Assessment of Pelvic Floor Muscle Exercise using Vaginal Cone in Stress Urinary Incontinence of Korea Women / 대한산부인과학회잡지

Defective or inadequate pelvic floor function is important etiologic factor for urinary stress incontinence and uterine prolapse. Pelvic floor muscle exercise is the mainstream of the nonoperative treatment for female stress urinary incontinence. Especially Vaginal cones have been known as a simple and practical means of improving both pelvic floor muscle strength and genuine stress incontinence using biofeedback mechanism. Forty adult women suffering from mild and moderate stress incontincnce were instructed to exercise their pelvic muscles using vaginal cones. They retained cones of increasing weight in the vagina by contracting pelvic floor muscles for 15 minutes twice a day for 4 weeks. The comparison of pelvic floor muscle function before and after the exercise were assessed by the frequency of incontinence, vaginal digital palpation, vaginal pressure measurement and speculm lift test. The results were as follows; 1. The frequency of incontinence was significantly reduced after the exercise using vaginal cone (P<0.001). 2. Vaginal digital palpation score (strength of vaginal levator muscle) was significantly increased after the exercise using vaginal cone (P<0.001). 3. The vaginal pressure by perineometer was significantly increased after the exercise using vaginal cones (P<0.001). 4. The vaginal lumen during contraction was significantly narrower after the exercise using vaginal cones (P<0.001). 5. The maximal cone weight which patients could hold over 1 minute was significantly increased after the exercise using vaginal cones (P<0.001).

Experimental animal model for preeclampsia by the infusion of nitric oxide synthase inhibitor and reverse of preeclampsia by high dose L-arginine infusion / 대한산부인과학회잡지

OBJECTIVES: To learn which inhibition of nitric oxide synthase with L-nitro arginine methylester(L-NAME) induces a preeclampsia-like syndrome in pregnant rabbits and high dose of L-arginine reverse the adverse changes induced by nitric oxide synthesis inhibition in pregnant rabbits. MTERIAL AND METHOD: Twenty Newzealand rabbits with 22-days of gestation were injected subcutaneously with 400mg of L-NAME for 7days and 100mg/kg L-arginine was also given intravenously 10 of 20 L-NAME injected pregnant rabbits. They are compared with the control group in which same volume of saline was subcutaneously injected to 5 rabbits with same condition. They were anesthesized by ketamine 50 mg/kg and roupum 2 mg/kg intramuscularly. Cutdown of femoral artery was performed and 22 gauge angioneedle was inserted. On manometer,three way catheter was connected, zeroed with saline, and blood pressure was read. Blood samples were taken from the vein of ear and checked for count of blood cells and bood chemistry (BUN/Cr, GOT/GPT, LDH, Uric acid). Urine protein was measured with nelaton catheterized urine. We injected drugs for 7 days begining on 22 days after mating and performed cesarian section to deliver fetus. To observe their effects on organs, lung, liver, placenta and kidney were taken and fixed with formalin. The sliced kidney tissue in thickness of 1 mm, was fixed with glutaraldehyde for electron microscopy and stored at 4degree C. Special staining was done for closed observation of pattern changes. For statistical analysis, mean+/-SEM was used. The control and experimental groups were compared by unpaired t-test and the differences were significant if probability level is less than 0.05(<0.05). RESULT: Mean blood pressure(MAP) in the experimental group I was significantly high compared to the control group(P<0.05). There was no significant differences in MAP between experimental group II and control group. Urine Protein, BUN, Cr, GOT/GPT, LDH, platelet count in the experimental group I was significantly high(p<0.05) compared to the control group. There was no significant difference between experimental group II and control group. In light microscopic examination, lung, liver, kidney, placenta showed specific finding in experimental group I. Misconstructive of glomerulus in the experimental kidney was well preserved under EM examination. Interstitium of kidney was widened by increase of mesangial matrix. Mild effacement of foot process and cytoplasm of proximal tubule containing electron dense myelin figure like structure were observed. CONCLUSION: Long term injection of L-arginine analogue produced preeclampsia like syndrome and pathologic changes of organ system in pregnant rabbits. Concurrent high dose of L-arginine reversed such chages.