Obstetrical management following incontinence surgery

OBJECTIVE: To analyze in a retrospective fashion our experiences with obstetrical management following previous incontinence surgery. METHODS: Between 1990 and 1997 4 women presented to our institution in the third trimester of pregnancy with a history of colposuspension performed 3 months to 4 years before onset of pregnancy for second degree stress incontinence. Three of 4 patients experienced recurrent incontinence during the third trimester. RESULTS: A cesarean section was performed before the onset of labor in all 4 patients. Postpartal pelvic floor exercises were prescribed and a follow-up ensued after 6 and 11 months in the form of a questionnaire. While incontinence persisted in 2 patients for 6 months, all 4 patients demonstrated complete continence after one year. CONCLUSIONS: We consider an elective cesarean section to be the optimal mode of delivery in women with a history of incontinence surgery.     

Relapse of leukemia and lymphoma after marrow transplant: a review of cases with extramedullary relapse

We review our cases of leukemia and lymphoma relapse after allogeneic marrow transplant and describe here a series of 10 patients with extramedullary (EM) relapse. In the 13 relapses in acute myeloid leukemia, 5 cases had EM involvement. There were 3 EM involvement out of 13 acute lymphoblastic leukemia relapses, one EM disease in 11 chronic myeloid leukemia relapses and one case of lymphoma with EM relapse. A common observation is that in some of these cases, EM relapse occurred in the presence of continuous marrow remission, In those cases with both marrow and EM involvement marrow remission could often be achieved and maintained temporarily while EM disease progressed despite chemotherapy or immunotherapeutic measures such as immunosuppressant withdrawal and donor lymphocyte infusion. Survival in partial remission after relapse could be prolonged in some cases but eventual death from progressive disease was often the case.     

An evaluation of traditional and alternative mental health facilities

Traditional mental health facilities were compared with alternative mental health facilities on their response to a crisis situation. Over one-third of the total sample of facilities (n = 50) did not respond with any help. Alternative facilities gave more direct counseling than did traditional facilities, indicating the particular suitability of alternative facilities for crisis intervention.     

A Global Assessment of Recent Stress (GARS) Scale

The Global Assessment of Recent Stress (GARS) Scale was developed to assess current stress perception. Most measurements of environment are derived from life event scales that capture amount of stress or change associated with stressful events that have occurred over the past six to twenty-four months. A scale that provides a more immediate estimate of stress is needed when physiological tests and perceived stress are studied together. The GARS has been subjected to a series of studies concerning its reliability, validity, and factor structure. Results suggest that it may be a useful instrument for helping individuals assess their current feelings of stress.     

Electron microscopic studies on the trabecular meshwork in two cases of corticosteroid-glaucoma

Two young patients without family history or indication of glaucoma had used corticoid eye drops for several years and developed a severe corticosteroid glaucoma leading to microsurgery. The specimens obtained by trabeculectomy were studied by electron microscopy. A marked densification of the cribriform and adjacent area of the trabecular mesh work by masses of an amorphous and fibrous material was found in both eases, but to a different extent. No free aqueous pathways were seen in this area. In contrast to various signs of cell degeneration, many trabecular endothelial cells showed an increased number of mitochondria and an enlarged endoplasmic reticulum indicating a stage of higher activity and protein synthesis. Possible mechanisms leading to these pathological changes were discussed, but no definite conclusions could be drawn from these two cases alone.     

Cultural factors and attrition in drug abuse treatment

The present study examined how race related to attrition in drug abuse treatment. 165 male voluntary admissions to an inpatient Substance Abuse Unit were tested at admission on functioning, motivation, attitudes, symptoms, and mood-using reliable and valid scales. One week later they completed a 12-factor scale measuring perception of the treatment milieu. Data were analyzed in a 2 x 2 factorial design of analysis of variance. There were 106 White subjects and 59 Blacks. The dropout rate for Blacks and Whites was 63%. Two factors measured at intake, motivation and social functioning, showed statistically significant interactions between race and attrition. Four ward perception factors showed a differential effect related to race and attrition. The White dropout and completer did not differ in how they perceived the ward. Blacks, however, who perceived the environment as being more insightful, spontaneous, autonomous, and practical remained. Although Blacks and Whites differed on many variables, only six showed race-related differences in attrition. Having higher motivation and poorer adjustment influenced Whites to stay. Factors in the environment, however, influenced Blacks. What might be considered a more "therapeutic" milieu was effective in helping Blacks remain in treatment. Knowledge of these cultural differences could help in designing treatment programs.