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Research strongly supports the view that pregnancy termination is seldom associated with adverse psychological sequelae in the short to medium term, but experience shows that there is a small group of women who experience long and intense suffering. This is a report of the cases of two women who presented with psychological problems associated with a termination 19 and 5 years earlier.
We describe 2 postmenopausal women with rheumatoid arthritis (RA). They developed fractures during their treatment with weekly low dose methotrexate (MTX). The adverse effect of longterm low dose regimens of MTX on bone metabolism has been described as "methotrexate osteopathy," an analogy of the syndrome known in pediatric oncology. MTX may be an additional risk factor for osteoporosis and fractures in RA. This therapy should be relatively contraindicated in patients with multiple risk factors for osteoporosis.
To assess the relationship of tubal ligation and risk of ovarian carcinoma, we conducted a case-control, retrospective analysis of 300 ovarian carcinoma cases and 606 nonmalignant disease controls, seen between 1982 and 1988 at Roswell Park Cancer Institute, Buffalo, New York. Women who had a tubal ligation had reduced risk for the development of ovarian cancer. This relative risk was 0.52, with a 95% confidence interval 0.31 to 0.85 (p = 0.0076). Controls were matched by age. Multivariate analysis adjusted for socioeconomic level, marital status, parity, age at first pregnancy, menarche age, menopause age, irregular menses, breast-feeding duration, body habitus, and oral contraceptive use. Suggested explanations for this observation are offered.
Female genital mutilation (FGM)-sometimes locally referred to as "female circumcision"-is a deeply rooted traditional practice that adversely affects the health of girls and women. At present it is estimated that over 120 million girls and women have undergone some form of genital mutilation and that 2 million girls per year are at risk. Most of the girls and women affected live in 28 African countries where the prevalence of female genital mutilation is estimated to range from 5% to 98%. The elimination of female genital mutilation will not only improve women's and children's health; it will also promote gender equity and women's empowerment in the communities where the practice persists. To achieve change will require more planning, and more sustained programmes for its elimination. The political will of governments is essential in order to eliminate this harmful traditional practice and concerted efforts from all concerned are required.
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Tissue factor (TF), the high affinity receptor and cofactor of factor VII, is considered as the main procoagulant in stimulated monocytes and macrophages. We studied the effect of longterm culture (differentiation) on "spontaneous" and induced (LPS) expression of TF (mRNA, antigen, cell surface associated VIIa-cofactor activity) in isolated human monocytes. TF was expressed transiently in monocytes cultured on Teflon membranes (suspension monocytes, Mo-S) and on plastic dishes (adherent monocytes, Mo-A), reaching maximal levels between days 3 and 5. Increased expression of TF was accompanied by increased stable expression of macrophage specific markers (CD71, the mannose receptor, the scavenger receptor). Bacterial lipopolysaccharide (LPS) induced (additional) TF mRNA, antigen, and activity in both Mo-S and Mo-A. In Mo-S and Mo-A of days 3 to 5, the period in which there was "spontaneous" expression of TF, TF response to LPS was considerably lower. It is concluded that during monocyte-macrophage transition, TF is "spontaneously" and transiently expressed and that with respect to TF induction the responsiveness of the cells to LPS is maintained.
Sexual abuse is one of the most dehumanising human offenses. There has been an increasing public concern and outcry regarding the escalating wave of sexual abuse of young girls in Malawi, in the recent past. Four young girls, aged between two and seven years who were sexually abused by adult males aged between 20 and 70 years seen and managed in the department within the past two years, are presented to illustrate the problem. Their physical injuries, varied reactions and those of their immediate families to the abuse; possible predisposing factors to the abuses; the related medical, psychosocial as well as legal management of such incidents, in the light of limited public awareness, and lack of adequately and appropriately trained personnel and facilities in Malawi are discussed. With the scare of AIDS and an increasing disintegration of the traditional family fabric, there is a high potential for an increase, not only of the prevalence of sexual abuse of minors in Malawi, but also the variety and severity of sequelae. It is therefore recommended that there is need to create public awareness about sexual abuse, train and equip the relevant personnel to appropriately manage such cases, as well as enact and enforce the relevant legal provisions, so as to curb the menace, for the well-being of the society.
Organophosphorus insecticides (OPI) are the commonest cause of poisoning in Sri Lanka. Being inhibitors of esterases, OPI cause an acute cholinergic crisis as the initial phase of neurotoxicity. The intermediate syndrome (IMS) which develops 24 to 96 hours after poisoning, and the delayed polyneuropathy (OPIDP) which manifests several weeks later, suggest a triphasic effect of OP intoxication. OPI may also cause extrapyramidal manifestations. Chronic neurobehavioural effects of longterm exposure to OPI are also a cause for concern. This paper reviews OPI poisoning in man emphasising the clinical, biochemical, and electrophysiological studies done at Peradeniya over the past two decades.
OBJECTIVES: To compare the effects of 1% and 2% propofol on the maximum and average lipid levels, the relative frequency of hyperlipidaemia, the propofol dose required to achieve an equivalent degree of sedation, the pharmacodynamic effects at the required infusion rates, and the effect on respiratory function. DESIGN: Open, randomised, parallel group, multicentre comparison study. SETTING: Intensive care units (ICUs) at the Faculty of Medicine, University of Stellenbosch and at Vergelegen Medicity, Somerset West. SUBJECTS: Patients who were artificially ventilated for at least 72 hours in the ICUs and who required sedation or analgesia. OUTCOME MEASURES: Continuous intravenous infusion of 1% or 2% propofol to provide an administration rate in the range of 1-4 mg/kg/h. The initial infusion rate was about 2 mg/kg/h, adjusted to achieve the appropriate level of sedation. RESULTS AND CONCLUSIONS: Seventy-five patients were enrolled in the study, of which 72 were evaluable for safety analysis and 58 were evaluable for efficacy analysis. The total daily dose of propofol (ml/day) in the 2% propofol group was about 60% of that in the 1% propofol group, indicating that the lipid load in the 2% propofol group had only slightly more than half the lipid load in the 1% propofol group. Thirteen of 27 patients (48%) in the 2% propofol group had abnormally.
Although cadmium is a well known toxicant, its effects at subtoxic doses on behavior have rarely been investigated. The present study examined the longterm effect on levels of spontaneous locomotor activity and performance in a learning task resulting from postnatal exposure to cadmium. Sixty-four male Sprague-Dawley rat pups were divided into seven treatment and one vehicle control group. Treated animals were intubated with CdCl2 from the sixth to fifteenth day of life at doses ranging from 0.25 to 7.0 mg/kg body weight. Activity was quantified in tilt cages at forty-five days of age and performance in an appetitively motivated spatial discrimination task, with reversal, was assessed at between ninety and ninety-four days of age in a T-maze. A significant increase in spontaneous locomotor activity was observed in rats treated with 0.25 mg/kg of cadmium. In general, cadmium treated animals performed better than control subjects during learning and reversal learning trials. Possible hypotheses accounting for these results are discussed.
Two sets of experiments have been carried out in an attempt to determine the role of hippocampal cholinergic mechanisms in a long-term memory storage. Three inbred strains of mice were presented with two different learning tasks in order to estimate their long-term retention abilities as well as changes in this ability after a post-trial hippocampal stimulation. In parallel experiments the enzymes involved in acetylcholine metabolism were studied under different experimental conditions. Our results indicate: (a) The capacity for long-term memory of the BALB/c line is much greater than that of either the C57BL/6 or C57BR strain. (b) Hippocampal post-trial electrical stimulation leads to an improvement of this capacity in the BALB/c strain. This phenomenon is less pronounced in C57BL/6 and non-existent in C57BR mice. (c) Choline acetyltransferase activity in the hippocampus is significantly higher in BALB/c than in the other two strains. In BALB/c this enzyme activity is greatly changed by the post-trial stimulation whereas in the C57BL/L strain only a slight variation of enzyme activity is observed. No modification occurs in C57BR. The results suggest that the more active acetylcholine synthesizing enzyme in the hippocampus of BALB/c may be related to a greater acetylcholine availability, thus favoring the establishment of a long-term memory, perhaps by releasing greater amounts of acetylcholine in the hippocampus immmediately after the learning session. The electrical stimulation of the hippocampus acts to magnify or accelerate this phenomenon. It is suggested that the efficiency of the stimulation would be related to the genetically determined higher cholinergic activity of the hippocampus.
OBJECTIVE: The impact of prolonged subclinical hyperthyroidism on quality of life is unclear. Therefore, we evaluated quality of life in patients with differentiated thyroid carcinoma (DTC) on TSH-suppressive thyroxine therapy as a model for subclinical hyperthyroidism and we investigated whether restoration to euthyroidism affects quality of life. DESIGN: We performed a prospective, single-blinded, placebo-controlled, randomized trial of 6 months' duration with two parallel groups. PATIENTS AND METHODS: Twenty-four subjects with a history of differentiated thyroid carcinoma with > 10 years TSH-suppressive therapy with L-thyroxine completed the study. L-thyroxine dose was replaced by study medication containing L-thyroxine or L-thyroxine plus placebo. Medication was titrated to establish continuation of TSH suppression (low-TSH group) and euthyroidism (euthyroid group). Both groups consisted of 12 patients. We evaluated quality of life using five validated questionnaires. RESULTS: At baseline, the somatic disorder questionnaire (SDQ) indicated more somatic dysfunction in patients as compared with reference values, whereas the depression score (HADS) revealed a better score than the reference group. All other quality of life parameters were normal. At baseline, no significant differences between the low-TSH and the euthyroidism groups were observed. After 6 months, none of the quality of life parameters in the low-TSH group was different from baseline values. In the euthyroid group, motivation was significantly improved (Multidimensional Fatigue Index-20, P = 0.003), although this parameter did not differ from the reference group at baseline. A probable worsening in role limitations as a result of physical problems (Short Form-36; P = 0.050) was observed. No improvement in the SDQ score was observed. CONCLUSION: In summary, quality of life in patients with DTC and long-term subclinical hyperthyroidism in general is preserved. Restoration of euthyroidism in general does not affect quality of life.
OBJECTIVE: The impact of prolonged subclinical hyperthyroidism on glucose and lipid metabolism is unclear. Therefore, we evaluated glucose and lipid metabolism in patients with differentiated thyroid carcinoma (DTC) on TSH suppressive thyroxine therapy as a model for subclinical hyperthyroidism and investigated whether restoration to euthyroidism affects metabolism. DESIGN: We performed a prospective, single-blinded, placebo-controlled, randomised trial of 6 months duration with 2 parallel groups. PATIENTS: Twenty-five subjects with a history of differentiated thyroid carcinoma with > 10 years TSH-suppressive therapy with l-thyroxine completed the study. l-thyroxine dose was replaced by study medication containing l-thyroxine or l-thyroxine plus placebo. Medication was titrated to establish continuation of TSH suppression (low-TSH group, 13 patients) and euthyroidism (euthyroidism group, 12 patients). MEASUREMENTS: We evaluated glucose metabolism by glucose tolerance test and HOMA (IR) and lipid metabolism by lipid profile. In addition, we measured plasma concentrations of glucoregulatory hormones. RESULTS: At baseline, glucose tolerance, HOMA (IR), lipid profile and plasma concentrations of glucoregulatory hormones were within the normal range. No significant differences between the low TSH and euthyroidism group were observed. After 6 months, neither glucose nor lipid metabolism in the low TSH group were different from baseline values. CONCLUSION: In summary, glucose and lipid metabolism in patients with DTC and long-term subclinical hyperthyroidism in general are not affected. Restoration of euthyroidism in general does not affect glucose and lipid metabolism.
Surgical diversion of bile and pancreatic secretions to the mid small bowel has been shown to provoke increased CCK plasma concentration and growth of the pancreas in rats. This study was undertaken to investigate the effects of chronic pancreaticobiliary diversion on pancreatic morphology as well as the circulating concentrations of pancreatic polypeptide, secretin, gastrin, and CCK. Fifteen month diversion provoked 73 and 86% increases in pancreatic weight and volume (p less than 0.001). Cholecystokinin blood concentration increased by 98%, from 20.9 +/- 5.7 pg/ml in controls to 41.3 +/- 5.4 after diversion (p less than 0.05), but pancreatic polypeptide, secretin, and gastrin levels were not affected. The volume of the exocrine pancreas doubled from 1104.6 +/- 78.2 mm3 in controls to 2201.2 +/- 229.2 (p less than 0.001), with a matching increase in interstitial tissue. On the contrary, the volume of the endocrine pancreas remained unchanged. Hyperplastic nodules developed in the exocrine pancreas, in 71% of diverted rats, but not in transected controls. We conclude from these observations that chronic diversion of bile and pancreatic juice stimulated pancreatic growth, most likely through a persistent rise of CCK plasma concentrations. Furthermore, this long lasting stimulation induced the development of exocrine pancreatic nodules.
To examine pharmacokinetics and tolerance of long term administration of olsalazine (azodisalicylate), increasing doses of the drug were given for one year to 31 patients with ulcerative colitis (UC) and nine patients with Crohn's colitis (CC), refractory to, or intolerant of sulphasalazine, until sustained remission was obtained or a maximum of 4 g/day was reached. Colonic drug metabolism was studied by equilibrium in vivo dialysis of faeces. Complete azoreduction occurred in most cases. Concentrations of 5-aminosalicylic acid, but not N-acetyl-5-aminosalicylic acid, in faecal dialysates increased dose dependently. Serum concentrations disclosed no cumulation in the long term and olsalazine was well tolerated, although loose stools occurred transiently in some patients with extensive disease: this was associated with a larger proportion of unsplit olsalazine in the faecal dialysates. Patients with ulcerative colitis having a high prostaglandin E2 concentration (greater than ng/ml) determined by equilibrium dialysis of rectum, were less likely to benefit from treatment. Olsalazine is a very effective means of delivery of 5-aminosalicylic acid to the colonic mucosa in active disease. Use of the drug in controlled trials may be considered safe even in prolonged high dosage.
The effect of long-term somatostatin analogue (SMS 201-995) treatment in two acromegalic patients is reported. Continuous tumor shrinkage was observed even after 129 and 139 weeks of treatment with 600 micrograms of SMS 201-995 daily. A huge and firm adenoma underwent shrinkage during treatment with SMS 201-995. No serious side effect appeared during 160 weeks of treatment. SMS 201-995 has a longterm tumor shrinkage effect and improves endocrinopathies.
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OM-8980 is an immunomodulating drug which has been shown in double blind placebo controlled trials to be effective in the management of rheumatoid arthritis (RA). For this report, longterm information was collected from 32 patients (27 women, 5 men) with RA who had been treated for periods ranging from one to over 8 years with OM-8980 daily (median 5 years). Statistically significant reductions were observed in duration of morning stiffness, articular index, pain and erythrocyte sedimentation rate (ESR). An improvement or strong improvement in overall condition was noted in 23 patients. Adverse events were reported in only 3 patients and were minimal in nature. Our study demonstrates that OM-8980 is an effective longterm slow acting antirheumatic drug which has minimal adverse effects and should be considered to have a role to play in the management of RA.