Diagnosis of superficial endometriosis on transvaginal ultrasound by visualization of peritoneum of pouch of Douglas

OBJECTIVE

Around 80% of women with endometriosis have superficial endometriosis (SE) rather than ovarian or deep endometriosis (DE). However, to date, advances in non-invasive, imaging-based diagnosis have been limited to DE or ovarian disease. The objective of this study was to determine whether we can detect SE on transvaginal ultrasound scan (TVS) by assessing the peritoneum of the pouch of Douglas (POD).

METHODS

This was a retrospective diagnostic test study following a change in practice to include POD peritoneum assessment for SE during TVS at a tertiary London hospital. Eligible patients underwent TVS by a single clinician trained in endometriosis scanning and a subsequent surgical procedure (laparoscopy) between April 2018 and September 2021. Participants formed a consecutive series. The TVS findings were compared with those of laparoscopy as the gold standard. Comparison of TVS findings with intraoperative findings was performed by calculating the diagnostic test performance measures (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and positive and negative likelihood ratios).

RESULTS

The study included a total of 100 patients. We found that 43/100 (43.0%) patients had no endometriosis, 33/100 (33.0%) had SE and 24/100 (24.0%) had DE on laparoscopy. SE was correctly detected on TVS in 17/33 patients, with a sensitivity of 51.5% (95% CI, 33.5-69.2%), specificity of 94.0% (95% CI, 85.4-98.4%), PPV of 81.0% (95% CI, 60.8-92.1%) and NPV of 79.7% (95% CI, 73.4-84.9%). DE was correctly diagnosed in 20/24 cases, including all ovarian cases, with a sensitivity of 83.3% (95% CI, 62.3-95.3%), specificity of 97.4% (95% CI, 90.8-99.7%), PPV of 90.9% (95% CI, 71.6-97.5%) and NPV of 94.9% (95% CI, 88.3-97.8%). The detection of SE on TVS was most accurate in the POD (sensitivity, 50.0%; specificity, 96.4%; PPV, 76.9%; NPV, 88.9%).

CONCLUSIONS

This study shows that the detection of SE in the POD is possible using routine TVS. While negative TVS does not reliably confirm the absence of disease or replace diagnostic laparoscopy, positive TVS facilitates non-invasive diagnosis for a much larger group of women than was previously possible. This should help to reduce the time from the onset of symptoms to diagnosis and enable initiation of medical treatment without the risk, cost and delay associated with a surgical diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

POS0743 CLINICAL CHARACTERISTICS AND BURDEN AMONG PATIENTS WITH SLE AND MUSCULOSKELETAL ORGAN INVOLVEMENT: RESULTS FROM A REAL-WORLD STUDY IN THE US

Background

Limited information exists concerning the clinical burden and unmet need of musculoskeletal (MSK) organ involvement among patients with SLE in clinical practice.

Objectives

To examine demographics, clinical status, treatment patterns, and patient-reported outcomes (PROs) among patients with SLE in clinical practices and assess the impact of MSK organ involvement.

Methods

Data were drawn from the Adelphi Real World Lupus IV (2021) Disease Specific Programme™, a point-in-time survey of 79 US physicians and their patients with SLE. Physicians completed questionnaires regarding patient demographics, clinical status, and treatment. The same patients were invited to complete questionnaires containing the EuroQoL 5-Dimensions (EQ-5D), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue) and Work Productivity & Activity Impairment questionnaire (WPAI) PRO tools.

Physicians stated their patients’ organ involvement at the time of data collection (current), in the categories of musculoskeletal, mucocutaneous, renal, cardiorespiratory, constitutional, haematologic, ophthalmologic, gastrointestinal, respiratory, or other.

Two mutually exclusive patient groups were analysed:

A.MSK – Current physician assessed musculoskeletal organ involvement (+/- other organ/tissue involvement).

B.Non-MSK – No current musculoskeletal organ involvement as assessed by the physician

Bivariate analysis was conducted for numeric variables using t-tests; binary categorical variables using a Fisher’s exact test; ordinal categorical variables using a Mann-Whitney test; and other categorical variables were compared using a chi-squared test.

Results

A total of 595 patients were included in this analysis: 64.7% MSK and 35.3% non-MSK. Mean[SD] patient age was 45.2[14.3] years, 83.2% were female, 53.3% were White/Caucasian, 27.9% were African American, and mean[SD] time diagnosed with any SLE was 5.3[6.2] years.

Point-in-time assessment of clinical status, treatment patterns and patient-reported outcomes, revealed that those with MSK organ involvement assessed by their rheumatologist had higher overall SLE disease severity, more flares in the last 12 months, and slightly worse quality of life scores and work impairment.

Table 1.

Point-in-time clinical status, treatment patterns and PROs among patients with SLE MSK organ involvement

TotalMSKNon-MSKp value(n=595)(n=385)(n=210)Physician-Reported Patient Clinical Status & Treatment HistoryCurrent SLE severity, n(%)Mild405 (68.1)243 (63.1)162 (77.1)<0.001Moderate169 (28.4)128 (33.3)41 (19.2)Severe21 (3.5)14 (3.6)7 (3.3)Current joint symptoms, n(%)Joint tenderness251 (42.2)210 (54.6)41 (19.5)<0.001Joint stiffness255 (42.9)212 (55.1)43 (20.5)<0.001Joint swelling135 (22.7)111 (28.8)24 (11.4)<0.001Mean [SD] Flares in the last 12 months1.6 [1.7]1.7 [1.8]1.2 [1.3]0.015Currently prescribed, n(%)Belimumab113 (19.0)79 (20.5)34 (16.2)0.198Immunosuppressant164 (27.6)105 (27.3)59 (28.1)0.830Corticosteroids333 (56.0)228 (59.2)105 (50.0)0.030Antimalarials429 (72.1)268 (69.6)161 (76.7))0.067Mean [SD] years on current treatment2.9 [3.6]2.5 [3.0]3.6 [4.4]<0.001Patient-Reported OutcomesMean [SD] EQ5D-5L Utility score (0= death to 1= full health)0.79 [0.20]0.76 [0.22]0.85 [0.16]0.002Mean [SD] FACIT-Fatigue score (0 worst fatigue to-52= no fatigue)32.4 [12.0]31.0 [11.5]35.4 [12.6]0.005Mean [SD] WPAI, overall work impairment score(0= no impact to 100= completely impacted)29.0 [21.0]30.5 [18.6]25.9 [25.2]0.223

Conclusion

In this large sample of patients with SLE followed in clinical practices in the U.S., compared to those with little or no rheumatologist assessed MSK involvement, those with MSK involvement, had lower quality of life, with higher impact on their work productivity. These results highlight the heterogeneity of SLE and the impact of major MSK manifestations on quality of life in SLE.

References

N/A

Disclosure of Interests

Aisha Vadhariya Employee of: Eli Lilly and Company, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jianmin Wu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kirstin Griffing Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Fiona Bailey: None declared, James Hetherington: None declared, Elke Rottier: None declared, Sophie Barlow: None declared, Karen Costenbader Consultant of: Lilly, Astra Zeneca, Janssen, Amgen, Glaxo Smith Kline, Grant/research support from: Exagen, Gilead, Merck

AB0554 CLINICAL CHARACTERISTICS AND BURDEN AMONG PATIENTS WITH SLE STRATIFIED BY SLEDAI DERIVED SEVERITY: RESULTS FROM A REAL-WORLD STUDY IN THE US

Background

Data are limited concerning the distribution of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores among patients with SLE in clinical practice and the characteristics of patients with specific SLEDAI scores.

Objectives

To investigate SLE patient demographics, clinical status, treatment patterns, and patient reported outcomes (PROs), overall and stratified by SLEDAI score.

Methods

Data were drawn from the Adelphi Real World Lupus IV (2021) Disease Specific Programme™, a point-in-time survey of 79 US rheumatologists and patients with SLE. Rheumatologists completed questionnaires regarding patient demographics, clinical status, and treatment. The same patients were invited to complete questionnaires containing the EuroQoL 5-Dimensions (EQ-5D), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue) and Work Productivity & Activity Impairment questionnaire (WPAI) Patient-Reported Outcomes (PRO) tools.

Physicians completed 24 questions based on the SLEDAI-2K questionnaire regarding their patients’ current clinical manifestations, from which a SLEDAI score was derived1. Patients were grouped based on their score: SLEDAI=0 (none), SLEDAI=1-6 (mild), SLEDAI=7-12 (moderate), and SLEDAI>12 (severe)2.

Data from patients without rheumatologist-perceived renal organ involvement and ≥ 1 year of SLE duration were included for analysis using bivariate tests.

Results

A total of 273 patients were included in this analysis. Mean [SD] patient age was 47.0[14.2] years, 83.9% were female, 57.1% were White/Caucasian, and 24.9% were African American.

Table 1.

Point-in-time clinical status, treatment patterns and PROs among patients with SLE stratified by SLEDAI score

Table 1.Total Sample (n=273)SLEDAI=0 (n=60, 22%)SLEDAI=1-6 (n=79, 28.9%)SLEDAI=7-12 (n=70, 25.6%)SLEDAI>12 (n=64, 23.4%)p valuePhysician-Reported Clinical Status and Treatment HistoryCurrent SLE severity, n(%)Mild221 (81.0)51 (85.0)70 (88.6)53 (75.7)47 (73.4)0.057Moderate49 (18.0)9 (15.0)9 (11.4)16 (22.9)15 (23.4)Severe3 (1.1)0 (0.0)0 (0.0)1 (1.4)2 (3.1)Current joint symptoms, n(%)Joint tenderness109 (39.9)24 (40.0)27 (34.2)28 (40.0)30 (46.9)0.498Joint stiffness121 (44.3)22 (36.7)33 (41.8)37 (52.9)29 (45.3)0.293Joint swelling60 (22.0)17 (28.3)13 (16.5)19 (27.1)11 (17.2)0.190Mean [SD] Flares in the last 12 months1.6 [1.5]1.3 [1.2]1.7 [1.7]1.5 [1.3]1.8 [1.5]0.550Currently prescribed, n(%)Belimumab58 (21.3)14 (23.3)18 (12.9)8 (10.1)15 (21.4)0.011Immunosuppressants48 (17.6)7 (11.7)26 (18.6)10 (12.7)13 (18.6)0.052Corticosteroids138 (50.6)35 (58.3)62 (44.3)29 (36.7)32 (45.7)0.003Antimalarials206 (75.5)28 (46.7)108 (77.1)64 (81.0)59 (84.3)<0.001Patient-Reported OutcomesMean [SD] EQ5D-5L Utility score (0=death to 1= full health)0.79 [0.19]0.83 [0.12]0.82 [0.21]0.79 [0.14]0.69 [0.25]0.024Mean [SD] FACIT-Fatigue score (0=worst fatigue to 52= no fatigue)32.7 [12.2]36.8 [8.7]36.1 [12.5]29.1 [9.8]26.4 [14.3]<0.001Mean [SD] WPAI overall (0= no impact to 100= completely impacted)26.8 [21.2]25.2 [15.8]19.5 [23.6]35.7 [20.2]31.9 [26.7]0.131

49% of SLE patients were categorized as SLEDAI 7-12 or >12 (moderate or severe).

Among the SLEDAI 7-12 (moderate) patients, 75.7% were subjectively categorized by their physician as having mild SLE. Of the SLEDAI >12 patients (severe), 73.4% were categorized as having mild SLE.

Joints symptoms and flaring in the last 12 months were not significantly different across SLEDAI groups.

Patients with greater SLEDAI reported lower EQ5D and greater FACIT-Fatigue scores. There was no statistical difference in WPAI between the SLEDAI groups.

Conclusion

A disconnect between point-in-time SLEDAI and physician-perceived severity exists. Patients with SLE, irrespective of SLEDAI, had high prevalence of joint symptoms, but higher SLEDAI impacted quality of life.

References

[1]Gladman D et al., Journal of Rheumatology, 2002.

[2]Fanouriakis A et al., Annals of the rheumatic diseases, 2019.

Disclosure of Interests

Aisha Vadhariya Employee of: Eli Lilly and Company, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jianmin Wu Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kirstin Griffing Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Fiona Bailey: None declared, James Hetherington: None declared, Elke Rottier: None declared, Sophie Barlow: None declared, Karen Costenbader Consultant of: Lilly, Astra Zeneca, Janssen, Amgen, Glaxo Smith Kline, Grant/research support from: Exagen, Gilead, Merck

The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital

Background

In response to the COVID-19 pandemic, a central London tertiary referral hospital’s nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments.

Objective

To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies.

Materials and Methods

A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 – 15th of July 2020 (pandemic) and 5th of March 2019 – 15th of July 2019 (pre- pandemic).

Main outcome measures

Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications.

Results

There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion.

Conclusion

This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates.

What is new

Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

The misuse/abuse of antihistamine antiemetic medication (cyclizine) by cancer patients

Cyclizine is an antihistamine, which is frequently used to manage nausea and vomiting in cancer patients. Antihistamines can be drugs of misuse/abuse, and the article describes four cancer patients who developed such problems after receiving parenteral cyclizine within the inpatient unit of a cancer centre. The article also briefly reviews the literature on the misuse/abuse of cyclizine and other antihistamines.

Perforation of the oesophagus and aorta after eating fish: an unusual cause of chest pain

This report describes perforation of the oesophagus after eating fish complicated by perforation of the aorta six days later. The patient had not knowingly swallowed a fish bone. Aorto-oesophageal fistula is almost universally fatal. In the case described here, the fistula was demonstrated on contrast computed tomography before surgery, thus informing surgical management. The patient is the eighth reported survivor.

Novel and selective 5-HT2C/2B receptor antagonists as potential anxiolytic agents: synthesis, quantitative structure-activity relationships, and molecular modeling of substituted 1-(3-pyridylcarbamoyl)indolines

The synthesis, biological activity, and molecular modeling of a novel series of substituted 1-(3-pyridylcarbamoyl)indolines are reported. These compounds are isosteres of the previously published indole urea 1 (SB-206553) and illustrate the use of aromatic disubstitution as a replacement for fused five-membered rings in the context of 5-HT2C/2B receptor antagonists. By targeting a region of space previously identified as sterically allowed at the 5-HT2C receptor but disallowed at the 5-HT2A receptor, we have identified a number of compounds which are the most potent and selective 5-HT2C/2B receptor antagonists yet reported. 46 (SB-221284) was selected on the basis of its overall biological profile for further evaluation as a novel, potential nonsedating anxiolytic agent. A CoMFA analysis of these compounds produced a model with good predictive value and in addition good qualitative agreement with both our 5-HT2C receptor model and our proposed binding mode for this class of ligands within that model.

Effect of SB 200646A, a 5-HT2C/5-HT2B receptor antagonist, in two conflict models of anxiety

SB 200646A is the first selective 5-HT2C/5-HT2B receptor antagonist and has previously been observed to have anxiolytic-like properties in the rat social interaction test. In the present study the effects of the compound in two conflict models of anxiety, the rat Geller-Seifter and marmoset conflict test, were examined. In the rat Geller-Seifter test, suppressed responding was increased by all doses of SB 200646A between 5 and 40 mg/kg PO when given 1 h pretest. Unsuppressed responding was slightly increased only at 10 mg/kg PO. Suppressed responding was also increased by the benzodiazepine anxiolytic, chlordiazepoxide, at 1, 2.5 and 5 mg/kg PO 1 h pretest. Unsuppressed responding was modestly increased by chlordiazepoxide only at 5 mg/kg PO. In the marmoset conflict test marmosets were trained to lever press for a palatable food reward. Lever pressing was subsequently suppressed by air puffs. In this procedure suppressed responding was increased by both the benzodiazepine anxiolytic diazepam at 2 and 5 mg/kg PO and SB 200646A after 10 and 20 mg/kg PO. Both treatments caused small increases in unsuppressed responding at 2 and 20 mg/kg PO respectively. Taken together with the previous effects of SB 200646A in the rat social interaction test, this is compelling evidence that 5-HT2C/2B receptor antagonists may possess anxiolytic properties.

Validation, role in perioperative assessment, and clinical applications of an immunoradiometric assay for human calcitonin

We have evaluated a new immunoradiometric assay (IRMA) for calcitonin (CT) (Medgenix, Belgium). The detection limit of immunoreactive CT (IR-CT) was 2.8 pg/ml, and plasma levels of IR-CT of 134 healthy adults (dynamic range, 2.8-1000 pg/ml) were < 19 pg/ml (median 4.1 pg/ml). Both basal and pentagastrin-stimulated IR-CT levels were < 30 pg/ml and were well separated from the levels in patients with medullary thyroid carcinoma (MTC) (46-29,000 pg/ml, n = 38). In preoperative plasma samples in five patients with C-cell hyperplasia, CT IRMA confirmed the diagnosis, although in two patients RIA failed to detect a significant increase of IR-CT. By modifying the IRMA, we could identify residual tumor tissues perioperatively in patients undergoing thyroidectomy for MTC. RIA of gel-permeation chromatography showed four IR-CT peaks, but IRMA had only three peaks, suggesting that IRMA is more specific. CT-IRMA is more specific, sensitive, robust, rapid, and reliable than RIA. In addition, neat plasma can be used directly in a single step in CT-IRMA.

Nitric oxide changes in the rat brain after transient middle cerebral artery occlusion

Using a porphyritic microsensor, we measured the cortical NO concentration within ischemic tissue during 2 h of middle cerebral artery (MCA) occlusion and 1 h of reperfusion in the rat (n = 36). Local cerebral blood flow was simultaneously measured by laser Doppler flowmetry to verify MCA occlusion and reperfusion. Baseline concentration of NO was < 10(-8) M. The maximum concentrations of NO during MCA occlusion and reperfusion were, respectively, 1.47 +/- 0.45 microM and 0.54 +/- 0.24 microM. Administration of N-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase, prior to ischemia, significantly (p < 0.05) reduced NO release to 0.04 +/- 0.02 microM during MCA occlusion and completely inhibited NO release during 1 h of reperfusion. Administration of L-arginine 30 min after administration of L-NAME restored NO release (3.45 +/- 1.14 microM) during MCA occlusion; however, administration of L-arginine did not overcome the effect of L-NAME on mean arterial blood pressure. Our data indicate that NO is released in the brain after the onset of ischemia and NO levels can be modulated by administration of NO substrate and NO antagonists.

Retention and use of personal health records: a population-based study

A parent-held record has been issued to all children born in New South Wales (NSW), Australia since 1988. Five years after its introduction, an evaluation was undertaken to determine its retention rate over time, rate of documentation of immunization status and other important child health information, and its perceived usefulness to parents. The cross-sectional study comprised an interviewer administered questionnaire to 622 households derived from a stratified random sample of 25 local government areas, representative of 73% of all households containing children under 5 years of age in NSW. A concurrent postal survey assessed the attitudes and use of the Personal Health Record (PHR) among a stratified random sample of 911 health care providers. Results showed that the PHR was well retained, with 89% claimed retention at 4 years, and over 78% of parents able to produce the record for inspection at interview. Of the records examined, 91% had at least one immunization recorded while 68% had a complete regimen documented by age 4 years. Overall, 93% of parents expressed satisfaction with the PHR, while 64% of all health care providers also felt that the PHR was 'beneficial to the health care children received', although only 53% of these used it regularly to record their findings. It is concluded that the PHR currently issued in NSW is well retained and valued by parents, and used by and useful to a range of health professionals.

Membrane potential of rat adipocytes: effect of phospholipase C, concanavalin A, and adenosine

The change in transmembrane potential of rat adipocytes was measured using the fluorescent probe 3,3'-diethylthiadicarbocyanine iodide, diS-C2-(5). The method was calibrated by altering the potassium ion concentration while keeping the sum of potassium and sodium ions at a constant concentration of 153 mM (Bailey et al: Bioelectrochem. Bioenergetics 21:333-42, 1989). Two insulin-mimetic agents, phospholipase C from Clostridium perfringens and concanavalin A, induced a dose dependent hyperpolarization of rat epididymal adipocytes, like insulin. Removal of endogenous adenosine with adenosine deaminase or adenosine receptor blockade with isobutylmethylxanthine following the initiation of insulin-induced hyperpolarization resulted in depolarization. These same agents induced hyperpolarization of -6 to -8 mV when added without insulin. The replacement of adenosine with its analogue, N6-phenylisopropyladenosine, plus insulin depolarized the cells toward the transmembrane potential established by insulin, -2.0 mV. These studies suggest that adenosine receptor occupancy is required to maintain insulin-induced hyperpolarization.

Nitric oxide measured by a porphyrinic microsensor in rat brain after transient middle cerebral artery occlusion

We measured, in vivo, the local concentration of nitric oxide (NO) in cerebral tissue, during and after transient middle cerebral artery occlusion in the rat (n = 8). Baseline concentration of NO was < 10(-8) M; upon initiation of ischemia, NO concentration increased to approximately 10(-6) M and then declined. Reperfusion likewise stimulated an increase in NO concentration to above baseline level. Administration of N-nitro-L-arginine methyl ester (n = 4), an inhibitor of nitric oxide synthase, before onset of ischemia, maintained NO at basal levels. Our data indicate that large increases in NO occur at onset of ischemia, which may affect tissue response to an ischemic insult.

Receptors mediating tachykinin-induced contractile responses in guinea-pig trachea

1. The classification of tachykinin receptors in the guinea-pig trachea has been investigated. This was of interest because, from previous studies, it was not clear whether the guinea-pig trachea contains either a mixture of NK1 and NK2 receptors or, alternatively, a single type of novel tachykinin receptor. 2. In the present study, the guinea-pig trachea was contracted by tachykinin agonists selective for NK1 receptors (substance P methylester (SPOMe) and GR73632) or NK2 receptors (GR64349) but not NK3 receptors (senktide). 3. Against SPOMe and GR73632, the NK1 antagonist, GR71251, behaved as a reversible competitive antagonist having apparent affinity (pKB 7.05 vs SPOMe) consistent with action at NK1 receptors. GR71251 (3 microM) did not antagonize responses to GR64349. 4. The NK2 antagonists L-659,877 and Ac-Leu-Asp-Gln-Trp-Phe-Gly-NH2 (R396) antagonized GR64349 although only R396 appeared to behave competitively (pKB 5.73). Neither L-659,877 (30 microM) nor R396 (30 microM) blocked responses to SPOMe. 5. For L-659,877 and R396, comparison was made between activity in guinea-pig trachea and in preparations known to contain tachykinin receptors predominantly of the NK2 type. In the rabbit trachea, both L-659,877 and R396 had effects similar to those in guinea-pig trachea. In contrast, in the rat colon muscularis mucosae, both L-659,877 and R396 appeared to behave competitively with pKB values against GR64349 of 7.83 and 6.90 respectively. 6. It is concluded that in guinea-pig trachea, contractile responses can be induced by activation of both NK1 and NK2 receptors. The present data are discussed with reference to the proposed existence of subtypes of the NK2 receptor.

CMHC's and elderly services: an analysis of direct and indirect services and service delivery sites

This study identified significant sources of variability in the utilization of CMHC services by the elderly. Program and staff specialization were examined as they critically influenced the rate of service utilization as well as the types of services made available. Data from a 1984 national survey of CMHC's were analyzed and statistically significant differences were found in overall utilization, types and amounts of direct and indirect services, and number and types of separate service delivery sites. These results suggest that variability in services utilization may be attributable to programmatic differences between CMHC's and may constitute a significant aspect of services designed to address the special needs of the elderly.

Effect of water stress on cotton leaves : I. An electron microscopic stereological study of the palisade cells

Palisade cells from fully expanded leaves from irrigated and nonirrigated, field grown cotton (Gossypium hirsutum L. cv. Paymaster 266) were subjected to a microscopic examination to evaluate the effect of water stress on subcellular structures. The water potential difference between the two treatments was 13 bars at the time of sampling. The dimensions of the palisade cells and their density per unit leaf area were determined by light microscopy. Palisade cells from stressed plants had the same diameter, but were taller than their counterparts in irrigated plants. The density of the palisade cells was the same in both treatments as was the fractional volume of the intercellular space. It was concluded that the reduced leaf area observed in the stressed plants resulted primarily from a mitotic sensitivity to water stress. Further, expansion of palisade cells was not inhibited by the stress imposed in this study.Morphometric analysis of electron micrographs was used to evaluate the subcellular structure of palisade cells from nonstressed and stressed plants. The fractional volumes of cell walls, total cytoplasm, chloroplasts, starch granules, intrachloroplast bodies, mitochondria, peroxisomes, and central vacuoles were determined. The surface densities of grana and stroma lamellae, outer chloroplast membranes, mitochondrial cristae, endoplasmic reticulum and Golgi cisternae were also measured. The number of chloroplasts, mitochondria, and peroxisomes were determined. These data were expressed as actual volumes, areas, and numbers per palisade cell for each treatment. Palisade cells from stressed plants had thinner cell walls, larger central vacuoles and approximately the same amount of cytoplasm compared to cells from nonstressed plants. Within the cytoplasm, stressed plants had more but smaller chloroplasts with increased grana and stroma lamellae surfaces, larger mithchondria with reduced cristae surfaces, smaller peroxisomes and reduced membrane surfaces of endoplasmic reticulum and Golgi cisternae.

Applications of high-performance liquid chromatography in the pharmaceutical industry

A survey of the literature has been carried out, covering pharmaceutical applications of high-performance liquid chromatography (HPLC) from 1972-1975. The abstracts are divided into seven groups, viz. alkaloids, antibiotics, nitrogen-containing compounds, steroids, sulphur-containing compounds, formulations, and general analytical techniques. A general resume of the development of HPLC in our own laboratory from 1969 onwards is given together with fourteen chromatograms covering the spectrum of our more novel activities in pharmaceutical analysis.

Automated chromatographic determination of chlorhexidine in pharmaceutical preparations

An automated method for the determination of chlorhexidine (Hibitane) and its salts in formulated pharmaceutical products is described. The equipment consists of a high efficiency liquid chromatograph, a variable wavelength high sensitivity ultraviolet spectrophotometric detector, the output of which is monitored simultaneously by a suitable recorder, and a digital computer. The sample is automatically introduced onto a 10-cm silica gel column by use of a slide valve. Results are calculated and printed out by the computer.

The quantitative determination of fluocinolone acetonide and acetonide acetate in formulated products by high pressure liquid chromatography

A chromatographic procedure for the determination of fluocinolone acetonide and acetate is described. The method employs high speed liquid chromatography through a Permaphase ODS column with an aqueous methanol eluant phase. The application of the method to the determination of fluocinolone acetonide and acetate in cream, and ointment formulations, is described.

A quantitative chromatographic method for the determination of purity of oxytetracycline

A chromatographic method for the determination of oxytetracycline is described, employing a hexane-ethyl acetate-pH 3·3 buffer partition system supported on Celite. Chromatographic separation is followed by measuring the absorbance of the eluate at 263 nm. The system enables the determination of oxytetracycline to be made in the presence of anhydro-oxytetracycline, chlortetracycline, α- and β-apo-oxytetracycline, and epi-oxytetracycline, the last three being the most likely contaminants of crude material.