Primary dysmenorrhoea

Dysmenorrhoea literally means painful menstrual flow and refers to cramping lower abdominal pain occurring with the onset of menstrual flow. In cases of primary dysmenorrhoea the pain commences during the teenage years and occurs in the absence of any pelvic disease. In contrast, secondary dysmenorrhoea usually commences later in life and results from some kind of underlying problem like endometriosis. This paper investigates the prevalence, aetiology, the distinction of primary and secondary dysmenorrhoea and treatments that can be offered to women.     

Primary hyperaldosteronism

Primary hyperaldosteronism (PHA), autonomic secretion of aldosterone by the adrenal gland, is rare. PHA usually results in therapy-resistant hypertension and is often but not always accompanied by hypokalaemia. Common causes of PHA are an aldosterone-producing adenoma, idiopathic aldosterone hypersecretion, unilateral hyperplasia or a genetic variant: glucocorticoid-remediable aldosteronism (GRA). The diagnosis should be phased and first of all requires a biochemical confirmation of the presence of PHA. In PHA patients, plasma renin is invariably suppressed. Blood should be collected under standardised conditions while the patient is not using beta-blockers or centrally-acting antihypertensive medication. Patients with a suppressed plasma renin and an elevated plasma aldosterone concentration have PHA. In patients with a suppressed plasma renin and a high-normal plasma aldosterone concentration a confirming test should be performed in which PHA is diagnosed if aldosterone is not suppressed following volume expansion with sodium chloride. The cause of PHA is determined by means of a CT scan or MRI of the adrenal glands to find a unilateral adenoma. If the CT scan or MRI is normal, adrenal vein aldosterone sampling may be considered as a next step in order to demonstrate lateralisation of aldosterone production. The hypertension and hypokalaemia of all forms of PHA respond well to spironolactone therapy. In the case of a unilateral adenoma or unilateral hyperplasia, adrenalectomy is the treatment of choice. For GRA, dexamethasone in doses that reduce the corticotropin (ACTH) level is indicated.     

Primary Prevention

Primary prevention has been heralded as the fourth revolution in society's approach to mental illness, signifying coming paradigmatic changes. Implications of this are explored for preventive social work. Major changes are observed, but these may be as much attributed to evaluation of practice as to the specific content of that practice.     

Primary immunodeficiencies

Increased understanding of the nature and variety of immunodeficiency states in man is rapidly accumulating both from studies of human patients and from experimental work on the immune response in animals. Progress is evident in the development of diagnostic tests for deficiencies in both humoral and cellular mechanisms of immunity, and in the introduction of new forms of therapy—for example, the grafting of lymphoid cells. Studies of immunodeficiency provide the most direct evidence concerning the nature of the immune response in man, and hence are of wide general interest. In this paper, current knowledge and concepts are summarized, a logical classification is presented, and recommendations are made for the investigation and treatment of these disorders.