Medico-legal Practices Research Articles

The praxeology of the office dilatation and curettage

Studies establishing the validity, safety, acceptability, and cost-effectiveness of dilatation and curettage (D&C) performed in the office have been published for 60 years. Major obstacles to office D&Cs have been third-party payers, congressional action and governmental regulations, social mores, medicolegal practices, and specialization. Analysis of 310 office D&Cs in a private gynecologic practice reveals a 300% reduction of patient short-term disability, 90% patient acceptability, 98% diagnostic accuracy, 450% improved physician time, approximately 450% cost reduction, and improved cost savings and income to patient and physician. The gynecologist has the substantial role in medical care decision-making. However, we must not lose sight of the fact that these very personal and individualized decisions must involve the patient as well. In order to maintain the most beneficial perspective for medical care decision-making, a hierarchy of values is presented: quality medical care, patient and physician satisfaction. economies of cost, and replicability. It is suggested that this praxeologic approach to the office D&C can be applied to other medical care decisions.

The electrophoretic heterogeneity of prostatic acid phosphatase.

Human seminal fluid, when examined by horizontal starchgel electrophoresis using 0.2 M phosphate-acetic acid buffer pH 5.0 and by specific staining of prostatic acid phosphatase (PAP) of the gel using phenolphthalein diphosphate as a substrate, has been proved to show 4 or 5 distinct zones of acid phosphatase activity, thus enabling us the classification of semen into three types, F (fast), S (slow) and 0 (zero), by their patterns of electrophoretic mobility. The frequency of PAP types of unrelated Japanese males is 71.6% S, 15.8% F and 12.6% 0. The typing by this method is independent from the erythrocyte acid phosphatase (EAP) typing. This technique has been proved to be useful in medico-legal practices (in rape cases).