Sexual assessment and the aging female

Due to an increasing population of elders, more women are in need of geriatric gynecologic care. Many of these women are capable of being active sexual partners throughout their lifetimes. However, there are a number of factors that can influence sexual relationships, including personal and societal values, the normal physiologic changes associated with aging and the availability of a sexual partner. Obtaining accurate histories and appropriate physical data regarding sexual functioning are important. Measures that will aid the collection of a complete database, along with pertinent physical assessment, are discussed. Options for treatment and education of the elderly woman in the area of sexual needs are presented to assist health care providers in their role as sex educators and counselors for older women.

Manipulation of oxygenation in a human tumour xenograft with BW12C or hydralazine: effects on responses to radiation and to the bioreductive cytotoxicity of misonidazole or RSU-1069

The influence of altered tumour oxygenation on the responses to radiation and/or bioreductive 2-nitroimidazole compounds was studied in a well differentiated, human, colon adenocarcinoma (MAWI), grown as a subcutaneous xenograft in nude mice. Tumour growth delays were measured after local, single 5-18 Gy doses of X-rays. BW12C, which inhibits dissociation of oxyhaemoglobin, produced radioprotection similar to that resulting from clamping off the tumour blood supply during irradiation. Hydralazine, a vasoactive agent, also appeared to give radioprotection. BW12C or misonidazole (MISO) alone had no measurable inhibitory effect on xenograft growth. Hydralazine or RSU-1069 slightly increased the time for tumours to reach 6 times their original volumes. When hydralazine was given 40 min after a dose of 800 mg/kg of MISO, without X-rays, growth delays in excess of 5 tumour volume doubling times resulted and fewer tumour cells were present in histological sections. Lower doses of MISO combined with hydralazine were ineffective. Other combinations of bioreductive cytotoxic agents and methods of manipulation of tumour blood flow/oxygenation induced slight and inconsistent growth delays. Hydralazine was injected after irradiation of tumours in mice previously treated with various doses of MISO in an attempt to exploit the bioreductive cytotoxic potential of MISO in conjunction with its radiosensitizing properties; however, tumour growth delays were similar with or without hydralazine after irradiation. Thus, post-irradiation restriction of tumour blood flow appears to be an ineffective therapeutic strategy in this human xenograft tumour model.

Post-traumatic headache with scintillating scotoma treated with phenytoin (Dilantin)

A post-traumatic headache patient was experiencing "flashing lights" in her visual field that correlated with sharp waves on the EEG. Phenytoin markedly improved the symptoms. The value of the EEG in post-traumatic headaches is reviewed. The use of phenytoin in headache syndromes and in prevention of post-traumatic epilepsy is discussed.

Flow cytometric analysis of lymphocyte subsets in peripheral blood of chronic headache patients

Lymphocyte subsets from 5 groups of patients with different types of chronic headaches were analyzed by flow cytometry to determine the number of cells bearing the following markers: T11 (E-rosette receptor), T3 (total T cells), T4 (T-helper/inducer cells), T8 (T-cytotoxic/suppressor cells), B1 (B-cells), NKH-1 (Natural killer cells), I2 (Class II histocompatibility antigens, monomorphic determinants) and Mo2 (monocytes). In 4 of 5 of these groups, the absolute number of T8 lymphocytes was significantly lower than that of control group. In addition, the T4:T8 ratio was higher in these 4 groups. These findings may suggest a relationship between the immune system and the cause of chronic headaches.

Fibronectin in severe sepsis

Fibronectin was given in the form of cryoprecipitate of human plasma to patients with severe surgical sepsis in a double blind, prospective and randomized clinical study. Of the 19 patients assigned to the control group receiving no fibronectin, only eight (42 per cent) survived. Of the 12 patients given the cryoprecipitate, nine survived (75 per cent) (p less than 0.05). In the control group, initial serum fibronectin levels were depressed to 121 micrograms per milliliter (normal = 313). The mean values in the blank plasma controls did not increase after 24 hours, with a mean of 122. In contrast, the group treated with cryoprecipitate increased serum fibronectin values after 24 hours to 216 micrograms per milliliter, up from initial values of 161 micrograms per milliliters. Improvements in pulmonary function, serum bilirubin and serum creatinine values were also noted, but the changes fell short of statistical significance. Fibronectin appears to benefit patients in severe surgical sepsis in this study of a relatively small number of patients.

Embolic stroke complicating systemic lupus erythematosus

Embolic stroke complicating systemic lupus erythematosus has been infrequently reported. We examined a 25-year-old woman who suddenly became hemiplegic. Two-dimensional echocardiography identified a source of emboli. At cardiac surgery, friable thrombotic vegetations were found adhering to the mitral valve leaflets, left ventricular septal wall, and chordae tendineae. At autopsy several weeks later, careful pathologic examination of the heart failed to reveal evidence of thrombus formation or endocarditis. An embolus identical in appearance to the thrombotic vegetations described at cardiac surgery was found lodged in the left middle cerebral artery underlying the recent brain infarction. To our knowledge, this is the first report of embolic stroke in systemic lupus erythematosus caused by extensive cardiac thrombus formation in the absence of underlying endocarditis.

Achievement motivation in medical students

Medical students were assessed by questionnaire in their third and fourth years regarding attitudes about sex role, medical school, and career plans and in the third year about fear of success. Nine percent of each sex were judged to fear success. Stereotypical responses were reported by the students. Males, anticipating that they would work more than 60 hours per week, looked forward to academic careers, while females more often desired the sharing of financial and child care responsibilities with spouses. Attitudes toward chores were egalitarian, but in reality women performed most routine household activities. Both sexes agreed upon the characteristics that are necessary to be a good student as well as to succeed in later life. Women were more inclined toward artistic and domestic interests and helping others, while men were more interested in scientific investigation, athletics, and adventure. The implications of these similarities and differences for the students' future careers are discussed.

Surgery for obesity and marriage quality

Before surgery for obesity, most of 54 morbidly obese patients considered their marriage to be good, although marked problems were higher than for a comparison group. One year later, a majority still rated their marriage as good; many reported better relations with their spouses. Sexual function was enhanced. Three years postoperatively (n=30), the incidence of marital harmony had risen to the same level as for the comparison group and sexual functioning continued to be improved. The divorce rate during the three years, however, was somewhat higher, particularly in those marriages originally found to be troubled before surgery. The implications of these findings for the decision to undertake surgery for obesity are discussed.

Social indicators and mental health planning: an empirical case study

This paper reports data from a series of studies designed to provide an empirical basis for making judgments regarding the utility and validity of social indicators as a method for assessing the need for mental health services. The following findings are included: (a) The methodological sophistication of the social indicators approach used did not greatly affect the utility of the technique as a means of identifying low- and high-need subareas in a large standard metropolitan statistical area. (b) Correlations between social indicator rankings of tracts/enumeration districts and mental health needs as determined by psychiatric scale scores varied in two different counties. (c) The degree of tract/district socioecological homogeneity appears to account for the diverse correlations. (d) Tract and enumeration district social indicator rankings uniquely account for less than 50% of the explained variance of individual mental health scores when analyzed in a regression equation which includes socioeconomic status as a variable.

Pigeon breeders' disease--a prevalence study and review

Among fifty-three Salt Lake City, Utah area pigeon fanciers, 21% were found to have the clinical picture of pigeon breeders' disease. This is a much higher frequency than has been observed previously. Abnormal spirometry and increased skin reactivity to pigeon sera were found more often, statistically significantly, in symptomatic than in exposed asymptomatic fanciers. Pigeon breeders' disease is associated with a variety of abnormal findings; skin test, precipitins, pulmonary function changes and radiographic derangements; but unfortunately none of these are diagnostic. Pigeon breeders' disease is best identified by clinical criteria.