Pregnancy outcome in patients with previous uterine rupture

BACKGROUND: To review the outcome of subsequent pregnancies in conservatively managed cases of uterine rupture. METHODS: Charts of patients with full thickness uterine rupture in the past 25 years were reviewed and information on subsequent pregnancies was extracted from maternal and neonatal charts. RESULTS: Thirty-seven patients with uterine rupture were identified; the uterus was scarred in 62.2%. Ruptures were repaired in 26 (70.3%). Twelve patients subsequently conceived (24 pregnancies), with recurrence in 8/24 (33.3%) pregnancies or 5/12 (41.7%) patients. Patients with recurrence had a shorter median interval from previous rupture (2 versus 5 years), a higher incidence of previous longitudinal ruptures (60.0% versus 0.0%), and the median gestational age at the preceding rupture was lower without reaching statistical significance (34 versus 38 weeks; p = 0.209). CONCLUSIONS: Longitudinal ruptures and short intervals between rupture and subsequent pregnancy predispose to recurrence of uterine rupture.     

Impact of Calcium and Two Doses of Vitamin D on Bone Metabolism in the Elderly: A Randomized Controlled Trial

The optimal dose of vitamin D to optimize bone metabolism in the elderly is unclear. We tested the hypothesis that vitamin D, at a dose higher than recommended by the Institute of Medicine (IOM), has a beneficial effect on bone remodeling and mass. In this double‐blind trial we randomized 257 overweight elderly subjects to receive 1000 mg of elemental calcium citrate/day, and the daily equivalent of 3750 IU/day or 600 IU/day of vitamin D3 for 1 year. The subjects’ mean age was 71 ± 4 years, body mass index 30 ± 4 kg/m², 55% were women, and 222 completed the 12‐month follow‐up. Mean serum 25 hydroxyvitamin D (25OHD) was 20 ng/mL, and rose to 26 ng/mL in the low‐dose arm, and 36 ng/mL in the high‐dose arm, at 1 year (p < 0.05). Plasma parathyroid hormone, osteocalcin, and C‐terminal telopeptide (Cross Laps) levels decreased significantly by 20% to 22% in both arms, but there were no differences between the two groups for any variable, at 6 or 12 months, with the exception of serum calcitriol, which was higher in the high‐dose group at 12 months. Bone mineral density (BMD) increased significantly at the total hip and lumbar spine, but not the femoral neck, in both study arms, whereas subtotal body BMD increased in the high‐dose group only, at 1 year. However, there were no significant differences in percent change BMD between the two study arms at any skeletal site. Subjects with serum 25OHD <20 ng/mL and PTH level >76 pg/mL showed a trend for higher BMD increments at all skeletal sites, in the high‐dose group, that reached significance at the hip. Adverse events were comparable in the two study arms. This controlled trial shows little additional benefit in vitamin D supplementation at a dose exceeding the IOM recommendation of 600 IU/day on BMD and bone markers, in overweight elderly individuals. © 2017 American Society for Bone and Mineral Research.     

Hernie Inguinoscrotale de l’Uretère: Fait Clinique et Revue de la Littérature

la hernie intrascrotale de l’uretère est une situation rare, nous rapportons un cas clinique, compliqué d’hydronéphrose gauche chez un patient de 83ans, l’anomalie avait été reconnue en peropératoire.     

Capsulorhexis in white cataract using a green-light endoillumination probe.

The authors describe a technique for performing a safe and controlled continuous curvilinear capsulorhexis (CCC) in white cataracts using the contrast-enhancing effect of green light from an endoillumination probe. After attaching a green filter to the endoillumination unit of the vitrectomy set, a CCC was performed under the green light of the endoillumination probe, which was placed on the periphery of the cornea in a manner that followed the tearing edge of the capsulorhexis. This technique may be an alternative to capsular dyes in performing a safe and controlled CCC in white cataracts.     

Distribution of blood pressures in Gemlik District,north-west Turkey

The objectives of the present study were to evaluate the prevalence, awareness and control of hypertension among individuals over 30 years of age and to plan a follow-up programme for the same age group. A community-based sample of 1992 individuals (952 men and 1,040 women) was selected randomly. Out of the total study population, 1,388 (69.7%) individuals had normal blood pressure according to World Health Organisation criteria (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg), and the rest (n = 604, 30.3%) had hypertension to varying degrees. Since 61 individuals with normal blood pressure were using antihypertensive medication, the overall hypertension prevalence was 33.4%. Among the study subjects with hypertension, 44.4% were aware of their condition, 37.7% were using medication and 9.2% had controlled hypertension. One out of five individuals (n = 399, 20.0%) had never had their blood pressure measured before. Females had a higher hypertension prevalence than males (36.7% and 29.7%, respectively). Hypertension prevalence increased with age and individuals with a body mass index > 25 were at greater risk. The present findings suggest that there is a need to implement an effective, community-based and low-cost management programme.