Steroid contraceptive use and cervical dysplasia: increased risk of progression.

In a prospective study of women with dysplasia of the cervix, there was an increase in severity of dysplasia and of conversion to cancer in situ in users of the contraceptive pill compared with users of other contraceptive methods. There was a delay in this adverse response. Nonreversal of dysplasia within the first 6 months of pill use is predictive of progression after prolonged exposure.

Structural correlates of seizure behavior in the mongolian gerbil.

Hippocampi of seizure-sensitive and seizure-resistant Mongolian gerbils were examined in search of structural correlates of seizure behavior. In animals with well-established seizure histories, differences were found in both presynaptic and postsynaptic structures. Seizing animals had less dense dendritic spines, a greater proportion of mossy tuft area devoted to presynaptic vesicles, and a smaller proportion devoted to spines. The possible relationship of these findings to epilepsy is discussed.

Evaluation of Papanicolaou smear and effect of sample biopsy in follow-up of cervical dysplasia.

In a prospective study of women with dysplasia, a superficial sampling biopsy of the cervix was carried out as a periodic check of the cytological findings. The relationship of smear and biopsy results was evaluated, as well as the effect of the biopsy procedure on the subsequent course of dysplasia. We found sufficiently close agreement between smear and biopsy results to conclude that smears and biopsies measure similar aspects of dysplasia. It would appear unwise, however, to rely on Papanicolaou smears exclusively in following women with a history of dysplasia, since negative smears in such women may occasionally show dysplasia in the corresponding biopsy. Periodic corroborative biopsy procedures are therefore indicated in the follow-up care of women with a history of dysplasia. There was no evidence that a superficial sampling biopsy significantly altered the short-term course of dysplasia. There was also no evidence of a cumulative effect of repeated sampling biopsies. These results do not rule out possible effects of other forms of biopsy procedures and schedules on the subsequent course of dysplasia.

Therapist characteristics and the outcome of treatment in schizophrenia.

The broad task of identifying and characterizing specific components of personality and behaviours of therapists that may be differentially helpful in the treatment of schizophrenia still remains to be addressed. This report presents data systematically collected in the course of a controlled study of the outcome of five different treatment methods in schizophrenia. Therapists seem to play a significant role in determining the outcome of the treatment of schizophrenia by drugs and by psychotherapy plus drugs. The salient therapist behaviors that seem to make a difference in outcome are yet to be identified and studied. The A-B dimension as customarily defined seems of little value for this task. The findings show a distinct need to identify cognitive and affective personality characteristics of the therapist relevant to eliciting patient cooperation, and the degree of knowledge and sophistication in the use of particular methods of treatment necessary for good results.

The Spanish Diagnostic Interview Schedule. Reliability and comparison with clinical diagnoses.

The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was translated into Spanish. The reliability of the Spanish instrument, its equivalence to the English version, and its agreement with clinical diagnoses were examined in a study of 90 bilingual (English-and Spanish-speaking) and 61 monolingual (Spanish-speaking only) patients from a community mental health center. The study design involved two independent DIS administrations and one independent clinical evaluation of each subject.

Lipoamide dehydrogenase: rapid heat inactivation in platelets of patients with recessively inherited ataxia.

The activity of lipoamide dehydrogenase was abnormally heat-labile in homogenized platelets from seven patients with as recessive ataxia conforming to the syndrome of Friedreich ataxia or clinical variants. Taken together, the abnormality and previous findings of low activity and abnormal kinetic properties are compatible with a change in the conformation of the enzyme in these patients.

Treatment of diabetic diarrhea and orthostatic hypotension with somatostatin analogue SMS 201-995.

A diabetic patient was treated with a somatostatin analogue, SMS 201-995, to control chronic diarrhea and orthostatic hypotension. The patient was injected with 50 micrograms, 100 micrograms, and 150 micrograms of SMS 201-995 subcutaneously twice daily for three days at each dose. Stool weight decreased from a basal mean value of 906 g per 24 hours to 628 g, 445 g, and 408 g per 24 hours, respectively. Diarrhea remained suppressed for 18 months when the patient was last seen. When SMS 201-995 was then given at 5 micrograms to 10 micrograms per hour by continuous subcutaneous infusion, stool weight decreased to a mean of 321 g per 24 hours. Basal blood pressure, which averaged 99/71 mm Hg, rose to 133/91 mm Hg five minutes after 75 micrograms of SMS 201-995 was injected subcutaneously; it remained elevated for six hours after injection. Serum motilin levels decreased significantly from 126 pg/ml before injection of SMS 201-995 to 52 pg/ml after injection. Serum norepinephrine levels rose from 50 pg/ml supine (normal range, 150 to 550 pg/ml) and 52 pg/ml erect before injection of SMS 201-995 to 72 pg/ml supine and 110 pg/ml erect after injection. SMS 201-995 may raise blood pressure, in part by increasing the release of circulating norepinephrine.

Chlamydia trachomatis isolation in a symptomatic university student population.

In a study of 638 women attending a University Student Health Service outpatient gynecologic clinic, their symptoms were either lower genital tract infection or a history of suspected exposure to sexually transmitted diseases. Forty-two (6.6%) harbored Chlamydia trachomatis, four (0.8%) Neisseria gonorrhoeae, and one (0.2%) both of these organisms. Chlamydia-positive patients were more likely to be using a contraceptive method, have multiple partners, and have partners with symptoms of urethritis (P = .05). The Chlamydia-positive patients were no more likely to have increased or abnormal vaginal discharge than were controls. Of the women harboring Chlamydia trachomatis, only one of 36 (3%) of those who were available for follow-up at one to eight weeks posttreatment was still infected with the organism.

Screening for gestational diabetes with the one-hour 50-g glucose test.

A one-year experience of screening for gestational diabetes is reported. Patients with any of seven risk factors were screened at the time of prenatal registration. Those without risk factors, and those not found to be diabetic by 24 weeks' gestation, were tested later in pregnancy. Of 4116 patients, 77% had at least one risk factor. The prevalence of diabetes in patients with risk factors was significantly greater than among those with no risk factors (P less than .001). Of 936 patients who had no risk factors, four were found to have diabetes. Multiple logistic regression analysis suggested that family history, obesity, and age over 25 years contributed significantly to the prediction of gestational diabetes. More than 10% of gestational diabetics had screening values between 135-139 mg/dL. Among patients whose early screening values were elevated and whose initial glucose tolerance tests were normal, the odds of being classified ultimately as a gestational diabetic were 7.3 times that of patients whose initial screening tests were normal. Selective screening based on risk factors including maternal age may enhance detection of diabetes early in gestation.

Effects of alexidine.2HCL mouthwash on plaque and gingivitis after six months.

Two-hundred and fourteen subjects ranging in age from 22 to 63 years used either a mouthwash that contained 0.035% w/v alexidine.2HCL (2-ethylhexyl bisbiguanidine dihydrochloride) or a placebo twice daily on a doubleblind basis for six months in conjunction with routine oral hygiene procedures. The results indicated that alexidine.2HCL was safe and was statistically more effective in producing a clinically significant reduction in gingivitis than was the placebo.

Nicotine vs. placebo gum in the alleviation of withdrawal during smoking cessation.

In a double-blind, placebo-controlled trial of nicotine gum, withdrawal symptoms were systematically scaled for one week in 50 subjects. Baseline responses on withdrawal items were obtained for comparison to five days of smoking abstinence. Twenty-six subjects receiving nicotine gum and twenty-four subjects receiving placebo gum provided the withdrawal data. A withdrawal scale (SCS) was derived from smokers' complaints in previous abstinence attempts. Pulse rate changes were recorded. Carbon monoxide served to verify abstinence. Pulse rate dropped significantly during abstinence for the placebo vs. nicotine group. All subjects experienced significant increases in withdrawal over time. However, the placebo group reported significantly more severe withdrawal than the nicotine subjects. No sex differences in reported withdrawal were found. It was concluded that the appearance of withdrawal symptoms may be attributed, in part, to the removal of nicotine per se. Conversely, nicotine-specific symptoms may be alleviated with nicotine gum.

Nicotine gum in smoking cessation: a placebo-controlled, double-blind trial.

Sixty subjects were run in a study comparing the use of nicotine gum with placebo gum during cessation from smoking. Subjects were given clinic support and chewed the gum ad libitum. A survival analysis showed the two groups differed significantly in successful abstinence over time (p less than .03). Differences between groups appeared early (within weeks) and, at six months, a 28% superiority of nicotine over placebo gum was demonstrated with mean success rates of 48% and 20%, respectively. Between six months and one year, relapse in the nicotine group accounted for the 30% vs. 20% success rates for nicotine and placebo observed at one year. In a pilot study ("dispensary") testing the efficacy of the two gums when intervention was minimal, subjects in both groups resumed smoking within the first two weeks. The enhanced short-term success rates with nicotine gum in the clinic study are attributed to an effective interaction between use of the active preparation and clinic support. Long-term cessation may require extended maintenance procedures and/or an identification of optimal gum use.

A Markovian model for evaluating dental care programs.

A Markov model is suggested as a means of evaluating dental care programs. Four mutually exclusive states of dental care are defined as Markovian states. These are episodic, initial, maintenance and nonuse. Records for all patients entering a university teaching clinic (n = 578) over a 12-month period were examined and classified in one of the states of care at entry into the clinic and at 1-year intervals from the date of entry for 3 years. An analysis of the findings indicated that the Markov model did fit reasonably well and provided a good approximation of the empirical data.