Effects of therapeutic lifestyle changes on peripheral artery tonometry in patients with abdominal obesity.

BACKGROUND AND AIMS: Abdominal obesity (AO) is associated with endothelial function (EF) alteration and increased global cardiovascular (CV) risk. Therapeutic lifestyle changes (TLSC) reduce CV risk, but the impact on EF assessed by peripheral artery tonometry (PAT) is unknown. In this study, we aimed to prospectively assess the effects of TLSC on EF measured by PAT in increased CV risk patients with AO. METHODS AND RESULTS: 150 patients with AO and moderate CV risk were randomized to groups receiving a one-year intervention of either conventional medical care (control group, CG) or an intensive TLSC program (intervention group, IG). Vascular studies (EF by PAT, intima-media thickness (IMT)) and lifestyle (LS) assessment were performed before and after intervention. The PAT ratio improved in the IG and worsened in the CG. The global CV risk was reduced (P = 0.017) in the IG due to a significant decrease in systolic blood pressure (P < 0.001), increase in HDL cholesterol and ApolipoproteinA1 (P = 0.013). More individuals in the IG than in the CG quit smoking (P = 0.001) and increased their physical activity (P = 0.014). The improvement in at least two LS components was associated with a PAT ratio increase (2.44 IC: 95% 0.99-6.00, P = 0.051). The PAT ratio increase determined less IMT progression (-1.1 IC: 95% 0.91-1.00, P = 0.053). CONCLUSIONS: Good adherence to a TLSC program reduces global CV risk and determines PAT ratio improvement. The PAT ratio increase is the main determinant of lower IMT progression.

Expulsión vaginal de los miomas tras la embolización de las arterias uterinas / Vaginal myoma expulsion following uterine artery embolization

Presentamos 2 casos de expulsión de un mioma por vía transcervical después de la embolización de las arterias uterinas, como tratamiento primario del mioma --con lo que se obtuvo una mejoría de la sintomatología de las pacientes--, así como el seguimiento posterior realizado por histeroscopia y resonancia magnética

We present 2 cases of spontaneous transcervical expulsion of myoma after uterine artery embolization as a primary treatment of leiomyomata, which produced symptom improvement. Subsequent follow-up was performed with hysteroscopy and magnetic resonance imaging

Programa de adiestramientoy resultados en la inserciónhisteroscópica dedispositivos para laesterilización tubáricapermanente / Training program and results of hysteroscopic insertion of devices for permanent tubal sterilization

Objetivos: Evaluar la metodología utilizada para aprender la técnica de inserción de los dispositivos Essure®, antes de proceder a su colocación, en mujeres que deseaban un método contraceptivo permanente. Sujetos y métodos: En una primera fase, el adiestramiento comenzó con sesiones teoricoprácticas de manejo del material, utilizando maquetas uterinas de plástico. En la segunda fase, se insertaron los dispositivos a 6 pacientes que iban a ser sometidas a una histerectomía por enfermedad benigna. En una tercera fase, se procedió a la inserción de los dispositivos a 25 mujeres voluntarias, en el marco de un ensayo clínico multicéntrico de fase II. Resultados: Se consiguió la inserción correcta de ambos dispositivos en 23 de las 25 participantes (92 por ciento). Las únicas complicaciones fueron dos reflejos vagales (8 por ciento) que no precisaron ingreso hospitalario. No se objetivó ningún embarazo. Conclusión: El elevado porcentaje de inserciones satisfactorias, el escaso número de complicaciones y la efectividad del método como contraceptivo demuestran la eficacia del entrenamiento efectuado (AU)

Apoyo psicológico en mujeres que se someten a histerectomía / Psychological support in women for undergoing an hysterectoomy

El objetivo de este estudio fue comprobar en qué medida el apoyo psicológico es efectivo para preparar a mujeres que se someten a histerectomía abdominal. La muestra se compuso de 30 pacientes que fueron repartidas al azar en dos grupos: experimental y control. Se emplearon técnicas de counselling y se proporcionaron habilidades y estrategias de afrontamiento del estrés como respiración profunda, relajación y visualización. Los resultados indicaron que las mujeres del grupo experimental respecto a las del grupo control, padecieron menos ansiedad, depresión y rebajaron sus preocupaciones durante el proceso quirúrgico y dos meses después del alta, pero además padecieron menos dolor, consumieron menos analgésicos y se acortó su estancia hospitalaria.La conclusión que se desprende de este estudio es que la técnica de apoyo psicológico diseñada es eficaz para mejorar la recuperación de estas pacientes, tanto a nivel físico como psicológico durante la hospitalización, y para facilitar la reincorporación a su vida cotidiana (AU)

Ruptura espontánea de las venas útero-ováricas durante la gestación / Spontaneous rupture of uterine-ovarian veins during gestation

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Patterns of regular drug use in Spanish childbearing women: changes elicited by pregnancy.

OBJECTIVE: To determine drug use in Spanish women before pregnancy and from conception to the awareness of pregnancy (early period of pregnancy, EPP), as well as to analyse attitudinal changes when pregnancy was planned or known. METHODS: Trained gynaecologists used a structured questionnaire to collect demographic and obstetric characteristics, histories of regular drug taking before pregnancy, attitudes towards drug taking during pregnancy and current drug use in the EPP. Women were interviewed at their first antenatal visit during the first trimester. RESULTS: Two hundred and seventy-two women were included (mean age 29.3 years and 66.3 days of gestation). Before pregnancy, 24% regularly took drugs, 70% of them more than twice a week; a significantly higher frequency was found in those receiving public antenatal care and in those who had had less education. In 39% of women, awareness of pregnancy did not change their attitudes towards regular drug use. Among those who decided to suppress their regular drug intake, 58% did so when their pregnancy was confirmed and 42% when they planned it. In women who planned their pregnancy, 30.1% stopped when they tried to become pregnant. However, 62% of all women took drugs during the EPP. In private antenatal care significantly more drugs were taken per patient. By the 168 women 278 compounds were consumed during the EPP: 40% were analgesics (mainly paracetamol and acetylsalicylic acid) and 25% were digestive and metabolic drugs (mainly antacids and laxatives). Drugs were often used more than twice a week, particularly in women receiving public antenatal care and in those who had had less education. CONCLUSION: Drug taking is common in Spanish women of childbearing age, and many of those in our study did not decide to stop during the EPP. Few women avoid drugs when planning a pregnancy. Therefore, gynaecologists must advise against drug taking in patients who wish to become pregnant and suggest that unnecessary drug use be avoided when the pregnancy is already diagnosed.

[The effect of pregnancy on the consumption of tobacco and alcohol]. / El embarazo como factor modulador del consumo de tabaco y alcohol.

OBJECTIVES: To determine if the knowledge of pregnancy modifies smoking and drinking habits and if some socio-demographic variables exert any influence in these changes. DESIGN: Descriptive observational study with a sectional design (prevalence study). SETTING: Obstetric service of a Spanish general hospital, and also three private centres in the same area. PARTICIPANTS: 271 women (mean age of 29 years) under 14 weeks of gestation (mean of 9 weeks) who attended to their first gynaecology visit and accepted to participate in the study. INTERVENTIONS: By means of direct interview to women, investigators filled a questionnaire with demographic characteristics, obstetric data, smoking and drinking habits and changes in these habits as a response to their pregnancy were also recorded. MEASUREMENTS AND MAIN RESULTS: Almost eighty percent of them planned their pregnancy, and 14.8% were using some contraceptive method when they became pregnant. Before learning of their pregnancy most of the women smoked cigarettes (53.5%), and a low proportion consumed alcohol at meals (20.3%) or between meals (10.7%). After knowledge of their pregnancy, 46.9% of smokers, 56.4% of drinkers during meals, and 86.2% of drinkers between meals, stopped these habits. Those women who smoked fewer cigarettes showed a higher capacity to stop consumption. It was also observed that those who gave up drinking at meals were those who drank less alcohol and who had no university degree. CONCLUSIONS: A high prevalence of smoking among fertile women was observed, although an important proportion of them stopped this consumption after learning about their pregnancy. This change was less frequent among the heavy smokers. Consequently, the establishment of specific programs for encouraging abstinence of alcohol and cigarette consumption in several population groups as described, could be recommended.

Effect of inclusion of sugar beet pulp, pelleting and season on laying hen performance.

1. The effect of three metabolisable energy (ME) concentrations 12.2, 11.3 and 10.5 MJ ME/kg and two forms of diet (mash and pellet) on egg production in summer and winter were studied. The different ME values were obtained by diluting the 12.2 MJ ME/kg diet with sugar beet pulp of 2.88 MJ/kg DM. In a 3rd summer experiment the water intake of hens on these diets was examined. Data were analysed by factorial analysis of variance, and the relationship between performance and dietary energy concentration was examined by regression analysis. 2. The use of low energy diets (10.5 to 11.3 MJ ME/kg) decreased egg production in both seasons, but pelleting diets improved egg production and egg weight in summer. Egg weight was not affected by energy density in winter, but decreased in the summer when energy density increased. 3. In winter, food consumption was not affected by the dietary ME, while in summer food consumption increased when the dietary ME increased. Therefore, energy intake was not the same at all energy densities, but tended to increase as the energy density increased. 4. In summer, pelleting improved food efficiency and egg production and increased water consumption and the ratio of water to food intake. Water intake and water: food ratio decreased with increasing dietary energy concentration.

Complications of Operative Hysteroscopy

We conducted a retrospective study of 324 operative hysteroscopies performed from January 1993 to December 1995 to evaluate and analyze possible complications. Our complication rate was 5.2%, with uterine perforation being the most common at 1.8%. We had no cases of water intoxication.