Purpose Fewer than 1/2 of the sexually active young females are being screened annually for C. trachomatis (CT). To address barriers to screening, this study examined gender, ethnicity, and age disparities in adolescents who are screened for CT during regularly scheduled pediatric health checks. Methods This study was part of a larger randomized controlled trial to increase CT screening among sexually active teens (14-18 years old) during their regularly scheduled health checks in 10 pediatric clinics at a large Northern California health maintenance organization. Teens attending the 5 intervention clinics were asked to complete an anonymous survey at the end of their visit to determine site specific sexual activity rates in order to monitor CT screening rates. The survey gathered basic demographic information on the teens9 age, gender, and race/ethnicity. In addition, the survey asked: “Have you ever had sexual intercourse?” and “Did you have a test for STDs today?” Results There were 4,368 (49.5% female, 46.4% male and 4.1% did not report gender). The response rate was 74%. The mean age was 15.4 years for females and 15.3 for males. The ethnicity of the overall population was: Asians 26.7%; Blacks 13.2%; Latino19.5%; Caucasian 25.5%; Multi-ethnic/other14.3%. Most teens (83%) were asked about sexual activity; 19.7% had had sex (20.4% for females and 19.0% for males); 7% had an STD test on the day of their visit, 80.1% were not tested for an STD, and 12.5% did not know whether they were tested for an STD. There was no difference in STD screening across gender, ethnicity, or age; yet, there were significant ethnic, age and gender differences in queries about sexual activity. Blacks were significantly more likely to report being asked than Asians (89% vs 81%, p≤0.001) and Latinos (89% vs 81%, p≤0.001). Older teens were more likely to be asked than younger teens (p≤0.05); and female adolescents were more likely than males to be asked about sex (85% vs 83%, p=0.01). Conclusions Data revealed that there were no differences in who is screened for CT once the sexual history is obtained: however, there are disparities in sexual history taking. While it is encouraging that so many teens were asked about their sexual history, African Americans, older teens, and females were more likely to be asked about sexual history than their counterparts. Providers should be wary of introducing their own bias into screening protocols when universal screening of all sexually active adolescent females is recommended.

s: Abstracts for the 20th Annual Scientific Meeting of the International Society for Biological Therapy of Cancer (Primary Authors are Italicized): IMMUNE MONITORING

The clearance of etoposide and formation of etoposide glucuronide have been measured in an isolated, perfused rat liver model to evaluate the effect of impaired hepatic function on etoposide kinetics. Hepatocellular injury was produced by pretreatment of rats with allyl alcohol or carbon tetrachloride; ligation of the bile duct simulated obstructive biliary disease. Etoposide clearance (3.59 +/- 1.06 ml/min) was reduced by both carbon tetrachloride (2.07 +/- 0.64 ml/min; P = 0.05) and allyl alcohol treatment (2.14 +/- 0.62 ml/min; P = 0.05). Biliary obstruction also impaired etoposide clearance but to a lesser extent than hepatocellular injury (2.47 +/- 0.69 ml/min; P = 0.20 versus control). In both hepatocellular and obstructive models, direct biliary etoposide excretion decreased. The metabolic clearance of etoposide to its glucuronide declined by 36% in the hepatotoxin models but was not decreased by biliary obstruction. Following hepatic injury, there is a reduction in the metabolism and excretion of etoposide by the liver. This effect is most marked on biliary drug excretion. Obstructive biliary disease does not significantly alter etoposide glucuronidation. Since most cancer patients have increased bilirubin on the basis of obstructive disease, little or no etoposide dose alteration will be needed. However, in the patient with significant hepatocellular injury, impaired etoposide clearance will be more pronounced, and etoposide dose alterations may be needed.

Isolated livers from male Sprague-Dawley rats were perfused at 20 ml/min for 3 h at 37 degrees C with 100 ml of an oxygenated, recirculating solution of 20% rat blood in Krebs bicarbonate buffer containing 20 micrograms/ml [3H]etoposide. Ninety % of administered radioactivity was eliminated in bile over a 3-h collection period. The clearance of etoposide was 3.56 ml/min indicating that, in the rat, it is not highly extracted. Its clearance is, therefore, independent of hepatic blood flow. Etoposide was both excreted into the bile and metabolized by the liver. Perfusate and bile samples analyzed by reverse-phase high-performance liquid chromatography techniques were found to contain three peaks of radioactivity. Positive and negative ion fast atom bombardment mass spectrometry identified the first two peaks as etoposide glucuronides and the third peak as parent drug. Following the i.v. administration of etoposide to rabbits, etoposide glucuronide was also identified in rabbit urine. The recovery of etoposide both from rabbit urine and rat bile was increased by preincubation with glucuronidase. However, the glucuronides were relatively resistant to the action of glucuronidase and showed varying sensitivity to the type of glucuronidase and the reaction conditions used. These studies document the presence of etoposide glucuronide as an etoposide metabolite in two mammalian species and suggest that previous clinical studies using beta-glucuronidase to quantitate glucuronide formation may have underestimated this metabolite due to its relative resistance to some glucuronidase preparations.

The role of prostaglandins in regulating splanchnic blood flow during hemorrhage has been investigated in the anesthesized dog using the microsphere technique. Indomethacin selectively decreased blood flow to the gastrointestinal tract, but did not change hepatic arterial flow. Hemorrhage (5 ml/kg and 10 ml/kg) generally increased peripheral resistance in the gastrointestinal tract as much as total peripheral resistance was increased. However, resistance in the stomach and pancreas increased to a greater extent while there was no change in hepatic arterial resistance. The effect of hemorrhage on splanchnic blood flow distribution was not changed by prior indomethacin treatment. Thus, prostaglandins contribute to the regulation of basal flow to the gastrointestinal tract but are not involved in regulatory changes in splanchnic blood flow during hemorrhage. The enhanced sensitivity of the gastric and pancreatic vascular beds to hemorrhage may contribute to local toxicity during hemorrhage.

Separation of urinary mephenytoin metabolites was evaluated under various gas-liquid chromatographic (GLC) and high-performance liquid chromatographic (HPLC) conditions. A simple and rapid alkylation procedure is described for GLC-using a nitrogen sensitive thermionic detector. The in situ formation of sodium methinylsulfinylmethide is used as base for the perpropylation of hydantoins and their metabolites. Normal-and reversed-phase HPLC of the underivatized compounds was performed using four different types of stationary phases. None of the GLC systems separated all the six hydantoin compounds tested, whereas, normal-and reversed-phase HPLC were able to obtain a complete separation of these compounds. The major metabolites of mephenytoin were 5-phenyl-5-ethylhydantoin, 3-methyl-5-(4-hydroxyphenyl)-5-ethylhydantoin and 5-(4-hydroxyphenyl)-5-ethylhydantoin in man, rat, mouse, rabbit, and guinea pig. 3-Methyl-5-phenyl-5-(2-hydroxyethyl)-hydantoin and 3-methyl-5-(3-hydroxyphenyl)-5-ethylhydantoin are major metabolites in the dog.

The elimination half-life (T1/2) of canrenone, the principal unconjugated metabolite of spironolactone, was 59 h (range 32–105 h) in 5 patients with chronic liver disease and 37 h (range 19–48 h) in 7 patients with congestive heart failure. In comparison the T1/2 in normal subjects was 13.5–24 h in previous reports and 20.5 h in the present study. However there was no evidence of greater cumulation of canrenone in the plasma of those patients with a prolonged T1/2.

The pharmacological activity of single oral doses of a new aldosterone antagonist, prorenoate potassium, has been compared with spironolactone and placebo in a balanced double-blind crossover study in six healthy subjects. Endogenous mineralocorticoids were stimulated by administration of frusemide followed by dietary sodium restriction, and the urinary excretion of electrolytes in response to prorenoate potassium, spironolactone and placebo was measured over a 24 hour period. Significant activity of prorenoate potassium and spironolactone was observed between 2 – 24 hours after medication, with peak activity at 6 – 8 hours. The active drugs significantly increased sodium excretion and the sodium: potassium (Na/K) ratio, but changes in potassium excretion were not significant. The total urine Na/K response to prorenoate potassium 45 mg was significantly greater than to spironolactone 100 mg.

SIR,-It is interesting that having challenged some of the things I wrote as being incapable of substantiation Dr. Russell then goes onin the sentence-to claim that what I say is more fantasy than fact. This must surely be equally difficult to substantiate. It is true in one sense that coitus is but part of a complete reproductive act. I might go further than he does and say that the care of the offspring is also a part of the process. However, to reach the conclusion he does is to ignore the possibility that with the advent of human sensibility orgasm has come to have a satisfaction, and perhaps indeed a purpose, quite separate from that of reproduction. The fact that there is no clear pattem to the acceptability of intercourse by the woman would suggest this. Evolution is occurring in patterns of behaviour as well as in our physical attributes. The physiological response to sexual stimuli, including the contraction of the muscle deep to the areola and the erection of the clitoris, have all been demonstrated and well documented in the sources I quoted, so to prove that they do not occur an equally impressive body of experimental evidence must be cited. Equally, the occurrence of changes in the shape of the vaginal vault and contractions of the levator ani muscles and of the uterus which accompany the female orgasm are also documented by research workers of good reputation. If one was to seek a purpose for these changes it may very well be found in the speed with which spermatazoa can make their way into the Fallopian tubes. It is, I think, too much to postulate that they always make their way by their own power. The "orgasm" of the female can at least assist the process. However, speculation on these lines is likely to be as unprofitable to me as it appears to be to others, so I will desist.-I am, etc.,