The importance of physician gender in the selection of an obstetrician or a gynecologist

OBJECTIVE: The purpose of this study was to determine the importance of gender in the selection of an obstetrician or a gynecologist. STUDY DESIGN: At a university-based hospital, 46 patients after delivery and 79 patients after gynecologic surgery who had selected their physician within the previous year were interviewed to determine the importance of physician gender in the selection of an obstetrician or gynecologist. Chi-square test, Fisher exact test, and the Student t test were used for statistical analysis. RESULTS: Of the 125 women who were surveyed, 52.8% of the women preferred a female physician, 9.6% of the women preferred a male physician, and 37.6% of the women stated no gender preference, with no significant difference between the obstetric and gynecologic groups. The groups were similar with respect to ranking the importance of gender; 24.8% of the women who were interviewed considered gender to be one of the 3 most important factors in the selection of a physician. When participants were asked to choose gender over physician experience, bedside manner, or competency, gender was selected by 12%, 10.4%, and 0.8%, respectively, with no significant differences between the groups. CONCLUSION: For most women, physician gender is not of primary importance in the selection of an obstetrician or gynecologist.     

Osteosarcoma: role of CT in limb-sparing treatment

The computed tomographic (CT) examinations of 17 patients undergoing evaluation for limb-sparing treatment of osteosarcoma were evaluated. In all cases information from CT directly affected the operative approach. The CT findings that helped in planning the operative approach included determination of intramedullary extent and evidence of "skip" metastases, direct extension into an adjacent joint, and neurovascular compromise. Performing CT of the affected bone at 1-cm intervals from the joint above through the joint below and including the contralateral side in the field of view allow precise localization of findings that can direct the operative approach. Close and contiguous scanning intervals allow identification of small intramedullary "skip" metastases that affect the resection margins.     

Effects of garlic extract on spreading depression: In vitro and in vivo investigations

Objectives: The potential use of garlic for prevention and treatment of different types of headaches has been suggested by several medieval literatures. Cortical spreading depression (CSD), a propagating wave of neuroglial depolarization, was established as a target for anti-migraine drugs. This study was designed to investigate the effect of garlic extract on CSD in adult rats.

Methods: CSD was induced by KCl microinjection in the somatosensory cortex. The effects of five different concentrations of garlic oil (1–500 μl/l) were tested on different characteristic features of CSD in necocortical slices. In in vivo experiments, the effects of garlic oil on electrophysiological and morphological changes induced by CSD were investigated.

Results: Garlic oil in a dose-dependent manner decreased the amplitude of CSD but not its duration and velocity in neocortical brain slices. Garlic oil at concentration of 500 μl/l reversibly reduced the amplitude of the field excitatory post-synaptic potentials and inhibited induction of long-term potentiation in the third layer of neocortical slices. In in vivo studies, systemic application of garlic oil (1 ml/l) for three consecutive days reduced the amplitude and repetition rate of CSD. Garlic oil also prevented of CSD-induced reactive astrocytosis in the neocortex.

Discussion: Garlic oil suppresses CSD, likely via inhibition of synaptic plasticity, and prevents its harmful effects on astrocyte. Further studies are required to identify the exact active ingredient(s) of garlic oil that inhibit CSD and may have the potential to use in treatment of CSD-related disorders.     

Serum TNF levels in neonatal sepsis and septic shock

Tumor necrosis factor (TNF-alpha) has been implicated as a principal mediator in the pathogenesis of septic shock. TNF-alpha was measured by immunoradiometric assay in serum samples from 23 full-term infants with sepsis (15 with severe infection and 8 with septic shock) and in 20 healthy full-term newborns. Serum TNF-alpha levels were significantly higher in the group with sepsis, at the time of admission to the neonatal intensive care unit, than in the healthy neonates. The highest TNF levels were found in those newborns with septic shock, particularly in those who died. Although the method is far too slow for any clinical routine work, our results suggest that the presence of elevated serum TNF-alpha levels could be considered a sensitive and specific test for predicting septic shock and its clinical outcome.     

Hyperphosphataemia after enemas in childhood: prevention and treatment

The case of a child with severe hyperphosphataemia and symptomatic hypocalcaemia secondary to retention of phosphate administered through an antegrade continence enema is reported. Caution should be exercised with the use of phosphate enemas and prompt action taken to remedy retention. The use of glucose with insulin in the emergency management of acute hyperphosphataemia is discussed.     

Conservative management of azoospermia following steroid abuse

As well as athletes and competitive body builders, recreational body builders attending gymnasia are known to abuse anabolic steroids, using doses from 10- to 40-fold above physiological levels. Androgenic steroids induce hypogonadotrophic hypogonadism with associated azoospermia, leading to infertility. Little literature exists on the treatment of steroid-induced azoospermia following the cessation of abuse. We present four cases of steroid-induced azoospermia, its conservative management and eventual return of normal semen density.      

The clinical syndromes of femmiphilic transvestism

Thirty-four members of a club established for heterosexual transvestites were interviewed. They were categorized into two groups. Subjects in group I were satisfied with cross-dressing and did not desire additional feminization. Subjects in group II desired to alter their bodily appearance toward female by taking female hormones or by having surgical intervention. Group II transvestites cross-dressed more frequently and had a more intense feminine gender identity and stronger homosexual interests than did group I transvestites. A feminine gender identity appeared to be present from childhood in both groups but to be stronger in group II. Cross-dressing in subjects of both groups often occurred first during childhood and almost always prior to age 15. All subjects showed a period of fetishistic arousal to women's clothes during adolescence. With increasing age, fetishistic arousal diminished or disappeared and the frequency of cross-dressing increased. Terms in the literature used to describe the types of transvestism reported in this study are discussed. It was suggested that the term femmiphilic transvestism be used to describe the condition of the subjects of both groups. The term has fewer disadvantages than terms previously suggested.The project was supported by a grant from the National Health and Medical Research Council of Australia. The research was carried out while N. B. was a Research Fellow of the New South Wales Institute of Psychiatry.     

Mifepristone in combination with methotrexate for the medical treatment of tubal pregnancy: a randomized, controlled trial

In the search for a more potent alternative to a single i.m. injection of methotrexate for ectopic pregnancy, a randomized trial was organized. The efficacy of a combination of methotrexate and mifepristone was compared with methotrexate alone in the treatment of unruptured tubal pregnancies. The diagnosis of an unruptured tubal pregnancy was confirmed laparoscopically in 50 patients during a 2 year period. Women were randomized to receive a single i.m. injection of 50 mg/m2 methotrexate alone or a single dose of 600 mg oral mifepristone in combination with the same dose of methotrexate. Both treatment protocols were successful in achieving the resolution of unruptured ectopic pregnancy (18/25 in the methotrexate group and 22/25 in the combination group) following the initial intervention. A second injection was needed in four (16%) cases in the methotrexate group and in one (4%) case in the combination group. Overall, a complete resolution was achieved in 22/25 and 23/25 cases respectively. Unruptured ectopic pregnancy resolved faster in women given the combination of methotrexate and mifepristone compared to women given methotrexate only (P = 0.01). The effect of the methotrexate and mifepristone combination was more pronounced in women with higher human chorionic gonadotrophin concentrations.      

The mechanisms of cyclophosphamide-induced testicular toxicity and the protective agents

Introduction: Cyclophosphamide (CP) is an alkylating antineoplastic agent with known toxicity to the male reproductive system.

Areas covered: This review summarizes the known mechanisms by which CP exerts its toxic effects on the male reproductive system and the methods utilized to prevent such effects so that it could be further investigated and applied in clinical use. Keywords including [‘Cyclophosphamide’ AND ’male reproductive’ OR’ sperm toxicity’ OR ’spermatotoxicity’ OR ’infertility] were searched through Google Scholar, PubMed and Scopus databases based on PRISMA guidelines. After removing duplicates and irrelevant data, 76 papers were reviewed concerning the outcomes of treatment of male mice, rats, and humans with CP and the effects of co-administration of various natural and synthetic compounds on male reproductive system.

Expert opinion: CP exerts its effect mainly by inducing oxidative stress and changing gene expression in spermatocytes variably during different stages of development. These effects could be either restored or prevented by the administration of compounds with antioxidant properties and those which target the biochemical alterations induced by CP.     

A review of the protective effect of melatonin in pesticide-induced toxicity

Introduction: Pesticides are among the most important chemicals used in agriculture sector. However, their extensive use has polluted the environment and increased human vulnerability to various chronic diseases. Pesticide exposure causes genetic and epigenetic modifications, endocrine disruption, mitochondrial dysfunction and oxidative stress.

Areas covered: This review is based on the literature studies currently reported on pesticide-induced toxicity and the protective role of melatonin. Scientific databases such as PubMed, Scopus and Web of Science were searched using keywords ‘pesticide’ and ‘melatonin’ up to January 2016. Full length articles related to animal and human exposure were retrieved. A total number of 181 records were obtained, and after excluding the duplicates, 97 papers were further screened on the basis of relevance to the topic.

Expert opinion: Melatonin as a broad-spectrum antioxidant is able to penetrate cellular compartments specifically the mitochondria. It is a potent free radical scavenger with low toxicity and desirable solubility in organic and aqueous phases. We are of the opinion that melatonin is a promising agent in minimizing organ injuries induced by pesticides.