Sexual function and pelvic floor disorders

Sexual wellbeing is an important aspect of women's health. Female sexual dysfunction is multifactorial and involves physical, social and psychological dimensions. Dysfunction may result from lack of sexual desire, sexual pain or arousal, and orgasmic problems. Sexual dysfunction is common and increases with age and pelvic floor disorders such as urinary incontinence and pelvic organ prolapse. Surgical treatment of pelvic floor disorders has been poorly studied but has the potential to improve sexual satisfaction or to cause sexual difficulties. New instruments such as condition-specific sexual questionnaires have recently been developed and will help us to better evaluate the results of incontinence and prolapse surgery on sexual function.     

Hemodialysis Urea Rebound and Membrane Biocompatibility: Accuracy of Kt/V Estimations

Abstract: To date, the magnitude, causes, and factors that govern urea rebound are not clearly defined. This study was undertaken to determine the possible influence of the biocompatibility of dialyzer membrane on urea rebound and to assess the participation of rebound in the calculation of Kt/V-urea by different methods. Blood urea samples were obtained before, and at 2, 30, and 60 min posthemodialysis in 8 patients undergoing dialysis with 2 different membranes, Cuprophan and polyacrylonitrile (24 sessions with each membrane). Urea rebound was documented in all patients. The degree of rebound was large,20%, and it was achieved within 30 min after the end of dialysis. Urea rebound was observed with both Cuprophan and polyacrylonitrile membranes, without significant differences. Kt/V-urea significantly decreased (p < 0.001) by all methods when urea rebound was incorporated. We conclude that urea rebound is clinically very important and is not influenced by the biocompatibility of the dialyzer membrane. This phenomenon must be taken into account in the calculation of Kt/V; otherwise, it might be overestimated.     

Cardiotoxic transplacental effect of idarubicin administered during the second trimester of pregnancy

Polychemotherapy including idarubicin was administered during the second trimester to treat acute lymphoblastic leukemia. The infant delivered at 28 weeks' gestation had acute cardiac failure attributed to the cardiotoxic effect of idarubicin. Cardiotoxicity may be caused by idarubicin's biophysical properties that facilitate its transplacental passage. Idarubicin should be used with extreme caution during pregnancy.     

Antibiotikaempfindlichkeit von Neisseria-gonorrhoeae-Isolaten in Berlin

Background and Objective. Because of the increasing resistance of Neisseria gonorrhoeae, we studied the actual resistance of isolats in Berlin. Patients/Methods. 85 Neisseria gonorrhoeae isolates were collected between 1995 and 1997. Susceptibility testing was performed for penicillin G, tetracycline, spectinomycin, ceftriaxon, ciprofloxycin and azithromycin by agar dilution. Results. 18.8% isolates were resistant or intermediately resistant to penicillin G (including 6 PPNG). 12.9% isolates were resistant, 43.5% intermediately resistant to tetracyclin. One strain was resistant against ciprofloxacin, 4 isolates showed increased MIC values (0.06–0.5 mg/l), whereas 78 isolates were fully susceptible (<0.007 mg/l). All isolates were susceptible to spectinomycin, ceftriaxone, and azithromycin. Conclusions. Penicillin G and tetracycline should be given only in cases of proven sensibility. Resistance against ciprofloxacin may occur, especially in isolates aquired in south-east Asia. Ceftriaxone, spectinomycin and azithromycin were active against all isolates. The actual resistance situation should be monitored.     

Continuous recording of intrarectal pressures during the second phase of labour: correlations with postpartum pelvic floor complaints. A biomechanical–clinical study

Introduction and hypothesis

We correlated intrarectal pressure parameter recordings during the second phase of labour in primiparous women with postpartum pelvic floor (PF) complaints to try to define a critical pressure threshold for the occurrence of permanent PF injury.

Methods

Using a microsystem device, the duration of bearing-down efforts, the area under the pressure curve and the peak pressure during bearing-down efforts were continuously recorded in 43 women with spontaneous delivery (group one) and in 17 women with forceps-assisted delivery (group two). PF complaints were assessed using ICS-validated questionnaires established before delivery and 14?±?6 months after delivery.

Results

Postpartum PF complaints were not significantly different between the groups. The first and second phases of labour were longer in women of group two. The three parameters measured were not correlated with the baby’s weight or mode of delivery. The duration of bearing-down efforts was correlated with difficulty voiding and lower abdominal discomfort in women of group one only. The area under the pressure curve was correlated with feeling of urgency to void, urge incontinence, drops escape, decreased frequency of orgasm and difficulties in reaching orgasm in women of group two only. Peak pressure values were not correlated with any PF dysfunction.

Conclusions

Intrarectal pressure parameters during second phase of labour show no significant correlations with obstetric parameters, but were significantly correlated with some urinary and sexual PF complaints 14 months after spontaneous and forceps-assisted delivery with a higher incidence of significant correlations in women of group two with forceps-assisted delivery, probably because of the longer first and second phases of labour.

     

An outbreak of scabies: a forgotten parasitic disease still present in Switzerland

INTRODUCTION: Scabies, a contagious parasitic dermatosis, has a worldwide distribution but is considered a "disease of the poor" in resourcerich countries. However, it can cause major public health problems following outbreaks in industrialised countries. The following study describes a large outbreak of scabies involving several health care institutions in the canton of Neuchatel, Switzerland. PATIENTS AND METHODS: After reporting a case of crusted scabies hospitalised for several months (for other comorbidities) in various health care institutions, a "scabies task force" was created in order to detect further cases by contact tracing. Suspected cases were reported to public health authorities, with notification of the health care institutions where cases or exposed patients had been transferred, and information to general practitioners and dermatologists of the entire area (100,000 inhabitants), RESULTS: Three health care institutions (a rehabilitation clinic, a 200-bed acute care hospital, a small hospital with a haemodialysis unit) were involved. Overall, 24 cases of scabies were detected, 12 among inpatients after exposure within the health care institutions, and 12 among household or other close contacts. 116 health care providers exposed to cases within the health care institutions were investigated with negative results for scabies. After the creation of the task force, no further transmission of scabies was observed. Prolonged misdiagnosis of crusted scabies as well as frequent transfers of cases between various health care institutions facilitated the outbreak. Barrier precautions for health care workers caring for patients with skin lesions even in the absence of a diagnosis of transmissible disease appeared to be efficacious since no transmission to health care workers could be detected. CONCLUSIONS: This is the first reported observation of a large scabies outbreak involving health care institutions in Switzerland. Our outbreak demonstrates that it is not an obsolete disease and that a high index of suspicion must be maintained in order to promptly detect difficult cases and to curb potential outbreaks.