Evaluation of the NovaSure endometrial ablation procedure in women with uterine cavity length over 10 cm.

OBJECTIVE: To evaluate procedure-related adverse events, post-procedure menstrual bleeding status, and surgical re-intervention in women with a sounded uterine length > 10 cm compared to women with a sounded uterine length ≤ 10 cm who underwent the NovaSure endometrial ablation procedure. METHODS: We conducted a retrospective cohort study of 188 women from a Canadian community-based gynaecology practice. Eighty-seven women had a sounded uterine length > 10 cm, and 101 patients had a sounded length ≤ 10 cm. Procedure-related adverse events, post-procedure menstrual bleeding status, and surgical re-interventions were compared between groups. RESULTS: Mean uterine sounding lengths were 11.0 ± 0.6 cm and 8.9 ± 0.8 cm in the > 10 cm and ≤ 10 cm groups, respectively. There were no differences between the groups in demographic characteristics or gynaecologic history, with the exception of higher BMI in the > 10 cm group and a greater prevalence of dysmenorrhea in the ≤ 10 cm group. Overall, 44.1% of all participants had been unsuccessfully treated with hormonal therapy, and 20.7% had failed non-hormonal treatment before the ablation procedure. The remaining 35.2% of participants had declined alternative therapy and proceeded directly to endometrial ablation. No serious procedure-related adverse events occurred in either group. Menstrual bleeding status at follow-up at 30.4 ± 15.3 months (> 10 cm group) and 30.5 ± 15.5 months (≤ 10 cm group) was not different between the groups (P = 0.85). In women who did not undergo surgical re-intervention after the initial ablation, amenorrhea was reported by 51.9% in the > 10 cm group and 65.9% in the ≤ 10 cm group. CONCLUSION: The NovaSure endometrial ablation procedure was associated with successful menstrual bleeding outcomes in women with sounded uterine length > 10 cm. No serious procedure-related adverse events occurred, and the need for surgical re-intervention was low. There was no significant difference in bleeding rates between the > 10 cm and ≤ 10 cm uterine length cohorts.

Objectif : Comparer, chez des femmes ayant subi une ablation de l'endomètre au moyen de la technique NovaSure et présentant une longueur utérine déterminée par hystérométrie de plus de 10 cm ou de 10 cm ou moins, les événements indésirables associés à l'intervention, l'état des saignements menstruels à la suite de l'intervention et la nécessité de procéder à une nouvelle intervention chirurgicale. Méthodes : Nous avons mené une étude de cohorte rétrospective qui portait sur 188 femmes ayant fréquenté une pratique gynécologique communautaire au Canada. Quatre-vingt-sept de ces femmes présentaient une longueur utérine déterminée par hystérométrie de plus de 10 cm, tandis que les 101 autres présentaient une longueur utérine déterminée par hystérométrie de 10 cm ou moins. Les événements indésirables associés à l'intervention, l'état des saignements menstruels à la suite de l'intervention et la nécessité de procéder à une nouvelle intervention chirurgicale sont les paramètres qui ont été comparés chez ces deux groupes de femmes. Résultats : Les longueurs utérines moyennes déterminées par hystérométrie ont été de 11,0 ± 0,6 cm et de 8,9 ± 0,8 cm au sein des groupes « > 10 cm ¼ et « ≤ 10 cm ¼, respectivement. Aucune différence n'a été constatée entre les groupes en matière de caractéristiques démographiques ou d'antécédents gynécologiques, exception faite d'un IMC accru au sein du groupe « > 10 cm ¼ et d'une prévalence accrue de dysménorrhée au sein du groupe « ≤ 10 cm ¼. De façon globale, 44,1 % de toutes les participantes avaient connu l'échec de l'hormonothérapie et 20,7 % avaient connu l'échec d'un traitement non hormonal avant la tenue de l'ablation. Les participantes composant les autres 35,2 % avaient refusé d'avoir recours à un traitement de rechange et décidé de subir directement une ablation de l'endomètre. Aucun événement indésirable grave associé à l'intervention ne s'est manifesté dans l'un ou l'autre des groupes. Aucune différence n'a été constatée entre les groupes (P = 0,85) pour ce qui est de l'état des saignements menstruels au moment du suivi à 30,4 ± 15,3 mois (groupe « > 10 cm ¼) et à 30,5 ± 15,5 mois (groupe « ≤ 10 cm ¼). Chez les femmes qui n'ont pas eu à subir une nouvelle intervention chirurgicale à la suite de l'ablation initiale, une aménorrhée a été signalée par 51,9 % des participantes du groupe « > 10 cm ¼ et par 65,9 % des participantes du groupe « ≤ 10 cm ¼. Conclusion : La technique NovaSure d'ablation de l'endomètre a été associée à des issues réussies en matière de saignements menstruels chez les femmes présentant une longueur utérine déterminée par hystérométrie de plus de 10 cm. Aucun événement indésirable grave associé à l'intervention ne s'est manifesté et la nécessité de procéder à une nouvelle intervention chirurgicale était faible. Aucune différence significative n'a été constatée en matière de taux de saignement entre les groupes « > 10 cm ¼ et « ≤ 10 cm ¼.

Comparing pregnancy in adolescents and adults: obstetric outcomes and prevalence of anemia.

OBJECTIVE: To characterize the obstetric outcome and prevalence of anemia in primiparous adolescents and compare them with those in older primiparas. METHODS: We conducted a retrospective chart review of 207 adolescents (or20 years old) whose prenatal care was provided by a single obstetrician in Kingston, Ontario, and who had a live singleton birth at >or24 weeks gestation between 1996 and 2004. RESULTS: The mean age of the adolescents (T) was 17.5 years and of the adults (A) 27.3 years. More than 95% of the women were Caucasian. Mean gestational age at delivery was similar in the two groups (T 39.4 weeks, A 39.6 weeks, P = 0.25). Adolescents were more likely to have a preterm delivery (T 12.6%, A 7.5%, P = 0.038), although smoking rather than young maternal age was an independent risk factor for preterm delivery (odds ratio [OR] 3.2; 95% confidence intervals [CI] 1.47.5). A significantly lower proportion of adolescents delivered by Caesarean section (CS) (T 12.1%, A 27.7%, P < 0.001). Older maternal age, higher pre-pregnancy BMI, increased weight gain during pregnancy, and pre-delivery anemia were all independent risk factors for CS. Smoking was the most influential factor in predicting infant birth weight. Adolescents had significantly more low birth weight infants (< 2500 g) than adults (T 10.1% vs. A 4.3%, P = 0.008). Gestational age rather than young maternal age was the most significant risk factor for low birth weight (OR 3.3; 95% CI 1.95.7). After controlling for smoking status, adolescents were 2.5 times more likely than adults to be anemic at 26 to 35 weeks gestation and pre-delivery. CONCLUSION: Our results suggest that primiparous adolescents have significantly different obstetric outcomes from primiparous adults. Smoking and anemia are significant risk factors for poor obstetric outcomes and are potentially modifiable.

Modulation of Kir4.2 rectification properties and pHi-sensitive run-down by association with Kir5.1.

Inwardly rectifying K+ channels (Kir) comprise seven subfamilies that can be subdivided further on the basis of cytosolic pH (pHi) sensitivity, rectification strength and kinetics, and resistance to run-down. Although distinct residues within each channel subunit define these properties, heteromeric association with other Kir subunits can modulate them. We identified such an effect in the wild-type forms of Kir4.2 and Kir5.1 and used this to further understand how the functional properties of Kir channels relate to their structures. Kir4.2 and a Kir4.2-Kir5.1 fusion protein were expressed in HEK293 cells. Inward currents from Kir4.2 were stable over 10 min and pHi-insensitive (pH 6 to 8). Conversely, currents from Kir4.2-Kir5.1 exhibited a pHi-sensitive run-down at slightly acidic pHi. At pHi 7.2, currents in response to voltage steps positive to EK were essentially time independent for Kir4.2 indicating rapid block by Mg2+. Coexpression with Kir5.1 significantly increased the blocking time constant, and increased steady-state outward current characteristic of weak rectifiers. Recovery from blockade at negative potentials was voltage dependent and 2 to 10 times slower in the homomeric channel. These results show that Kir5.1 converts Kir4.2 from a strong to a weak rectifier, rendering it sensitive to pHi, and suggesting that Kir5.1 plays a role in fine-tuning Kir4.2 activity.

Cloning, expression, and localization of a rat hepatocyte inwardly rectifying potassium channel.

Bile formation involves anion accumulation within the apical lumen of hepatocytes. Potassium flux through hepatocellular basolateral membrane channels may provide the counterion for apical anion efflux. Here we cloned a molecular candidate for maintaining charge balance during bile secretion. Two transcripts resembling the Kir4.2 subclass of inwardly rectifying potassium channels were found. The longer deduced isoform (4.2a) has 30 additional NH(3)-terminal amino acids, which identifies this as a new isoform. The short-form isoform shared 86-91% identity with the mouse, human, and guinea pig channels. Whole cell currents of either rat isoform expressed in HEK293T cells demonstrated time independence and inward rectification. Antibodies against a COOH-terminal fragment recognized bands between 40 and 45 kDa and at 90 kDa and recognized a high molecular mass band around 200 kDa in overexpressing HEK cells. Immunohistology of liver tissue shows hepatocellular plasma membrane localization. In hepatocyte couplets, Kir4.2 was predominantly localized to the basolateral membrane. Results demonstrate expression of a new Kir4.2 isoform in the rat hepatocyte whose functional properties are compatible with a role in maintaining electrical integrity of bile-generating hepatocytes.

Models of depressed hepatic mrp2 activity reveal bromosulphophthalein-sensitive passive K+ flux.

Bile acid independent flow composes up to 40% of hepatic bile secretory capacity. Apical (canalicular) efflux of non-bile-acid organic anions provides the major osmotic driving force for bile acid independent flow. Organic anion accumulation in the hepatocyte is accompanied by increases in both K+ conductance in isolated hepatocytes and passive K+ flux in the perfused rat liver, which are indicative of K+ channel activation. We used two models of disrupted canalicular anion transport to test whether organic anion stimulated K+ efflux occurs independently of anion excretion. In both wild type (wt) and mrp2 mutant (transport minus, tr-) rat liver, bromosulfophthalein (BSP; 0.5 mM) caused a reversible increase in K+ flux that (i) was outwardly directed with low external K+ and (ii) depended upon the electrochemical potential for K+. K+ efflux from wt livers of both sexes was about 1.5 times larger than that from tr- livers. Further, K+ release from female rat livers was about three times higher than that from male livers, independent of phenotype. Two transcripts of the rat hepatocyte K+ channel (Kir4.2) were expressed in hepatocytes of all rats. The results demonstrate that BSP stimulates basolateral (sinusoidal) K+ channels independently of its canalicular excretion, revealing an early event in BAIF and suggesting that Kir4.2 may mediate BSP-sensitive K+ flux.