Adherence to published guidelines for the management of menorrhagia in women undergoing second generation endometrial ablation.

Second-generation endometrial ablation techniques provide an effective surgical treatment option for women with menorrhagia. Their ease of use might result in inappropriate surgical treatment without previous medical therapy. We sought to establish local compliance with national guidelines following the recent introduction of second generation ablation techniques into routine practice. We collected data at the time of ablation on the preceding medical management of women undergoing either microwave endometrial ablation or thermal balloon ablation. One hundred and thirty-two consecutive women underwent second-generation endometrial ablation. At least one medical treatment (range 1-5) was used before ablation in 86% of women. The majority (86%) of women undergoing a second-generation endometrial ablation technique received at least one effective medical therapy before surgical intervention, indicating a high level of compliance with published guidelines.     

Cricopharyngeal Crohn's disease

We report a case of Crohn's disease of the cricopharyngeal oesophagus which presented with complete dysphagia and was successfully treated by balloon dilatation. We can find no previous reports of such a case.     

Trial of an intervention to reduce chronic benzodiazepine use among residents of aged-care accommodation

Abstract Background: Many residents of aged-care accommodation are chronic users of benzodiazepines. This pattern of use contradicts current guidelines and may adversely affect residents. It was hypothesised that a lasting reduction in benzodiazepine use could be achieved through a programme which involved prescribers, residents and caregivers in the change process. Aim: To demonstrate that an intervention which involved education and relaxation training for patients, and education of prescribers and caregivers, could reduce levels of chronic benzodiazepine use among residents of an aged-care facility. Methods: Two aged-care facilities from metropolitan Adelaide were chosen; one received the intervention, the other was a no-intervention comparison. Pre-test, post-test and follow-up interviews were conducted with 60 residents: 27 from the intervention setting and 33 from the comparison setting. Residents at the intervention setting were provided with relaxation skills training, and their medical practitioners and caregivers were provided with information about alternative strategies for managing sleep disturbance. Outcome measures were: the proportion of residents using benzodiazepines, total medication use, cognitive performance, emotional responsiveness, subjective health and sleep ratings and an index of well-being. Results: The proportion of participants in the intervention condition who used benzodiazepines declined significantly (from 70% to 35%); the reduction was maintained over the subsequent three months. No adverse consequences were associated with cessation of benzodiazepine use; there was improvement in emotional responsiveness among those who ceased benzodiazepine use. This structured intervention strategy is a useful approach for reducing levels of chronic benzodiazepine use among residents of aged-care accommodation.     

Staff members' acceptance of the introduction of workplace smoking bans in the Australian public service

The acceptability to employees of workplace smoking bans is an important factor in their introduction and in subsequent compliance. This study describes the acceptance by affected staff members before the ban on smoking in Australian public-service premises. Four thousand, two hundred and fifteen (79% of those who were approached) public servants were surveyed from areas of six departments across three states. Twenty-five per cent of the sample were current smokers. Support for the bans was strong, with 76% of the sample approving over all. Approval among smokers was less, with 40% of smokers approving, compared with 82% of ex-smokers and 90% of "never" smokers. Thus, the results show a generally favourable attitudinal milieu among employees who were facing an impending ban on smoking, and far-from-unanimous opposition from smokers. Among smokers, acceptance of the bans was predictable from the attitudes towards smoking acceptance of the bans was predictable from the attitudes towards smoking in general, and from the perceived impact of the bans on smokers. The existence of restrictions on smoking at the time of the survey was associated with slightly higher levels of approval of the impending total ban, especially when the restrictions were not seen as being imposed on the respondents by others.     

Delta-like 1 is necessary for the generation of marginal zone B cells but not T cells in vivo

Notch receptors and their ligands contribute to many developmental systems, but it is not apparent how they function after birth, as their null mutants develop severe defects during embryogenesis. Here we used the Cre-loxP system to delete the Delta-like 1 gene (Dll1) after birth and demonstrated the complete disappearance of splenic marginal zone B cells in Dll1-null mice. In contrast, T cell development was unaffected. These results demonstrated that Dll1 was dispensable as a ligand for Notch1 at the branch point of T cell-B cell development but was essential for the generation of marginal zone B cells. Thus, Notch signaling is essential for lymphocyte development in vivo, but there is a redundancy of Notch-Notch ligand signaling that can drive T cell development within the thymus.     

Inefficient clustering of tyrosine-phosphorylated proteins at the immunological synapse in response to an antagonist peptide

Interactions of T cells with MHC plus peptide in the peripheral lymphoid system are important for their survival. In this study we investigated further the molecular consequences of such interactions using F5 TCR transgenic mice and peptides previously shown to induce either negative or positive selection in the thymus. Following TCR ligation with the negatively selecting agonist peptide, mature CD8(+) cells proliferated and up-regulated the activation marker CD69. Interestingly, ligation of this TCR with MHC molecules loaded with high concentrations of the positively selecting peptide also resulted in the aforementioned changes, but with slower kinetics. Analysis of the biochemical changes that occur following stimulation with these peptides showed that phosphorylation of key signaling molecules, such as ZAP-70, CD3zeta, Vav, SLP-76, LAT, and ERK-1 and 2, could be detected after exposure to agonist but not antagonist peptide. Confocal microscopy, however, revealed infrequent phosphorylation 'patches' at the site of contact between T cells and APC presenting the antagonist peptide. Our data suggest that peptides capable of inducing positive selection in the thymus can be recognized by mature T cells and cause proliferation, up-regulation of CD69 and accumulation of phosphorylated proteins at the immunological synapse with low efficiency; however no phosphorylation of signaling molecules can be detected using conventional biochemical assays.     

Effects of intracerebral implants of steroid hormones on scent marking in the ovariectomized female gerbil (Meriones unguiculatus)

The effects of intracerebral implants of steroid hormones on scent marking in the female gerbil (Meriones unguiculatus) were studied in two experiments. In Experiment 1 various steroids were implanted alone or in combination into the preoptic and anterior hypothalamic area of ovariectomized females. Unilateral implants of testosterone + estrogen, estrogen, estrogen + progesterone, testosterone and testosterone + progesterone stimulated a significant level of marking when compared to controls. Experiment 2 utilized bilateral implants of estrogen dissolved in paraffin in order to explore the distribution hormone sensitive areas in the brain which might be important in the regulation of scent marking in the female gerbil. Pellets of estrogen-paraffin were implanted stereotaxically into either the anterior hypothalamus, preoptic area, septum, hippocampus, thalamus, amygdala or anterior olfactory nucleus of ovariectomized females. Total dosage of hormone implanted was 8.2–8.4 μg. A significant level of marking resulted in animals receiving implants into the anterior hypothalamus, preoptic area and septum when compared to controls. Marking appeared at about the same rate in each of these groups; however, the level of marking attained differed. By the last trial, anterior hypothalamic implanted animals were marking significantly more often than animals in either the preoptic or septum groups. Although there was no evidence of ieakage from the brain, the data suggested that some rapid diffusion of hormone, largely restricted to the brain, was taking place or that the three areas were differentially responsive to the hormone. The data do indicate that some localization of function does exist with respect to regulation of scent marking in the female.