Interposition of fallopian salpinges in the treatment of sigmoidovaginal fistula, secondary to vaginal hysterectomy with failure of previous repair

A 50-year-old woman, para 4, suffering from uterine fibromatosis and recurrent menometrorrhagia, underwent vaginal hysterectomy with preservation of salpinges. About 15 days after surgery, hydrosoluble contrast enema showed sigmoidovaginal fistula; after about two months there was failure of surgery repair by the rectal endoscopic technique. A month later, we performed repair surgery by the abdominal approach interposing fallopian salpinges between the sigmoid and the vagina. About two months later, a enema showed absence of fistula and today the women is free from disease. Received: 26 March 1999 / Accepted: 7 October 1999     

Biliopancreatic diversion: long-term effects on gonadal function in severely obese men

BACKGROUND: This study investigated hormonal parameters of gonadal function in severely obese men before and 1 year after undergoing biliopancreatic diversion (BPD). METHODS: This observational 1-year postoperative study conducted at medical and surgical clinics at an academic medical center in Italy followed 20 severely obese men age 21 to 63 years, with a mean (+/- standard deviation) body mass index (BMI) of 47.3 +/- 13.1. The following parameters were evaluated: body composition, using body impedance analysis (BIA), and serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, estradiol 17beta, and leptin. RESULTS: At a mean 12 +/- 1 months after surgery, the patients showed a significant decrease in weight, from 132.1 +/- 36.9 before surgery to 93.5 +/- 20 kg (P < .0001), and BMI, from 47.3 +/- 13.1 before surgery to 33.5 +/- 7 (P < .0001). LH increased from 2.42 +/- 1.59 to 4.97 +/- 2.6 mIU/ml (P < .0001), FSH increased from 2.85 +/- 1.85 to 4.9 +/- 4.2 mIU/mL (P = .021), and total testosterone increased from subnormal presurgical values to within normal range (2.81 +/- 1.08 to 9.12 +/- 1.37 ng/mL; P < .0001), whereas estradiol 17beta decreased from elevated basal levels of 44.0 +/- 29 to 16.7 +/- 6.9 pg/mL (P < .0001). The basal leptin level dropped from 33.0 +/- 9.23 to 16.6 +/- 5.12 ng/mL (P < .0001), reflecting the decrease in body fat. Subjective improvement in sexual performance was reported by 80% of patients. CONCLUSIONS: Severe obesity is coupled with some significant alterations of the gonadotropin-testicular axis and estradiol 17beta and leptin blood levels. These derangements were substantially corrected by 1 year after BPD.     

Negative impact of 'old-to-old' donations on success of cadaveric renal transplants

The effect of 'old-to-old' cadaveric renal transplants on operative complications and graft survival was assessed in all 325 patients undergoing solitary cadaveric renal transplantations in Israel during a 3-yr period. Preoperative information and hospital course data were abstracted from the charts. Results were analyzed using Kaplan-Meyer survival curves, univariate and multivariate Cox models. Overall, 62 (19.1%) grafts failed within a year. Failure rate was 46.2% for 'old-to-old' transplants compared with 15.5% for all other donor/recipient age combinations (p < 0.0001). 'Old-to-old' transplants remained independently associated with graft failure in a multivariate Cox model after controlling the effect of other risk factors. 'Old-to-old' transplants were also associated with increased operative complications relative to other age combinations. The decision to use 'old-to-old' transplants, even when donors are scarce, is problematic and should be reconsidered.     

Effects of timolol maleate on tear flow in human eyes

Lacrimal function was studied in 30 patients treated for glaucoma, with 0.25% timolol eye drops. Rose bengal and fluorescein staining disclosed punctate epithelial defects in 11 eyes after one week. During the following weeks there defects disappeared spontaneously in most eyes. Schirmer tests (I and II), tear lysozyme and pre-corneal film break-up time were significantly decreased by the treatment, while tear immunoglobulins were unimpaired. The authors conclude that topical timolol treatment decreases tear production. This effect is quantitatively limited and does not appear dangerous for normal eyes, although it may become so for eyes with an originally low lacrimal secretion.     

Experimental corticosteroid ocular hypertension in the rabbit

Summary Weekly subconjunctival injections of 4mg repository betamethasone, repeated over three weeks, produced a sustained increase of intraocular pressure (IOP) in 96 % of the treated rabbits.Treatment was generally well tolerated and important systemic toxic effects were present only in a few animals.The ocular hypertension so obtained was constant, well reproducible and sensitive to antiglaucoma drugs.The authors believe they have developed an animal model which is very suitable for testing the pressure-lowering effect of drugs and for other studies on ocular hypertension and glaucoma.     

The Relationship Between Self-Reported Sexual Orientation and Behavior in a Sample of Middle-Aged Male Injection Drug Users

Data are sparse on injection drug using (IDU) men who have sex with men (MSM). Previous literature suggests perceived taboos can result in an underreporting of atypical sexual orientation (i.e., bisexuality, homosexuality). As a result, HIV prevention programs have been difficult to mount, particularly programs for IDU-MSM. The association between self-reported sexual orientation and sexual behavior at semi-annual study visits was longitudinally assessed in a population of 1300 male IDUs in Baltimore during the period 1993 to 1998. Overall, a small minority (5%) of the male IDUs inconsistently reported their sexual orientation over time. Logistic regression analyses were performed, which yielded five significant predictors. These men tended to be older, to have been incarcerated, to have attended shooting galleries during follow-up, and were more than twice as likely to be HIV-seropositive (OR, 2.66; 95% CI, 1.62–4.36) compared with those who consistently reported their sexual orientation. Furthermore, men reporting inconsistent sexual orientation tended to engage in higher risk behaviors, suggesting that these men should be especially targeted for interventions.     

<Emphasis Type="Italic">Abriendo Puertas</Emphasis>: Feasibility and Effectiveness a Multi-Level Intervention to Improve HIV Outcomes Among Female Sex Workers Living with HIV in the Dominican Republic

Female sex workers (FSW) are disproportionately affected by HIV. Yet, few interventions address the needs of FSW living with HIV. We developed a multi-level intervention, Abriendo Puertas (Opening Doors), and assessed its feasibility and effectiveness among a cohort of 250 FSW living with HIV in the Dominican Republic. We conducted socio-behavioral surveys and sexually transmitted infection and viral load testing at baseline and 10-month follow-up. We assessed changes in protected sex and adherence to antiretroviral therapy (ART) with logistic regression using generalized estimating equations. Significant pre-post intervention changes were documented for adherence (72–89 %; p < 0.001) and protected sex (71–81 %; p < 0.002). Higher intervention exposure was significantly associated with changes in adherence (AOR 2.42; 95 % CI 1.23–4.51) and protected sex (AOR 1.76; 95 % CI 1.09–2.84). Illicit drug use was negatively associated with both ART adherence and protected sex. Abriendo Puertas is feasible and effective in improving behavioral HIV outcomes in FSW living with HIV.     

The effect of HIV infection on overdose mortality

OBJECTIVES: To quantify the association of HIV infection with overdose mortality and explore the potential mechanisms. DESIGN: A prospective cohort study. METHODS: A total of 1927 actively injecting drug users who were HIV seronegative at baseline, of whom 308 later HIV seroconverted, were followed semi-annually for death from 1988 to 2001. Survival analyses using marginal structural and standard Cox models were used to evaluate the effect of HIV infection on the risk of overdose mortality. RESULTS: Overdose death rates were higher in HIV-seropositive than HIV-seronegative drug users: 13.9 and 5.6 per 1000 person-years, respectively (P < 0.01). The hazard ratio (HR) was 2.54 [95% confidence interval (CI) 1.47, 4.38] for the marginal structural model and 2.06 (95% CI 1.25, 3.38) for the standard Cox model, both adjusted for demographics, drug injection characteristics, alcohol abuse, substance abuse treatment, and sexual orientation. Adjusting for possible time-varying mediators (i.e. drug use, medical conditions and healthcare access) in extended marginal structural models reduced the effect of HIV on overdose mortality by 30% (HR 1.82, 95% CI 1.01, 3.30). Abnormal liver function was associated with a higher risk of overdose mortality (HR 2.00, 95% CI 1.05, 3.84); adjustment for this further reduced the effect of HIV on overdose mortality. CONCLUSION: HIV infection was associated with a higher risk of overdose mortality. Drug use behavior, systematic disease and liver damage associated with HIV infection appeared to account for a substantial portion of this association. The data suggest a group to target with interventions to reduce overdose mortality rates.