Cyclic steroid replacement alters auditory brainstem responses in young women with premature ovarian failure

To determine the independent contributions of estradiol and progesterone to the auditory brainstem response (ABR) latency changes associated with the menstrual cycle, we obtained ABRs on young women with premature ovarian failure who were undergoing cyclic hormone replacement therapy (HRT). We evaluated the influence of cyclic HRT on the ABRs of young women in three controlled phases of the same replacement cycles: 1) no steroid replacement, 2) estrogen-only replacement (E2-only), and 3) estrogen-plus-progesterone replacement (E2-plus-P). A significantly lengthening of wave V peak latency and I-V interpeak interval was found during E2-only replacement. Despite equivalent circulating estradiol levels, both wave V peak latencies and wave I-V interpeak intervals significantly decreased during the E2-plus-P replacement phase as compared to the E2-only replacement phase. These findings are compatible with the hypothesis that estradiol potentiates secretion of the inhibitory neurotransmitter gamma-amino-butyric acid (GABA) at auditory nerve synapses, leading to delayed synaptic conduction time. Progesterone is known to blunt E2-potentiated GABA release and may antagonize its prolongation of wave V latency.

The Ontario HIV seroprevalence study of childbearing women: results from the first year of testing

The Ontario HIV Seroprevalence Study of Childbearing Women is an unliked anonymous seroprevalence study designed according to the well-established ethical and legal guidelines for such studies. Commencing in November, 1989, randomly selected neonatal heelprick specimens were tested for the presence of HIV antibodies after all identifying information had been permanently and irrevocably unlinked from the specimens. During the first year of the study 94,119 (approximately 60% of all submitted specimens) were tested. Twenty-six specimens which were repeatedly reactive by EIA were confirmed as positive for an overall crude seroprevalence rate of 2.8 per 10,000 women having live births (95% CI: 1.8-4.1). Twenty-five of the 26 confirmed seropositive results came from babies born in hospitals in the Metropolitan Toronto, Ottawa-Carlton, or Hamilton-Peel-Halton regions.

Long term psychotherapy training in residency: influences on therapy and training

The authors discuss the changing role of psychotherapy training and the impact of rotations on long term psychotherapy in psychiatric residency. A conceptual model for a long term psychotherapy program for residents is presented, and a case example illustrates the influence of changes in setting, supervisors and in the resident-therapist's way of thinking have on the process of psychotherapy. The educational value of long term patient contact and the opportunity to use apparent obstacles in residency training as catalysts for growth and the opportunity to learn about psychotherapy are emphasized.

Clostridium difficile-associated diarrhoea

During the course of 1 year, Clostridium difficile was isolated from 145 (4 per cent) of 3591 faecal specimens submitted to a hospital routine bacteriology laboratory. These C. difficile positive specimens came from 95 patients or 10.99 per cent of 864 patients investigated for suspected gastroenteritis. In a control population of 318 persons C. difficile was isolated from only 10 of them or 3.1 per cent; this difference was statistically significant. We conclude that as this increase in the isolation of C. difficile from patients with diarrhoea is significant and is about as frequent as that of Campylobacter spp., faecal specimens submitted for routine bacteriology should also be cultured for C. difficile . As with diarrhoea caused by other enteric pathogens, most C. difficile -associated episodes of diarrhoea are mild and spontaneously reversible but approximately 20 per cent of patients have prolonged diarrhoea and may benefit from treatment.

Biochemical screening of hospitalized geriatric patients

Blood specimens were collected from 50 hospitalized geriatric patients with a range of chronic diseases. Analyses were conducted for 12 plasma components. Additional tests were performed on patients with abnormal results in the first tests. Of the 50 patients, 21 (42 per cent) had biochemical abnormalities, often unexpected on the basis of current diagnoses. It is suggested that routine biochemical screening should be conducted on geriatric patients at regular intervals.