Transforming growth factor beta1 gene expression during vaginal wound healing in a rabbit menopause model.

OBJECTIVE: Surgical outcome following reconstructive pelvic surgery is largely dependent on the vaginal wound healing process. As peri- and post-menopausal women are the most likely candidates to undergo these surgeries, it is important to understand the effect of estrogen deficiency on this process. Transforming growth factor beta (TGFß) is an important mediator of wound healing. We sought to assess TGFß1 gene expression during the vaginal incisional wound healing process in a rabbit menopause model. DESIGN: Animal study. SETTING: Animal laboratory. SAMPLE: Sixty-three rabbits were used for this study. METHODS: Twenty-one underwent bilateral oophorectomy, 21 underwent a sham surgery, and 21 served as controls. Eight weeks later, standardised full-thickness 6-mm diameter circular segments were excised from the vagina of all rabbits. Animals were killed sequentially, before wounding, and at 0, 4, 7, 14, 21 and 35 days after wounding, and the wounds were harvested. MAIN OUTCOME MEASURES: Wound closure and TGFß1 gene transcription, as measured by real-time polymerase chain reaction (PCR). RESULTS: Wound closure was significantly protracted (P < 0.02), whereas TGFß1 gene expression was significantly increased (P < 0.0001) during the wound healing process in oophorectomised rabbits, as compared with both control and sham groups. CONCLUSION: Oophorectomised rabbits show protracted incisional vaginal wound healing associated with increased TGFß1 gene transcription.

Comparison of microtransducer and fiberoptic catheters for urodynamic studies.

OBJECTIVE: To assess the validity and reproducibility of a fiberoptic transducer urodynamic catheter for urethral closure pressure profiles and leak point pressure determination, using a microtransducer catheter as the standard. METHODS: Ninety women without significant pelvic organ prolapse underwent urodynamic evaluations with both fiberoptic and microtransducer catheters. Maximal urethral closure pressures and "leak point pressures" were repeatedly measured by the two catheters and statistically compared. The order of catheter use was randomized. RESULTS: Significantly lower mean maximal urethral closure pressures were recorded by the fiberoptic system than by the microtransducer system (28.9 cmH(2)O +/- 17.3 versus 43.2 cmH(2)O +/- 24.9, P <.001). The fiberoptic catheter predicted microtransducer values for maximum urethral closure pressure only within a range of 27 cmH(2)O. Mean "leak point pressure" recorded by the fiberoptic catheters (66.9 cmH(2)O +/- 2.9) was not significantly different than that recorded by the microtransducer catheters (66.4 cmH(2)O +/- 2.9, P =.97). CONCLUSION: There is a significant difference between maximum urethral closure pressure values recorded by the microtransducer and fiberoptic catheter systems. No significant difference was found between the two systems in measurement of Valsalva "leak point pressure."

Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation.

OBJECTIVE: To compare vaginal anatomy and sexual function after the conventional posterior and anterior sacrospinous vault suspension. METHODS: A retrospective repeated measures cohort study included all 168 consecutive sacrospinous vault suspension procedures between July 1990 and February 1997. The posterior suspension (n = 92) used a posterior vaginal incision and pararectal dissection. Anterior suspension (n = 76) involved an anterior rather than posterior vaginal incision, retropubic perforation, and dissection of a paravaginal-paravesical rather than pararectal space to accommodate the vaginal vault. Two polytetrafluoroethylene (00) sutures anchored the anterior vaginal cuff (for the anterior sacrospinous suspension) or the posterior vaginal cuff (for the posterior sacrospinous suspension) to the ligament. Postoperative evaluation included an examination using the pelvic organ prolapse quantitative system, assessment of vaginal width and axis, and symptom questionnaire. RESULTS: Total vaginal length and apical suspension were slightly greater after the anterior suspension, and recurrent anterior vaginal relaxation was less likely. No differences were found in maximal dilator size or apical narrowing between the two groups. New onset dyspareunia was reported by two subjects in the anterior vault suspension group, and two in the posterior vault suspension group. Three of these four cases of de novo dyspareunia were attributable to either severe atrophy or recurrent prolapse, and none to vaginal narrowing or shortening. CONCLUSION: After anterior sacrospinous vault suspension, vaginal length and apical suspension were slightly increased, and recurrent anterior vaginal prolapse decreased compared with the posterior sacrospinous suspension technique. Upper vaginal caliber and sexual function appear well preserved using either technique.

Electromagnetic pelvic floor stimulation: applications for the gynecologist.

The therapeutic potential of magnetic energy has been a subject of long-standing interest within both conventional and alternative medical practice. Numerous devices using magnetic fields, ranging from the dubious to truly innovative, have claimed a wide variety of clinical benefits. For gynecologists involved with the diagnosis and treatment of pelvic floor and bladder dysfunction, magnetic stimulation of the sacral nerve roots and peripheral nerves continues to evolve as a noninvasive treatment alternative. The conduction characteristics of magnetic energy confer several practical advantages for its use. This article reviews the use of electromagnetic stimulation for treatment of common urogynecologic conditions, and provides an historical overview of the therapeutic application of electromagnetic energy.

Prediction of vertebral body compressive fracture using quantitative computed tomography.

We performed quantitative computed tomography in vitro on the first and third lumbar vertebrae in human cadavera using a dibasic potassium phosphate phantom for calibration. The quantitative computed-tomography numbers exhibited a significant positive correlation (R2 = 0.89, p less than 0.0001) with direct measurements of the apparent density of the vertebral trabecular bone. We also conducted uniaxial compression tests to failure of the vertebral bodies after removal of the posterior elements, and found that vertebral compressive strength was also correlated at a high level of significance (R2 = 0.82, p less than 0.0001) with direct measurement of the trabecular apparent density. These findings suggested the possibility that the quantitative computed-tomography values might be directly predictive of vertebral compressive strength. However, when we correlated the quantitative computed-tomography values directly with vertebral compressive strength, the results (R2 = 0.46, p less than 0.061) were suggestive but not quite significant. All vertebral bodies failed by compression of the end-plate, suggesting only a modest structural role for the cortical shell under these loading conditions. This was confirmed by comparing the compressive load to failure of twenty additional pairs of vertebrae that were tested with and without an intact vertebral cortex. Removal of the cortex was associated with approximately 10 per cent reduction in vertebral load to failure.

Contributions of cytosolic and mitochondrial acetyl-CoA syntheses to the activation of lipogenic acetate in rat liver.

Acetate derived from ethanol oxidation is activated by cytosolic and mitochondrial acetyl-CoA synthetases before contributing to the extra-mitochondrial processes of fatty acid and 3-beta-hydroxysterol synthesis. Mitochondrially-generated acetyl-CoA is transferred to the cytosol via citrate and ATP-citrate lyase; this transfer is blocked by (-)-hydroxycitrate. Rats were injected IV with 3.3 mmol/kg of [2-3H,2-14C] acetate and IP with either 0.5 mmol/kg hydroxycitrate or saline. After one hour, the rats were killed and the incorporation of label was measured in liver fatty acids and 3-beta-hydroxysterols. The 3H/14C ratio was increased by 12 and 13% in the fatty acids and 3-beta-hydroxysterols of the hydroxycitrate-treated group. The lower ratio in the fatty acids and 3-beta-hydroxysterols derived from mitochondrially-generated acetyl-CoA is ascribed to a loss of 3H in the citrate synthase reaction. The data showed that (1) fatty acids and 3-beta-hydroxysterols syntheses use the same pool of cytosolic acetyl-CoA; and (2) in the absence of an isotope effect in the citrate synthase reaction, mitochondrially-generated acetyl-CoA contributes about 36% to lipogenesis from acetate.

Pregnancy after medical management of a uterine arteriovenous malformation. A case report.

BACKGROUND: The natural history of conservatively managed uterine arteriovenous malformations is largely unknown, and the risks associated with subsequent pregnancy and vaginal delivery have not been established. CASE: A multiparous woman with a previously reported history of uterine arteriovenous malformation was monitored throughout pregnancy and vaginal delivery. Serial ultrasound studies were performed prior to a successful induction of labor for severe preeclampsia at 34 weeks' gestation. CONCLUSION: To our knowledge, this is the first report of pregnancy and vaginal delivery in a woman with a prior history of a medically managed uterine arteriovenous malformation. Noninvasive treatment of uterine arteriovenous malformations is rare, and the potential long-term risks of this approach, including pregnancy, remain uncertain.

Cultural elements of postpartum depression. A study of 327 Jewish Jerusalem women.

OBJECTIVE: To examine the social, cultural and religious factors underlying postpartum depression within a cultural cross-section of Jewish Jerusalem women. STUDY DESIGN: A prospective, repeated-measures study of 327 women. The Edinburgh Postpartum Depression Scale (EPDS) was administered immediately postpartum and 6-10 weeks later. Detailed sociodemographic information included perceptions of the pregnancy, community supports and religious affiliation. Odds ratios, 95% confidence interval and P values were calculated for all covariates. Multiple logistic regression was performed to estimate the degree of independent association between religiosity and postpartum depression. RESULTS: Postpartum depressive symptoms significantly associated with secular affiliation (odds ratio [OR] 2.9 [1.3-6.3] and tended toward an inverse association with orthodox affiliation (OR 0.6 [0.3-1.3]). Across secular, traditional, religious and orthodox groups, there was a decreasing trend in EPDS mean scores. Other predictors of depressive symptoms were psychiatric history, immigrant status and poor support with newborn care. CONCLUSION: Our study sample was particularly suitable for the assessment of cultural and religious elements of postpartum depression. We found religiosity, with its associated social and community structuring and well-defined social roles, to be significantly associated with self-reported postpartum depressive symptoms. These findings suggest that cultural factors, including role definitions, community support and rituals, may explain discrepancies found in the incidence of postpartum depression.

A C-arm fluoroscopy-guided progressive cut refinement strategy using a surgical robot.

We describe a new method to cut a precise, high-quality femoral cavity in Revision Total Hip Replacement surgery (RTHR) using a surgical robot and an intra-operative C-arm fluoroscope. With respect to previous approaches, our method contains several new features. (1) We describe a novel checkerboard plate designed to correct the geometric distortion within fluoroscopic images. Unlike previous distortion correction devices, the plate does not completely obscure any part of the image, and the distortion correction algorithm works well even when there are some overlaid objects in the field of view. (2) Also included are a novel corkscrew fiducial object designed to be integrated with the robot end-effector, and a 6D pose estimation algorithm based on the two-dimensional (2D) projection of the corkscrew, used in robot-imager registration and imager co-registration. (3) In addition, we develop a cavity location algorithm, which utilizes image subtraction and 2D anatomy contour registration techniques. (4) Finally, we propose a progressive cut refinement strategy, which progressively improves the robot registration during the procedure. We have conducted several experiments, in both simulated and in vitro environments. The results indicate that our strategy is a promising method for precise orthopedic procedures like total hip replacement.

Urinary incontinence after multiple gestation and delivery: impact on quality of life.

An anonymous 77-item urogenital symptom questionnaire was administered to 769 women with a history of previous multifetal gestation and delivery, including long forms of the Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI). IIQ and UDI scores were analyzed using univariate and multivariate regression to determine the impact of incontinence on quality of life (QOL). Mean age was 37 years (22-75), and nearly half [49.8% (365)] reported at least one type of incontinence. Higher mean UDI scores were reported by women with stress incontinence (SI) (12.3 vs 4.7, p=0.0001), urge incontinence (UI) (14.9 vs 5.7, p=0.0001), and mixed incontinence (15.1 vs 6.2, p=0.0001) compared to continent women. Similarly, higher mean IIQ scores were associated with SI (6.9 vs 1.9, p=0.0001), UI (9.4 vs 2.2, p=0.0001), and mixed incontinence (9.3 vs 2.7, p=0.0001). In conclusion, among "mothers of multiples," stress and urge urinary incontinence were associated with strongly adverse effects on QOL at a young age.

Oblique angled view for coracoid fractures.

In cases of shoulder injury when clinical signs suggest a possible coracoid fracture, a 20 degree posterior oblique film with 20 degrees of cephalad angulation has been shown to demonstrate coracoid fractures when other views have been inconclusive.

Computed tomography of axillary and supraclavicular adenopathy.

The normal cross-sectional anatomy of the axillary and supraclavicular regions is demonstrated. One hundred and sixty chest computed tomography scans were reviewed and criteria for differentiating normal axillary and supraclavicular structures from enlarged lymph nodes established. Axillary structures 14 mm or larger are suggestive of axillary adenopathy. Axillary structures 10-13 mm in size raise the possibility of adenopathy.

Absence of thoracic osteophytosis in the area adjacent to the aorta: computed tomography demonstration.

Computed tomography of the chest shows that right-sided unilateral thoracic osteophytosis is a common phenomenon. The cross-sectional images obtained appear to support the thesis that aortic pulsations have a preventive effect on the formation of left-sided osteophytes.

Calcified bodies in popliteal cysts: a characteristic radiographic appearance.

Calcified bodies in popliteal cysts have a characteristic radiographic appearance which can be confirmed by arthrography. Calcified bodies may arise in the true joint due to trauma, arthropathy resulting in joint destruction, or synovial osteochondromatosis. These calcified loose bodies may pass into a popliteal cyst through posterior joint-bursal communications or can arise in a popliteal cyst by chondrometaplasia. Correct radiographic interpretation will exclude soft tissue tumors and vascular lesions as differential considerations. Management of these patients will be determined by the clinical circumstances since neither popliteal cysts nor synovial osteochondromatosis are necessarily symptomatic.

Preoperative localization of nonpalpable breast lesions using a wire marker and perforated mammographic grid.

Preoperative wire localization of mammographically identified nonpalpable breast lesions is facilitated by using a perforated mammographic compression plate. This device is used in conjunction with a self-retaining wire, and its use results in accurate placement of the wire-marker tip in close proximity to the mammographically suspicious lesion. In 39 of 47 lesions, the wire tip was within 1.0 cm of the lesion, and in 45 of 47 lesions, the wire tip was within 1.5 cm of the lesion.

Pseudomyxoma peritonei: preoperative diagnosis by ultrasound and computed tomography. A case report.

Pseudomyxoma peritonei is an unusual condition caused by rupture of a mucinous neoplasm. Correct preoperative diagnosis can now be made by use of ultrasound and computed tomography.

Intrauterine small bowel entrapment and obstruction complicating suction abortion.

A patient is presented in whom small bowel obstruction occurred after a suction abortion. During the abortion the uterus was perforated and small bowel drawn into the uterus where it became entrapped and obstructed. The diagnosis and treatment are discussed.

Aluminum hydroxide gel bezoar--CT diagnosis.

An obstructing aluminum hydroxide gel bezoar was first recognized on a retrograde gastrografin study through an ileostomy. In retrospect, a computed tomographic (CT) scan had demonstrated the bezoar as a high density intraluminal mass surrounded by somewhat less dense contrast material distending the bowel. A CT image of a phantom made of aluminum hydroxide gel surrounded by gastrografin was remarkably similar.