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Objective: To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdominal pain (RAP) was more effective than SMC alone., Methods: Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple dimensions of child and parent reported child pain, somatization, and functional disability, and school absences and physician contacts., Results: Children and parents participating in the combined SMC + CBT intervention reported significantly less child and parent reported child abdominal pain than children in the SMC intervention immediately following the intervention and up to 1 year following study entry, as well as significantly fewer school absences. Significant differences in functional disability and somatization were not revealed., Conclusions: These results, in combination with previous studies, add support to the effectiveness of CBT intervention in reducing the sensory aspects of RAP. Results are discussed with respect to the cost-benefit of integrated medical and short-term psychological services.

Trichloroethylene (TCE) has been identified as a widespread groundwater contaminant. Trichloroacetic acid (TCA) and dichloroacetic acid (DCA) are toxicologically relevant metabolites of TCE that produce tumors in B6C3F1 mice. A sensitive method for measuring these metabolites in plasma has been developed to obtain pharmacokinetic data from TCE exposure. This is particularly important because DCA is more potent at producing hepatoproliferative lesions than TCA. At present, it is unclear whether DCA is produced by humans. Existing gas chromatographic methods cannot detect DCA at low nanogram-per-milliliter levels. A Finnigan TSQ 700 mass spectrometer (MS) with electrospray ionization was used to measure TCA, DCA, and monochloroacetic acid (MCA) in plasma. The MS was operated in negative ion tandem MS mode. The limit of detection for TCA and DCA was 4 ng/ml, and the limit of detection for MCA was 25 ng/mL. Plasma samples from human subjects exposed to 100 ppm TCE for 4 h contained TCA at concentrations as high as 10 micrograms/mL. DCA concentrations were less than 5 ng/mL, and MCA was not detected (less than 25 ng/mL).

Trichloroethylene (TCE) has been identified as an environmental contaminant in groundwater. Trichloroacetic acid (TCA), dichloroacetic acid (DCA), chloral hydrate (CH), trichloroethanol (TCOH), and trichloroethanol glucuronide (TCOG) have been identified as metabolites of TCE. Studies have shown that TCA and DCA are toxicologically significant metabolites that can induce liver tumors in B6C3F1 mice. Methods for the analysis of these metabolites are important for conducting pharmacokinetic studies. In this study, TCA and DCA were derivatized to their methyl esters by dimethyl sulfate under acidic conditions and analyzed by gas chromatography with electron capture detection. In developing a method for esterifying TCA and DCA, the conversion of TCA to DCA was observed in freshly drawn blood upon the addition of acid. After blood was drawn from the animals, the amount of TCA converted to DCA by the addition of acid decreased with time. This conversion could be prevented by freezing blood samples overnight prior to the addition of acid. Further experiments demonstrated that this activity could be restored by the addition of dithionite to inactivate blood samples or the addition of dithionite to methemoglobin prior to the addition of acid. The results reported here show that reduced hemoglobin may be involved in the acid-catalyzed conversion of TCA to DCA.