Elizabeth R. Barnhart

A Survey of Gynecologists Concerning Menorrhagia: Perceptions of Bleeding Disorders as a Possible Cause

We sought to determine perceptions and practices of American gynecologists when treating with a woman complaining of menorrhagia, specifically with regard to an underlying bleeding disorder as a potential cause. A mail survey of Georgia members of the American College of Obstetricians and Gynecologists was conducted. The survey response was 52%, and the analysis includes 376 physicians who reported seeing at least one gynecological patient per week. On average, respondents were in practice 20 years and reported that 8% of their patient population complain of menorrhagia. Virtually all physicians reported employing a menstrual history as a starting point for the workup for menorrhagia, and 95% order a hemoglobin/hematocrit determination. About 50% of physicians considered saturating three tampons/pads per 4 hours as excessive, although the criterion varied widely (range 0-24 per 4 hours, SD = 3). The diagnoses considered most likely among reproductive age women were anovulatory bleeding or benign lesions or that the heavy bleeding was within normal limits. Only 4% of physicians would consider von Willebrand disease (VWD) for this age group (women of reproductive age). Among girls near menarche, physicians overwhelmingly consider anovulatory bleeding or bleeding within normal limits the likely diagnoses, and 16% would consider VWD in this age group. Only rarely (3%) do surveyed physicians refer menorrhagia patients to other specialists. Most respondents believe that most menorrhagia is caused by anovulation or is within normal limits. Bleeding disorders are believed to be a rare cause of menorrhagia.

Gas chromatographic/mass spectrometric analysis of human serum for non-ortho (coplanar) and ortho substituted polychlorinated biphenyls using isotope-dilution mass spectrometry

Abstract We have synthesized in our laboratory all of the totally carbon-13-labeled PCBs normally found in human tissues. The mixture of carbon-13-labeled PCBs consists of more than 50 congeners including the 13 c 12 -labeled, coplanar, non-ortho substituted PCBs. We used this spiking material to prepare analytical standards at various concentration levels, and established standard curves using isotope-dilution mass spectrometry for each congener over a range of concentrations normally found in human samples. The PCBs were analyzed on a Finnigan MAT 4500 in either the electron-impact or negative-ion chemical ionization mode on a DB-5 capillary column.

Reversed-phase liquid chromatography of the twenty-two tetrachlorodibenzo-p-dioxin isomers on pyrenylethyl- and octadecylsilylated silica gel columns

To purify the tetrachlorobenzo-p-dioxins synthesized for chemical and biological reference standards, reversed-phase liquid chromatography on pyrenylethyl- and octadecylsilylated stationary phase (PYE and C18) columns was employed with 100% methanol. The pyrenylethyl phase satisfactorily separated isomers resulting from mixtures of reaction products which had not been adequately separated with conventional C18 or silica gel. The use of a single chromatographic mode, liquid chromatography, and a single mobile phase with columns of distinctly different properties, C18 and PYE, separates 20 of the 22 isomers from each other and from the 1246/1249 pair. (The observed properties of the two columns afford insight into steric and polarizability differences among isomers.)

HPLC Separation and FT-IR Isomer Differentiation of the 1,2,4,7/1,2,4,8-Tetrachlorodibenzodioxin Isomer Pair—A Theoretical/Empirical Approach to Dibenzodioxin Isomer Assignment

The 1,2,4,7- and 1,2,4,8-tetrachlorodibenzodioxin (TCDD) isomers were separated by reversed-phase high-performance liquid chromatography (HPLC) with the use of a pyrene column. Fourier transform infrared (FT-IR) matrix isolation and vapor-phase spectra of the individual isomers were recorded. The spectra of the HPLC-separated isomers correlate well with spectral subtraction results and were found to be distinct in three spectral regions—one of which allows for isomer structural assignment. Ambiguities and differences in published TCDD isomer FT-IR assignments are discussed in terms of a qualitative valence-bond approach and empirically derived estimates of ether linkage asymmetric stretching frequencies.

Photodecomposition of 1,2,3,4- and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in water-alcohol media on a solid support

We used a hydrophobic solid support, octadecylsilylated silica gel (C18), packed in a quartz column as a reaction medium for the photolysis of 2,3,7,8-tetrachlorodibenzo-p-dioxin (2,3,7,8-TCDD) and 1,2,3,4-tetrachlorodibenzo-p-dioxin (1,2,3,4-TCDD). When we exposed the column to a 450 W UV lamp, the adsorbed 1,2,3,4-TCDD or 2,3,7,8-TCDD in 10% 2-propanol/water decomposed completely in 20 minutes and 5 minutes, respectively. The large estimated partition coefficient of 1,2,3,4-TCDD in 10% 2-propanol/water (> 1000) indicates that on the C18 stationary phase, both the saturated hydrocarbon chains and the absorbed 2-propanol may act as proton donors and accelerate the photolysis. In direct sunlight, the adsorbed 1,2,3,4-TCDD in 10% 2-propanol/water decomposed much faster than in a nonaqueous solvent (50% 2-propanol/methanol). This solvent effect is advantageous for the practical use of the C18 photolysis process in aqueous waste treatment. We have demonstrated that complete C18 trapping with continuous photodecomposition of TCDD contained in an aqueous alcohol waste is possible.

Synthesis and analytical characterization of all tetra to octachlorodibenzo-p-dioxins

Abstract We describe the synthesis and analytical characterization of the tetrachlorodibenzo-through octachlorodibenzo-p-dioxins. We determined the relative response factors for each chlorinated dioxin by both electron impact (EI) and negative chemical ionization mass spectrometry (NCI). An assumption of a 1:1 response factor for a polychlorinated dibenzo-p-dioxin (PCDD) congener within a group with the same number of chlorines is valid in EI but is not a valid assumption in NCI. We have determined the proton nuclear magnetic resonance chemical shift and coupling constants for each PCDD. All of the tetrachlorinated through heptachlorinated congeners, with two exceptions, gave appropriate first order proton spectra in Benzene-d6. The vapor phase infrared absorption bands are unique for each PCDD congener and allow a second method of structural assignment.

Synthesis of polychlorinated biphenylenes (PCBPs): Structural characterization of 2,3,6,7-TCBP and analysis for PCBPs in human adipose tissue by negative-ion chemical ionization (NCI) mass spectrometry

Abstract A tetrachlorobiphenylene was isolated from a SO 2 Cl 2 -biphenylene reaction mixture by reversed-phase liquid chromatography. The structural assignment of 2,3,6,7-tetrachloro-biphenylene is based on data from the synthesis route, gas chromatography/mass spectrometry, and nuclear magnetic resonance longitudinal relaxation studies. The UV photolysis of octachlorobiphenylene (OCBP) produced a mixture of tetra through octachlorobiphenylenes which provided a standard to assess the retention times of biphenylenes relative to PCDDs and PCDFs. The recoveries of the biphenylenes through the adipose tissue cleanup procedures developed for PCDDs and PCDFs ranged from 62–92%. Composite extracts from control and exposed groups were analyzed by NCI mass spectrometry and no peaks characteristic of biphenylenes were found.

Identification of Polychlorinated Pyrenes and Pyrene-Addition Products Using Proton Nuclear Magnetic Resonance Techniques

Nuclear magnetic resonance (NMR) techniques are used to determine the chlorination pattern on a number of chlorinated pyrenes and pyrene-addition products. Determining chemical shifts, couplings, and longitudinal relaxation rates makes the unequivocal assignment of these molecules possible. Chlorination under the conditions described here were found to follow the normal orientation rules for pyrene. Spectral parameters obtained from these molecules are consistent enough to allow further application to unknown compounds. This should simplify assigning NMR spectra to other chlorinated pyrene standards.

Purification of PCDD synthesis products by reversed-phase liquid chromatography with pyrenylethylsilylated and octadecylsilylated silica gel

Abstract Pure chlorinated dioxin congeners (including 20 of the 22 TCDDs) were isolated from synthetic reaction mixtures by reversed phase liquid chromatography on two stationary phases.