OBJECTIVE: To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk. DESIGN: An observational study. SETTINGS: Departments of Obstetrics and Gynaecology and of Surgery D, Glostrup County University Hospital, Denmark. PARTICIPANTS: Ninety-four consecutive women who had sustained an obstetric anal sphincter rupture. INTERVENTIONS: Assessment of history, anal manometry, anal sphincter electromyography and pudendal nerve terminal motor latency at three months postpartum A questionnaire regarding anal and urinary incontinence was sent two to four years postpartum. MAIN OUTCOME MEASURES: The frequency of anal and urinary incontinence and risk factors for the development of incontinence. RESULTS: Thirty of 72 women (42%) who responded had anal incontinence two to four years postpartum; 23 (32%) had urinary incontinence and 13 (18%) had both urinary and anal incontinence. Overall, 40 of 72 women (56%) had incontinence symptoms. The occurrence of anal incontinence was associated with pudendal nerve terminal motor latencies of more than 2.0 ms, and the occurrence of urinary incontinence was associated with the degree of rupture, the use of vacuum extraction and previous presence of urinary incontinence. Seventeen women had subsequently undergone a vaginal delivery in relation to which four (24%) had aggravation of anal incontinence, and three (18%) had aggravation of urinary incontinence. Of the women with incontinence, 38% wanted treatment but only a few had sought medical advice. CONCLUSIONS: Obstetric anal sphincter rupture is associated with a risk of approximately 50% for developing either anal or urinary incontinence or both. The prediction of women at risk is difficult. Information and routine follow up of all women with obstetric anal sphincter rupture is mandatory.
Between 1971 and 1985, 598 patients with ovarian carcinoma were treated with abdomino-pelvic radiation therapy. Acute complications included nausea and vomiting in 364 patients (61%) which were severe in 36, and diarrhea in 407 patients (68%), severe in 35. Leukopenia (less than 2.0 x 10(9) cells/liter) and thrombocytopenia (less than 100 x 10(9) cells/liter) occurred in 64 patients (11%) each. Treatment interruptions occurred in 136 patients (23%), and 62 patients (10%) did not complete treatment. In both situations the most common cause was myelosuppression. Late complications included chronic diarrhea in 85 patients (14%), transient hepatic enzyme elevation in 224 (44%), and symptomatic basal pneumonitis in 23 (4%). Serious late bowel complications were infrequent: 25 patients (4.2%) developed bowel obstruction and 16 required operation. Multivariate analysis was unable to determine any significant prognostic factors for bowel obstruction; however, the moving-strip technique of radiation therapy was associated with a significantly greater risk of developing chronic diarrhea, pneumonitis, and hepatic enzyme elevation than was the open beam technique. We conclude that abdomino-pelvic radiation therapy as used in these patients is associated with modest acute complications and a low risk of serious late toxicity.
PURPOSE: Metachronous bilateral UUTTs are rare. The authors reported baseline and long-term followup data for all patients diagnosed in Western Sweden during a 28-year period. MATERIALS AND METHODS: We performed a clinical and histopathological analysis of all patients in Western Sweden surgically treated for ureteral and renal pelvic tumors from 1971 to 1998. RESULTS: Of 768 patients a contralateral UUTT developed in 24 (3.1%) after a median of 46 months (range 2 to 232). The projected incidence after initial UUTT diagnosis was 2.7%, 5.8% and 6.5% at 5, 10 and 15 years, respectively. Median age of the 24 patients at initial UUTT diagnosis was 67 years and the median age at death was 77 years. Bladder cancer was significantly more common among patients with bilateral UUTT compared to those with unilateral UUTT (83% vs 31%, p
Previous studies have indicated that body mass can be estimated from stature and bi-iliac (maximum pelvic) breadth with reasonable accuracy in modern humans, supporting the use of this method to estimate body mass in earlier human skeletal samples. However, to date the method has not been tested specifically on high latitude individuals, whose body form in some ways more closely approximates that of earlier higher latitude humans (i.e., large and broad-bodied). In this study, anthropometric data for 67 Alaskan Inupiat and 54 Finnish adults were used to test the stature/bi-iliac body mass estimation method. Both samples are very broad-bodied, and the Finnish sample is very tall as well. The method generally works well in these individuals, with average directional biases in body mass estimates of 3% or less, except in male Finns, whose body masses are systematically underestimated by an average of almost 9%. A majority of individuals in the total pooled sample have estimates to within +/-10% of their true body masses, and more than three-quarters have estimates to within +/-15%. The major factor found to affect directional bias is shoulder to hip breadth (biacromial/bi-iliac breadth). Male Finns have particularly wide shoulders, which may in part explain their systematic underestimation. New body mass estimation equations are developed that include the new data from this study. When applied to a sample of earlier (late middle Pleistocene to early Upper Paleolithic) higher latitude skeletal specimens, differences between previous and new body estimates are small (less than 2%). However, because the Finns significantly extend the range of morphological variation beyond that represented in the original world-wide reference sample used in developing the method, thereby increasing its generality, it is recommended that these new formulas be used in subsequent body mass estimations.
The aim of this study was to characterise the hospital burden of fractures in the Swedish population by age and gender. The number of patients and number of fractures were documented according to site of fracture, age, sex and duration of hospital stay for the whole population of Sweden in 1996. Fractures were additionally classified as osteoporotic according to fracture site. In 1996 there were 54,000 admissions for fracture in men and women aged 50 years or more, accounting for 600,000 hospital-bed days. Hip fractures accounted for 63% of admissions for fracture in men and 72% in women, for 69% and 73% of hospital-bed days, respectively. Fractures considered to be osteoporotic accounted for 84% of all hospital-bed days due to fracture in men, and 93% in women. More hospital-bed days were due to osteoporotic fracture than to breast cancer and prostate cancer combined. The number of hospital-bed days due to osteoporotic fracture was between the amount due to ischaemic heart disease and the amount due to stroke.
To report the prevalence and factors associated with ever having had a Papanicolaou (Pap) test or pelvic examination among Canadian women with physical disabilities and the barriers to having the tests.
Convenience sample of 1095 women between the ages of 18 to 93 completed the survey. The most frequently reported health conditions were musculoskeletal (44%), neurologic (17%), and sensory (13%).
Outcomes included prevalence of ever having a Pap test or pelvic examination and odds ratios of having the tests.
Prevalence of ever having a Pap test was 90% and 91% for a pelvic examination. The most common barriers to the screening tests were "not being sexually active," "my doctor told me I do not need one," and "the exam table is too high/narrow."
Although the prevalence of ever having a Pap test or pelvic examination was at or above 90%, women with physical disabilities need further education on the necessity and benefits of having regular cancer screening behaviors, especially among those who may not be sexually active. Further research is also required into why these women are informed that they do not require cancer screening tests.
The relationship between the increased incidence of ectopic pregnancy and the known risk factors of this disorder was examined by 5-year age groups and equivalent calendar periods to determine the causes of the recent "epidemic" of ectopic pregnancy. None of the known risk factors would alone explain the observed increase. Consequently, multivariate analysis by log-linear models was applied: age, past pelvic operation, previous pelvic inflammatory disease, antecedent legal abortion, and current use of an intrauterine contraceptive device were responsible for the increase in the occurrence of the disease. The strongest association with the observed temporal trend in the increase of ectopic pregnancy was found for pelvic operation (including previous ectopic pregnancy), pelvic inflammatory disease, and current use of an intrauterine contraceptive device. Improved diagnosis and changing demographic patterns also contributed to the increase in the annual number of ectopic pregnancies.
Comment In: Am J Obstet Gynecol. 1990 Jul;163(1 Pt 1):265-62375365
Comment In: Am J Obstet Gynecol. 1990 Apr;162(4):1130-22327458
OBJECTIVE: We studied prevalences and risk factors for cesarean section among different groups of immigrants from countries outside Western Europe and North America in comparison to ethnic Norwegians. METHODS: The study is population based using data from the Medical Birth Registry of Norway. A total of 553,491 live births during the period 1986-1995 were studied, including 17,891 births to immigrant mothers. RESULTS: The prevalences of cesarean section ranged from 10.1% among women from Vietnam to 25.8% in the group of Filipino origin. The use of abdominal delivery was also high in the groups from Sri Lanka/India (21.3%), Somalia/Eritrea/Ethiopia (20.5%) and Chile/Brazil (24.3%), while the frequency among women from Turkey/Morocco (12.6%) and Pakistan (13.2%) was approximately the same as among ethnic Norwegians (12.4%). Feto-pelvic disproportion, fetal distress and prolonged labor were the most important diagnoses associated with the high prevalences, but the significance of these diagnoses differed among the groups. Other unknown factors come into play, particularly among women from Somalia/Eritrea/Ethiopia and Chile/Brazil. CONCLUSION: There was substantial variation in the use of cesarean section among ethnic groups in Norway. The diagnoses feto-pelvic disproportion, fetal distress and prolonged labor may be confounded by a number of factors including maternal request for cesarean section and difficulties in handling the delivery. Further research is needed to explain the observed differences.
Follow-up study to observe if provincial mean effective radiation dose for head, chest, and abdomen-pelvis (AP) computed tomographies (CTs) remained stable or changed since the initial 2006 survey.
Data were collected in July 2008 from Saskatchewan's 13 diagnostic CT scanners of 3358 CT examinations. These data included the number of scan phases and projected dose length product (DLP). Technologists compared projected DLP with 2006 reference data before scanning. Projected DLP was converted to effective dose (ED) for each head, chest, and AP CT. The total dose that the patients received with scans of multiple body parts at the same visit also was determined.
The mean (± SD) provincial ED was 3.4 ± 1.6 mSv for 1023 head scans (2.7 ± 1.6 mSv in 2006), 9.6 ± 4.8 mSv for 588 chest scans (11.3 ± 8.9 mSv in 2006), and 16.1 ± 9.9 mSv for 983 AP scans (15.5 ± 10.0 mSv in 2006). Single-phase multidetector row CT ED decreased by 31% for chest scans (9.5 ± 3.9 mSv vs 13.7 ± 9.7 mSv in 2006) and 17% for AP scans (13.9 ± 6.0 mSv vs 16.8 ± 10.6 mSv in 2006) and increased by 19% for head scans (3.2 ± 1.2 mSv vs 2.7 ± 1.5 mSv in 2006). The total patient dose was highest (33.8 ± 10.1 mSv) for the 20 patients who received head, neck, chest, and AP scans during a single visit. Because of increased utilisation and the increased CT head dose, Saskatchewan per capital radiation dose from CT increased by 21% between 2006 and 2008 (1.14 vs 1.38 mSv/person per year).
Significant dose and variation reduction was seen for single-phase CT chest and AP examinations between 2006 and 2008, whereas CT head dose increased over the same interval. These changes, combined with increased utilisation, resulted in per capita increase in radiation dose from CT between the 2 studies.