The natural history of pelvic organ support in pregnancy

 Little is known about the anatomic and physiologic changes in the pelvic floor that occur during pregnancy. The purpose of this study was to prospectively document pelvic organ support throughout pregnancy using the standardized system of the International Continence Society, also known as the Pelvic Organ Prolapse Quantification (POPQ) Staging System. Pelvic organ support evaluations were performed in nulliparous pregnant women presenting for routine obstetric care during each trimester. POPQ stage assignments and POPQ component measurements were compared for first-, second- and third-trimester examinations. Overall POPQ stage was significantly higher in the third trimester than in the first (P=0.001). Individual POPQ points which showed significant differences between the first and third trimesters include Aa, PB, Ap, Ba, Bp, TVL and GH. These findings probably represent normal physiologic changes of the pelvic floor during pregnancy, but suggest that significant changes may be objectively demonstrated prior to delivery. Received: 15 January 2002 / Accepted: 9 September 2002     

Factors affecting attitudes towards medical abortion in Lithuania.

OBJECTIVE: Surgical abortion in Lithuania is governed by a 1994 ministerial decree that made it legal for any woman 16 or older. This article seeks to determine the key demographic factors in Lithuanian attitudes towards medical abortion, which is currently not legal. METHODS: A random sample of the adult population was asked if they supported medical abortion. The dependent variable of attitude towards medical abortion was tested against the eight independent variables reported for each respondent using Chi-square tests and odds ratios. The effects of the variables upon each other were tested with two logistic regression models. RESULTS: Among the respondents, 62.6% supported access to medical abortion. The independent variables of urban/rural residence, employment status and educational level significantly affected opinion. Overall, education level provided the strongest odds ratio for support of medical abortion. CONCLUSION: The majority of the Lithuanian population supports the legalisation of medical abortion. There is somewhat less support for it in rural areas, among those who are least educated and in certain nonworking population groups. Lithuanian policy-makers should consider responding to popular sentiment and legalising medical abortion.     

Exogenous nucleosides modulate proliferation of rat intestinal epithelial IEC-6 cells

Exogenous nucleotides are considered semiessential nutritional components that play an important role in intestinal development, maintenance, and recovery from tissue damage. Nucleosides (NS) are the best-absorbed chemical form of nucleotides in the intestinal epithelium. The aim of this work was to clarify, at the cellular level, the effects described in vivo. Under conditions of high intracellular availability of NS, we studied the effects of 2 NS mixtures on the NS uptake and intracellular distribution and on the proliferation, morphology, viability, and cell-cycle phase distribution of rat intestinal epithelial cell line 6. Purine and pyrimidine NS showed a similar uptake profile, but the intracellular incorporation of guanosine was greater than that of uridine, without differences in intracellular distribution. Proliferation assays demonstrated that IEC-6 cell proliferation is increased by a mixture containing thymidine but decreased by one containing uridine. In fact, the antiproliferative effect started at 75 micromol/L, which indicated that it may not be correct to consider concentrations of uridine >75 micromol/L as physiological. Interestingly, these effects were not related to increased cell necrosis or apoptosis or to changed cell morphology but rather to a reduced S-phase and increased G0/G1 phase of the cell cycle. In summary, our results suggest that NS molecules are well-absorbed by rat intestinal epithelial cell line 6 cells, whose proliferation can be promoted or inhibited (according to the NS mixtures used) by a mechanism that is not dependent on the toxicity of the mixtures.     

Job satisfaction among physicians and nurses involved in the management of multiple sclerosis: the role of happiness and meaning at work

Neurological Sciences - Health professionals caring for persons with multiple sclerosis (MS) are faced with increasingly complex working conditions that can undermine their job satisfaction and the...     

Surgical management of life-threatening ventricular arrhythmias in patients with coronary artery disease.

Twenty-one patients with coronary artery disease and severe, symptomatic ventricular arrhythmias underwent cardiac surgery after failure of medical managememt. All had coronary artery disease and either localized areas of severe hypokinesis (three patients), or ventricular aneurysms (18 patients) documented angiographically prior to surgery. Operation within one month after acute infarction resulted in an 80% in-hospital mortality, whereas operation more than one month postinfarction showed a 20% mortality. Operative treatment that included myocardial resection had a significantly lower mortality (P less than 0.05) than that which did not. With an average of 36.5 months of follow-up, 13 of the 21 patients were long-term survivors, despite the persistence of ventricular arrhythmias. Surgical treatment which includes myocardial resection and occurs more than one month after infarction should be considered in patients with symptomatic ventricular arrhythmias and severe, well-localized left ventricular wall motion abnormalities.     

Reduced plasma ghrelin concentration in celiac disease after gluten-free diet treatment

OBJECTIVE: Celiac disease (CD) is characterized by malabsorption, weight loss and increased energy expenditure. The aim of this study was to investigate the relationship between circulating ghrelin and leptin, which are produced at gastrointestinal level and are involved in energy balance regulation, and changes in body composition and energy metabolism in CD patients before and after gluten-free diet (GFD)-induced restoration of the intestinal mucosa. MATERIAL AND METHODS: Body composition (by dual-energy X-ray absorptiometry), resting metabolic rate and substrate oxidation rates (by indirect calorimetry) were assessed in 18 adult women with the classic form of CD (age 31.4 +/- 7.8 years, body mass index (BMI) 20.6 +/- 2.1 kg/m2) before and at least 2 years after GFD treatment and in 22 age-matched healthy women (age 33.1 +/- 7.2 years, BMI 22.9 +/- 2.1 kg/m2). Plasma leptin and ghrelin concentrations were assessed by the ELISA and RIA procedures, respectively. RESULTS: Fat-free mass was reduced before and after GFD compared to control subjects (p < 0.01), while fat mass increased after treatment (p < 0.01). Plasma leptin concentration was similar between groups and correlated only with BMI (r = 0.84; p < 0.0001) and percentage body fat (r = 0.86; p < 0.0001). Circulating ghrelin levels (pg/ml) were similar between untreated patients and control subjects, but decreased after GFD treatment (untreated CD: 282.6 +/- 55.5 versus treated 109.2 +/- 49.9; p < 0.0001 and versus control subjects 262.2 +/- 30.0; p < 0.0001) and were negatively correlated with BMI in CD patients (r = -0.32; p < 0.01). CONCLUSIONS: The low plasma ghrelin concentration found in CD patients after GFD treatment could only be partially explained by the slight increase in body-weight and fat mass. Further studies are needed to better ascertain the role played by an incomplete functional or quantitative recovery of ghrelin-producing cells in CD.