Comparison of saline infusion sonography with office hysteroscopy for the evaluation of the endometrium

OBJECTIVE

Intrauterine infusion of saline solution during transvaginal ultrasonography enhances visualization of the endometrium. We compared the accuracy and pain rating of saline infusion sonography with those of flexible office hysteroscopy.

STUDY DESIGN

The uterine cavities of 130 patients with abnormal bleeding were evaluated by two physicians in an office setting. Findings of endometrial polyps, submucous myomas, synechiae, endometrial hyperplasia, or cancer were recorded independently and subsequently compared. Patients rated their pain after each procedure.

RESULTS

Both procedures were performed in 113 of 130 patients. With saline infusion sonography pathologic findings were identified in 61 patients (54%). For all findings combined, sensitivity was 0.96 and specificity was 0.88, compared with hysteroscopy. The results of saline infusion sonography and hysteroscopy did not differ significantly (p = 0.18). The former was less painful for patients than hysteroscopy (p < 0.0001).

CONCLUSION

Saline infusion sonography is an accurate and well-tolerated method to evaluate abnormal uterine bleeding, compared with hysteroscopy.

Tenidap in patients with rheumatoid arthritis. A 4-week, placebo-controlled study

The present double-blind, placebo-controlled study was conducted to compare the safety and efficacy of tenidap in patients with rheumatoid arthritis (RA). Patients with flare of active RA following NSAID withdrawal were randomized to receive either placebo (n = 67) or tenidap (n = 131; 40-200 mg/day). The mean changes from baseline in efficacy and biochemical variables were compared between treatment groups at endpoint (4 weeks). The improvements in four of the five primary efficacy variables were significantly greater in the tenidap group compared with the placebo group (p < 0.01). Tenidap was also associated with an 18% reduction in erythrocyte sedimentation rate (ESR) and a marked, 51%, reduction in serum C-reactive protein (CRP) level, both of which were significantly greater than the changes in the placebo group (p < 0.05). The percentage of patients who discontinued because of side effects was the same in both groups (3%). In conclusion, tenidap 40-200 mg/day was effective and well tolerated in the treatment of patients with RA for 4 weeks.

The role of ethnic versus nonethnic sociocultural factors in substance use and misuse

Substance use research in the United States has focused on ethnicity/race to the detriment of studying the role of nonethnic sociocultural factors. Reliance on politically defined ethnic categories has not added to knowledge on the etiology, prevalence, prevention, or treatment of substance use and misuse. Rather it has reflected the preoccupation with race/ethnicity in the larger United States society and has contributed to further stereotyping of non-European ethnic groups. Ethnicity serves as a proxy for a number of sociocultural factors (e.g., socioeconomic status) that are linked to substance use. To make progress in understanding substance use and misuse, researchers must move away from the simplistic reliance on ethnic labels to a more complex understanding of the impact of the sociocultural variables that such labels represent.

Ovulation induction using s.c. pulsatile gonadotrophin-releasing hormone: effectiveness of different pulse frequencies

To determine the ovarian response to a fixed dose of gonadotrophin-releasing hormone (GnRH) administered s.c. at four different pulse frequencies, 20 patients with hypothalamic amenorrhoea were treated over 41 cycles using a dose of 20 ng/kg/pulse. These patients were randomly assigned to receive GnRH at pulse frequencies of 60, 90, 120 or 180 min. GnRH was administered s.c. using portable infusion pumps. Subjects were paid volunteers with a diagnosis of hypothalamic amenorrhoea. All patients had low to less than detectable serum concentrations of luteinizing hormone and follicle stimulating hormone on 8 h serial sampling, and normal serum concentrations of prolactin and androgen, including androstenedione, testosterone and dihydroepiandrosterone sulphate. Six of the 20 patients were enrolled in the protocol to achieve a pregnancy, while 14 were volunteers using a barrier method of contraception. Highest ovulation rates were achieved using pulse frequencies of 90 and 120 min (60 and 88% of cycles respectively). Ovulation occurred significantly less often with frequencies of 60 and 180 min (12 and 38% respectively; P </= 0.05). Pregnancy was achieved in four of the six patients who desired a pregnancy at pulse frequencies of 90 (three out of three) and 120 (one out of one) min. No pregnancies occurred at pulse frequencies of 60 (none out of one) and 180 (none out of one) min. When ovulatory cycles were considered, oestradiol concentrations were not different among pulse frequencies but varied significantly between ovulatory and anovulatory cycles. Integrated luteal progesterone concentrations for 90 and 120 min frequencies (118.26 +/- 25.89 and 125.15 +/- 32. 10 ng/ml/luteal phase respectively) were significantly higher than for 60 and 180 min (80.1 +/- 48.2 and 42.75 +/- 26.48 ng/ml/luteal phase respectively). Ovulation may be induced by a broad range of pulse frequencies. Pulse frequencies of 90 or 120 min for s.c. GnRH appear to induce more reliably the sequence of follicular development, ovulation and normal luteal function than frequencies of either 60 or 180 min. Significantly higher ovulation rates occurred at 90 and 120 min by s.c. administered GnRH.

Tenidap in rheumatoid arthritis. A 24-week double-blind comparison with hydroxychloroquine-plus-piroxicam, and piroxicam alone

OBJECTIVE

To compare the clinical efficacy, effect on serum C-reactive protein (CRP), serum amyloid A (SAA), and plasma interleukin-6 (IL-6) levels, and safety of tenidap with a combination of hydroxychloroquine-plus-piroxicam, and piroxicam alone, in the treatment of rheumatoid arthritis (RA) patients.

METHODS

A double-blind, randomized, multicenter study in which patients with active RA were treated with tenidap 120 mg/day, hydroxychloroquine 400 mg/day and piroxicam 20 mg/day, or piroxicam alone 20 mg/day, for 24 weeks.

RESULTS

At weeks 12 and 24, tenidap produced greater improvements than piroxicam based on 5 primary efficacy parameters; this improvement showed statistical significance in 4 of the 5 measures at week 12, and in 3 of the 5 measures at week 24. Clinical improvements in the hydroxychloroquine-plus-piroxicam-treated with tenidap. Compared with piroxicam, tenidap was associated with significantly greater reductions in serum CRP concentrations at 4, 12, and 24 weeks, and significantly greater reductions in SAA concentrations at weeks 12 and 24. The decrease in SAA concentrations was also significantly greater at weeks 4 and 24 in the tenidap-treated group than in the hydroxychloroquine-plus-piroxicam-treated group. Significant reductions in plasma IL-6 levels were observed at weeks 4, 12, and 24 within the tenidap group, and at week 24 within the hydroxychloroquine-plus-piroxicam-treated group. The overall occurrence of side effects, including gastrointestinal side effects, was similar in all 3 treatment groups. A small proportion of tenidap-treated patients (6.4%) manifested mild, nonprogressive, reversible proteinuria of presumed renal proximal tubular origin, and 3-4% of patients had elevated transaminase levels.

CONCLUSION

In the treatment of patients with RA, tenidap is as effective as the combination of hydroxychloroquine-plus-piroxicam, and is more effective than piroxicam alone; moreover, tenidap's safety profile is comparable to that observed with piroxicam alone, and with hydroxychloroquine-plus-piroxicam. The clinical response observed in this study, as well as the prompt decreases in acute-phase protein levels of CRP and SAA, and in plasma IL-6 levels, suggest that tenidap represents a new type of antiarthritic medication, with properties similar to, but not identical to, a therapeutic combination of a nonsteroidal antiinflammatory drug with disease-modifying antirheumatic drugs.

Covering embryo cultures with mineral oil alters embryo growth by acting as a sink for an embryotoxic substance

PURPOSE

Assisted reproductive technologies require the use of culture media for gametes and embryos. Culture media and conditions intended for use in human in vitro fertilization are tested prior to use by evaluating their ability to support normal development of mouse embryos.

RESULTS

Development to blastocysts of two-cell mouse embryos was equivalent for embryos cultured in center well dishes alone (93 +/- 10%, mean +/- SD) and embryos cultured in center well dishes with an overlay of 1 ml of mineral oil (94 +/- 5%). In contrast, no development of two-cell-stage mouse embryos occurred in an embryotoxic medium when cultured in center well dishes. However, when this medium was covered with an overlay of mineral oil, development to blastocyst was no different than that of controls (96 +/- 5%). Similar results were found with cultures of one-cell-stage mouse embryos.

CONCLUSION

These results indicate that in some circumstances the presence of mineral oil can significantly alter the outcome of embryo culture. Further, these results reinforce the necessity of directly testing the exact culture conditions to be used for assisted reproductive technologies.

Affective and behavioral reactions to the violation of limits on alcohol consumption

The limit violation effect (LVE) was studied by inducing male social drinkers to consume either more or less beer than their prestated limit on alcohol intake. Affective and behavioral reactions to the violation of drinking limits were mediated by attributional style and aspects of drinking restraint. Subjects who reported greater than average levels of self-blaming attributions, restrictions on alcohol intake and cognitive preoccupation with alcohol became depressed and angry after the violation of drinking limits. In contrast to the hypothesized excessive-drinking component of the LVE, subjects who experienced negative affective reactions to the violation ordered fewer shots in a subsequent whiskey-tasting task. Possible conceptual and methodological reasons for observing only the affective component of the LVE are discussed.

Psychological screening and the success of donor insemination

In a previous case series, a psychologist's rating of couples' emotional adjustment and readiness for donor insemination was predictive of pregnancy rates. We attempted to replicate this finding with an extended series of 120 consecutive couples in which each spouse filled out questionnaires when evaluated for donor insemination. The Stress and Infertility Questionnaire measured specific attitudes and anxieties about donor insemination. The Brief Symptom Inventory assessed psychological distress. The Dyadic Adjustment Scale measured marital happiness. A psychologist used these questionnaires to rate the couple's overall adjustment in regard to donor insemination. Those couples rated as distressed had a session of psychological counselling. Outcome was reviewed at a mean of 20 months after evaluation, with categories of pregnancy, continuing donor insemination, failure to begin the programme, or dropped out. For the 120 couples overall, psychological factors did not predict pregnancy outcome. Younger age of the wife did predict higher pregnancy rates.

Psychopharmacological effects of alcohol on time perception: the extended balanced placebo design

Time perception is affected by the pharmacological action of many drugs, but the contribution of expected effects of drugs has not been considered. A new design, the extended balanced placebo design (EBPD), is presented to study both the pharmacological and expected effects of alcohol on time perception. The EBPD makes it possible to examine the effects of alcohol across a broad range of expected and pharmacological doses. By contrast, the domain of inquiry was limited to low doses of alcohol in the original balanced placebo design. The design was later modified to study higher doses, but the control and the pure drug and expectancy conditions were sacrificed in the transformation. In the EBPD, however, any realistic combination of the expected and actual dose of alcohol can be studied, while retaining pure drug and expectancy conditions. The EBPD was tested in the present study with respect to its psychopharmacological effectiveness and the effects of alcohol on time perception. The design was effective in terms of three manipulation checks: blood alcohol concentration, subjective intoxication and postexperimental beliefs about the alcohol content of the beverage consumed. In addition, the expected and actual doses of alcohol interacted over time to evidence active compensation for the pharmacological effects of alcohol on time perception. Finally, a covariance structure model was confirmed in which the expected and actual doses of alcohol increased the perceived rate of time passage, which in turn lengthened objective estimation of a one-second interval.

Relative/Proportional Scoring of the Ways of Coping Checklist: Is it Advantageous or Artificial

One way of scoring the Ways of Coping Checklist is to compute relative1 proportional scores in which the mean score for each scale is divided by the sum of the means for all of the scales. The proportional scoring method reportedly sets the score on each scale relative to the score for the whole scale. Using the proportional scores, direct comparisons can be made for the profiles of subjects who differ in term of the sheer magnitude of their responses. In the present article, it is argued that the relative scoring method introduces an artifact that confounds multivariate statistical analyses and ignores an individual's general reactivity to problems. Quantitative examples are given to illustrate some of the ways in which relative scoring distorts the pattern of intercorrelations among the WCC scales and thereby produces misleading multivariate results. Multivariate analysis of the raw scores is then shown to accomplish the mission set forth for the relative1 proportional scores. The latter analysis suggests that an intricate structural relationship exits between components of coping and depression. It is concluded that the relationship between coping and depression may be a matter of how effective the coping effort is when the individual is reactive to problems.

Genetic and behavioral tests of the McManus hypothesis relating response to selection for lateralization of handedness in mice to degree of heterozygosity

McManus advanced a genetic hypothesis to explain differences of lateralization between HI and LO lines of mice selectively bred for degree of handedness. It states that lateralization is a function of heterozygosity. Specifically it predicts that (a) the HI line will be more heterozygous than the LO line and (b) populations with a greater average heterozygosity (AH) will be more strongly lateralized. Both genetic and behavioral predictions were tested here. Results using coat color and biochemical variants show that AH in the HI line is somewhat less (not greater) than that in the LO line. The handedness of HET control mice and HI by LO reciprocal hybrids, where AH is greater than that of the HI line, exhibits lessened (not greater) lateralization. Results reject the heterozygosity hypothesis. A model for the inheritance of human handedness that accounts for difficulty in detecting heritable differences in degree of asymmetry is presented.

Recovery of susceptibility to audiogenic seizure in mice

The applicability of the auditory fatigue and anoxia hypotheses for the refractory period observed after sound-induced seizure was examined in SJL/J mice. Duration of auditory stimulation was varied independent of attainment of clonic seizure activity by use of an acoustic interruption technique. Duration of the recovery period affected the pattern of preconvulsive running. Furthermore, the motor asymmetries exhibited during clonus remained consistent across tests. Because duration of acoustic stimulation and attainment of clonus did not affect recovery rate, we conclude that neither the auditory fatigue nor the anoxia hypothesis provides a complete account for the refractory period after audiogenic seizure. We suggest that an inhibitory process, activated before clonus occurs and perhaps linked to depletion of excitatory amino acids in the inferior colliculus, may also be involved.

Forgoing life-supporting or death-prolonging therapy: a policy statement

Avoiding death is not always the preeminent goal of health care, and decisions about the use of life-supporting treatment may either hasten or forestall death. What are the health care professional's responsibilities regarding the use of life-supporting therapy? This report offers general and specific guidelines for termination of life-supporting treatment.

The effects of early experience on callosal development and functional lateralization in pigmented BALB/c mice

A proportion of animals of the BALB/c inbred mouse strain have an unusually small (sometimes absent) midsagittal area of the corpus callosum (CC). In this study, we used a large sample of both males and females (total n = 198) from a pigmented congenic BALB/c line to investigate the relations among preweaning handling, area of CC, and direction and degree of lateralization as measured by Collins' paw preference task. Twenty litters were handled daily from the day after birth until day 25 (weaning) according to Denenberg's procedure and 18 litters were left undisturbed until weaning. All animals were tested for degree and direction of paw preference in a modification of Collins' apparatus at about 60 days and measures taken on CNS structures at 100 days of age. There were no handling or sex effects on degree or direction of paw preference or on the extent of CC defects, but for animals in the normal range (CC > or = 0.7 mm2), those which had been handled had significantly smaller callosa. No significant differences were detected between right and left hemisphere weights, and these measures did not appear to be related to the behavioural measures. There was no significant correlation between CC area and degree of paw preference nor was there any relationship between total agenesis and degree of handedness. This last result is particularly interesting in light of recent evidence that ILn/J mice, all acallosal, are exclusively ambilateral.

Monaural audiogenic seizures: evidence for control by parallel processes

SJL/J mice were binaurally sensitized and monaurally tested for susceptibility to sound-induced seizure. Most control subjects exhibited the expected biphasic pattern of running. In mice in the experimental groups, the acoustic stimulation was interrupted for less than 20 s at the conclusion of the initial burst of running. During this quiet period, the side of the blocked ear was reversed for some mice. These mice had an independent biphasic seizure when acoustic stimulation was reintroduced, indicating that the biphasic seizure progression characteristic of monaural testing is the result of a lateralized process. We conclude that the locus of this process is probably at the level of the inferior colliculus (IC).

Improvement in pulmonary function following smoking cessation

This study investigated improvement in pulmonary function following smoking cessation. It employed three indices of lung function that are sensitive to improvement following smoking cessation and that can be easily assessed within a clinical setting: maximum mid-expiratory flow (MMF), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Smoking status was verified by saliva thiocyanate analysis. Significant improvement in MMF was evident after 3 months of cessation and was maintained at the 6-month follow-up. This study demonstrates that significant improvement in at least one parameter of lung function occurs within the time span typically used in smoking cessation programs.

The Temptation and Restraint Inventory for measuring drinking restraint

In the present study, the measurement of drinking restraint was broadened by developing new items that better characterized its cognitive nature as well as by testing a factor structure which represents restraint as including both the regulation and the failure to regulate alcohol intake. A previously observed (Collins, George & Lapp, 1989) three-component structure of the Restrained Drinking Scale (RDS; Ruderman & McKirnan, 1984) was confirmed. In addition, two factors were extracted from the new set of cognitive items, which when combined with the RDS clusters formed a new measure of drinking restraint, the Temptation and Restraint Inventory (TRI). The factor structure of the TRI matched the conceptualization of drinking restraint as involving successful and unsuccessful regulation of alcohol intake, and differentially predicted self-reported weekly consumption and alcohol-related problems.

The personality and motivation of semen donors: a comparison with oocyte donors

Seventeen consecutively recruited candidates for semen donation were evaluated by a psychologist with testing and a structured interview. Most men (71%) were motivated by financial compensation. Only 29% would donate semen if records were open to potential offspring. Fifty-nine per cent of the men were rated as excellent candidates from a psychological perspective and 35% were rated as acceptable with slight reservations. One was excluded as a donor. Psychological testing revealed mildly abnormal subscale scores for 35% of donors. Forty-seven per cent had histories of minor depressive or anxiety episodes and 35% had had periods of heavy alcohol use. Compared to oocyte donors at the same institution, the men were less altruistic, more affluent, and more likely to have abused alcohol. Women had more traumatic family and reproductive histories. Psychological evaluation can be a valuable tool in gamete donor selection.

Psychological aspects of donor insemination: evaluation and follow-up of recipient couples

OBJECTIVE

To evaluate the utility of psychological screening for couples entering a donor insemination program.

DESIGN

Each spouse completed questionnaires. A psychologist reviewed them and rated the psychological fitness of the couple for participation in the program. Follow-up questionnaires were sent to each couple at a mean of 11 months after entry into the program.

SETTING

Applicants for donor insemination were studied in an infertility program in a large, tertiary referral center.

PATIENTS, PARTICIPANTS

Consecutive applicants to enter the donor insemination program were required to participate in the initial evaluation.

INTERVENTIONS

Couples judged by the psychologist to be at risk for a poor psychological outcome had an assessment and counseling interview with the psychologist before proceeding with insemination.

MAIN OUTCOME MEASURES

Initially, the Stress and Infertility Questionnaire measured specific anxieties related to donor insemination, marital and sexual impact, and attitudes about confidentiality; the Brief Symptom Inventory measured psychological distress; and the Dyadic Adjustment Inventory assessed marital satisfaction. At follow-up, 48% of couples returned a modified version of the Stress and Infertility Questionnaire and the other two questionnaires.

RESULTS

The psychologist's rating was predictive of pregnancy rates (59% for excellent candidates, 41% for acceptable couples, and 14% for couples psychologically at risk). At-risk couples were more likely to drop out of the program (50% versus only 20% of other couples). Sexual problems were reported by 59% of women and 53% of men. Couples believed that a child should not be told of the donor insemination (74% of wives and 80% of husbands). Initially, 64% of wives and 70% of husbands chose total secrecy with families or friends, and these attitudes shifted little over time.

CONCLUSION

This screening procedure is cost-effective and suggests that psychological intervention should be attempted with at-risk couples.

Outcome of laparoscopic versus traditional surgery for ectopic pregnancies

OBJECTIVE

To compare pregnancy rates after three surgical procedures for ectopic pregnancy (EP) over a 9-year period for normal and infertility patients.

DESIGN

In a retrospective analysis, we examined crude pregnancy rates and life-table analysis of cumulative pregnancy rates. A proportional hazard regression model was used to examine relative risk of type of surgery and fertility rates.

PATIENTS, PARTICIPANTS

One hundred twenty-six cases of EPs were reviewed at the Cleveland Clinic Foundation, a tertiary institution.

MAIN OUTCOME MEASURES

Comparisons of rates of viable term deliveries were calculated between three types of surgery and were stratified according to the status of infertility. Confidence intervals for relative risk of surgery and fertility status on future pregnancy were calculated.

RESULTS

No difference in pregnancy rates was observed after the three procedures (P = 0.08). Normals had a significantly higher (4 times higher) pregnancy rate than infertility patients, independent of surgical procedure.

CONCLUSION

Successful pregnancy after EP is related to history of infertility rather than type of surgery to treat ectopic event. More randomized study is needed to examine laparoscopic salpingostomy, especially in patients with other infertility problems.

Confirmation of the influence of a chromosome 7 locus on susceptibility to audiogenic seizures

Mouse strain differences in susceptibility to audiogenic seizures (AGS) are due to allelic differences at multiple genetic loci. Three loci that influence susceptibility to AGS have been mapped on Chromosomes (Chr) 12, 4, and 7 (Asp-1, Asp-2, and Asp-3, respectively). Here we report evidence that confirms linkage of Asp-3 to c on Chr 7 and parental effects on AGS susceptibility, but not genomic imprinting of Asp-3.