Assessment of pelvic floor function: A series of simple tests in nulliparous women

The aim of the study was to assess normal ranges, variations, test-retest reliability and correlations between tests for a battery of simple, minimally invasive tests of pelvic floor function in nulliparous asymptomatic women. Women were recruited by advertisement and underwent dipstick urinalysis, simple cystometrics, provocative tests for incontinence, Q-tip test and surface electromyography with acrylic plug electrodes. Subjects were retested at a later date. Nineteen subjects underwent initial testing and 12 were retested. A wide range of normal values was obtained. Cystometric measures of first and strong urge to void the maximum bladder capacity, Q-tip test and rectal perineometry had significant correlations between the two visits. There were no significant between-test correlation coefficients. It was concluded that the simple tests used demonstrate a mixed ability to follow pelvic floor function longitudinally.Editorial Comment: This study attempts to assess the normal ranges and reproducibility of a series of minimally invasive clinical tests commonly used to measure pelvic floor function. The second goal of the study is to determine whether there is any correlation among these tests. Nineteen nulliparous asymptomatic women underwent a battery of tests, including postvoid residual, simple cystometry, translabial sonography, Q-tip test, stress test and electromyography; 12 of the women repeated the tests at a later date. The investigators found a wide range of values, large standard deviations and poor correlation on test-retest in most of the tests performed. Furthermore, no correlation between the tests could be found. The study is severely limited by its small population size, a key ingredient when trying to assess normal values of specific tests or parameters. However, the failure to detect a significant correlation between the different tests of pelvic floor function, in spite of the small numbers, is interesting. Again, the complexity of pelvic floor function is clearly evident-assessment of the pelvic floor requires a variety of tests to obtain a clear picture of normal versus abnormal function.     

Implantable self-powered detector for on-line determination of neutron flux in patients during NCT treatment.

A novel system to determine thermal neutron flux in real time during NCT treatments was developed in the National Atomic Energy Commission of Argentina. The system is based on a special self-powered detector that can be implanted in patients owing to its small size and biocompatibility. High voltage is not required to operate this kind of detectors, which is a considerable advantage in terms of medical uses. By choosing the appropriate materials, it was possible to obtain a prototype with thermal neutron sensitivity providing for an adequate signal level in typical NCT thermal fluxes. It was also possible to minimize gamma response in order to neglect its contribution.     

Magnetic resonance imaging of the pelvic floor in the postpartum patient

Magnetic resonance imaging (MRI) was used to assess anatomical changes in the pelvic floor after childbirth. Six women underwent serial MRI examination within 30 hours and at 1 week, 2 weeks, 6 weeks and 6 months after delivery; 8 additional women were studied only within 30 hours of delivery. T-1 and T-2-weighted images of the pelvis in the transverse and sagittal planes with a 1.5-T MR imager were obtained. In the sagittal section we assessed the urethrovesical angle, urethral length, distance from the symphysis to the proximal and distal vagina, vaginal length, width and length of the sphincters, and the presence of sphincter defects. Axial sections were assessed for sphincter defects for the distance between the symphysis and midurethra, vagina and rectum. Only one parameter (distance between symphysis and distal vagina) changed significantly over time, without a clear trend in direction. Interobserver variation was reasonable (<15%) except for anal canal length, urethral length and distance between symphysis and anus. There were no significant correlations between birthweight and MRI parameters. There was a non-significant association (P=0.09) between the sole combined sphincter defect and rectal injury, but not with episiotomy or parity. We concluded that it is feasible to determine multiple measurements on MR images to evaluate structures of the pelvic floor.EDITORIAL COMMENT: Although the presented study has multiple limitations — i.e. small sample size, no control group, static images, lack of correlated symptomatology — the investigators show that magnetic resonance imaging can be used to follow the natural course of pelvic floor changes after vaginal delivery. Hopefully this work will be continued and expanded, shedding more light on the effects of childbirth on pelvic floor anatomy and function.     

Hypoactive Sexual Desire Disorder in Postmenopausal Women: Quality of Life and Health Burden

ObjectivesTo describe the health-related quality of life (HRQOL) implications of hypoactive sexual desire disorder (HSDD) in a national sample of postmenopausal women ages 30–70.MethodsThe Nationwide Survey of Female Sexual Health, a random-digit telephone survey of US households, collected information on female sexual function, demographic characteristics, HRQOL, and the presence of specific medical disorders from 1189 naturally or surgically postmenopausal women in stable relationships of ≥3 months duration. HSDD was defined as <40 on the Profile of Female Sexual Function© scale and <60 on the Personal Distress Scale©. Short Form-12 Health Survey (SF-12) summary and domain scores, and EuroQol (EQ-5D) index score and dimensions were compared with population-based norms for healthy individuals and selected chronic conditions.ResultsHSDD was associated with significant HRQOL decrements, with the largest SF-12 score differences in mental health (HSDD: 45.4 [standard error 1.9] vs. no HSDD: 51.0 [0.6], P < 0.01), vitality (HSDD: 47.7 [1.3] vs. no HSDD: 52.0 [0.7], P < 0.01), social function (HSDD: 47.3 [1.4] vs. no HSDD: 50.9 [0.7], P < 0.05), and bodily pain (HSDD: 41.4 [2.2] vs. no HSDD: 46.7 [0.9], P < 0.05). EQ-5D index was 0.08 points lower (HSDD: 0.76 [0.03] vs. no HSDD: 0.84 [0.02], P < 0.05) for those with HSDD compared with those without. HSDD was associated with a 0.1-point decrement in naturally menopausal women (HSDD: 0.78 [0.03] vs. no HSDD 0.88 [0.01], P < 0.01). Women with HSDD showed more HRQOL impairment than healthy population norms but were similar to adults with other chronic conditions such as diabetes and back pain.ConclusionsWomen with HSDD showed substantial impairment in HRQOL. Given a prevalence of 6.6% to 12.5% among US women, HSDD represents an important burden on quality of life.     

Category generation testing in the search for implicit memory during general anaesthesia

We gave auditory examples of two semantic categories through headphones to 100 surgical patients anaesthetized with propofol and enflurane. This presentation was made during certain stages of the procedure, potentially associated with arousal, and during steady-state anaesthesia. Postoperative review using category generation tests showed successful priming in a pre-induction group but no evidence of implicit memory in the anaesthetized groups. These results suggest that timing an auditory input to coincide with surgical stimulation does not increase the probability of retrieval of information by this type of testing.      

Randomized study of six umbilical cord care regimens. Comparing length of attachment, microbial control, and satisfaction

Two hundred and seventy one infants were enrolled in a study to compare six different methods of treating the umbilical cord. Antimicrobial control was equal for all methods. Repeated triple dye application was considered least acceptable by staff and parents and had the longest attachment time. Povidone-iodine was associated with the shortest attachment time and was most liked. If there is no special need to treat a specific nosocomial outbreak, duration of cord attachment and satisfaction of staff and parents can help clinicians decide on a cord care regimen.