Prediction of genital prolapse after Burch colposuspension

OBJECTIVE: The aim of this prospective observational study was to investigate the gynecological and defecographic features in women with stress urinary incontinence operated with Burch colposuspension in order to analyze if the findings could predict subsequent development of genital prolapse. SUBJECT: Twenty-one women with urodynamically proven genuine stress urinary incontinence were consecutively operated with the Burch colposuspension during 1991-1992. No concomitant prolapse repair surgery was performed. METHODS: All were carefully examined in the lithotomy position at rest and with the Valsalva maneuver. The pelvic floor laxity was graded semiquantitatively. The defecography and the clinical examination were done preoperatively and repeated one year postoperatively. RESULTS: The clinical examination revealed a significant progression of rectoceles (p = 0.003) after the colposuspension. The colposuspension cured a significant number of cystoceles (p = 0.035). Six women (29%) had subsequent corrective prolapse surgery median 2 years after the colposuspension. The defecographic measurements showed a significant increase of the recto-vaginal distance (RVD) following the operation (p = 0.020). At the postoperative measurement the group with subsequent prolapse surgery had a significantly larger RVD as compared to the group without further surgery (p = 0.004). The kappa reliability test showed poor agreement between the defecographic and clinical assessment of the rectoceles. CONCLUSION: We failed to find any clinical or defecographic characteristic which could predict the development of surgery-demanding genital prolapse following colposuspension. The colposuspension seemed to accelerate the deterioration of the pelvic floor. However, only a minority of the patients developed symptomatic genital prolapse demanding corrective surgery. We suggest that only women with symptomatic prolapse should be considered for concomitant corrective surgery at the time of the colposuspension.     

The effect of genital prolapse on voiding

Jovin and co-workers have demonstrated that DNA strands containing guanine-adenine repeats generate a parallel-stranded homoduplex. Here we propose that the homoduplex is a dimer of the ordered single strand discovered by Fresco and co-workers at acid pH. The Fresco single strand is shown here to be stabilized in aqueous ethanol where adenine is not protonated. Furthermore, we demonstrate that the strands dimerize at higher salt concentrations without significantly changing their conformation, so that the dimerization is non-cooperative. Hence, the Jovin homoduplex can form through a non-cooperative dimerization of two cooperatively melting single strands. The available data indicate that the guanines stabilize the Fresco single strand whereas the adenines cause dimerization owing to their known intercalation or clustering tendency. The guanine-adenine repeat dimer seems to be a DNA analog of the leucine zipper causing dimerization of proteins.     

The role of the Family Planning Association in Hong Kong's fertility decline

The fertility decline in Hong Kong appears to be the result of 1) the economic and social development achieved during the 1960s which created an environment favorable to the development of a family planning program, and 2) the changes in the practice of and to a lesser extent the attitude toward contraception induced by the Family Planning Association (FPA). The FPA has motivated people to accept family planning services and has provided them with an inexpensive and convenient source of contraceptives. Prior to 1966, posters, pamphlets, and newspaper advertisements were the main sources of publicity with radio and television used only on a limited basis. Since 1966 the existing channels of communication have been modified and new approaches in the form of film showings, contests, and telephone inquiry services have been developed to inform and motivate couples to begin contraceptive practice. After many years of these publicity campaigns, over 95% of all married women in Hong Kong understand that contraceptives can be used for limiting births and practically all of them are familiar with the FPA. Additionally, the most important referral source, accounting for over 85% of all new acceptors, has been the person-to-person contact made by the FPA family planning workers as well as satisfied clients. In 1966 fieldwork operations were expanded and a new recruitment strategy was initiated in which activities were increasingly concentrated in maternal and child health centers. The effect of reaching young and low parity women in the mid- to late 1960s has been cumulative. Since 1969 there have been indications that fertility decline is increasing in the older age groups. Although the extent to which the FPA's activities encouraging the use of the more modern methods of contraception affected the fertility decline is difficult to determine, it is obvious that the population was receptive to the new and improved methods as evidenced by the boom of acceptors in 1965 when IUD insertions were at their peak and by the 2nd boom in 1969 when the large-scale distribution of orgal contraceptives began.     

Conservative treatment of descensus and genital prolapse by means of pessaries from permanent-soft plastic

Clinical experience with soft synthetic pessary in the conservative treatment of genital prolapse is discussed. No local inflammation or laceration of the vagina, or cervix was seen.     

Association of Bologna-type cervicocystopexy and Richter-type sacro-spinal fixation in low approach treatment of genital prolapse. Apropos of 18 cases

We report our experience with Richter spinofixation in association with Bologna cervicocystopexy. Eighteen patients underwent surgery for voluminous prolapse. Spinofixation did not lead to complications. This technique allows a vaginal approach in cases where only an abdominal operation was possible before. Incontinence results were similar to those with the Bologna procedure alone with the additional improvement of allowing a permeable vagina. Currently mean follow-up is 13 months, but these encouraging results suggest that this association should be continued in the future.     

Association of herpesvirus infection with the development of genital cancer

Clinical observations and epidemiological studies on genital cancer have revealed an association with sexual behavior, thus motivating research into sexually transmitted agents which may be responsible for the neoplasia. In this study, we used the PCR technique to examine the presence of CMV, HSV and EBV viruses in 187 cases of human genital lesions and found that infection with CMV or HSV was associated with cervical cancer. When we stratified according to HPV status this association was found only for HPV-DNA-negative cases. These findings indicate that past infection with CMV or HSV could be interpreted as a surrogate marker of HPV infection. However, these viruses may play an important role themselves in cervical cancer.     

Female genital anxieties: views from the nursery and the couch

The author evaluates developmental and clinical data concerning female genital anxieties in an attempt to address the question of its clinical utility. An effort is made to clarify evidence for female genital anxiety as distinct from castration anxiety in females in the clinical situation and in development. This paper examines these concepts from the perspective of the author's detailed observational and clinical data, which are central to this report.     

The structure of psychosis: latent class analysis of probands from the Roscommon Family Study

BACKGROUND: The nosologic structure of psychotic illness, still influenced as much by historical as empirical perspectives, remains controversial. METHODS: Latent class analysis was applied to detailed symptomatic and outcome assessments of probands (n=343) with broadly defined schizophrenia and affective illness ascertained from a population-based psychiatric registry in Roscommon County, Ireland. First-degree relatives (n=942) were assessed by personal interview and/or review of hospital record. RESULTS: Six classes were found, all of which bore substantial resemblance to current or historical nosologic constructs. In order of decreasing frequency, they were (1) classic schizophrenia, (2) major depression, (3) schizophreniform disorder, (4) bipolar-schizomania, (5) schizodepression, and (6) hebephrenia. These classes differed on many historical and clinical variables not used in the latent class analysis. Compared with relatives of controls, significantly increased rates of major depression were seen in relatives of depressed and schizodepressed probands. Significantly increased rates of bipolar illness were restricted to relatives of bipolar-schizomanic probands. The risks for schizophrenia and schizophrenia spectrum disorders were significantly increased in relatives of all proband classes except major depression. This increase was moderate for bipolar-schizomanic probands, substantial for schizophrenic, schizophreniform, and schizodepressed probands, and marked for hebephrenic probands. CONCLUSIONS: These results suggest a relatively complex typology of psychotic syndromes consistent neither with a unitary model nor with a Kraepelinian dichotomy. The familial vulnerability to psychosis extends across several syndromes, being most pronounced in those with schizophrenialike symptoms. The familial vulnerability to depressive and manic affective illness is somewhat more specific.     

Association of genital infection with specific Chlamydia trachomatis serovars and race

Black race is an important risk marker for Chlamydia trachomatis genital infection. To define whether C. trachomatis serovars differ by ethnic distribution, a panel of monoclonal antibodies was used to serotype 934 urethral and 581 cervical isolates from patients attending a sexually transmitted diseases clinic over 2 years. The overall serovar distribution in cervical and urethral infections was comparable, with B class serovars predominating. Significantly higher inclusion counts were observed both in younger women and in nonblacks regardless of serovar. Serovar D was less frequent among blacks at the urethral site (P = .001), while serovar Ia was more frequent in blacks at both sites (urethral, P < .001; cervical, P = .02). These associations remained significant after adjusting for age and number of inclusion-forming units by multivariate analysis. Thus, specific serovars may be associated with particular racial groups; either behavioral or biologic factors could explain these findings.     

External genital warts: report of the American Medical Association Consensus Conference. AMA Expert Panel on External Genital Warts

A consensus process was undertaken to describe and evaluate current information and practice regarding the diagnosis, treatment, and evaluation of patients with external genital warts (EGWs) and their sex partners. This process developed a number of key statements that were based on strong evidence in the literature or reasonable suppositions and opinions of experts. Key statements included the following. In most cases, EGWs can be diagnosed clinically by visual inspection. No one treatment is ideal for all patients or all warts. Women with EGWs and female sex partners of men with EGWs are at increased risk for human papillomavirus-related cervical disease and, like all women, should be screened for cervical cancer. The diagnosis of EGWs in children requires a sexual abuse evaluation. Clinicians who treat EGWs have a responsibility to counsel patients and to provide information about the infectivity, diagnosis, treatment, and natural history of EGWs and general information about sexual health and other sexually transmitted diseases.     

Family planning services in developing countries: an opportunity to treat asymptomatic and unrecognised genital tract infections?

OBJECTIVE: To determine the prevalence of asymptomatic and unrecognised genital tract infections among women attending a family planning clinic in rural South Africa. METHODS: 189 consecutive women had genital samples taken to diagnose infection with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Treponema pallidum, and HIV, and to diagnose bacterial vaginosis. RESULTS: Mean age was 25 years; 155 (82%) were unmarried, 156 (83%) were currently using contraception, and 41 (22%) reported having an STD treated in the preceding 12 months. Although none volunteered abnormal urogenital symptoms, 74 (39%) had at least one elicited by direct questioning. 119 women (63%) had at least one genital infection: N gonorrhoeae (eight; 4%), C trachomatis (14; 8%), T vaginalis (26; 14%), C albicans (56; 30%), active syphilis (15; 8%), HIV (44; 24%), and bacterial vaginosis (29; 15%). 49 women (26%) had multiple infections. Most infections (71; 60%) were asymptomatic. Symptomatic women failed to recognise and report their symptoms, and routine services failed to detect the infections. CONCLUSION: Prevalence of genital tract infection is high among these women, most infections are asymptomatic, and symptomatic infections are frequently not recognised. Women attending family planning clinics in such settings should be screened for syphilis and offered testing for HIV infection. Strategies to detect and treat other genital infections need to be developed.     

Mucous prolapse of the urethra

Urethral prolapse represent a rare cause of urological consultation. Frequent in older women, it also happens in under 10-year-old little girls with a racial predominance. For most cases, medical treatment and follow-up are sufficient, but failure of these or possible complications may necessitate a surgical correction. Circumferential excision and muco-mucous suture are effective treatments with very few complications. About four case-reports, we are reviewing here the literature and discussing etiopathogenic mechanisms and therapeutic options for this disease.     

Report of the Task Force on Psychology, Family Planning, and Population Policy.

Summarizes the activities of the American Psychological Association (APA) Task Force since its inception in 1969. Research trends are identified in various areas, e.g., personal and attitudinal variables related to fertility and variations in fertility. Steps are recommended to aid the development of the relatively new field of population research, including availability of graduate and undergraduate training, dissemination of research findings, participation in legislative and program consultation, and the establishment of an APA Division of Population Psychology. It is concluded that psychologists could make significant contributions to the multidisciplinary field of population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Familial clustering of insulin and abdominal visceral fat: the HERITAGE Family Study

Abdominal visceral fat (AVF) is an obesity-related phenotype thought to be associated with insulin resistance, diabetes mellitus, and atherosclerosis. Significant genetic influences on both AVF and insulin levels have been reported. However, information is lacking as to whether common genetic influences on AVF and insulin levels exist. AVF was assessed by computed tomography scan, and fasting insulin was measured by RIA in 512 members of 98 sedentary Caucasian families participating in the HERITAGE Family Study. Baseline data, collected before exercise training, were used in the present investigation. A bivariate familial correlation model was applied to evaluate whether there are familial influences that are common to insulin and AVF before and after adjustment for total fat mass (FM), and to assess the overall heritability of insulin and AVF. The maximal heritability for AVF, before and after adjustment for total FM, was 42% and 50%, respectively; and for insulin, it was 21%. Interestingly, 29% of the familial influences on insulin were also common to AVF, whereas 14% of the familial influences on AVF were shared by insulin. Furthermore, after AVF was adjusted for total FM, these common familial influences were increased to 48% and 20%. Genes and/or familial nongenetic factors with pleiotropic effects seem to influence both AVF and plasma insulin levels to a certain degree. Genes involved in the regulation of lipid storage and mobilization in the abdominal fat depot are potential candidates for these genetic pleiotropic effects.     

Epidemiology of idiopathic dilated cardiomyopathy in the elderly: pooled results from two case-control studies

Although idiopathic dilated cardiomyopathy is often viewed as an affliction of young of middle-aged adults, morbidity and mortality rates from idiopathic dilated cardiomyopathy rise sharply with age and are the highest in the elderly. To learn more about the determinants of this increasingly important cause of heart failure in the elderly, the authors conducted a pooled analysis of data from two case-control studies of idiopathic dilated cardiomyopathy carried out in Baltimore, Maryland (1984-1986), and in Washington, DC (1990-1992). Identical diagnostic criteria and interviewing procedures had been used in both studies. All of the cases of idiopathic dilated cardiomyopathy had evidence of ventricular dilation and hypokinesis, with a left ventricular ejection fraction of < 40%. Cases with a history of coronary artery disease were excluded along with those with known secondary forms of cardiomyopathy, Up to two neighborhood controls of the same sex and appropriate age (+/- 5 years) were selected for each case using a random digit dialing technique. The subjects or a suitable surrogate was interviewed by telephone to obtain medical history information. The present analysis was limited to 94 cases and 152 matched controls who were at least 60 years of age. Conditional logistic regression methods were used in the analysis. Significant associations were observed with lower educational attainment and a history of hypertension (P < 0.05). The association with hypertension (relative odds = 2.2, 95% confidence interval 1.1-4.6) persisted after adjustment for race, education, and diabetes and was not accounted for by coronary angiography utilization patterns. The association with diabetes was of borderline significance (p < 0.10). The pattern of risk factors identified in this analysis may allow for the early identification of elderly persons who are at increased risk of idiopathic dilated cardiomyopathy.     

Electrolysis: observations from 13 years and 140,000 hours of experience

Electrolysis has been performed since 1875. Electrolysis satisfactorily removes hair from women with static hair growth, but women with hirsutism often require concomitant management of their hormonal problems. We have found the blend method to be the most effective modality for permanent hair removal. Attention must be given to proper electrolysis technique, including accurate needle insertion and appropriate intensities and duration. Scarring does not occur with properly performed electrolysis. Hair is not an electrical conductor and electronic tweezers do not result in permanent hair removal. Shaving 1 to 5 days before electrolysis greatly increases efficacy because it ensures that only growing anagen hairs are epilated. The recent availability of EMLA (eutectic mixture of local anesthetics) has been beneficial in reducing the sensations of electrolysis. The availability of prepackaged, presterilized, individual electrolysis needles has greatly reduced the need for more complicated sterilization procedures.     

Obstetric practice in the Oxford Record Linkage Study Area 1965-72

The secular trends in induction in 111 818 births over eight years in the largely rural areas of Oxfordshire and west Berkshire were analysed. Although the induction rate started to rise only in 1969, the forceps and episiotomy rates had been increasing throughout, but both procedures were always twice as prevalent in induced as in non-induced cases. The proportion of women given an anaesthetic was also consistently higher in induced cases, but that of women with long labours fell considerably over the period. The reduction in stillbirth rate was more apparent in induced than in non-induced births.     

Transvaginal repair of vault prolapse: a review

The effect of histone acetylation was monitored on CHO chromatin structure, following the addition of 7 mM Na-butyrate to the cell culture medium. The properties of both control and hyperacetylated chromatins and nuclei were investigated by circular dichroism, ethidium bromide intercalation, differential scanning calorimetry, and affinity chromatography. Our results are compatible with modest but significant alterations in the various levels of chromatin organization, as a result of the charge neutralization of some lysine residues within the N-terminal region of the histonic octamer. Namely, large statistically significant differences do exist in the heat capacity thermograms of native nuclei, where unfolding into single nucleofilament of the highly packed native chromatin superfiber appears associated with acetylation; at the same time CD, EB, and affinity chromatography point to modest but consistent differences in the compactness of isolated nucleosomes and polynucleosomes.