Reporting bias and mode of interview in a study of adverse pregnancy outcomes and water consumption.

In an earlier publication, it was shown that consumption of tapwater during the first trimester of pregnancy was associated with a risk of spontaneous abortion among women who attended three prenatal clinics located in northern California between September 1981 and June 1982. Evidence for biased recall was presented. This report demonstrates that the association is limited to women interviewed by telephone and is not observed among those who completed a mail questionnaire. The possibility that the association among women interviewed by telephone is causal and that the lack of association among mail respondents is due to bias, confounding, or apparently chance fluctuations is shown to be unlikely. For instance, the probability is low that, among mail respondents, cases underreported exposure as compared with controls or that random errors were common enough to camouflage a true effect. Demographic differences between mail and telephone respondents also do not explain the results. Interviewers were, however, aware of the outcome of the pregnancy, suggesting that differential reporting of exposure may have been stimulated in the nonblind telephone interview. The pattern of heterogeneity between mail and telephone respondents was also observed for reportable anomalies and tapwater consumption. The data on heterogeneity support the previously published conclusion that differential reporting (biased recall) of this common exposure, tapwater consumption, is the likely explanation for its observed association with the risk of spontaneous abortion. That this association is limited to telephone respondents elucidates the mechanism that apparently produced the bias: that is, the medium of nonblind telephone interviews.     

A leg ulcer as manifestation of metastatic squamous cell vaginal carcinoma

Cutaneous metastasis of vaginal carcinoma is extremely rare. So far, the total number of reported skin metastasis of vaginal carcinoma is only one. We present another case with an unusual manifestation of vagina carcinoma metastasis: skin metastasis presenting as a leg ulcer on the lower leg.     

Localization of a gene for otosclerosis to chromosome 15q25-q26

Among white adults otosclerosis is the single most common cause of hearing impairment. Although the genetics of this disease are controversial, the majority of studies indicate autosomal dominant inheritance with reduced penetrance. We studied a large multi- generational family in which otosclerosis has been inherited in an autosomal dominant pattern. Five of16 affected persons have surgically confirmed otosclerosis; the remaining nine have a conductive hearing loss but have not undergone corrective surgery. To locate the disease- causing gene we completed genetic linkage analysis using short tandem repeat polymorphisms (STRPs) distributed over the entire genome. Multipoint linkage analysis showed that only one genomic region, on chromosome 15q, generated a lod score >2.0. Additional STRPs were typed in this area, resulting in a lod score of 3.4. STRPs FES (centromeric) and D15S657 (telomeric) flank the 14. 5 cM region that contains an otosclerosis gene.      

Peritoneal fluid concentrations of interleukin-8 in women with endometriosis: relationship to stage of disease

There is increasing evidence that immunological mechanisms play a role in the pathogenesis and pathophysiology of endometriosis. It was therefore of interest to study interleukin-8 (IL-8), a chemokine, in the peritoneal fluid and peripheral blood of women undergoing laparoscopic procedures. The presence and concentrations of IL-8 in relation to endometriosis, infertility and abdominal pain were evaluated. Samples of peritoneal fluid (n = 49) and peripheral blood (n = 50) were obtained from 50 consecutive patients undergoing laparoscopic surgery for various gynaecological indications (abdominal pain, infertility, sterilization). IL-8 was present in the peritoneal fluid of most women (87%). The concentration of IL-8 in the peritoneal fluid was higher in women with endometriosis compared to women without (P = 0.02). This difference was more pronounced in early (stage 1) endometriosis (P = 0.001). IL-8 concentrations in the peritoneal fluid were also higher in women with early endometriosis compared to women with later stages of the disease (P = 0.003). Peripheral blood concentrations did not correlate with peritoneal fluid concentrations of IL-8 and/or the presence of endometriosis. We conclude that IL-8 is an important factor that may contribute to the pathogenesis of endometriosis possibly by promoting neovascularization. This information can be a guide in the development of new therapeutic approaches for the treatment of endometriosis.