Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system

Our objective was to determine the inter-examiner agreement of a simplified pelvic organ prolapse quantification (POPQ) exam and to assess its correlation with the standard POPQ exam. This study consists of two parts; both were preformed in a prospective, randomized, blinded fashion on women presenting with complaints attributed to pelvic organ support defects. The first study was done to determine the inter-examiner reliability of a simplified POPQ exam. The simplified POPQ exam is based on the POPQ with similar ordinal staging but with only four points measured instead of nine. Forty-eight women underwent exams by five different investigators. The order of exams was randomized and the examiners were blinded to the results of each other’s findings. The results of these two exams were compared using weighted kappa statistics. The second part of the study was done to determine the inter-system agreement between the simplified vs standard POPQ exam. A group of 49 women were examined by four different investigators: one using the simplified and the other using standard POPQ exams. The order of the exams was randomized and the examiners were blinded to the results of each other’s exam. Kendall’s tau-b statistics were used to determine the inter-system agreement. For the inter-examiner reliability of the POPQ exam, the average age was 60±13 years. The weighted kappa statistics for the inter-examiner reliability of the simplified prolapse classification system were 0.86 for the overall stage, 0.89 and 0.86 for the anterior and posterior vaginal walls, respectively, 0.82 for the apex/cuff, and 0.72 for the cervix. All demonstrate significant agreement. For the inter-system association between the simplified POPQ and standard POPQ, the average age was 61±15 year. The Kendall’s tau-b value for overall stage was 0.90, 0.83, and 0.87 for the anterior and posterior walls respectively, and 0.78 for the cuff/apex and 0.98 for the cervix. There is good inter-examiner agreement of a simplified POPQ classification system and it appears to have good inter-system association with the POPQ.IUGA Standardization of Terminology Committee members: Robert Freeman MD (chairman), Steven Swift, Eckhard Petri MD, Richard J. Scotti MD, and Peter Dwyer MD.     

Oligonucleotide fingerprint analyses of influenza C virion RNA recovered from five different isolates

Summary Five different isolates of influenza C virus which were isolated over a period of 32 years and from four different continents were compared by RNA genome oligonucleotide fingerprinting analyses. The earliest isolate of influenza C virus was reported in 1949 byTaylor (19) and served as a reference strain for this study.The results obtained using this technique of comparing relatedness between viruses clearly showed that all strains are distinct. However, the similarities in the pattern of the oligonucleotide fingerprints are marked for the more recent virus isolates (1966–1979), whereas the reference strain C/Taylor shows more pronounced differences.The results are consistant with the high degree of serological crossreaction amongst influenza C viruses isolated over a long period of time, a property which sets this group of viruses apart from type A and B members of the orthomyxoviridae.With 3 Figures     

Mental health in the population approaching retirement age. Preliminary findings of the TURVA project

The present paper deals with a Finnish long-term prospective study, the objective of which is to shed light on adjustment to retirement and old age. In this phase, only the preliminary findings of the initial survey carried out in 1982 are available. For the purposes of the study, a random sample of 200 individuals was drawn from among Turku inhabitants born in 1920. Another sample, consisting of 189 persons of the same age, was drawn from rural municipalities in the neighborhood of Turku. An extensive structured psychosocial interview could be conducted with a total of 339 subjects. The research methods used included e.g. the 36-item version of Goldberg's General Health Questionnaire (GHQ). Relatively little mental disturbance was revealed in the interview, and no major differences occurred between the urban and the rural sample. Somewhat over one-third of both samples were probable psychiatric cases as defined according to the GHQ.     

First-pass effects of verapamil on the intestinal absorption and liver disposition of fexofenadine in the porcine model.

The aim of this study in pigs was to investigate the local pharmacokinetics of fexofenadine in the intestine and liver by using the pig as a model for drug transport in the entero-hepatobiliary system. A parallel group design included seven pigs (10-12 weeks, 22.2-29.5 kg) in three groups (G1, G2, G3), and a jejunal single-pass perfusion combined with sampling from the bile duct and the portal, hepatic, and superior caval veins was performed. Fexofenadine was perfused through the jejunal segment alone (G1: 120 mg/l, total dose 24 mg) or with two different verapamil doses (G2: 175 mg/l, total dose 35 mg; and G3: 1000 mg/l, total dose 200 mg). The animals were fully anesthetized and monitored throughout the experiment. Fexofenadine had a low liver extraction (E(H); mean +/- S.E.M.), and the given doses of verapamil did not affect the E(H) (0.13 +/- 0.04, 0.16 +/- 0.03, and 0.12 +/- 0.02 for G1, G2, and G3, respectively) or biliary clearance. The E(H) for verapamil and antipyrine agreed well with human in vivo data. Verapamil did not increase the intestinal absorption of fexofenadine, even though the jejunal permeability of fexofenadine, verapamil, and antipyrine showed a tendency to increase in G2. This combined perfusion and hepatobiliary sampling method showed that verapamil did not affect the transport of fexofenadine in the intestine or liver. In this model the E(H) values for both verapamil and antipyrine were similar to the corresponding values in vivo in humans.     

Incidence and survival in patients with pharyngeal cancer in northern Finland

A population-based survey was conducted in northern Finland in order to study the incidence rate and survival in patients with pharyngeal cancer diagnosed between 1986 to 1996. A total of 95 new patients with hypopharyngeal, oropharyngeal or nasopharyngeal cancers were identified. The overall age-adjusted incidence rates (per 100,000 years) were 1.28 in men and 0.60 in women, giving an overall incidence rate of 0.89. Most of the tumours were diagnosed at stage IV, and the median disease-specific survival times were 27.6 months for the patients with oropharyngeal cancer, 13.5 months for nasopharyngeal cancer and 17.7 for hypopharyngeal cancer. The most important factors that were associated with a poor prognosis were stage IV in oropharyngeal [Hazard ratio (HR) 3.68, 95% confidence interval (CI) 0.97-13.92] and hypopharyngeal cancer (HR 3.99, CI 1.51-10.67) and age over 65 years in nasopharyngeal cancer (HR 9.28, CI 1.79-47.99).     

Surgical treatment of cavernous haemangiomas of the liver

Cavernous haemangiomas of the liver were surgically treated in 36 women and 14 men over a 10-year period. The tumours were solitary in 42 cases and multiple in 8. Locations were the right lobe in 39 cases, the left one in 5 and both lobes in 6. The size of the tumours ranged from 0.4 to 14 cm in diameter. Enucleation of tumours was carried out in 29 cases, an atypical liver resection in 19 cases, anatomical lobectomy in 2 cases and a right trisegmentectomy in 1 case. There was no mortality. Morbidity rate seems to be lower in patients who underwent enucleation. The authors indicate the importance of enucleation for removal of liver haemangiomas of various sizes.

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Chirurgische Behandlung kavernöser Hämangiome der Leber

Zusammenfassung Über einen Zeitraum von 10 Jahren wurden kavernöse Hämangiome der Leber bei 36 Frauen und 14 Männern chirurgisch behandelt. Bei 42 Patienten waren die Tumoren solitär, bei 8 multipel. Sie waren in 39 Fällen im rechten, bei 5 Patienten im linken und bei 6 in beiden Leberlappen lokalisiert, ihr Durchmesser betrug 0,4 bis 14 cm. In 29 Fällen wurde eine Enukleation, in 19 eine atypische Leberresektion, in 2 eine anatomische Lobektomie und in einem Falle eine rechtsseitige Trisegmentektomie durchgeführt. Die Mortalität war gleich Null; die Morbiditätsrate scheint bei den Patienten geringer, die mit Enukleation behandelt wurden. Der Beitrag hebt die Bedeutung der Enukleation zur Beseitigung von Leberhämangiomen unterschiedlicher Größe hervor.

     

Dietary Xylitol Retards the Ovariectomy-Induced Increase of Bone Turnover in Rats

The effects of 10% dietary xylitol supplementation in ovariectomized rats were studied on the degradation of bone organic and inorganic structures. The osseal concentrations of hydroxyproline, pyridinoline, and deoxypyridinoline were analyzed by high-performance liquid chromatography. Bone resorption was measured in [³H]tetracycline-prelabeled rats by urinary excretion of ³H, and by the amount of ³H preserved in bone. Bone trabeculation was measured by a computer image analyzer from sections stained by the method of von Kossa. The amount of collagen in bone organic fraction was lower in ovariectomized rats as compared with the sham-operated controls. This most likely is partly a consequence of an increased resorption, and partly a consequence of a higher proportion of immature periosteal bone in the ovariectomized animals, leading to a higher ratio of noncollagenous protein to collagen. The number of pyridinium crosslinks was lower in proportion, indicating no selective changes in the structure of collagen. Dietary xylitol significantly retarded the ovariectomy-associated decrease in the relative amount of collagen and the number of its mature crosslinks. Ovariectomy doubled the excretion of ³H and caused a significant decrease in the amount of ³H preserved in bone; both these changes were significantly retarded by the 10% dietary xylitol supplementation. Ovariectomy significantly decreased the volume of bone trabeculae, but this effect was also significantly inhibited by the xylitol supplementation in the diet. In conclusion, these findings suggest a dietary xylitol-induced normalizing effect on the rate of bone turnover in ovariectomized rats. Received: 12 February 1996 / Accepted: 20 August 1996     

Intrascrotal adenomatoid tumors

Adenomatoid tumors are regarded as uncommon neoplasms of the paratesticular tissues, probably of mesothelial origin. The majority of cases reported have involved the epididymis. We report our experience with 8 cases of testicular tumors and 11 of epididymal adenomatoid tumors during a 13-year period, and review the relevant literature. The incidence of adenomatoid tumors relative to all tumors in the testis was 6.9% (8 of 116), exceeding that of Leydig cell tumors, which were previously believed to be the most common benign testicular neoplasms. The adenomatoid tumors included 38% epididymal tumors (11 of 29). The clinical course of the tumors was benign, without recurrences. Local excision is regarded as the treatment of choice for epididymal and testicular adenomatoid tumors.