Vaginal evisceration 3 years after abdominal hysterectomy and bilateral salpingo-oophorectomy.

Vaginal evisceration after a pelvic operation is a rare gynecological emergency. When intercourse is the cause, most cases occur within 1 year of surgery. A 53-year-old woman presented to the emergency room for vaginal evisceration half a day after the first postoperative occurrence of intercourse 3 years after an abdominal hysterectomy and bilateral salpingo-oophorectomy. In an emergency laparotomy, the protruding small bowel was replaced within the abdominal cavity. The avulsed vaginal cuff, which measured 6 cm in length and had atrophic but non-necrotic margins, was sutured. Women who go for long periods without intercourse after a hysterectomy, especially post-menopausal women, should be made aware of unrecognized vaginal atrophy that could, in some cases, lead to rupture and evisceration during the next occurrence of intercourse.

Postpartum maternal pneumococcal meningitis complicated by endocarditis.

Bacterial meningitis is associated with high morbidity and mortality. Few cases of pneumococcal meningitis during pregnancy and the postpartum period have been reported. We describe a case of postpartum pneumococcal meningitis complicated by endocarditis. A 26-year-old para-2 woman who had had a normal vaginal delivery at 38 weeks at a maternity home was transported to our hospital with a 39.5°C fever 11 days postpartum. Eight hours after her arrival, her state of consciousness deteriorated rapidly. Lumbar puncture revealed Gram-positive cocci consistent with Streptococcus pneumoniae. She was immediately treated with antibiotics and subsequently diagnosed with endocarditis. Final culture results from the blood and cerebrospinal fluid confirmed the presence of S. pneumoniae. She recovered completely with no evidence of neurological damage. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential to reducing the morbidity and mortality associated with bacterial meningitis.

Impact of dietary intake, education, and physical activity on bone mineral density among North Indian women.

The aim of the study was to determine the relationship of dietary nutrients and bone mineral density (BMD) in North Indian women. This cross-sectional study was conducted from April 2006 to March 2008. Subjects included 255 healthy women, aged 20-69 years, who were relatives of patients being admitted in the hospital. Various demographic characteristics including socioeconomic status and serum parameters in relationship to BMD were evaluated. In addition, the daily dietary intake of energy, protein, fat, and calcium and the amount of physical activity were assessed. BMD at the lumbar spine, femoral neck, and Ward's triangle was measured by dual-energy X-ray absorptiometry (DXA). Body mass index (BMI), physical activity, and educational level were positively correlated with BMD. The daily intakes of energy (1563.4 +/- 267.2 kcal) and protein (48.7 +/- 8.7 g) were below the recommended dietary allowance. Daily dietary energy, protein, and calcium intakes were correlated with BMD at the lumbar spine. Stepwise multiple linear regression analyses showed that age, BMI, and physical activity were significant predictors for BMD at all sites. In addition, energy intake was also a predictor for BMD at the lumbar spine. The protein intake was associated with BMD at the spine (P = 0.02 and beta = 0.163) even after making adjustments for energy intake. Thus, dietary pattern coupled with higher education levels and greater physical activity favored bone health.

Age-related distribution of bone and skeletal parameters in 1,322 Japanese young women.

We explored factors that could serve as indices for therapeutic intervention aimed at prevention of osteoporosis. In this cross-sectional study, we investigated the timing of peak bone mass (PBM) in 1,322 Japanese women aged 12-30 years old. We measured height, body weight, bone mineral density (BMD), bone mineral content (BMC), and bone area at the lumbar spine and total hip, as well as the blood markers calcium, phosphorus, and the bone metabolic markers bone alkaline phosphatase (BAP) and type I collagen cross-linked N-telopeptide (NTX). All measurements were standardized with the mean at age 18 defined as 100% to identify age-related differences. In the total hip, BMD peaked at age 18, while, in the lumbar spine, BMD peaked at age 29, of which 99.8% was attained at age 18, suggesting that peak BMD was attained at age 18 at both the total hip and lumbar spine. No age difference was observed in serum calcium, while there was a 15.1% decrease between ages 12 and 18 in serum phosphorus. There were 273.8% and 208.5% decreases in serum BAP and NTX, respectively, between ages 12 and 18, while these levels remained constant thereafter, suggesting that bone and calcium metabolism are constant between ages 19 and 30. Factors that had stronger correlations with BMD, BMC, and bone area from 12 years to 18 years were height and body weight. PBM was reached at age 18. Control of body weight by using total hip BMD as an index for intervention should be reasonable.

The impact of lifestyle factors on serum 25-hydroxyvitamin D levels: a cross-sectional study in Japanese women aged 19-25 years.

Insufficient levels of serum 25-hydroxyvitamin D [25(OH)D] lead to low bone mineral density (BMD) by increasing serum levels of intact parathyroid hormone (PTH), and are associated with a high mortality rate. Therefore, the 25(OH)D level is used as an indicator of frailty in older persons. To obtain higher serum 25(OH)D levels, management of lifestyle habits and nutrient intake is important beginning in a person's younger years. This study evaluated the degree of association between serum 25(OH)D concentrations and lifestyle factors in young Japanese women. A cohort study was conducted from December 2003, and the survey was finished by February 2004. The subjects were 274 Japanese women aged 19-25 years old. The parameters evaluated in these subjects included: (1) serum concentrations of 25(OH)D, intact PTH, calcium, and phosphorus; (2) BMD in the lumbar spine and hip; and (3) lifestyle factors (nutrient intake, physical activity, and duration of sunlight exposure). The serum 25(OH)D level was negatively associated with the intact PTH level (Spearman; r = -0.17, P = 0.006). The BMD was significantly higher in the high 25(OH)D and low intact PTH group than the other group (P < 0.05). The serum 25(OH)D level was significantly correlated with daily intake of dietary vitamin D (r = 0.20, P = 0.001), the mean number of steps taken per day (r = 0.16, P = 0.010) and the mean time spent in sedentary activity (r = -0.14, P = 0.018) among the lifestyle factors evaluated. Multiple regression analysis showed the degree of association between lifestyle factors and serum 25(OH)D to be small (R (2) = 0.084). Daily intake of dietary vitamin D and daily walking may be useful for increasing the serum 25(OH)D level in young Japanese women.

Influence of maternal genetic and lifestyle factors on bone mineral density in adolescent daughters: a cohort study in 387 Japanese daughter-mother pairs.

We conducted a cross-sectional study in a cohort of Japanese adolescent schoolgirls (12-18 years of age) and their mothers (387 pairs). Age, lumbar bone mineral density (BMD), birth and menarche-related status, height, body weight and lifestyles were surveyed in the participants. The values of BMD, height and body weight were converted to standard deviation (SD) by age. There were 49 (12.7%) pre-menarche and 338 (87.3%) post-menarche daughters. BMD-SD, height-SD, vitamin D intake and vitamin K intake were significantly correlated between the pre-menarche daughters and mothers (P < 0.05), while BMD-SD, birth weight, age at menarche and all lifestyle-related factors were significantly correlated between the post-menarche daughters and mothers (P < 0.05). BMD-SD in the pre-menarche daughters was affected by BMD-SD in mothers (R (2) = 0.069, P = 0.033) and their own height-SD (R (2) = 0.199, P = 0.001) (model R (2) = 0.340), independently. BMD-SD in the post-menarche daughters was affected by BMD-SD in mothers (R (2) = 0.073, P < 0.001) as well as by their own age at menarche (R (2) = 0.020, P = 0.001), height-SD (R (2) = 0.022, P < 0.001), body weight-SD (R (2) = 0.081, P < 0.001) and intensity of exercise (R (2) = 0.015, P = 0.045) (model R (2) = 0.372), independently. The results suggest that BMD is strongly correlated between daughters and mothers and that a greater age at menarche leads to lower peak bone mass. It was also suggested that maintaining high-intensity physical activity and adequate body weight is important in achieving maximum BMD as factors amenable to intervention in post-menarche daughters.

Peripheral arterial thrombosis induced by chemotherapy in ovarian carcinoma coexisted with endometrial carcinoma.

INTRODUCTION: Most patients with peripheral arterial occlusion have underlying atherosclerosis. Peripheral arterial thrombosis induced by chemotherapy in gynecological malignancies is rare. CASE REPORT: A 60-year-old woman was diagnosed with ovarian carcinoma coexisting with endometrial carcinoma after surgical histopathological examination. Chemotherapy was started on postoperative day 11. On day 2 of chemotherapy, she developed bilateral lower extremity cyanosis. Thrombocytopenia due to chemotherapy was diagnosed and treated with repeated platelet transfusions. Anticoagulant therapy was also continued. However, the patient worsened steadily and died of liver dysfunction due to multiple liver metastases. CONCLUSION: Although arterial thrombosis induced by chemotherapy is rare, it is important for physicians to consider this possibility in the course of treatment with cytotoxic agents because this complication has serious health implications.