Adherence to dietary guidelines and risk of dementia: a prospective cohort study of 94 184 individuals.

AIMS: Recent estimates suggest that 40% of dementia cases could be avoided by treating recognised cardiovascular risk factors such as hypertension, diabetes, smoking and physical inactivity. Whether diet is associated with dementia remains largely unknown. We tested if low adherence to established dietary guidelines is associated with elevated lipids and lipoproteins and with increased risk of Alzheimer's disease and non-Alzheimer's dementia ­ a dementia subtype with a high frequency of cardiovascular risk factors. METHODS: We used the prospective Copenhagen General Population Study including 94 184 individuals with dietary information and free of dementia at baseline. Mean age at study entry was 58 years, and 55% (N = 51 720) were women and 45% (N = 42 464) were men. Adherence to dietary guidelines was grouped into low, intermediate and high adherence based on food frequency questionnaires. Main outcomes were non-Alzheimer's dementia and Alzheimer's disease. RESULTS: Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and plasma triglyceride levels were higher in individuals with intermediate and low adherence to dietary guidelines compared with individuals with high adherence (all p for trends <0.001). Age and sex-adjusted hazard ratios (HRs) for non-Alzheimer's dementia v. individuals with high adherence were 1.19 (95% confidence interval 0.97­1.46) for intermediate adherence, and 1.54 (1.18­2.00) for low adherence. Corresponding HRs in multivariable-adjusted models including APOE genotype were 1.14 (0.92­1.40) and 1.35 (1.03­1.79). These relationships were not observed in individuals on lipid-lowering therapy. CONCLUSIONS: Low adherence to national dietary guidelines is associated with an atherogenic lipid profile and with increased risk of non-Alzheimer's dementia ­ the subtype of dementia with a high frequency of vascular risk factors. This study suggests that implementation of dietary guidelines associated with an anti-atherogenic lipid profile could be important for prevention of non-Alzheimer's dementia.

Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes.

AIMS: To determine the progression of diabetic retinopathy in pregnant women with diabetes offered tight glycaemic and blood pressure control. METHODS: A prospective study of 102 (87%) out of 117 consecutive pregnant women with Type 1 diabetes for median 16 years (range 1-36) and HbA(1c) 6.7% (4.9-10.8) in early pregnancy. Fundus photography was performed at 8 and 27 weeks. Retinopathy was classified in five stages. Diabetic macular oedema was classified as present in a mild form or as clinically significant macular oedema (CSMO). Progression was defined as at least one stage of deterioration of retinopathy and/or development of macular oedema in at least one eye. Sight-threatening progression was defined as loss of visual acuity>or=0.2 on Snellen's chart or laser treatment performed during pregnancy due to proliferative retinopathy or CSMO. RESULTS: Diabetic retinopathy was present at inclusion in at least one eye in 64 (63%) women and proliferative retinopathy and macular oedema were present in nine and 16 women, respectively. Progression of retinopathy occurred in 28 (27%) women. Sight-threatening progression occurred in six women; in three, visual acuity deteriorated and four required laser treatment. Sight-threatening progression was associated with presence of macular oedema (P=0.007), impaired visual acuity (P=0.03) and higher blood pressure (P=0.016) in early pregnancy, but not with HbA1c, decline in HbA1c, or prevalence of severe hypoglycaemia. CONCLUSIONS: Loss of visual acuity and the need for laser treatment during diabetic pregnancy remain clinical problems associated with presence of macular oedema, visual impairment and higher blood pressure in early pregnancy.

[Vaginal hysterectomy in non-prolapsed uterus]. / Vaginal hysterektomi ved ikke-prolaberet uterus.

AIM OF STUDY: To describe the results of vaginal removal of the non-prolapsed uterus in women conventionally operated on abdominally or with the assistance of laparoscopy. MATERIAL AND METHODS: At the departments of gynaecology, Herning Central Hospital and Holstebro Central Hospital, approximately one third of all hysterectomies are performed vaginally. All records of women, who had had a vaginal hysterectomy on a non-prolapsed uterus over a nineteen-month period, were reviewed retrospectively. Women, who had additional surgery, were excluded. RESULTS: One-hundred and thirteen patients entered. In one patient (1%) the vaginal hysterectomy was converted to an abdominal one. One fourth of the women had a uterus weighing more than 200 grams. The median operation time was 58 minutes; 73% bled less than 200 ml. Half of the women were discharged from hospital on the third postoperative day or earlier; 90% on the fifth postoperative day or earlier. During operation three accidental bladder lesions occurred, and four women needed an additional haemostatic operation. Postoperatively, 10 women (9%) suffered from a haematoma or an abscess in the vaginal vault. CONCLUSIONS: Vaginal hysterectomy on the non-prolapsed uterus is an operation that should be offered to a large group of women, who today are operated on abdominally or with laparoscopic assistance. The operation is quick and the patients are discharged after a few days. No advanced equipment is needed. Some women will, however, suffer from a haematoma in the vaginal vault.

Adenocarcinoma of the small intestine mistaken as a primary ovarian cancer.

A case of primary adenocarcinoma of the small intestine metastazing to the ovary is described. The patient was erroneously thought to suffer from a primary ovarian malignancy. To avoid unnessessary surgery, severe gastrointestinal symptoms in a patient thought to have an ovarian cancer should warn the surgeon against a possible gastrointestinal cancer.

[Feeling of illness after hysterectomy. Women's own assessment]. / Sygdomsfølelse efter hysterektomi. Kvindernes egen vurdering.

INTRODUCTION: The aim of the study was to investigate the time interval from the operation to no feeling of illness at all in a population of women, who had undergone a total abdominal or vaginal hysterectomy. MATERIAL AND METHODS: Data on 361 women who had had a total abdominal or vaginal hysterectomy during the period, 1.1.1998 to 31.3.1999 were collected from a regional database. Those born before 1.1.1940, presented with a genital malignancy, had a diagnosis of genital prolapse, or received surgery in addition to the hysterectomy were excluded. Four months after the hysterectomy, all the women were sent a questionnaire asking about the time of returning to work and the complete absence of any feeling of illness. This information was related to selected perioperative data. Women who had had a total abdominal hysterectomy were not statistically comparable with those who had had a vaginal hysterectomy. RESULTS: A total of 313 women participated (87%). After a total abdominal hysterectomy, 92%, 80%, and 35% had a subjective feeling of illness at four, six, and ten weeks, respectively. The median duration of feeling ill was nine weeks. The figures after a vaginal hysterectomy were 85%, 71%, and 18%, with a median duration of feeling ill of seven weeks. Only peroperative blood loss and the presence of postoperative complications related statistically to the duration of feeling ill. CONCLUSION: The interval between the operation and no feeling of illness at all after a total abdominal or vaginal hysterectomy is longer than was formerly believed. Further investigation is recommended.

[Cancer of the endometrium following radiotherapy of cervical cancer]. / Endometriecancer udviklet efter strålebehandlet cervixcancer.

We describe three cases of women who have been treated with radiotherapy for cervical cancer and then many years later develop cancer of the uterine endometrium. Apparently there may be active endometrium left in the uterus after radiotherapy, for which reason we recommend combined hormone therapy with oestrogen and progesterone.

[Premenopausal vulvar basocellular carcinoma]. / Praemenopausalt basocellulaert karcinom i vulva.

A case of vulvar basocellular carcinoma in a 49-year-old woman is presented. The treatment of choice is local excision and the prognosis in general is excellent. The importance of taking biopsies from atypical vulvar lesions is underlined.

A preliminary description of responses of free-ranging rhesus monkeys to brief capture experiences: behavior, endocrine, immune, and health relationships.

A cohort of free-ranging rhesus monkeys has been followed since birth in 1994 on the island of Cayo Santiago, Puerto Rico. At 3 years of age, subjects were trapped and blood samples were collected after capture and prior to release the following day. Blood samples were processed for natural cytotoxicity toward xenogeneic tumors, phenotyping, and plasma hormones. Intestinal parasites were determined from fresh stool samples collected during trapping. Data were also available from the previous year for antibody titers to latent viruses prevalent in this population. Behavioral traits of each monkey were characterized using a previously developed trait scale for rhesus monkeys. Natural cytotoxicity toward both K562 and Raji targets declined from capture until release the following day. Plasma cortisol rose and plasma prolactin and growth hormone fell during the period of captivity; a rise in insulin was significant. It was expected that individual differences in behavioral traits might predict immune and hormone levels at the time of capture or changes in these parameters during the capture period. Although behavioral adjectives tended to cluster along three orthogonal dimensions (Insecurity, Irritability, and Sociability), they bore no relationship to the physiological parameters collected acutely (in vitro immune and endocrine parameters). The individual difference markers of gender and maternal rank were not related to the magnitude of the observed changes in these in vitro parameters, either. However, an in vivo measure (CMV titer) was related to individual differences in Irritability. It was concluded that the magnitude of the stress associated with capture overwhelmed the individual difference effects.

Histocompatibility antigen studies in women with recurrent miscarriages and Müllerian uterine anomalies.

OBJECTIVE: To determine whether the HLA alleles DR1, DR3, DR4 and DR10 which have been suggested to be risk markers for unexplained recurrent miscarriages also play a part in women with recurrent miscarriages with Müllerian uterine fusion anomalies. STUDY DESIGN: HLA-DR typing was undertaken in 28 women with recurrent miscarriage who had been surgically treated for Müllerian anomalies and in 360 controls. In the study group, outcome of pregnancies after surgery was correlated to the results of the HLA typing. RESULTS: In the study group, 61% were positive for HLA-DR1, -DR3, -DR4 or -DR10 compared with 65% of the controls (not significantly different). Among patients positive for these HLA risk markers, 64% of the pregnancies after surgery miscarried compared with 13% in those negative (P<0.005, RR for miscarriage=4.8, 95% CI= 1.3-18.0). CONCLUSION: The proposed risk HLA markers for unexplained recurrent miscarriage also seem to display a negative impact on pregnancy outcome in patients with recurrent miscarriages with Müllerian uterine anomalies.

[Prolapse of the salpinx after hysterectomy]. / Salpinxprolaps efter hysterektomi.

Prolapse of the fallopian tube through the vaginal vault is a rare, but possible complication after hysterectomy, and a tubal prolapse may be mistaken as granulation tissue or an adenocarcinoma. A possible treatment is vaginal extirpation with simultaneous laparoscopy. A case is presented and the relevant literature is reviewed.

[Violence towards pregnant women]. / Vold mod gravide.

The current literature concerning violence against pregnant women is reviewed. The prevalence of battering during pregnancy is estimated to be between one and ten percent, and the problem is most often hidden from the medical staff. In one fourth of the cases, violence increases during pregnancy, and usually the violent episodes are a continuation of the couple's habitual way of life. An episode of battering per se is only in extreme situations dangerous for the pregnancy, but serves as a marker of negative social events, e.g. unemployment, smoking, emotional instability etc., which increases the risk of an adverse pregnancy outcome. Furthermore, the violent husband may extend the battering to the child after delivery. It is concluded, that all medical personnel dealing with pregnant women should be aware of the high prevalence of battering during pregnancy. If battering is detected, the pregnancy may be at risk, but the main problem is the social issue and the later consequences for the child. The general practitioner is central in the long-term approach to these cases.

The possible role of ultrasound in early cervical cancer.

The value of preoperative ultrasonography to detect lymph node metastases in patients with early cervical carcinoma (stage IB-IIA) was investigated in 111 patients. Comparison was made between ultrasound and the operative histopathologic findings in 109 patients and with fine-needle biopsy in 2 patients. The positive predictive value was 71%, and the negative predictive value was 84%. Sensitivity was 23%, specificity was 98%. Lymph node metastases were found in 19% (21 patients) by operative histopathologic examination; these patients received subsequent radiotherapy. The rest, 92 patients with no lymph node metastases at Meigs' operation, were followed by abdominal and transvaginal ultrasonography as well as clinical examination at 6, 9, 12, 18, 24, 36, and 48 months postoperatively to detect recurrences. The recurrence rate was 9.8%. Ultrasound alone detected only one recurrence in an asymptomatic patient. We conclude that ultrasonography is not reliable in the preoperative detection of lymph node metastases. Moreover, ultrasound examination presents no advantage over clinical examination in early detection of asymptomatic recurrent cervical cancer after radical hysterectomy.

A comparison of survival and side effects in two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa.

The study compares survival and complications during two periods with a different approach to radical hysterectomy as treatment of cervical cancer stages Ib and IIa. Group A included 128 patients operated during the years 1983-87. In that period 5 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Group B included 135 patients operated during the years 1988-91. In that period 7 of the patients who were offered radical hysterectomy had cervical cancer stage IIa. Considering stage 1b separately, the frequency of operation was raised from 52 (123/237) to 87% (128/148). A 5-years crude survival rate of 85% and 88% was observed in the two groups. The mortality rate was zero in both periods and no fistulae occurred. There were no significant increase in morbidity or length of hospitalization. In the elderly patients over sixty years a significant increase in minor postoperative complications and hospitalization more than 2 weeks were seen. The conclusion is that the frequency of radical hysterectomy as treatment of cervical cancer stage Ib can be raised from 52% to 87% without any noticeable influence on survival or complication rate.

Coecal volvulus following caesarean section.

A case of coecal volvulus following caesarean section is reported. The importance of knowing the possibility of intestinal obstruction during pregnancy and puerperium is underlined.

[Effect of uterine fibromas on pregnancy]. / Uterusfibromers betydning for graviditetsforløbet.

The recent published journal reports concerning the influence of uterine myomas on pregnancy are reviewed. The prevalence of uterine myomas in pregnancy is 0.1-5%, and less than half of the cases can be diagnosed by clinical investigation alone. The previous belief that continuous growth of myomas occurs during pregnancy seems incorrect. Most myomas grow during the first trimester, whereafter only few continue to enlarge. The most often recognized complication during pregnancies with uterine myomas is abdominal pain. About ten percent will suffer from this. Treatment is with non-steroidal anti-inflammatory drugs, which are extremely effective. In resistant cases epidural blockade may be used. Placental abruption is possibly more common among women with myomas that have direct contact to the placenta, and there is a trend towards shorter pregnancies in women with myomas. Further investigation on these subjects is required. No other complications are consistently reported more frequently among women with myomas than among those without. Myomectomy during pregnancy should only be performed in extreme cases. The value of myomectomy before conception to avoid pregnancy complications is doubtful, if no other pathology is present.

[Long-term prognosis for women with chronic pelvic pain without laparoscopically demonstrable cause]. / Langtidsforløbet hos kvinder med kroniske underlivssmerter uden laparoskopisk påviselig årsag.

With the object of assessing the long-term prognosis and the frequencies of recurrence and remission in women chronic low abdominal pain without laparoscopically visible cause, questionnaire were sent in 1985 and 1991 to 55 women who had been submitted to laparoscopy in 1982-1984 for this reason. These women had been told that there was no demonstrable explanation of the pain experienced and were then discharged. 65% and 55% respectively had experienced and unfavourable course with considerable and continued symptoms. Only 22% stated in both investigations that they had experienced a favourable course and that they were, by and large, free from pain. 36% changed from an unfavourable to a favourable course or the reverse. The assessment made by the women was confirmed by a series of subordinate questions and this demonstrated a marked difference between the favourable and unfavourable courses of the condition. It is concluded that laparoscopy with exclusion of significant pathology is not, in itself, satisfactory as treatment of this patient group and that no improvement occurs in the course of time. The condition varies greatly with many recurrences and remissions and, for this reason, uncontrolled reports of the therapeutic effects are of no significance. When compared with the literature, it is suggested that this patient group should be referred early in the course of the condition to a therapist with specialist psychological/sexological insight and/or to a physiotherapist with interest in this patient group.