Faculty Bibliography

In the medical evaluation of older female patients with sexual problems, you need to assess the woman's psychological state, as well as her physical condition. An important question to ask is whether her level of sexual activity is satisfactory to her. Women's early sexual experiences, in some cases including childhood sexual abuse, impact greatly on their sexuality in later life. When sexual problems are related to the menopause, customized hormone replacement therapy is the treatment of choice. Other clinical factors that impact on older women's sexuality include urinary incontinence, breast surgery, and hysterectomy

Insulin-dependent diabetes (IDD) results from the autoimmune destruction of the insulin-producing pancreatic beta cells. Autoreactive T-lymphocytes are thought to play a pivotal role in the pathogenesis of IDD; however, the target antigens of these cells, as well as the inductive events in the disease, are unclear. PBMC in persons with or at increased risk for IDD show elevated reactivity to the beta cell enzyme glutamate decarboxylase (GAD). To identify the T-lymphocyte-reactive determinants of GAD, an overlapping set of synthetic peptides was used to stimulate the PBMC from these individuals, PBMC responsiveness to GAD peptides was not restricted to those with IDD, and a number of peptides elicited responses in PBMC. However, the major determinant of GAD recognized by persons at increased risk for IDD was amino acids 247-279, a region which has significant sequence similarity to the P2-C protein of Coxsackie B virus (47% of 15 increased risk [islet cell autoantibody-positive relatives]; 25% of 16 newly diagnosed IDD patients; and 0% of 13 healthy control subjects). Responses to tetanus and insulin antigens were not different between the study groups. In addition, PBMC from individuals responding to GAD peptides within 247-279 also responded to a Coxsackie viral peptide (i.e., P2-C amino acids 32-47), an observation supporting potential molecular mimicry in this immune response. Although the role of environmental agents in the pathogenesis of the disease remains unclear, these cellular immunological findings support the epidemiological evidence suggesting an inductive role for enteroviruses like Coxsackie B in the autoimmunity underlying IDD

A chronic cough, one that lasts for more than two to three weeks, isn't an unusual problem. However, it usually indicates an underlying health problem that, while not often serious, warrants medical attention. Common causes of chronic cough and when to seek treatment are discussed

The diagnosis of adjustment disorder is a dilemma in older medically ill patients. The authors conducted a prospective study of older cardiac surgery patients. Semistructured interview techniques were used to distinguish emotional impairment from physical impairment to diagnose an adjustment disorder. Among 71 patients interviewed at three points in time, 50.7% had an adjustment disorder. At 6 months after surgery, 30.6% were still showing evidence of emotional functional impairment. Continued impairment was related to initial severity of depressive and anxiety symptoms. Implications and suggestions for future research are discussed

A new federally financed study has found that women who have abortions increase their risk of breast cancer. The authors of the study cautioned that the overall results should be viewed as hypotheses, because of limitations in the way the study was designed and conducted. The study, which was conducted by Janet R. Daling of the Fred Hutchinson Cancer Center in Seattle, is scheduled to be reported in the Nov 2, 1994 issue of the Journal of the National Cancer Institute

An experimental new immune therapy for rheumatoid arthritis has shown significant promise in two small short-term studies being reported by researchers in England. The results of the studies, sponsored by Centocor Inc, the drug's manufacturer, were published on Oct 22, 1994 in the Lancet

[Troyen A. Brennan], who holds degrees in medicine, public health and law, said he was outraged that Edelman Medical Communications of New York City, a prominent medical public relations firm, offered to pay him to write an editorial on liability issues that might arise from prescribing drugs with sedative side effects, such as antihistamines. Edelman is now helping a doctor and a lawyer prepare the manuscript that Brennan declined to write. It has not yet been submitted to a journal, and the client drug company declined to be identified, she said. Brennan wrote that Edelman had sent him a packet of material that included an editorial it said it had commissioned, which appeared in 1993 in a weekly journal. Brennan would not identify the journal other than to say it was not the New England Journal of Medicine

Two studies to determine the most effective dose of heparin, a widely used drug for treating heart attack patients, have found that a high dose can unexpectedly prove unacceptably dangerous. Tests of the drug were halted in Apr 1994 because of a high risk of paralyzing and fatal strokes

The drug is heparin, a powerful agent that interferes with the body's normal clotting process. Heparin, along with other drugs, is recommended for heart-attack patients because it inhibits the formation of blood clots that can lead to a second heart attack. Doctors are using heparin in a range of doses on hundreds of thousands of heart-attack patients, the study leaders said. A large study established last year that a low dose of intravenous heparin was reasonably safe and effective when given with clot-dissolving drugs. Two large follow-up trials involving patients in more than 365 hospitals in the United States and 12 other countries were then begun, testing a high dose of heparin and a similar but experimental drug