Is cervical intra-epithelial neoplasia symptomatic?

Very little is known about cervical intra-epithelial neoplasia (CIN) and associated symptomatology. It is often quoted that that CIN is asymptomatic. We wanted to look at whether women with CIN were symptomatic or not. We are not aware of a similar study. We performed a case control study. Our cases were 22 women with abnormal cytology and histology results and our controls were 56 women who had been treated in the recent past and whose smears had returned to normal and those women whose smears had returned to normal spontaneously. Our study shows that there is no evidence that CIN is associated with post-coital bleeding, intermenstrual bleeding or discharge. Women with post-coital bleeding (PCB) are often fast tracked to the colposcopy clinic and women awaiting colposcopy suffer high levels of anxiety. There is no evidence for such practice.

Paralytic poliomyelitis in Ontario: laboratory studies of two recent cases.

Sporadic cases of paralytic poliomyelitis are being reported with increasing frequency, particularly in unvaccinated persons, in several countries in which the disease had been absent for several years following adequate initial vaccination programmes. In Ontario, two paralytic cases occurred in unvaccinated children after several disease-free years. Detailed studies of the strains of poliovirus type 1 isolated from these patients showed that they were not vaccine strains. Contact surveillance in one case showed that 21 originally unvaccinated contacts were also excreting virulent virus.

Aldosterone in metabolic alkalosis.

Studies have been carried out in human volunteer subjects to evaluate the role of aldosterone in the development, maintenance, and correction of metabolic alkalosis induced by selective depletion of hydrochloric acid. During the first phase of our study the rate of aldosterone secretion was measured before the induction of alkalosis (while the subjects were on a low salt diet) and again after a steady state of metabolic alkalosis had been established. The data demonstrate a fall in aldosterone secretion from a value of approximately 500 mug/day to a value of approximately 200 mug/day. Thus, it appears that an increased rate of aldosterone secretion is not a prerequisite to the elevation of the renal bicarbonate threshold. During the second phase of our study, aldosterone was administered to the alkalotic subjects in doses of 1000 mug/day (or deoxycorticosterone acetate in doses of 40 mg/day) in order to determine the effects of a persistent steroid excess on the ability of sodium chloride to correct the acid-base disturbance. The data demonstrate that despite the administration of steroid, the ingestion of sodium chloride led to a reduction in plasma bicarbonate concentration from 39 to 29 mEq/liter, accompanied by a suppression of renal acid excretion. This reduction in plasma bicarbonate concentration occurred without a concomitant retention of potassium, a deficit of as much as 400-500 mEq of potassium persisting during repair of the acid-base disturbance. Our findings suggest that "saline-resistant" alkalosis, when it occurs in the absence of primary hyperadrenalism, cannot be attributed to aldosterone excess and/or potassium depletion of the magnitude seen in our study. We also suggest the need for a reappraisal of the way in which aldosterone excess contributes to the genesis and maintenance of alkalosis in primary aldosteronism.