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The article presents a study which examines the circulation of insulin-like growth factors-I (IGF-I) and IGF-binding protein-3 (IGFBP-3) polymorphisms in Caucasian and African American women. It notes the multiple IGF -I and IGFBP-3 single nucleotide polymorphisms (SNP) which have been limited among African American women. It stresses that the plasma IGFBP-3 levels among Caucasians and African Americans is influenced by the common IGFBP-3 SNPs.

Presents letters to the editor on medical topics. Comparison of the selective serotonin reuptake inhibitors paroxetine, fluoxetine, and sertraline in the treatment of depression; Laparoscopic-assisted surgery for colon cancer; Withholding of data among academic geneticists; Others.

Summary Preterm labour (PTL) is a major contributor to preterm delivery (PTD) but delivery is often not preventable by current therapies. We conducted this study to determine the proportion of women with PTL who were and who were not candidates for tocolytic therapy. The cohort comprised residents of Olmsted County, Minnesota who delivered at >20 weeks’ gestation in 1985–94 and who experienced PTL. Medical records were abstracted to identify episodes of PTL, its treatment and outcome. We developed an algorithm that accounted for gestation at delivery and pregnancy complications to determine the proportion of pregnancies complicated by PTL that were candidates for tocolytic therapy. Of 651 pregnancies complicated by PTL, a 50% probability sample, stratified by delivery year, were selected and abstracted. The cumulative incidence of PTL ranged from 3.6 to 6.4 per 100 deliveries of live or stillborn infants. Tocolysis was not contraindicated for 49.4% of all women with PTL and for a third of women with only one PTL episode. Delivery was delayed to >35 weeks in 53.8% of candidates for tocolysis. Only an additional 11.7% of women with one or more PTL episodes could have had their PTD delayed beyond 35 weeks if a perfect tocolytic therapy had been available. Many pregnancies complicated by PTL occurred at ≥35 weeks or involved maternal or obstetric factors that contraindicated tocolytic medications. The maximum incremental benefit that could be expected of a new safe and efficacious tocolytic therapy would be to reduce current PTD rates resulting from PTL by about 12%. [ABSTRACT FROM AUTHOR]

Gallbladder epithelium is unique among the gastrointestinal cell types because proteins and protein levels in the fluid bathing the luminal side of the cells (bile) are different from and can be compared with those in the fluid bathing the basal side (serum). To help identify cellular changes that occur during the development of gallbladder cancer, we obtained gallbladder tissue, serum, and bile specimens from 20 patients with invasive adenocarcinoma of the gallbladder, three with high-grade dysplasia (carcinoma in situ), six with low-grade dysplasia, 12 with hyperplasia, and 10 with acute or chronic cholecystitis. We obtained serum samples from 40 patients with invasive adenocarcinoma and bile samples from 29 of these patients; serum samples from three with high-grade dysplasia and bile specimens from two of these; serum and bile samples from five with low-grade dysplasia; serum or bile samples from 126 with metaplasia, hyperplasia, or cholecystitis, including serum samples from 121 and bile samples from 110; and serum and bile samples from eight with normal biliary tracts. The study was conducted in Mexico City, Mexico, and La Paz, Bolivia. We performed flow cytometric DNA analysis on gallbladder tissue specimens and measured levels of carcinoembryonic antigen (CEA) and CA 19-9 antigen in the serum and bile specimens. Analysis of the cell cycle compartments by flow cytometry revealed marked variations of the proliferation index for the different disease states (<.0001). The proliferation index increased with progression from cholecystitis to invasive adenocarcinoma. Of the bile and serum measurements, only serum CA 19-9 values were correlated with flow cytometry measurements ( = −.49, = .005). Overall, the serum and bile measurements were in agreement ( < .01). However, with the exception of the correlations among serum measurements for the patients with invasive adenocarcinoma, most of the correlations could be explained by differences in the disease state. In particular, the progression from normal tissue to invasive adenocarcinoma involved no change in bile CA 19-9 level and only a slight change in bile CEA level but much larger changes in serum CEA and CA 19-9 levels. It appears that the progression from normal tissue to invasive adenocarcinoma results in increased production of these antigens and often in loss of cell polarity as well, i.e., inability to prevent leakage of the antigens into the serum. [J Natl Cancer Inst 81:1575–1580, 1989] [ABSTRACT FROM PUBLISHER]

Objective: Postpartum depression occurs in 13% of women after delivery making it one of the most common puerperial complications. The purpose of the study was to examine: (1) the extent to which obstetricians/gynecologists and family physicians report discussing depression and other psychosocial issues during postpartum visits and (2) how physician specialty and gender are related to whether physicians report discussing depression and other psychosocial issues with patients during postpartum visits., Methods: A survey was sent to a random sample of 600 obstetricians/gynecologists and 600 family practitioners in North Carolina., Principal Findings: The overall response rate was 42%. Forty-six percent of the responding physicians (N=228) reported that they had seen women for postpartum visits during the past 3 months. Of physicians conducting postpartum visits within this time period, 43% of physicians were almost certain to ask whether the woman felt down, depressed, or hopeless and 27% were almost certain to ask about the woman's interest in her usual activities. Seventy-nine percent of physicians stated that they were unlikely to use a formal screen for depression. Obstetricians/gynecologists were less likely to ask about a womans social support network (OR=0.33, 95% CI=0.14, 0.75), to ask about her relationship with her partner (OR=0.40, 95% CI=0. 18, 0.87), and to use a formal depression screen (OR= 0. 16, 95% CI=0.04, 0.57) than family practitioners., Limitations: The study only examined physician self-report of the extent to which they communicated about different issues with women during postpartum visits., Conclusions: Communication about depression and related psychosocial issues during postpartum visits is substantially limited, likely contributing to the underdiagnosis of this common disorder.