Rolled Vaginal Wall Flap for the Treatment of Stress Urinary Incontinence

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes; we describe the preliminary results of a modified AVWS technique for the treatment of SUI types II and III. Patients and Methods: In this series; a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled flap is used to provide compression and support of the urethra. The vaginal mucosal surface of the flap is cauterized and two diagonal sutures are placed across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months; 91of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall flaps. It could offer a durable and effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure

The mindfulness-based stress reduction program (MBSR) reduces stress-related psychological distress in healthcare professionals

This semi-experimental study examines how Mindfulness facilitates a distress reduction in a group of health professionals. The sample comprises 29 professionals seeking stress reduction who undertook an 8 weeks psico-educative intervention, involving 28 hours of class, based on a program called Mindfulness-based Stress Reduction or MBSR. Results show a 35% reduction of distress, from percentile 75 to 45, combined with a 30% reduction in rumination and a 20% decrease in negative affect. These benefits lasted during the 3 months of the follow up period. The correlation analysis indicates that the decrease in distress is significantly related to the other two variables. These results confirm the effectiveness of MBSR to decrease distress and its applicability in training programs for health professionals (AU)

Este estudio cuasi-experimental examina si el Mindfulness o conciencia plena reduce el malestar psicológico asociado al estrés en profesionales de la salud. La muestra estaba compuesta por 29 profesionales interesados en reducir el estrés, que siguieron una intervención psicoeducativa de 8 semanas, empleando un total de 28 horas lectivas y denominada Reducción de estrés basada en Mindfulness (Mindfulness-based Stress Reduction o MBSR). Los resultados muestran una disminución del malestar del 35%, descendiendo del percentil 75 al 45, así como reducciones del 30% en rumiación y del 20% en afectividad negativa. Estas mejoras se mantienen durante el periodo de seguimiento de 3 meses posteriores a la intervención. Las correlaciones encontradas indican que la reducción en malestar psicológico conlleva una disminución de la rumiación y de la afectividad negativa. Estos resultados confirman la utilidad de la técnica MBSR para reducir el malestar psicológico en programas de formación para profesionales de la salud (AU)

Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence

The transobturator tape (TOT) is based on a similar principle as the tension-free vaginal tape (TVT); but introduced through the obturator foramen. The aim of this study was to compare these slings as surgical procedures for the treatment of stress urinary incontinence (SUI) in women. Patients and Methods This is a retrospective case-control study including female patients with SUI; either due to urethral hypermobility or intrinsic sphincter deficiency. Thirty patients were treated with TVT (group 1) and 30 were treated with TOT (group 2). The parameters studied were: pre-operative clinical data; operative data and surgical outcome. Results The post-operative complications in group 1 consisted of bladder perforation in one patient (3.3); urinary retention in 3 (10) and de novo urgency in 3 (10). The post-operative complications in group 2 consisted of vaginal xposure in 2 patients (6.7); de novo urgency in 2 (6.7) and transient urinary retention in one (3.3). In the TVT group; objective cure was achieved in 27/30 patients (90); while 3 patients (10) reported subjective cure; failure was not encountered. In the TOT group; objective cure was achieved in 24/30 patients (80) and subjective cure in 4 patients (13.3); and it failed in 2 patients (6.7). Conclusion TVT and TOT are effective procedures for the treatment of female SUI; with comparable results regarding operative time; hospital stay and the risk of complications

Rabdomiólisis en deportista veterano / No disponible

La rabdomiólisis es un síndrome clínico y bioquímico que ponede manifiesto el resultado de un estrés continuado al músculo esquelético conresultado de necrosis muscular. La presentación clínica de este síndrome esmuy heterogénea, pero la principal preocupación de los médicos que utilizamosel deporte como un arma terapéutica más en el control de enfermedadesson las complicaciones de arritmia cardíaca y de fracaso renal agudo.Presentamos el caso de un varón de 40 años, de profesión pintor y que practicadeporte diariamente, natación y footing

Rhabdomyolysis is a biochemical and clinical syndrome resultingfrom continued stress to a skeletal muscle and finally muscle necrosis. Theclinical presentation is heterogeneous, but cardiac arrhythmia and acute renalfailure may arise and are the main concern of physicians who prescribe sporttherapy to alleviate the symptoms of other diseases.We present the case of a 40-year-old man, a professional painter, who practised sports, including swimming and jogging, daily (AU)

Effects of plasmid growth hormone-releasing hormone treatment during heat stress.

A gene therapy treatment with plasmid-based growth hormone-releasing hormone (GHRH) delivered by electroporation (EP) was investigated during heat stress; 32 primiparous cows received 2.5 mg of a GHRH-expressing myogenic plasmid (pSP-HV-GHRH), while 20 were designated as controls. Offspring of treated animals showed a reduction in mortality (47%; p < 0.02), and survival from birth to 260 days was dramatically improved (0% mortality vs. 21% in controls) along with an increase in weight gain (p < 0.05). Milk production was increased compared to controls with an average yield gain of 421 kg/cow (p = 0.028). Prolactin (PRL) levels were also significantly increased compared to controls (p < 0.05). The second pregnancy rate was improved by GHRH treatment (53.3% vs. 30.8%). This study shows that the use of plasmid-mediated therapy delivered by EP can maintain health status during periods of heat stress, important for both animals and potentially humans in hot, challenging climates.

Mind-body medicine and cancer.

Mind-body medicine, grounded in a respectful, therapeutic partnership, should be a central element in the care of every person diagnosed with cancer. This article reviews some of the physiologic foundations of mind-body medicine, the introduction of mind-body approaches to cancer care in the 1970s, the specific mind-body approaches that have been used, and the evidence that supports their use. The importance of group support for enhancing the effectiveness of these approaches is discussed. Guidelines are offered for integrating mind-body approaches and perspectives in the care of people who have cancer.

[Stress related mucosal disease prophylaxis in intensive care unit patients]. / Profilaktyka owrzodzen stresowych zoladka u chorych leczonych na oddziale intensywnej terapii.

Among the patients admitted to the Intensive Care Unit there frequently occur disturbances of the upper gastrointestinal tract. They can be found as stress ulcerations which in turn may lead to bleeding. The high incidence of stress ulcers and bleedings from the upper gastrointestinal tract is associated with disturbances of gastric acid secretion, an interrupted integrity of gastric mucosa and abnormal motor activity of gastrointestinal tract. The presence of clinically important bleeding results in prolonged hospitalization and increased mortality. The aim of this study is twofold; first, the pathogenesis and the consequences of stress-related mucosal disease are elucidated. Afterwards, the prophylaxis modalities are presented on the basis of the latest medical literature.

Personality, coping style, and constitutional neuroimmunology.

Risk of developing certain diseases correlates with human personality. Cardiologists have defined Type "A" personalities as coronary-prone. Associated psychological peculiarities are easily angered, competitive, impatient and hard-driving. Psychologically-opposite people who are prone to suppress emotions and avoid conflicts (Type "C"), have a high risk of infectious diseases and certain forms of cancer. The development of contemporary biology and medicine determined an important role of the neuroendocrine and immune systems in these correlations. The peculiarity of human personality, as much as of animal behavioral patterns, is strongly expressed under stress conditions. The strategies of stress coping display a normal distribution in the human and wild animal populations, with truly passive and active coping styles located at the outermost regions of the curve. However, there are a number of strategies to breed experimental animals with extreme coping styles; animals selected for a passive coping style to acute stress show marked activation of the hypothalamic-pituitary-adrenal (HPA) axis and low stimulation of the sympathetic-adrenal system; both are associated with immunosuppression. An opposite reaction of the neuroendocrine system has been shown in animals with an active coping style to stress; this was associated with the signs of immunostimulation. Similarly, people with passive coping style (type "C") might be at higher risk of infectious diseases and cancer, while people with active coping style (type "A") might be predisposed to coronary, allergic, and autoimmune diseases. Furthermore, pain, decreased productivity, and anxiety, all common in patients with different diseases, are additional stressful entities. Thus, an adequate coping with a disease is an important approach to improve life quality and disease prognosis. Therefore, psychological and psychopharmacotherapeutic interventions that enhance effective coping should have beneficial effects in patients with immune-mediated diseases.

A systematic review of networked technologies supporting carers of people with dementia.

We conducted a systematic review of the effectiveness of networked ICT interventions in supporting carers of people with dementia. Five bibliographic databases were searched and a total of 1456 abstracts were identified as potentially relevant. From these we identified 15 papers describing five interventions: ComputerLink, AlzOnline, Caring for Others and two studies from the REACH project (TLC and CTIS). The interventions reviewed were multifaceted with elements of networked peer support. Outcomes were inconsistent but suggested that the interventions had moderate effects on improving carer stress and depression. Treatment effects were found to vary with caregiver characteristics such as ethnic groups, formal support and baseline burden. Further evaluation is needed in robust trials with good follow-up.

A biphasic theory for the viscoelastic behaviors of vocal fold lamina propria in stress relaxation.

In this study, a biphasic theory is applied to investigate the viscoelastic behaviors of vocal fold lamina propria during stress relaxation. The vocal fold lamina propria tissue is described as a biphasic material composed of a solid phase and an interstitial fluid phase. The biphasic theory reveals the interaction between the solid and the fluid. For the one-dimensional case, the analytical solutions of solid displacement, fluid velocity, and stress are derived. The biphasic theory predicts the stress relaxation of the vocal fold lamina propria. The quasilinear viscoelastic model as well as its higher-order elastic parameters can be derived from this biphasic theory. Furthermore, the fluid is found to support the majority of the stress at the early stage of stress relaxation; however, when the time becomes sufficiently large, the solid eventually bears all the stress. The early fluid stress support is much higher than the eventual solid support and may be important for understanding the effects of dehydration on tissue damage. By considering the solid-fluid structure of the vocal fold lamina propria, the biphasic theory allows for a more physical theory of tissue viscoelasticity than a single phase solid description and may provide a valuable physical mechanism for the observed vocal fold rheologic behaviors.

Impact of endurance exercise on levodopa-associated cortisol release and force increase in patients with Parkinson's disease.

Levodopa (LD) application improves motor symptoms and reduces cortisol levels in patients with Parkinson's disease (PD). Endurance exercise enhances cortisol release in proportion to the intensity of the effort and thus may counteract the LD associated cortisol decrease. We measured levels of cortisol and LD over an 1-h long interval following administration of soluble 200 mg LD/50 mg benserazide with concomitant maximal grip strength assessment in 16 PD patients under cued conditions during rest and endurance exercise. The motor response, the plasma levels of cortisol and LD did not significantly differ between both conditions. Cortisol concentrations significantly decreased even during exercise. Grip strength only significantly went up during rest. Endurance exercise did not counteract the LD associated decreased cortisol release. Since cortisol improves muscle function, the lack of increase in maximal grip strength following LD administration during exercise may contribute to reduced exercise capacity, which is reported by PD patients.

WITHDRAWN: Home-based support for disadvantaged adult mothers.

BACKGROUND: Babies born to socio-economically disadvantaged mothers are at higher risk of a range of problems in infancy. Home visiting programs are thought to improve outcomes, both for mothers and children, largely through advice and support. OBJECTIVES: To assess the effectiveness of home visiting programmes for women who have recently given birth and who are socially or economically disadvantaged. SEARCH STRATEGY: We searched the following electronic databases: The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 3, 2006); MEDLINE (1966 to March 2006); EMBASE (1980 to 2006 week 12); CINAHL (1982 to March week 4 2006); PsycINFO (1872 to March week 4 2006); ASSIA (1987 to March 2006); LILACS (1982 to March 2006); and Sociological Abstracts(1963 to March 2006). We searched grey literature using ZETOC (1993 to March 2006); Dissertation Abstracts International (late 1960s to 2006); and SIGLE (1980 to March 2006). We also undertook communication with published authors about ongoing or unpublished research. SELECTION CRITERIA: Included studies were randomised controlled trials investigating the efficacy of home visiting directed at disadvantaged adult mothers. DATA COLLECTION AND ANALYSIS: Two reviewers (EC and JP or CB) independently assessed titles and abstracts identified in the search for eligibility. Data were extracted and entered into RevMan (EC, JP and CB), synthesised and presented in both written and graphical form (forest plots). Outcomes included in this review were established at the protocol stage by an international steering group. The review does not report on all outcomes reported in included studies. MAIN RESULTS: We included 11 studies with 4751 participants in this review. Data show no statistically significant differences for those receiving home visiting, either for maternal outcomes (maternal depression, anxiety, the stress associated with parenting, parenting skills, child abuse risk or potential or breastfeeding) or child outcomes (preventive health care visits, psychosocial health, language development, behaviour problems or accidental injuries. Evidence about uptake of immunisations is mixed, and the data on child maltreatment difficult to interpret. AUTHORS' CONCLUSIONS: This review suggests that for disadvantaged adult women and their children, there is currently no evidence to support the adoption of home visiting as a means of improving maternal psychosocial health, parenting or outcomes for children. For reasons discussed in the review, this does not amount to a conclusion that home visiting programmes are ineffective, but indicates a need to think carefully about the problems that home visiting might influence, and improvements in the conduct of outcome studies in this area.

Management of the difficult and failed airway in obstetric anesthesia.

Difficulty with airway management in obstetric patients occurs infrequently and failure to secure an airway is rare. A failed airway may result in severe physical and emotional morbidity and possibly death to the mother and baby. Additionally, the family, along with the medical and nursing staff, may face emotional and financial trauma. With the increase in the number of cesarean sections performed under regional anesthesia, the experience and training in performing endotracheal intubations in obstetric anesthesia has decreased. This article reviews the management of the difficult and failed airway in obstetric anesthesia. Underpinning this important topic is the difference between the nonpregnant and pregnant state. Obstetric anatomy and physiology, endotracheal intubation in the obstetric patient, and modifications to the difficult airway algorithms required for obstetric patients will be discussed. We emphasize that decisions regarding airway management must consider the urgency of delivery of the baby. Finally, the need for specific equipment in the obstetric difficult and failed airway is discussed. Worldwide maternal mortality reflects the health of a nation. However, one could also claim that, particularly in Western countries, maternal mortality may reflect the health of the specialty of anesthesia.

Emotional responses to music: towards scientific perspectives on music therapy.

Neurocognitive research has the potential to identify the relevant effects of music therapy. In this study, we examined the effect of music mode (major vs. minor) on stress reduction using optical topography and an endocrinological stress marker. In salivary cortisol levels, we observed that stressful conditions such as mental fatigue (thinking and creating a response) was reduced more by major mode music than by minor mode music. We suggest that music specifically induces an emotional response similar to a pleasant experience or happiness. Moreover, we demonstrated the typical asymmetrical pattern of stress responses in upper temporal cortex areas, and suggested that happiness/sadness emotional processing might be related to stress reduction by music.

Pinch-induced behavioral inhibition ('clipnosis') in domestic cats.

Research has documented immobilization of rodents, rabbits, guinea pigs and dogs by mechanical means, typically using neck clips or inversion ('animal hypnosis'). In contrast, only a few studies of mechanical immobilization of cats are available, although some success has been reported in the literature. Domestic cats may be effectively immobilized by clips placed along the animal's dorsum. We use the term 'pinch-induced behavioral inhibition' (PIBI) for this behavior because it describes both the method and the response, while avoiding the more anthropomorphic term 'hypnosis'. We investigated the effectiveness of PIBI and its neurological and habituation effects in healthy cats and cats with idiopathic cystitis (IC). Although not all cats were susceptible to PIBI and effectiveness varied among individuals, PIBI was useful for gentle restraint in most cats.

Neuroendocrine and oxidoreductive mechanisms of stress-induced cardiovascular diseases.

The review concerns a number of basic molecular pathways that play a crucial role in perception, transmission, and modulation of the stress signals, and mediate the adaptation of the vital processes in the cardiovascular system (CVS). These highly complex systems for intracellular transfer of information include stress hormones and their receptors, stress-activated phosphoprotein kinases, stress-activated heat shock proteins, and antioxidant enzymes maintaining oxidoreductive homeostasis of the CVS. Failure to compensate for the deleterious effects of stress may result in the development of different pathophysiological states of the CVS, such as ischemia, hypertension, atherosclerosis and infarction. Stress-induced dysbalance in each of the CVS molecular signaling systems and their contribution to the CVS malfunctioning is reviewed. The general picture of the molecular mechanisms of the stress-induced pathophysiology in the CVS pointed out the importance of stress duration and intensity as etiological factors, and suggested that future studies should be complemented by the careful insights into the individual factors of susceptibility to stress, prophylactic effects of 'healthy' life styles and beneficial action of antioxidant-rich nutrition.

Physical exercise as adjuvant therapy for patients undergoing hematopoietic stem cell transplantation.

Even when the procedures are successful, patients experience considerable physical, psychological and psychosocial stress before, during and after hematopoietic stem cell transplantation (HSCT). Physical exercise therapy constitutes a potentially promising intervention to reduce such stress within the framework of HSCT because of its multidimensional effectiveness. Up to May 2007, fifteen published studies have examined physical exercise interventions in the context of HSCT, with no study reporting any unexpected or negative effects. The most common intervention involved isolated aerobic exercise programs and occurred during or after the transplantation process; strength training programs and combined intervention strategies are being examined more rarely. Significant benefits from the exercise interventions have been predominantly reported for physical performance, quality of life and fatigue status of the patients. Several other benefits like a faster recurrence of immune cells or reduced severity of therapy-related side effects can be estimated. Future research is needed for the purpose of evidence-based medicine/therapy to provide more rigorous examinations of these interventions, to address existing methodological problems and to identify further effect levels of physical exercise therapy in the context of HSCT.