Diagnostic options for assessment of postmenopausal bleeding.

Postmenopausal women should undergo endometrial assessment when bleeding occurs in the absence of replacement hormone therapy, after a 1-year regimen of continuous-combined hormone replacement therapy, or at an unexpected time during cyclic replacement therapy. Endometrial assessment can be accomplished by endometrial biopsy, transvaginal ultrasonography, or hysteroscopy. Dilation and curettage should be reserved for those rare cases when the other methods are infeasible. Each method of assessment has advantages and disadvantages, and the choice of method should be made accordingly.

Forestomach neoplasms in Fischer F344/N rats and B6C3F1 mice exposed to diglycidyl resorcinol ether--an epoxy resin.

Repeated dose (14 days), subchronic (13 wk) and chronic (2 yr) studies were carried out in succession to evaluate the toxic and carcinogenic effects of diglycidyl resorcinol ether (DGRE), a liquid spray epoxy resin, in F344/N rats and B6C3F1 mice. DGRE in corn oil was administered by gavage for 14 consecutive days in the repeated dose study and 5 days/wk in the subchronic and chronic studies. The mortality rate was increased in rats and mice in the repeated dose and subchronic studies. Hyperkeratosis, basal cell hyperplasia and squamous cell papillomas of the forestomach were observed in a few treated rats and mice in the subchronic study. Based on the results of the subchronic study, F344/N rats and B6CF1 mice (50 males and 50 females/species/dose) were administered DGRE (rats--0, 12, 25 and 50 mg/kg body weight, mice--0, 50 and 100 mg/kg body weight) in corn oil by gavage 5 days/wk for 103 wk. The incidence of neoplastic and non-neoplastic changes of the forestomach was increased in rats and mice in the chronic study. Under the conditions of the study, DGRE is considered to be carcinogenic to F344/N rats and B6C3F1 mice.

Sternoclavicular joint arthritis: an unusual presentation of metastatic carcinoma.

Metastatic carcinoma presenting as sternoclavicular joint arthritis has only recently been reported. We describe a unique case of carcinoma arising from the tongue presenting with bilateral enlargement of the sternoclavicular joints. Diagnosis of metastatic squamous cell disease was made antemortem by Wright's stain and cytology of a joint fluid aspirate; the primary eluded detection until postmortem examination. Primary carcinoma of the tongue and oral cavity should be considered when confronted with metastatic squamous cell disease.

Thymic humoral factor effect on intracellular lymphocyte cAMP in patients with ankylosing spondylitis.

Intracellular cAMP was measured in peripheral blood mononuclear cells from patients with ankylosing spondylitis and from controls. The effect of thymic humoral factor (THF) on T lymphocyte cAMP content was monitored in both groups to determine if there were any differences in immature T cell proportions. Equivalent cAMP levels were found in patients and controls in the absence of THF and again after stimulation with this immune modulator.

In vitro thymosin effect on T lymphocytes in ankylosing spondylitis.

Peripheral blood "total" and "avid" T-cell rosettes (ER) were enumerated in 35 patients with ankylosing spondylitis (AS). The in vitro effect of thymosin fraction 5 on "avid" ER formation was also determined. "Total" ER numbers, but not proportions, were lower in patients with AS as compared to matched controls, Both the proportion and number of "avid" ER were lower in the patient group. Thymosin induced a significant increase in "avid" ER proportions and numbers in the patient group with no such effect observed in the controls. It is suggested that there are increased numbers of circulating T lymphocytes in patients with AS that can respond to exogenous thymic factors and acquire the capability to form "avid"ER.

Further observations on the arthropathy of calcium pyrophosphate crystal deposition disease.

The arthropathy of calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is distinctive and may affect lumbar spinal and sacroiliac joints, as well as appendicular joints. Subchondral pseudocysts that are a hallmark of the disease have a variable appearance, but often occur as a typical cluster of subchondral, coalescent lucencies with smudged, sclerotic margins. Structural joint collapse with fragmentation of cartilage and bone may occur and appear to be related, at least in some cases, to antecedent pseudocysts. Characteristic intra-articular osteochondral bodies are often extensive and may affect multiple joints; their pathogenesis is discussed. Articular synovial calcification is common and may be due to calcium hydroxyapatite, as well as CPPD, particularly if advanced degenerative changes are present. Recognition of the radiologic features may be encountered in CPPD crystal deposition disease is important for differential diagnosis.

Reiter's syndrome. Evaluation of preliminary criteria for definite disease.

A retrospective evaluation of 83 patients with Reiter's syndrome (RS) and 166 comparison arthritis patients was conducted in order to assess the preliminary criteria for definite RS. Data analysis was based on the statement that Reiter's syndrome consists of an episode of peripheral arthritis of more than 1 month duration occurring in association with urethritis and/or cervicitis. During the initial episode of RS, 70 of the 83 RS patients satisfied the criteria, yielding a sensitivity of 84.3%.

Computed tomography in the evaluation of sacroiliac arthritis.

Computed tomography (CT) in the evaluation of the sacroiliac joints was compared with conventional radiography in a double-blind study. CT did not increase the probability of detecting sacroiliitis. Because only a few patients were evaluated near the onset of their disease, the sensitivity of CT as compared with that of routine radiography in detecting early morphological changes remains undetermined. An inexperienced observer may find it easier to evaluate CT scans than conventional radiographs of the sacroiliac joint; however, with optimal images, an experienced radiologist does not need CT to evaluate the sacroiliac joint in clinical practice.

Comparison of phosphohydrolase activities from articular cartilage in calcium pyrophosphate deposition disease and primary osteoarthritis.

One abnormality in calcium pyrophosphate deposition disease (CPDD) which fosters consistently high synovial fluid pyrophosphate ion (PPi) and large accumulations of calcium pyrophosphate dihydrate crystals (Ca pyrophosphate) might be an aberration in chondrocytes involving elaboration of PPi and failure of its hydrolysis within cartilage matrix. Exploration of this hypothesis required further information on the phosphohydrolases in relevant human articular cartilages. Triton X-100 extracts of whole homogenized cartilage from 18 patients with primary osteoarthritis (OA), 10 patients with CPDD and secondary OA, as well as 6 "normal" subjects were partially purified by DE-52 chromatography and eluates studied for phosphohydrolase activity in a variety of substrates, inhibitors, and environmental conditions. Almost all the protein as well as crude alkaline phosphatase and pyrophosphatase activities were clustered in peaks designated I and II. Findings in CPDD cartilage not observed in OA controls were: 1) consistent alkaline phosphatase activity in the void volume of DE-52 columns, 2) high levels of 5'nucleotidase activity, 3) abundant generation of PPi by CPDD cartilage during in vitro incubation of cartilage extract fractions with ATP. This enzymatic behavior is likely to bear a regulatory relationship to PPi production by chondrocytes in CPDD.

HLA profile and Reiter's syndrome.

The analysis of the clinical and HLA profiles of 99 patients with Reiter's syndrome is reported. Antigen HLA-B27, which has previously been firmly associated with Reiter's syndrome, predisposes patients to develop disease features which reflect articular involvement. The HLA haplotype A2, B27 was found to be at an elevated frequency in our Reiter's syndrome sample, and the latter two antigens are also associated with a general increase in disease severity. Conversely, antigen BW35 appears to be protective against certain features of the syndrome. Patients with certain antigenic profiles (namely A2 and A3 together with B27) tend to develop certain syndrome manifestations earlier in the course of the disease than those with other antigens.

Fixed eruption and fever after urography.

We have described a patient with fixed bullous eruption, usually associated with severe fever, occurring on five occasions after a series of seven intravenous urograms between 1974 and 1979. Diagnosis was initially obscured because the onset of fever and dermatitis was delayed as long as 72 hours. This is only the second report of true ioderma ascribed to urographic contrast media.