History of abortion,preterm, term birth,and risk of preeclampsia: a population-based study

OBJECTIVE: The objective of this study was to examine the effect of previous abortion and preterm and term birth on the incidence of preeclampsia in subsequent pregnancies. STUDY DESIGN: A population-based retrospective cohort study was conducted that was based on 140,773 pregnancies that had delivered between 1993 and 1999 in 49 hospitals in Northern and Central Alberta, Canada. Multivariate logistic regression was applied to estimate odds ratios, with 95% confidence intervals, and to control for confounding variables. RESULTS: No significant difference was found in the incidence of preeclampsia in nulliparous women with previous abortion (2.6%) as compared to nulliparous women without previous abortion (2.9%; adjusted odds ratio, 0.89; 95% confidence interval, 0.78-1.01; P >.05). A single previous abortion was associated with a slightly decreased risk of preeclampsia (adjusted odds ratio, 0.84; 95% confidence interval, 0.72-0.97; P <.05). However, 2 and > or =3 abortions were not associated with a decreased risk of preeclampsia. In women with no history of previous abortion and term pregnancy, there was no significant difference in incidence of preeclampsia between women who had previous preterm birth (2.7%) and primigravid women (2.8%; adjusted odds ratio, 0.71; 95% confidence ratio, 0.48-1.03; P >.05). However, > or =2 previous preterm births were associated with a decreased risk of preeclampsia (adjusted odds ratio, 0.28; 95% confidence interval, 0.09-0.84; P <.01). The incidence of preeclampsia was markedly lower in multiparous women who previously delivered at term (0.9%) as compared to the incidence in primigravida women (2.9%; adjusted odds ratio, 0.29; 95% confidence interval, 0.26-0.33; P <.001). The adjusted odds ratios of preeclampsia for women with 1, 2, 3, and > or =4 previous term pregnancies were 0.32 (95% confidence interval, 0.28-0.36), 0.27 (95% confidence interval, 0.22-0.34), 0.22 (95% confidence interval, 0.15-0.33), and 0.21 (95% confidence interval, 0.12-0.35), respectively. CONCLUSION: A history of term pregnancy (> or =37 weeks) conveys a substantial "protection" against preeclampsia in the subsequent pregnancy.     

Melanocytic colonization of a meningothelial meningioma: histopathological and ultrastructural findings with immunohistochemical and genetic correlation: case report

OBJECTIVE AND IMPORTANCE: Melanocytic colonization of nonpigmented extracranial tumors has been reported in adenocarcinomas, squamous cell carcinomas, skin appendage tumors, and dermatofibrosarcoma protuberans. To our knowledge, melanocytic colonization of a meningioma has not previously been described. CLINICAL PRESENTATION: We report an unusual case of a 70-year-old African-American woman who presented with a large frontoparietal meningioma that extended through the calvarium. INTERVENTION: Craniotomy with gross total resection of the tumor was performed. Histochemistry, immunocytochemistry, ultrastructural analysis, and molecular genetic study via fluorescence in situ hybridization confirmed melanocytic colonization of a meningothelial meningioma. CONCLUSION: With the inclusion of meningothelial meningioma, the spectrum of tumors affected by melanocytic colonization continues to expand.     

Peyronie's disease: a review

PURPOSE: We provide a current review of Peyronie's disease. MATERIALS AND METHODS: We reviewed the world peer reviewed literature on the pathology, pathogenesis, diagnosis and treatment of Peyronie's disease. RESULTS: The incidence of Peyronie's disease has continuously increased during the last 30 years. However, fewer patients need prosthesis surgery as the sole treatment option because of earlier diagnosis, improved medical therapy, refinement in surgical technique and better understanding of the basic sciences of the disease. CONCLUSIONS: Currently patients with Peyronie's disease have had improvements in prognosis and experienced an expansion of the available therapeutic options.     

Uterine scars and subsequent vaginal birth: follow-up of 73 parturients in the Central Maternity Hospital of Bangui (Central African Republic)

Uterine rupture is a threat during vaginal deliveries of women with uterine scars from previous caesarean deliveries or other surgery. Special prudence among this group has resulted in a rise of cesarean rates in developed countries but also in Africa. The lack of available data in this domain in our country led us to conduct this preliminary study, with the objectives of: determining the frequency of deliveries among these patients and of the complications associated with them; identifying some of the risk factors and assessing maternal and fetal prognosis. This should facilitate further studies to determine the management attitudes most appropriate to the realities of our health system. We conducted a cross-sectional study during the last six months of 1999 at the central maternity hospital in Bangui. We included in this study only women with previous caesarean scars giving birth again during the study period. We followed them from admission to the labour room until discharge, without intervening in their delivery. Structured questionnaires enabled us to collect data on clinical, social and demographic variables. We recorded 74 births, including one set of twins, among the 73 parturient subjects. Vaginal delivery occurred in 45 cases (60.8%), and caesarean in 29. Women with a single uterine scar gave birth by vaginal delivery significantly more often than they had caesareans. We recorded 7 cases of uterine rupture, most often associated with a birth interval less than 2 years. One uterine rupture led to the mother's death. Perinatal mortality was 10.8%: no newborn survived these uterine ruptures. Vaginal delivery remains possible for women with uterine scars when adequate monitoring of a trial of labor is available and on condition that the pelvis is normal and the birth interval exceeds two years.     

Preoperative attitudes, fears and expectations of non-small cell lung cancer patients

Knowing preoperative fears in cancer patients should help us to overcome perioperative psychological problems. One hundred and three patients underwent a semistructured interview addressing the effect of preoperative information on disease and forthcoming operation, attitude towards operation, expectations for the postoperative time and family support. Evaluation was performed by three psychologists by qualitative structured content analysis according to Mayring. Interrater reliability was 85%. Only 42 patients (40.8%) were informed in detail about their diagnosis. Eighty-three patients (80.6%) considered the information given on their disease and the forthcoming operation as understandable, 57 patient (55.3%) experienced reduction of fear. Eighty-three patients (80.6%) showed a positive attitude to the operation, 21 (20.4%) expected an impairment of later life after operation although becoming healthy again. Diffuse fears were named in 47 cases (45.6%), 19 (18.4%) patients were afraid of metastases, 11 (10.7%) of postoperative death, 19 (18.4%) of pain, 11 (10.7%) of mutilation and 17 (16.5%) of surgical complications. Seventy-three patients (70.9%) had good family support, seven (6.8%) not. Of the support group 32 patients (31%) considered their relatives' empathy as onerous. Problems, that are self-evident to the attending staff may be insurmountable for the patients. If we succeed to overcome their most simple fears they can focus their energy on mastering the postoperative course.     

Associative memory in chronic schizophrenia: a computational model

We developed a computer model to simulate associative memory recall of patients with chronic schizophrenia. Model inputs consisted of words derived from normative data that differed in terms of connectivity and network size, with the former quantitatively represented by parametric weights and the latter by the specific number of word associates that formed a particular network. Previous behavioral studies of normal subjects indicated better recall for words of high connectivity-small network (HCSN), followed by low connectivity-small network (LCSN), high connectivity-large network (HCLN), and low connectivity-large network (LCLN). This pattern of recall differed from that observed in behavioral studies of schizophrenic patients, which showed better recall for high connectivity words, regardless of network size. Holding constant network size while manipulating connection weights effectively simulated this schizophrenic pattern of recall. That is, manipulation of parametric weights coupled with a slight increase in noise significantly and reliably elicited the response pattern of abnormal connectivity demonstrated in the prior behavioral study of patients with chronic schizophrenia. An increase in noise was a necessary, but insufficient step in modeling the response pattern of abnormal connectivity. These findings provide support for the use of computational models to investigate dynamics of associative word recall in patients with chronic schizophrenia.