properties of the conjugates derived from the two oligophosphate molecules studied, providing a basis for the application of rational design to future work. Such subtle details would not have been as readily discernible in heterogeneous conjugates, thus validating the rigorous experimental design employed here.