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Este artigo analisa fontes produzidas nos séculos XVII e XVIII por autoridades na América portuguesa que enviaram suas dúvidas ao Conselho Ultramarino e à Coroa portuguesa sobre diferentes aspectos relacionados à administração. Tais incertezas expressam dimensões relevantes da comunicação política entre as duas partes e, afinal, uma dimensão negociada destas. As práticas administrativas correntes e o recurso à dúvida armavam os agentes régios com um conjunto de dispositivos argumentativos que ampliavam o seu poder de interlocução. A partir da análise de casos pontuais, observa-se as distintas motivações dos oficiais que estavam por detrás desta comunicação como o receio de errar e a intenção deliberada de resistir às ordens. Este artículo analiza las fuentes elaboradas por las autoridades de la América portuguesa de los siglos XVII y XVIII, una documentación donde remitían sus dudas al Consejo Ultramarino y a la Corona portuguesa acerca de diferentes aspectos relacionadas con la administración. Esas incertidumbres expresan facetas relevantes de la comunicación política entre las dos partes y, al final, una dimensión negociada de estas. Las prácticas administrativas corrientes y el recurso a la duda dotaron a los agentes regios con un conjunto de dispositivos argumentativos que ampliaban su poder de interlocución. A partir del análisis de casos puntuales, se pueden observar las distintas motivaciones de los oficiales que estaban detrás de esta comunicación, como podía ser el temor a equivocarse y la intención deliberada de resistir las órdenes. Así como también es probable que el margen para la expresión de las dudas se haya restringido en la misma proporción en que crecieron las formas más ejecutivas de comunicación y de decisión en el funcionamiento. This article analyses the sources produced in the seventeenth and eighteenth centuries by authorities in Portuguese America who have sent their doubts to the Overseas Council and to the Portuguese Crown on different aspects / issues related to the administration. Such uncertainties convey significant dimensions of political communication between the two segments and, after all, a component of negotiation between them. Existing administrative practices and the use of doubt vested the royal agents with argumentative tools that broadened their power of interlocution. From the analysis of a number of cases, we can observe the different motivations of the officers who were behind this communication such as fear of making mistakes and the deliberate intention of resisting orders.

Background The study was conducted to determine whether increased desire for fertility coupled with increased awareness of reduction in mother-to-child HIV transmission (MTCT) with increased availability and use of highly active antiretroviral therapy (HAART) has been associated with reduction in use of tubal sterilization as a form of contraception among women infected with HIV. Study Design One hundred HIV+ women, 18 to 45 years of age, receiving care at university-affiliated HIV facilities between October 2008 and February 2009, were surveyed about their contraceptive knowledge and practices. We performed descriptive analysis of population characteristics to determine contraception choices and fertility desires following initiation of HAART. Results The study group was composed of women with median age of 35 years, 55% African American, 18% Caucasians, 19% Hispanic and 8% “other”. Most (63%) were single; 36% were married. Contraception choices were condom 61%, injectable contraceptive 7%, pills 6% and only 3% said they used female sterilization. Thirty-four percent of respondents said that their choice of contraception was based primarily on ease of use, 19% said that their choice was primarily based on convenience and only 9% said that their choice was primarily based on provider recommendation. Desire for future childbearing increased to 19% following knowledge that MTCT can be reduced by taking antiretroviral therapy (ARV) and to 22% following initiation of ARV. Conclusions Initiation of ARV and awareness that maternal treatment can reduce MTCT may explain lower use of female sterilization as a form of contraception among a cohort of HIV+ women in the post HAART era.

To shed light on factors that may help explain inaccurate medical error reporting and do not receive much attention: ob-gyns' comfort with reporting medical errors and personal experience with being injured while receiving medical care.Questionnaires were sent to a total of 600 members of the American College of Obstetricians and Gynecologists between September and December 2006. The questionnaire included demographics and three questions about practice patterns and opinions about patient safety: (1) How comfortable are you reporting medical errors? (2) Have you or a friend/family member ever been injured while receiving medical care? (3) How frequently do you witness medical errors?A 53.2% response rate was obtained. Only 56.3% of ob-gyns "felt free" to frequently report medical errors, with no differences by sex or age. One in 5 (20.8%) reported that they or a family member had been injured by a medical error. Ob-gyns who reported that they or a friend or family member had been injured during medical care more frequently reported witnessing medical errors.Our results show that many physicians do not feel free to report errors. Research on the decision making of physicians (e.g., person-who effect, regret avoidance, and the availability heuristic) may provide useful insights to problems with medical error reports.

Background To elucidate the patient safety practices of obstetrician-gynecologists (OB/GYNs), the perceived barriers to patient safety improvements in obstetrics and gynecology, and OB/GYN's beliefs about mandated reporting. Methods A sample of 600 OB/GYNs was sent a survey from the American College of Obstetricians and Gynecologists about their beliefs and practice regarding patient safety. Results The response rate was 53.2%. More than 92% of respondents said that patient safety is important in women's health care. The most important barriers to improving patient safety were cost of new technologies and concern about liability. Half agreed that mandatory reporting would improve patient safety. Physicians who practice in states with mandated error reporting were no more or less likely to think that these mandates improve patient safety than physicians who do not work in states with mandates. Physicians who practice in states with “I'm Sorry” laws more strongly disagreed that mandates improve patient safety than physicians who do not work in states with “I'm Sorry” laws. Discussion and Conclusions It may be effective to aim at making patient safety activities more affordable to increase implementation. In addition, the effects of reporting and disclosure laws on physicians' concerns with liability should be examined more closely.

There are great opportunities to enhance patient safety in office practice, but the pattern of medical errors and techniques to reduce their frequency appears to differ from the hospital environment. A focus on decreasing the risks of prescribing errors and tracking errors may be particularly fruitful in the office setting, such as electronic prescribing, electronic medical records, the use of detailed patient instructions, unambiguous prescribing, and meticulous follow-up of test results. The surgical environment presents its own unique set of risks to patient safety, particularly because of the catastrophic consequences that may result from even infrequent events. Vigilance against stress and fatigue is particularly important. Patient safety in surgery is promoted by routine use of the "universal protocol," antibiotic prophylaxis, thromboprophylaxis, open communication among all members of the surgical team, and clear guidelines for introducing new procedures and technology.

Zusammenfassung Gegenstand: Feldstudie zum Fieber unbekannter Genese beim Pferd. Ziel: Die routinemäßigen Laborparameter wurden hinsichtlich ihrer Wertigkeit für eine ätiologische Diagnose analysiert. Das diagnostische Profil wurde durch die Parameter CRP und Neopterin sowie durch antiendotoxische Antikörper erweitert. Grundlage der Studie war die Hypothese, dass Endotoxine mit ihrem fieberauslösenden Potenzial eine ätiologische Bedeutung haben könnten. Material und Methoden: Über einen Zeitraum von drei Jahren wurden 383 Fieberfälle untersucht und entsprechend der klinischen Symptomatik in vier verschiedene Fiebertypen eingeteilt. Die Voraussetzung für die Einordnung in die Gruppe 1 (Fieber unbekannter Genese) war der Ausschluss einer anderen Fieberursache bei der Erst- und den Nachuntersuchungen. Die Blutprobe wurde am ersten Untersuchungstag entnommen. Die Bestimmungen von CRP und Neopterin sowie der antiendotoxischen Antikörper erfolgten jeweils mit einem ELISA. In die Auswertung dieser Messergebnisse wurde deren Korrelation zu weiteren klinisch-chemischen Parametern einbezogen. Ergebnisse: Bei 195 (50,9%) Patienten wurde Fieber unbekannter Genese registriert. Während der mittlere CRP-Wert (8,08 g/l) im Normbereich lag, war die Neopterinkonzentration (7,29 mmol/l) erhöht. Die Mittelwerte für die antiendotoxischen Antikörpertiter der Immunglobulinklasse M waren pathologisch erhöht (Anti-Lipid-A-IgM 1,18 OD, Anti-Endotoxin-IgM 1,5 OD). Klinische Relevanz: Das pyrogene Potenzial der Endotoxine ist bei Fällen von Fieber unbekannter Genese in die ätiologischen Betrachtungen mit einzubeziehen. Nach Ausschluss anderer Fieberursachen ist eine diesbezügliche Erweiterung des labordiagnostischen Profils sinnvoll. Neopterin und CRP stellen unspezifische Effektparameter dar, die im Zusammenhang mit weiteren Befunden auch beim Pferd für die Beurteilung des Gesundheitszustandes wertvoll sein können.

Variation in attitudes and preferences among communities has been cited as a primary consideration for the development of grizzly bear management plans in North America. We undertook a study in 2004 to determine if there were differences among two rural populations and an urban population on the issue of grizzly bear management in Alberta, Canada. Results from a mail survey showed that there was a greater diversity of views and potential for conflict between the two rural groups than between the rural groups and the urban group. We used a cognitive hierarchy of knowledge, attitudes, and normative beliefs as a theoretical foundation and analyzed the effects of social influences (including residency) and demographics. A structural equation analysis showed that being an off-road vehicle user had a greater influence on acceptance of access restrictions than residency or cognitive and demographic factors.

Voluntary Review of Quality of Care (VRQC) is a confidential, voluntary, consultative peer review service offered to healthcare institutions by the American College of Obstetricians and Gynecologists (ACOG). Institutions may request ACOG's VRQC team of practicing, Board-certified obstetricians and gynecologists to visit the institution in order to evaluate the degree to which practice patterns are consistent with published guidelines, and to suggest possible avenues for improvement. Since the VRQC program began in 1986, over 230 site visits have been conducted using a clinically-oriented and evidence-based approach to examine the quality of patient care delivered. In the 20-year experience of VRQC, deficiencies in system function were more commonly cited than individual practitioner problems, confirming the observations of other patient safety projects. Issues identified in the VRQC reviews can serve as needs assessment for designing Continuing Medical Education activities. Services such as VRQC provided by national medical specialty organizations may assist institutions to implement practice guidelines, performance standards, quality improvement and patient safety initiatives.

Zusammenfassung Gegenstand: Das Krankheitsbild der kongenitalen Zwerchfellhernie (CDH) ist aufgrund der damit häufig assoziierten Lungenhypoplasie mit einer Letalität von > 50% oder einer Langzeitmorbidität behaftet. Hieraus ergibt sich als einzige rationale Alternative zum Schwangerschaftsabbruch, bereits in utero durch minimal invasive fetalchirurgische Maßnahmen ein therapeutisches Vorgehen einzuleiten. Durch Okklusion der Trachea mithilfe eines Ballonkatheters erfolgt eine Retention des Trachealsekretes mit konsekutiver Ausdehnung des Lungengewebes, sodass hernierte Organe zurückgedrängt werden können und die Lungenentwicklung unbeeinträchtigt bleibt. Ziel: Die Untersuchung diente dazu, ein röntgenologisches Verfahren zu etablieren, mit dem nach der trachealen Okklusion beim ungeborenen Lamm der Therapieerfolg kontrolliert werden kann. Material und Methoden: Am etablierten Schafmodell für fetalchirurgische Operationen wurde am 105. Gestationstag bei Merinoschafen (Tragzeit 150 Tage) ein Brillant-Ballonkatheter aus dem Bereich der Neonatologie endoskopisch eingesetzt, der mit 1 ml Solutrast®-Kontrastmittel geblockt wurde. Am ersten postoperativen Tag erfolgte die Röntgenuntersuchung am stehenden Tier. Nach der Ermittlung des optimalen Verfahrens wurde mit konventioneller Röntgentechnologie durch Verlaufsuntersuchungen der Sitz des Katheters beim prämaturen Lamm kontrolliert. Ergebnis: Der minimal invasiv platzierte Katheter zeigte keine Deviation. Schlussfolgerung: Die Technik der trachealen Okklusion bei fetaler CDH kann interdisziplinär suffizient durchgeführt werden, wobei radiologische Untersuchungen des ungeborenen Schaffeten eine zusätzliche Möglichkeit bieten, den Therapieerfolg zu kontrollieren.

Since the 1990s, the mountain pine beetle (MPB) population has exploded in western Canada. In national parks, MPB has the potential to impact visual quality and safety of visitors, and to spread beyond park boundaries to the industrial forest landbase. Control measures have been initiated in some parks to lessen these impacts. A study was undertaken to examine public attitudes, knowledge, issue salience, and management preferences for MPB in Banff and Kootenay national parks. Data were collected by mail survey in 2003 from 1385 residents living in or near the parks. MPB was an important issue for the majority of respondents and they had low knowledge of MPB, expressed negative attitudes towards it, and supported measures to control it. Preferred control measures included those directed at the current infestation. Proactive approaches in uninfested forests were generally not supported. Issue salience and knowledge were the best predictors of attitudes toward the MPB. Attitudes were the best predictors of support for no intervention in beetle infestations in national parks. Management implications include the lack of knowledge and support for natural disturbance and ecological integrity policies in national parks.

Zusammenfassung: Gegenstand: Erkrankung an der Schweifrübe des Pferdes. Material und Methoden: Bei einem adulten Pferd entwickelte sich eine Umfangsvermehrung und eine Fistel an der Schweifrübe. Die klinischen und röntgenologischen Untersuchungen führten zu der Diagnose Discospondylitis vertebrae coccygealis. Das Pferd wurde über 28 Tage einmal täglich per os antibiotisch mit 2,5 mg/kg KM Enrofloxacin (Baytril®, BayerVital GmbH, Leverkusen) behandelt. Der Therapieeffekt wurde durch Verlaufsuntersuchungen über einen Zeitraum von vier Monaten kontrolliert. Ergebnisse: Durch die konservative Behandlung konnte die Diskospondylitis zur Abheilung gebracht werden. Schlussfolgerungen: Die bei erwachsenen Pferden selten auftretende Diskospondylitis lässt sich konservativ behandeln. Bei ungünstigem Heilungsverlauf istdie Anwendung der alternativ diskutierten chirurgischen Therapie in der Behandlungskaskade sinnvoll. Klinische Relevanz: Die bisher nicht beschriebene Diskospondylitis an der Schwanzwirbelsäule beim adulten Pferd istbei Umfangsvermehrungen der Schweifrübe differenzialdiagnostisch zu berücksichtigen.

Our objective was to survey, evaluate, improve and credential the basic medical computer skills of all residents in our obstetrics and gynecology program. All of our residents were surveyed for their individual prior experience and attitude toward using computers. We then tested each resident individually using a clinical simulation, similar to the approach we have used for teaching and evaluating clinical skills. In this computer-based exercise, each resident is presented a clinical scenario outlining a virtual patient and then asked to accomplish, under direct observation, a predefined series of activities. We documented a wide range of prior training and experience among our residents. Although all reported a comfort level of “average” or “expert”, only 18% (2/11) were able to demonstrate competence in all areas tested; these residents were immediately credentialed without further instruction. The remaining 82% (9/11) demonstrated both some minor deficiencies that the examiner was able to rectify with minimal instruction, as well as significant difficulties using the slide preparation program that required formal classes to correct. Of the residents needing additional training in slide preparation, 67% (6/9) had had prior experience with that same software but nevertheless were unable to demonstrate correct use. After completing additional training, all of our residents were able to demonstrate acceptable competence in all areas of medical computer use that we tested, and they also were credentialed. Our conclusions were as follows: 1) Ob/Gyn residents initially may have varying levels of computer experience; their competence cannot be assumed simply based on prior education. 2) Basic medical computer skills of residents can be objectively evaluated using a testing system analogous to that applied to clinical skills. 3) Properly designed testing can identify specific areas of deficiency that can be efficiently addressed by individualized tutoring and/or group classes. 4) Such a system allows credentialing of residents for medical computer use.

Infection with methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide problem and is no longer acquired only in a hospital setting. Community-associated MRSA is an emerging pathogen of increasing interest to both obstetricians and neonatologists, reported in all three trimesters of pregnancy and postpartum, and in neonatal intensive care units, leading to severe outcomes, including neonatal death. This case report describes a serious and potentially life-threatening infection (including wound abscess, septicemia, septic thrombophlebitis, and septic pulmonary emboli) that developed in an otherwise healthy postpartum woman who had screened positive for MRSA in nares, vagina, and rectum at the time of her prior admission in labor as part of a research study. We conclude that asymptomatic nasal, vaginal, and rectal colonization with MRSA occurs in pregnancy and may be a risk factor for serious systemic infection after delivery.

Various signal motifs that are required for efficient pre-mRNA 3'-end formation in the yeast Saccharomyces cerevisiae have been reported. None of these known signal sequences appears to be of the same general importance as is the mammalian AAUAAA motif. To establish the importance of yeast pre-mRNA termini in 3'-end formation, the ends of a pre-mRNA transcript synthesized in vitro were ligated before incubation in a yeast whole-cell extract. Such covalently closed circular RNAs were not cleaved at their poly(A) sites. Interestingly, pseudocircular RNAs with complementary 3'- and 5'-terminal sequences allowing the formation of panhandle structures were also resistant to cleavage. However, 3'-end processing was impeded neither by terminal hairpins at either or at both ends nor by RNA oligonucleotides complementary to either or both ends of a linear pre-mRNA. Intriguingly mammalian pseudocircular pre-mRNAs also were not cleaved at their poly(A) sites when incubated in a HeLa cell nuclear extract. These results provide evidence for the general importance of RNA topology in the formation of an active 3'-end processing complex in S. cerevisiae and higher eukaryotes. The possibility of a torus-shaped factor involved in 3'-end formation is discussed.

Complementation of a temperature sensitive mutant of the yeast Saccharomyces cerevisiae resulted in the isolation of PTF1 (processing/termination factor 1), an essential gene encoding a putative 3′-end processing or transcription termination factor of pre-mRNAs. Ptf1p shows significant homology to a newly discovered family of PPIases. This family is characterized by its insensitivity to immunosuppressive drugs and the lack of homology with cyclophilins and FK-506 binding proteins [Rahfeld et al. (1994) FEBS Lett. 352, 180–184]. Should Ptf1p display PPIase activity, it would be the first characterized, eukaryotic member of this putative family, which is essential for growth.

This study was conducted to test the hypothesis that normotensive, normoalbuminuric IDDM patients with glomerular hyperfiltration may present functional or structural cardiac abnormalities. Eleven normoalbuminuric and normotensive IDDM patients with normal glomerular filtration rate and 11 patients with hyperfiltration were compared with a group of 17 age and sex matched controls. Glomerular filtration rate was measured by the 51Cr-EDTA technique and hyperfiltration was defined as a glomerular filtration rate higher than 134 ml/min/1.73 m2. Phonocardiogram, M-mode and pulsed Doppler two-dimensional echocardiograms were performed to evaluate resting left ventricular dimensions, systolic and diastolic function. Left ventricular dimensions, fractional shortening, mean velocity of fiber shortening, early and late diastolic peak filling velocity, deceleration time, mitral flow velocity integral, and isovolumic relaxation time were similar (ANOVA P > 0.05) in normal controls, diabetic patients with normal glomerular filtration rate, and diabetic patients with hyperfiltration. In conclusion, the results of our controlled observations indicate that normoalbuminuric and normotensive IDDM patients who have normal glomerular filtration rate or hyperfiltration have no Doppler-echocardiographic evidence of functional and structural abnormalities.

Various signal motifs have been reported to be essential for proper mRNA 3'-end formation in the yeast Saccharomyces cerevisiae. However, none of these motifs has been shown to be sufficient to direct 3'-end processing and/or transcription termination. Therefore, several structural motifs have to act in concert for efficient 3'-end formation. In the region upstream of the three polyadenylation sites of the yeast gene for alcohol dehydrogenase I (ADH1), we have identified a hitherto unknown signal sequence contained within the octamer AAAAAAAA. This motif, located 11 nucleotides upstream of the first ADH1 polyadenylation site, is responsible for the utilization of this site in vitro and in vivo, since mutational alteration drastically reduced 3'-end formation at this position. Insertion of 38 ADH1-derived nucleotides encompassing the (A)8 motif into the 3'-end formation-deficient cyc1-512 deletion mutant restored full processing capacity in vitro. Insertion of the octamer alone did not restore 3'-end formation, although mutation of the (A)8 motif in the functional construct had abolished 3'-end processing activity almost completely. This demonstrates that the sequence AAAAAAAA is a necessary, although not sufficient, signal for efficient mRNA 3'-end formation in S. cerevisiae.

The rate of improvement in patient safety is slow. The goal of this review is to address the results of a survey of Ob-Gyn physicians regarding important patient safety issues. A sample of 600 obstetricians and gynecologists were sent a survey asking them about their beliefs, activities, problems, and source of information regarding patient safety with a response rate of 53.2%. Results about beliefs and patient safety activities have been reported [Stumpf et al., 2009]. Misdiagnosis (95.6%), failure to follow-up with patients (94.9%), and administration of the wrong medication or dosage of a medication (90.5%) were the most often reported patient safety problems. Obstetricians and gynecologists most often use printed materials, CMEs, journals, and practice guidelines for information regarding patient safety. Ob-Gyns prefer to learn new patient safety information using printed materials and post graduate classes rather than materials on compact disk or online webcasts. A majority of respondents recognize patient safety as an important issue. Education about the importance of patient safety may be a less pertinent topic when compared to the need for education about implementing specific tools for patient safety and moving from awareness to action.

Summary Surgically removed testicular tissue in cryptorchid stallions is sometimes difficult to identify because of morphological and histological malformation. Therefore, a sure method to characterise the removed tissue is required. A 2-year-old Haflinger stallion was castrated after diagnosis of cryptorchidism to remove the left intra-abdomnial testis. Intra-operative exploration of the abdominal cavity revealed a firm, dysmorphic structure, which could not be identified as testis based on macroscopic anatomy. The removed tissue was Bouin-fixed and paraffin-embedded for histological examination. We additionally applied immuno-histochemistry for smooth muscle actin to identify tubular structures as well as reverse transcriptase polymerase chain reaction (RT-PCR) to detect the expression of steroidogenic acute regulatory protein (StAR), indicating the presence of Leydig cells. A hCG test was conducted after surgery to screen for remaining testicular tissue. Histological examination using haematoxylin and eosin staining revealed signs of tissue calcification, amorph matrix with scattered cells and round structures. The latter could not be definitely identified as tubules. Actin staining revealed a few tubular wall structures. StAR mRNA expression indicated the presence of Leydig cells in parts of the removed tissue. The hCG test after castration showed no increase in testosterone. Histological and molecular biological examination of extirpated tissue in cryptorchid stallions can play an important role in the identification of the malformed testes like structures. The use of molecular biological techniques provides the opportunity to characterise surgically removed abdominal tissue that cannot be clearly diagnosed by routine histological examination.

To elucidate the patient safety practices of obstetrician-gynecologists (OB/GYNs), the perceived barriers to patient safety improvements in obstetrics and gynecology, and OB/GYN's beliefs about mandated reporting.A sample of 600 OB/GYNs was sent a survey from the American College of Obstetricians and Gynecologists about their beliefs and practice regarding patient safety.The response rate was 53.2%. More than 92% of respondents said that patient safety is important in women's health care. The most important barriers to improving patient safety were cost of new technologies and concern about liability. Half agreed that mandatory reporting would improve patient safety. Physicians who practice in states with mandated error reporting were no more or less likely to think that these mandates improve patient safety than physicians who do not work in states with mandates. Physicians who practice in states with "I'm Sorry" laws more strongly disagreed that mandates improve patient safety than physicians who do not work in states with "I'm Sorry" laws.It may be effective to aim at making patient safety activities more affordable to increase implementation. In addition, the effects of reporting and disclosure laws on physicians' concerns with liability should be examined more closely.

Endothelin-converting enzyme 1 (ECE-1) is a membrane-bound metalloprotease that catalyses the conversion of inactive big endothelins into active endothelins. Two different isoforms (ECE-1a and ECE-1b) have previously been identified for human ECE-1. In the present study we have cloned a novel human ECE-1 isoform, termed ECE-1c, and have thus shown for the first time the existence of three distinct ECE-1 isoforms. The three isoforms differ only in their N-terminal regions and are derived from a single gene through the use of alternative promoters. Ribonuclease protection experiments revealed that, although the relative levels of the three isoform mRNA species vary between human tissues, ECE-1c mRNA is generally the predominant isoform messenger. Immunofluorescence microscopy analysis showed distinct subcellular localizations for the three isoforms: whereas ECE-1a and ECE-1c are localized at the cell surface, ECE-1b was found to be intracellular and showed significant co-localization with a marker protein for the trans-Golgi network. We determined that the three isoforms have similar kinetic rate constants (Km, kcat and Vmax) for the processing of big endothelin 1 and that the big endothelin isoforms 1, 2 and 3 are cleaved with similar relative velocities of 1.0:0.1:0.1 by the three isoenzymes.

Because menopause and its consequences constitute an endocrinopathy, long-term administration of HRT is often necessary to achieve optimal results. Compliance is therefore an important consideration in the clinical use of HRT. A number of factors appear to influence physicians in their prescribing of HRT, including estimates of benefits and risks that may not be supported by scientific data. In addition, some physicians appear to use patterns of administration of HRT that may diminish the chance of appropriate patient compliance, or of maximizing benefits while minimizing risks. Patients may elect to avoid HRT or stop HRT prematurely because of incorrect impressions about the benefits and risks, or because of bothersome side effects. Although the side effects are more prevent some appropriate candidates from using HRT. Fortunately, a range of possible options is available for prescribing HRT, and modifications may be used for patients who are experiencing problems. In order for patients to receive maximum benefit from HRT, clinicians must be willing to educate and reassure patients, and to adjust therapy when problems occur.

A variety of metabolic and renal disturbances have been described in patients with Acquired Immunodeficiency Syndrome (AIDS) but their influence on the clinical outcome has not been reported. The present study was undertaken in order to evaluate the prevalence of fluid and electrolyte, acid-base, and renal function disturbances in AIDS patients. The influence of these abnormalities on the clinical outcome was studied as well.Following to a previously established protocol, the charts of all patients hospitalized during the first semester of 1989 were reviewed.The prevalence of hyponatremia was 45% and 80.7% at admission and during hospitalization respectively of 99 patients. Hypokalemia was present in 23.1% of the patients. Metabolic acidosis and renal failure were 20.1% and 28.4% prevalent. The relative risk for mortality in patients with hypokalemia was 4.4. Metabolic acidosis and acute renal failure had relative risks of 12.9 and 21.4.There is an elevated prevalence of fluid and electrolyte, acid-base and renal function disturbances in these patients. The presence of hypokalemia, metabolic acidosis, and renal failure are significantly associated with mortality in AIDS.

The authors report their experience with digital lumicescence radiography (Digiscan, Siemens) gained in 35’000 examinations over a 12 month period. The examinations were performed in a daily routine setting and consisted of 48% skeletal and 34,5% chest examinations as well as 17,5% other procedures including mammography. As a result digital radiography, using a 2’000 x 2’000 matrix and a grayscale range of 10 bits provides equal perceptibility of small details and offers a superior contrast display as compared to conventional film-screen techniques. Moreover, it allows to work without retakes.

Estradiol stimulates hyperprolactinemia in human beings and in experimental animals by mechanism(s) that remain largely undefined. We have tested the hypothesis that estrogen modulates episodic and rhythmic prolactin release. To this end we studied six postmenopausal women by repetitive venous sampling basally and on days 1, 5, 10, and 30 after intravaginal placement of an estradiol-impregnated polymeric silicone (Silastic) ring. Computerized analysis of episodic prolactin pulsatility revealed that estrogen amplified prolactin pulse amplitude threefold without changing prolactin pulse frequency. Fourier analysis disclosed heightened amplitudes of specific ultradian rhythms, and deconvolution analysis demonstrated a sevenfold increase in the mass of prolactin secreted per pulse with no change in its half-life. We conclude that estradiol selectively augments the amplitude of episodic prolactin pulsatility, amplifies ultradian rhythms, and increases the mass of prolactin released per secretory burst.

The adsorption of carbon dioxide and the coadsorption of carbon dioxide and water on CaY- and NiY-zeolite have been studied by means of in situ infrared spectroscopy. The spectroscopic studies have been carried out systematically between 323 and 623°K in 50° steps. Physically adsorbed carbon dioxide behaves almost identically on CaY- and NiY-zeolites with absorption bands around 2360 and 2340 cm−1. However, differences are observed in the chemical adsorption. On CaY-zeolite at 373°K the monodentate carbonate species is formed with a doublet band at 1476 and 1457 cm−1. The chemisorption of carbon dioxide on NiY-zeolite produces three surface species: at 373 K the free carbonate ion (CO32−) correlated to an absorption band at 1441 cm−1, between 357 and 403°K the monodentate carbonate appears intermediary and when the temperature of 403°K is reached the bidentate carbonate with absorption bands at 1560 and 1355 cm−1 is observed. In the presence of water, the physical adsorption of carbon dioxide on CaY- and NiY-zeolite is scanty, because water is preferably adsorbed onto these surfaces. The chemisorption is influenced on CaY-zeolite by water, shifting the temperature of formation of the monodentate carbonate to 453°K. On NiY-zeolite the bidentate carbonate species is observed as in the absence of water. However, the temperature of formation for the free carbonate (CO32−) is also shifted to 453°K and the intermediary monodentate is even missed.

Pronounced eddies along the western edge of the Gulf Stream were again observed by the Very High Resolution Radiometer aboard the NOAA-2 satellite. A rare sequence of infrared images obtained over a period of seven days shows for the first time the complete evolution of meanders through the eddy stage.

17 β -estradiol (E 2 )- and/or crystalline progesterone (P)-impregnated polysiloxane vaginal rings and cylinders were tested as a system for endometrial priming in functionally agonadal women awaiting donor embryo transfer. Endometrial tissue was obtained by a transcervical biopsy procedure on simulated cycle day 26. The adequacy of the replacement regimen was judged by endometrial histologic dating, scanning electron micrographs, receptor content, and circulating E 2 and P serum concentrations. Endometrial dating was consistent with cycle day 26. Electron micrographs showed normal surface characteristics. E 2 and P receptor concentrations were within the normal range. Serum E 2 levels were midfollicular, 105 ± 12.8 pg/ml (mean ± SEM), and midcycle, 254 ± 28.6 pg/ml. P levels during the simulated follicular phase were undetectable ( 2 and P within the normal range for the entire menstrual cycle, and a convenient and physiologic therapeutic alternative to oral, vaginal, or intramuscular steroid replacement.

Family planning agencies are attempting to increase their efficiency and cost-effectiveness in delivering services, as federal funding is diminishing. We have examined the effects of establishing guidelines in a family planning agency, outlining the types of OCs to be routinely prescribed. We found that substantial savings in purchase costs were achieved, in addition to simplified inventory and distribution. These savings were accomplished with no perceptible change in patients' satisfaction. The equivalence of modern OCs in safety and effectiveness allows the creation of guidelines which are medically sound.Family planning agencies are attempting to increase their efficiency and cost effectiveness in delivering services as federal funding is diminishing. The authors examined the effects of establishing guidelines in a family planning agency, outlining the types of oral contraceptives (OCs) which can be routinely prescribed. They found that substantial savings in purchase costs were achieved, in addition to simplified inventory and distribution. These savings were accomplished with no perceptible change in patients' satisfaction. The equivalence of modern OCs in safety and effectiveness allows the creation of guidelines which are medically sound.

We examined the kinetically distinct characteristics of estradiol's effects upon pituitary luteinizing hormone (LH) and follicle-stimulating hormone (FSH) release in response to pulses of exogenous gonadotropin-releasing hormone (GnRH) in healthy postmenopausal individuals. The putative self-priming actions of GnRH on LH and FSH release were tested by intravenous injections of equal paired doses of GnRH (10 micrograms) before and after 1, 5, 10, and 30 d of pure estradiol-17 beta delivery via an intravaginal silastic ring. Self-priming actions of GnRH, as defined by heightened gonadotropin release in response to the second pulse of GnRH compared with the first, were completely absent in the hypoestrogenemic state. However, estradiol administration unmasked GnRH self-priming in a time-dependent fashion, with maximal expression after 5 and 10 d of steroid replacement, followed by attenuation by 30 d. Since estradiol's modulation of GnRH action was expressed differentially on LH and FSH release, we suggest that such facilitation of GnRH-stimulated pituitary LH and FSH release may provide an additional mechanism for dissociated secretion of gonadotropic hormones in health or disease.

A Lippes type intrauterine device (IUD) was modified to be used for immediate postpartum insertion. In 114 patients in whom the modified IUD was inserted immediately after delivery, expulsion rates at six months averaged approximately 30%. Expulsion rates were significantly different, at p less than 0.05, for women in whom the IUD was inserted digitally (19.5 +/- 5.6% at 6 months) compared to those in whom it was inserted using surgical forceps (39.6 +/- 7.1%). Furthermore, expulsion rates were higher for inexperienced inserters (p less than 0.01). We conclude that: 1) this modification of an otherwise standard IUD has a continued high expulsion rate, and 2) the technique of insertion has significant impact upon the likelihood of expulsion.A Lippes loop IUD was modified to be used for immediate postpartum insertion. In 114 patients in whom the modified IUD was inserted immedicately after delivery, expulsion rates at 6 months averaged approximately 30%. Expulsion rates were significantly different at P0.05 for women in whom the IUD was inserted digitally (19.5 +or- 5.6% at 6 months) compared to those in whom it was inserted using surgical forceps (39.6 +or- 7.1%). Furthermore, expulsion rates were higher for inexperienced inserters (P0.01). The authors conclude that: 1) this modification of an otherwise standard IUD has a continued high expulsion rate, and 2) the insertion technique has significant impact on the likelihood of expulsion.

Active mesoscale (300 km diameter) eddy formation off the Pacific coast of Central America was observed during February 1976 by a thermal infrared sensor aboard the NOAA 4 satellite. These anticyclonic eddies, closely associated with wind-induced upwellings, propagate westward at an average speed of 13 km day−1, which is approximately the speed of nondispersive baroclinic Rossby waves at latitude 12°N.

The daily acquisition of thermal infrared imagery from the NOAA-2 satellite permitted the delineation and monitoring of a series of upwellings in the Gulf of Tehuantepec during December 1973. Following the upwelling, a large anticyclonic gyre was detected in the imagery as the coastal currents returned to their historical positions.

A Very High Resolution Radiometer on the NOAA-2 satellite has provided some imagery of the Lesser Antilles showing large areas of relatively calmer water (about 200 km) downwind from the islands. The relatively calm seas are caused by the disruption of air flow over the islands.

The ability of polysiloxane vaginal rings containing 17β -Estradiol (E2) to deliver E2 into the systemic circulation at a steady rate over long periods of time was evaluated in castrate and postmenopausal volunteers. Standard laminar designs, used to release contraceptive gestagens, deliver low levels of E2 (about 50 pg/ml) and only for 1 month. With a modified design, E2 levels of 109 to 159 pg/ml were maintained for at least 3 months, and circulating gonadotropins were suppressed to values approaching the premenopausal range. This homogeneous design provides for physiologic replacement of E2 as well as a practical research tool for studying chronic effects of E2 in human subjects.

Standardized bovine cervical mucus penetration by human sperm in vitro provides information for evaluating male fertility. Normal semen specimens from 20 sperm donors and 17 infertile men were tested for cervical mucus penetration. Rigorous control of test temperature was necessary to guarantee the reliability and reproducibility of cervical mucus penetration. Sperm washing was found to significantly improve cervical mucus penetration for infertile men, from 18 +/- 2.2 to 27 +/- 3.4 mm, P less than .025. Sperm washing for normal donors had no apparent effect on cervical mucus penetration (58 +/- 1.5 mm prewash, 55 +/- 1.7 mm postwash, P greater than .1). The authors conclude that: 1) temperature for cervical mucus penetration testing is critical to reliability, and 2) cervical mucus penetration is a useful screening tool for in vitro procedures proposed to improve sperm function.

An unusual case of twin unilateral interstitial pregnancy is described. On admission the patient was thought to have an intrauterine pregnancy of 14 weeks' gestation. Because of an irregularity in the right cornual region of the uterus, a culdocentesis was performed which returned unclotted blood. Because of this finding the patient underwent laparoscopy which revealed an unruptured right cornual pregnancy. An early diagnosis before rupture allowed for conservative surgical management and uterine conservation.

The incidence of condylamata acuminata in adults is reported to be increasing. The presence of this lesion in young children, previously a rare occurrence, is also being seen more frequently. A review of the English-language literature revealed only 19 cases reported since 1940. This report adds 3 new cases to that number, all young premenarchal girls. Since the etiology of this disease is the infectious transmission of a viral agent, it is reasonable to suppose that more children are being exposed to the disease by infected adult family members. Clinicians should be aware of this possibility when treating adults with condylomata acuminata,and when examining children referred to them because of perineal lesions.

Foreign bodies present in the vagina for long periods of time are infrequent but potentially serious findings in adult women. Significant injury can occur to bowel, bladder or other pelvic structures. Repair of fistulae is delayed following removal of the foreign bodies until the chronic inflammation produced by the objects has resolved. Coexisting psychiatric illness or physical abuse may complicate the evaluation and treatment of some women with long-standing vaginal foreign bodies.

17 beta-estradiol (E2)-and/or crystalline progesterone (P)-impregnated polysiloxane vaginal rings and cylinders were tested as a system for endometrial priming in functionally agonadal women awaiting donor embryo transfer. Endometrial tissue was obtained by a transcervical biopsy procedure on simulated cycle day 26. The adequacy of the replacement regimen was judged by endometrial histologic dating, scanning electron micrographs, receptor content, and circulating E2 and P serum concentrations. Endometrial dating was consistent with cycle day 26. Electron micrographs showed normal surface characteristics. E2 and P receptor concentrations were within the normal range. Serum E2 levels were midfollicular, 105 +/- 12.8 pg/ml (mean +/- SEM), and midcycle, 254 +/- 28.6 pg/ml. P levels during the simulated follicular phase were undetectable (less than 0.2 ng/ml) but rose to a mean peak level of 17.3 +/- 1.8 ng/ml. The steroid-impregnated polysiloxane vaginal ring and cylinder system provided continuous and sustained hormone release, morphologically and endocrinologically normal endometrium, serum levels of E2 and P within the normal range for the entire menstrual cycle, and a convenient and physiologic therapeutic alternative to oral, vaginal, or intramuscular steroid replacement.

Prolonged, constant, systemic administration of estradiol-17 beta is useful for research and clinical purposes. Sustained systemic administration of estradiol-17 beta can be accomplished by means of estradiol-17 beta-containing polydimethylsiloxane vaginal rings. The ability to preselect a specific circulating serum level of estradiol-17 beta from several possible levels using estradiol-17 beta vaginal rings would be advantageous. In the present study, the author examined the effects of changes in the surface area and estradiol-17 beta content of estradiol-17 beta vaginal rings on the resulting serum levels of estradiol-17 beta. During three months of estradiol-17 beta vaginal ring exposure, the average serum levels of estradiol-17 beta produced were 53 +/- 10 pg/mL with a 100-mg estradiol-17 beta vaginal ring, 81 +/- 7 pg/mL with a 200-mg estradiol-17 beta vaginal ring, and 152 +/- 14 pg/mL with a 400-mg estradiol-17 beta vaginal ring. When compared with levels of estradiol-17 beta observed in normal menstrual cycles, the levels obtained with the 100-mg estradiol-17 beta vaginal ring, 200-mg estradiol-17 beta vaginal ring, and 400-mg estradiol-17 beta vaginal ring correspond to early follicular phase, midfollicular phase, and complete menstrual cycle, respectively. The author concludes that stable circulating levels of estradiol-17 beta resulting from estradiol-17 beta vaginal ring administration resemble estradiol-17 beta levels characteristic of specific phases of the normal menstrual cycle. Therefore, estradiol-17 beta administration by estradiol-17 beta vaginal ring may be helpful for research and clinical applications.