A Systematic Review of the Efficacy of Cesarean Section in the Preservation of Anal Continence

Purpose Elective primary cesarean section is performed largely to avoid maternal pelvic trauma that may result in anal incontinence, although its efficacy in this regard has not been thoroughly assessed. We perform a systematic review of published reports that compare anal incontinence risk by mode of delivery. Methods PubMed was searched from 1966 through August 2005. Authors were contacted for missing data or analyses. Both randomized and nonrandomized reports were included. Eligible studies included females having vaginal delivery or cesarean section, fecal and/or flatal incontinence was reported as an outcome, and risk was calculable from the reported data. Crude data were extracted from the reports, as well as reported odds ratios and confidence intervals. In the nonrandomized studies, adjusted odds ratios also were extracted and additional data obtained from authors to adjust risks for age and parity if not originally done. Sensitivity analyses were performed using quality indicators: age and parity adjustment, time to continence assessment, and mode of previous delivery. Results Fifteen studies were found eligible, encompassing 3,010 cesarean sections and 11,440 vaginal deliveries. The summary relative risk for fecal incontinence was 0.91 (95 percent confidence interval, 0.74–1.14). For flatus the relative risk was 0.98 (range, 0.86–1.13). The number needed to treat by cesarean section was 167 to prevent a single case of fecal incontinence. Five studies were judged to be of high quality. In these studies, the summary relative risk was 0.94 (range, 0.72–1.22) and number needed to treat was 198. Conclusions The best evidence to assess the efficacy of cesarean section in the prevention of anal incontinence would be in randomized trials of average-risk pregnancies with few crossovers. In the absence of such trials and based on this review, cesarean section does not prevent anal incontinence. This implies that incontinence associated with delivery may be more likely incontinence caused by pregnancy.     

女性缩阴术30例临床分析

1 临床资料 2000-03/2004-06阴道松弛症女性30例,年龄24～44岁,其中24～30岁12例,占40%;31～40岁10例,占33.3%;41～44岁8例,占26.7%.术前检查阴道容三指以上,自诉因阴道松弛性生活时快感不足,均排除子宫脱垂、阴道炎及阴道肿瘤等疾病.手术在月经完全干净3 d后,采用硬膜外麻醉或局部麻醉下进行.患者取膀胱截石位,于阴道口外6点处设计出一弧形切口,左右宽度3～7 cm具体视阴道松弛程度而定,沿设计线在阴道黏膜下注射盐酸肾上腺素盐水以利止血和分离,切开并剥离阴道后壁黏膜,暴露黏膜下肌肉,以可吸收缝线拉拢缝合阴道黏膜下左右侧阴道括约肌及肛提肌等,从阴道深处开始缝合,缝到阴道口附近处.缝合后阴道容二指松.阴道后壁黏膜不切除,阴道黏膜下肌肉左右对叠缝合后阴道黏膜自然向上膨隆形成一皱襞.阴道外的横弧形切口因黏膜下肌肉左右拉拢缝合,变成竖形切口以丝线间断缝合.术后静滴抗生素3 d,每天以碘伏清洗切口1次,7 d拆线,2 mo内禁止性生活.术后随访3～6 mo,自诉性快感明显增强22例,改善8例.     

Living with Marfan syndrome I. Perceptions of the condition

We present data from an exploratory study of 174 adults with Marfan syndrome regarding their cognitive perceptions of the condition as postulated by the self-regulatory model (Leventhal H, Benyamini Y, Brownlee S et al. In: Petrie KI, Weinman JA, eds. Perceptions of Health and Illness: Current Research and Applications. Amsterdam, The Netherlands: Harwood Academic, 1997: 19-45; Leventhal H, Nerenz DR, Steele DJ. In: Baum A, Taylor SE, Singer JE, eds. Handbook of Psychology and Health. Hillsdale, NJ: Lawrence Erlbaum Associates, 1984: 219-252). The vast majority of the respondents had adequate general knowledge about Marfan syndrome. Eighty-three percent of the respondents perceived Marfan syndrome as having had significant adverse consequences on their lives. Having striae, pain (sore joints), and depression were each independently correlated with this view. Fifty-eight percent of the respondents indicated that they felt they had low to moderate control over their condition, demonstrating variability. History of aortic dissection, pain (sore joints), and depressive symptoms were each negatively correlated with the view that Marfan syndrome is a curable/controllable condition. Moreover, approximately 28% view the condition as a lethal condition, whereas 67% view it as a serious condition. Forty-four percent of the cohort were found to have significant symptomatology of depression independent of beta- and Ca2+-channel blockade use. Respondents cited both advantages and disadvantages of being affected. Genetic counseling that addresses patients' perceptions of Marfan syndrome, and its associated pain, fatigue, and depressive symptoms, may enhance patient adaptation to the condition.     

Interference with high performance liquid chromatographic chloramphenicol assay in a patient receiving dobutamine

We report potential interference by dobutamine with our high performance liquid chromatography (HPLC) procedure for assaying chloramphenicol succinate and chloramphenicol. Interference was discovered in a 1-year-old boy receiving chloramphenicol succinate and dobutamine. The identity of the interfering substance was confirmed by HPLC and gas chromatography.