Incarceration of sessile uterine fibroids in an incisional hernia in a postmenopausal woman: a case report

Incarceration of sessile fibroids in an incisional hernia is uncommon and can cause pain and discomfort. Very few cases have been reported in the literature but none in our region in women in the postmenopausal period. We present an uncommon case of a 57-year-old primipara with a previous history of caesarean section and a laparotomy on account of adhesive intestinal obstruction. She presented with lower abdominal swelling and abdominal pain since 7 years. She had surgical removal of the mass and total abdominal hysterectomy with mesh repair of the incisional hernia. Histology of the resected hernia content revealed leiomyoma. Abdominal wall fibroid is a good differential diagnosis to be considered in any woman with an anterior abdominal mass and previous uterine surgery, including caesarean section.     

A neuroimmunoregulatory-like mechanism responding to stress in the marine bivalve Mytilus edulis

Mytilus edulis has been the subject of recent studies to determine whether the relationship between the immune and nervous systems seen in vertebrates also exists in invertebrates. In the present study the effects of experimentally induced “stressful” stimuli on immunoactive hemocytes were studied in this mollusc. This subpopulation of invertebrate blood cells, resembling vertebrate granulocytes, has been previously shown to produce and react to opioid peptides. Their activation, like that of vertebrate immunocytes, expresses itself in distinctive conformational changes preceding cellular mobilization. The cellular response to “stress” observed is the same as that to the administration of exogenous mammalian opioid peptides. This strongly suggests that under the conditions of stressful stimuli, the immune/defense system can be alerted by endogenous neuropeptides. The involvement of opioids in neuroimmunoregulatory phenomena appears to have a long evolutionary history.     

Cyclo-oxygenase-2, endothelium and aortic reactivity during deoxycorticosterone acetate salt-induced hypertension

OBJECTIVE: To test the hypothesis that the enhanced vascular responsiveness to norepinephrine that occurs during deoxycorticosterone acetate (DOCA)-salt induced hypertension is causally related to increased expression of cyclo-oxygenase (COX)-2 and oxidative stress, which diminishes the vasomodulatory influence of endothelium-derived nitric oxide. METHODS: Four groups of age-matched, male Sprague-Dawley rats were studied: Sham (normotensive); DOCA-salt (hypertensive); DOCA-salt treated with manganese(III) tetra(4-benzoic acid) porphyrin chloride [MnTBAP, an antioxidant; 15 mg/kg intraperitoneally (i.p.) for 21 days]; DOCA-salt treated with {N-[2-(cyclohexyloxy)-4-nitrophenyl]-methane sulfonamide} (NS-398, a COX-2 selective blocker; 5 mg/kg i.p. for 7 days). Contraction and relaxation were measured with FT03 force transducers coupled to a Grass polygraph in aortic rings bathed with physiologic salt solution (37 degrees C) and bubbled with a 5%CO2/95%O2 gas mixture. Aortic sensitivities (pD2 values) to norepinephrine and serum isoprostanes (8-iso-prostaglandin F2alpha, a marker of oxidative stress) were measured for each experimental paradigm. RESULTS: NS-398 significantly reduced maximal contractions in response to norepinephrine in aortic rings from Sham (44 +/- 3%) and DOCA-salt (96 +/- 2%) group rats. Expression of COX-2 protein increased significantly in vessels from DOCA-salt rats compared with those from Sham group rats. Treatment of DOCA-salt rats with either MnTBAP or NS-398 alleviated hypertension, normalized aortic pD2 values for norepinephrine and restored serum 8-isoprostane concentrations towards those observed in Sham group rats. CONCLUSIONS: COX-2 expression increases during DOCA-salt hypertension, and mediates production of factors that enhance rat aortic contractility in response to norepinephrine. Our data also suggest a role for increased oxidative stress, which is at least in part dependent on enhanced COX-2 expression, in the mechanism(s) of enhanced aortic contractility in response to norepinephrine during DOCA-salt hypertension.     

Increased Phosphodiesterase Type 5 Levels in a Mouse Model of Type 2 Diabetes Mellitus

IntroductionDiabetes mellitus (DM) is a major risk factor for developing erectile dysfunction (ED) and men with DM are often less responsive to phosphodiesterase type 5 (PDE5) inhibitors than ED due to other causes.AimsThe aim of this study was to explore potential mechanisms whereby PDE5 inhibitors may have reduced efficacy in type 2 DM.MethodsAt 4 weeks of age, mice were either fed a high‐fat diet (HFD) for 22–36 weeks or fed regular chow (control). An additional group of mice in the same genetic background had a genetic form of type 1 DM.Main Outcome MeasuresGlucose tolerance testing, intracorporal pressures (ICPs), oxidative stress (OS), apoptotic cell death (active caspase‐3 and apostain), PDE5, p53, and cyclic guanosine monophosphate (cGMP) levels, and histological examination of inflow arteries were performed in mice fed a HFD and control mice. A group of mice with type 1 DM were studied for PDE5 expression levels.ResultsAll mice fed a HFD had impaired glucose tolerance compared with the age‐matched mice fed on standard chow diet (control). HFD fed mice had reduced maximum ICPs following in vivo cavernous nerve electrical stimulation and increased apoptotic cell death, OS, and p53 levels in the corporal tissue. Interestingly, PDE5 levels were increased and cGMP levels were decreased. In contrast, mice with type 1 DM did not have increases in PDE5.ConclusionsTaken together, our results suggest that type 2 DM‐induced ED is associated with findings that could lead to reduced cGMP and may account for reduced efficacy of PDE5 inhibitors. Ellati RT, Dokun AO, Kavoussi PK, Steers WD, Annex BH, and Lysiak JJ. Increased phosphodiesterase type 5 levels in a mouse model of type 2 diabetes mellitus. J Sex Med **;**:**–**.     

Sexual hazards,life experiences and social circumstances among male sex workers in Nigeria

The sexual health and rights needs of male sex workers in Nigeria remain poorly understood and served. Men who sell sex are at high risk of discrimination and violation because of laws criminalising same-sex activity and sex work. This paper examines the experiences, social circumstances, vulnerabilities and sexual hazards experienced by male sex workers in Nigeria. In-depth interviews were used to explore the experiences of six male sex workers who were selected by means of convenience sampling from among those who came for counselling. Findings reveal that economic disadvantage drives some men to engage in sex work and risky sexual behaviour. Subsequently, sex work may put their lives and health at risk as a result of violation by the police and clients, including ritual murder. Men's extreme vulnerability points to the need for appropriate interventions to improve well-being. Sexual health and rights programmes must identify ways of making male sex workers less vulnerable to abuse, and devise strategies for protecting their health and human rights, while empowering them economically to reduce their dependency on often risky sexual behaviour for livelihoods.     

Doctors’ attitude towards people with mental illness in Western Nigeria

INTRODUCTION: It had been suggested that those more knowledgeable about mental illness are less likely to endorse negative or stigmatizing attitudes. This study aimed to evaluate the attitude of doctors in Nigeria towards the mentally ill. METHODS: Medical doctors (n = 312) from eight selected health institutions in Nigeria completed various questionnaires on knowledge and attitude towards people with mental illness. RESULTS: Beliefs in supernatural causes were prevalent. The mentally ill were perceived as dangerous and their prognosis perceived as poor. High social distance was found amongst 64.1% and the associated factors include not having a family member/friend with mental illness (OR 7.12, 95% CI 3.71-13.65), age less than 45 years (OR 2.33, 95% CI 1.23-4.40), less than 10 years of clinical experience (OR 6.75, 95% CI 3.86-11.82) and female sex (OR 4.98, 95% CI 2.70-9.18). CONCLUSION: Culturally enshrined beliefs about mental illness were prevalent among Nigerian doctors. A review of medical curriculum is needed and the present anti-stigma campaigns should start from the doctors.