Incontinencia urinaria a los 2 meses posparto. Persistencia de los síntomas a los 6 y 12 meses

Objectives

To determine the prevalence of urinary incontinence (UI) 2 months after delivery as well as the factors associated with delivery and pregnancy. To determine the persistence of UI at 6 and 12 months after delivery among women with UI at 2 months after delivery.

Material and methods

We performed an observational, prospective, longitudinal study with follow-up at 2, 6 and 12 months after inclusion in the study during hospital admission for delivery in the Vic General Hospital, the basic general hospital in the region of Osona (central Catalonia). Women who delivered live newborns at term between 1 January, 2001 and 31 March, 2002 were included. During admission for delivery, data were gathered on 707 women (age, parity, body mass index, symptoms of incontinence during pregnancy), type of delivery (vaginal, cesarean) and fetuses (weight, head circumference). At 2 months after delivery, 531 women were seen by a gynecologists to detect and establish a clinical diagnosis of UI through a specific protocol.Women were asked whether they had involuntary leaks of urine. Women with UI symptoms underwent a pelvic examination and a pad test was requested. Women with UI at 2 months after delivery were called for further clinical evaluation at 6 months. All women with persistent symptoms at the 6-month visit were contacted by telephone at 12 months. The prevalence of UI at 2 months after delivery was calculated and the persistence of symptoms at 6 and 12 months of delivery was determined. The association of IU at 2 months of delivery with maternal, fetal, and delivery-related factors was analyzed by obtaining odds radios (OR) and confidence intervals.

Results

Of the 531 women seen 2 months after delivery, 41 were diagnosed with UI. At 12 months after delivery, 11 (26.8%) of the 41 women with UI had persistent symptoms. The prevalence of UI at 2 months after delivery was 7.7% (95% CI, 5.6- 10.3). A logistic regression model for UI at 2 months (dependent variable), in which the independent variables of type of delivery, maternal age, and weight and head circumference of the newborn were introduced, revealed that UI was associated with vaginal delivery (OR = 14.4; 95% CI, 1.9-107.2).

Conclusions

Vaginal delivery is a known risk factor for UI and our results confirm the impact of this route of delivery in clinical practice in a general hospital. Although severe cases persist, there is substantial reduction in symptoms in the first 12 months.     

Citología en medio líquido (Thin Prep Pap Test). Un año de experiencia

Objectives

To describe our experience of liquid-based cytology (Thin Prep Pap Test) over a 1-year period by evaluating the follow-up of patients with an abnormal result and to compare the results obtained with the Thin Prep Pap Test with those previously obtained with conventional cytology.

Subjects and methods

The results of 11,150 cervico-vaginal pap tests (8,086 conventional tests and 3,064 liquid-based tests [Thin Prep]) were evaluated. The follow-up of patients with a diagnosis of atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) was evaluated.

Results

Diagnosis of abnormal results in all categories increased, although this increase was only statistically significant when the results were evaluated as a whole. The results of follow-up were similar with both methods.

Conclusions

Liquid-based cytology (Thin Prep Pap Test) substantially increases the detection of preneoplastic cervical lesions and consequently improves the yield of cervico-vaginal cytology.     

Incarcerated Umbilical Hernia in a Super-super-obese Patient

Abdominal wall hernias are more prevalent in the morbidly obese. Incarceration of external hernias is a relatively common process in adults and is associated to a high rate of complications and mortality. We present the case of a morbidly super-super-obese patient (body mass index, 80 kg/m(2)) who underwent emergency surgery for an incarcerated umbilical hernia; the patient died despite segmental intestinal resection, hernia repair using mesh, and intensive care.     

Serum Matrilysin Levels Predict Outcome in Curatively Resected Colorectal Cancer Patients

Background   Matrix metalloproteinase 7 (MMP-7) is involved in invasion, metastasis, growth, and angiogenesis. The aim of this study is to assess the prognostic role of serum MMP-7 in curatively resected colorectal cancer (CRC). Materials and Methods   Patients undergoing resection for CRC (n = 175) were recruited from July 2003 to December 2004. MMP-7 was determined using a quantitative solid phase sandwich ELISA. Cox analysis was used to assess the role of MMP-7 in predicting overall survival (OS) and disease-free survival (DFS). Results  The median length of follow-up was 45 months (range 1 to 59). Levels of MMP-7 are predictors of DFS (hazard ratio [HR] 1.119, 95% confidence interval [95% CI] 1.038–1.207) and of OS (HR 1.113, 95% CI 1.025–1.209). Patients with MMP-7 higher than the median (4.3 ng/ml) are more likely to relapse (29.5% vs 18.4%, P = .084); median time to progression in relapsed patients is 8 months if MMP-7 is ≥4.3 ng/ml and 18 months if MMP-7 is <4.3 ng/ml. Node-negative patients with low MMP-7 have a predicted probability of relapse-free survival at 4 years of 88% (95% CI 83–92%); if the MMP-7 is higher than the median value; this probability is 77% (95% CI 73–81%). Conclusion   MMP-7 predicts recurrence in curatively resected CRC patients. AMF and XGA contributed equally to this project and should be considered co-first authors. Presented in part at the 47th American Society of Clinical Oncology Meeting, Chicago, June 1–5, 2007.     

Influence of the Electron Beam and the Choice of Heating Membrane on the Evolution of Si Nanowires’ Morphology in In Situ TEM

We used in situ transmission electron microscopy (TEM) to observe the dynamic changes of Si nanowires under electron beam irradiation. We found evidence of structural evolutions under TEM observation due to a combination of electron beam and thermal effects. Two types of heating holders were used: a carbon membrane, and a silicon nitride membrane. Different evolution of Si nanowires on these membranes was observed. Regarding the heating of Si nanowires on a C membrane at 800 °C and above, a serious degradation dependent on the diameter of the Si nanowire was observed under the electron beam, with the formation of Si carbide. When the membrane was changed to Si nitride, a reversible sectioning and welding of the Si nanowire was observed.     

Low Potential Ocular Irritation of Arginine-Based Gemini Surfactants and Their Mixtures with Nonionic and Zwitterionic Surfactants

Purpose. The aim of this study was to find new biocompatible surfactants and mixtures with low ocular irritant action for application in pharmaceutical formulations and to establish a relationship between their structure and their potential ocular irritant activity. Methods. An alternative method to the Draize in vivo test, based on the adverse effects of surfactants on the cytoplasmic membrane of red blood cell, was used to evaluate the potential ocular irritation of the surfactants. Results. It was found that the hemolytic activity of arginine-based gemini surfactants increased with the aliphatic alkyl chain lengths of the hydrophobic tail. The addition of the surfactant with an alkyl chain length of 10 carbon atoms to cocoamidopropilbetaina (TB), decylglucoside (APG), and N-lauroyl-arginine ethyl ester (LAE) increases the hemolytic activity moderately for the mixtures with TB and LAE (1.1- and 1.5-fold, respectively) and strongly for APG (fivefold). Conclusions. The new arginine-based gemini surfactants constitute a suitable alternative to commercial surfactants because of their natural origins, which make them biocompatible and renewable products. Based on their hemolytic activity as an alternative to the Draize test, these new arginine-based gemini surfactants and their mixtures can be classified as mild irritants. This fact constitutes an advantage, especially for pharmaceutical and cosmetic applications.     

Outcome of HCV/HIV‐Coinfected Liver Transplant Recipients: A Prospective and Multicenter Cohort Study

Eighty‐four HCV/HIV‐coinfected and 252‐matched HCV‐monoinfected liver transplant recipients were included in a prospective multicenter study. Thirty‐six (43%) HCV/HIV‐coinfected and 75 (30%) HCV‐monoinfected patients died, with a survival rate at 5 years of 54% (95% CI, 42–64) and 71% (95% CI, 66 to 77; p = 0.008), respectively. When both groups were considered together, HIV infection was an independent predictor of mortality (HR, 2.202; 95% CI, 1.420–3.413 [p < 0.001]). Multivariate analysis of only the HCV/HIV‐coinfected recipients, revealed HCV genotype 1 (HR, 2.98; 95% CI, 1.32–6.76), donor risk index (HR, 9.48; 95% CI, 2.75–32.73) and negative plasma HCV RNA (HR, 0.14; 95% CI, 0.03–0.62) to be associated with mortality. When this analysis was restricted to pretransplant variables, we identified three independent factors (HCV genotype 1, pretransplant MELD score and centers with <1 liver transplantation/year in HIV‐infected patients) that allowed us to identify a subset of 60 (71%) patients with a similar 5‐year prognosis (69%[95% CI, 54–80]) to that of HCV‐monoinfected recipients. In conclusion, 5‐year survival in HCV/HIV‐coinfected liver recipients was lower than in HCV‐monoinfected recipients, although an important subset with a favorable prognosis was identified in the former.     

Etiology of surgical site infections after primary total joint arthroplasties

We sought to characterize the causative pathogens of surgical site infections (SSIs) following primary total joint arthroplasties and to evaluate trends in the microbial etiology. We analyzed the etiology of SSIs following 2,632 total hip arthroplasty and knee arthroplasty procedures performed at our institution from 2004 through 2010. We calculated the annual proportion of SSIs accounted for each of the most common organisms and evaluated trends using the χ² test for trend. SSIs were identified in 111 procedures (4.2%). The annual incidence of SSIs did not change significantly during the study period. Staphylococci were the most common cause of infection (59.6%) and most of infections were monomicrobial (82.8%). From 2004 to 2010, the annual proportion of infections due to gram‐negative bacilli (GNB) increased from 21.4% to 66.7% (p = 0.085 for trend). This increase was accompanied by a decline in the proportion of SSIs from coagulase‐negative staphylococci (p = 0.003). Additionally, we found an increase in the percentage of polymicrobial infections (from 7.1% in 2004 to 41.7% in 2010, p = 0.014). Multivariate analysis corroborated these trends. Our study reports an emergence of GNB as a cause of SSIs after primary total joint arthroplaties and an increase of polymicrobial infections. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:633–637, 2014.