Comparison of vaginal length after iliococcygeus fixation and sacrospinous ligament fixation

OBJECTIVE: To compare vaginal length after iliococcygeus fixation (ICF) and sacrospinous ligament fixation (SSLF). METHODS: A retrospective cohort study was performed on patients undergoing ICF or SSLF. Sixty-seven patients were identified and, of these, only 46 had complete data sets, leaving 23 patients in either group eligible for study. RESULTS: There were no significant differences in demographic data between the 2 groups. Mean vaginal length measurements were not significantly different before and after the ICF procedure (7.7+/-0.9 cm vs 7.6+/-0.8 cm, respectively; P=0.68). However, the mean vaginal length was significantly shortened following SSLF (7.9+/-0.8 cm vs 7.1+/-1.1 cm, P=0.001). The mean vaginal lengths preoperatively (7.7+/-0.9 cm vs 7.9+/-0.8 cm, P=0.51) and postoperatively (7.6+/-0.8 cm vs 7.1+/-1.1 cm, P=0.07) were similar. CONCLUSION: Iliococcygeus fixation does not significantly shorten vaginal length at the time of vaginal vault suspension, whereas the sacrospinous ligament fixation procedure does shorten vaginal length.     

Muscular sufficiency, serum protein, enzymes and bioenergetic studies (31-phosphorus magnetic resonance spectroscopy) in chronic malnutrition

Muscle sufficiency was significantly lower in 1336 children with chronic malnutrition of moderate to severe degree. Eighteen children with a chronic moderate degree of malnutrition and 8 well-nourished, age-matched controls were selected for biochemical and 31-phosphorus magnetic resonance spectroscopy (31 -P MRS) studies. The results showed that: (a) serum total protein, albumin, iron, calcium and inorganic phosphate were similar in both groups; (b) serum enzyme levels were significantly increased in the malnourished group; (c) 31-P MRS showed significantly higher means for total ATP, β-ATP, a-ATP and inorganic phosphate for the malnourished compared to the control group. In chronic malnutrition, proteins are maintained by degradation in muscle resulting in release of amino acids and enzymes. 31-P MRS studies showing increases in total ATP, β-ATP and inorganic phosphate and a decrease in phosphocreatine suggest that ATP is maintained at the cost of phosphocreatine.     

Insulinoma in pregnancy: a case report and review of the literature

Insulinomas are rare tumors with an incidence of approximately four cases per million person-years. Nineteen cases of insulinoma during pregnancy have been reported. Hypoglycemic symptoms usually appear during the first trimester. A 28-year-old primigravida was admitted at 6 weeks of gestation after referral for uncontrolled seizures. Her previous seizure work-up included a normal EEG and a normal magnetic resonance imaging of the brain. Elevated fasting insulin and C-peptide levels accompanied severe hypoglycemia. The patient was managed with glucose monitoring, frequent small meals, and rare doses of glucagon. Postpartum testing was consistent with insulinoma, and magnetic resonance imaging indicated a mass in the tail of the pancreas. During surgical exploration with intraoperative ultrasound, two insulinomas were removed from the tail of the pancreas. The hypoglycemic episodes resolved and the fasting glucose levels normalized. Insulinomas are rare in pregnancy and can be difficult to diagnose. Symptoms may resolve during the second and third trimesters, possibly due to changes in glucose metabolism associated with pregnancy. Misdiagnosis has been fatal. Careful management during pregnancy and aggressive treatment after delivery are essential. TARGET AUDIENCE: Obstetricians and Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the pathophysiology of an insulinoma, to list the potential tests used to make the diagnosis of insulinoma, and to outline potential treatment options for a patient with an insulinoma.     

Reliability,validity and psychometric properties of the Greek translation of the Major Depression Inventory

Background  

The Major Depression Inventory (MDI) is a brief self-rating scale for the assessment of depression. It is reported to be valid because it is based on the universe of symptoms of DSM-IV and ICD-10 depression. The aim of the current preliminary study was to assess the reliability, validity and psychometric properties of the Greek translation of the MDI.