ABSTRACT
Pelvic organ prolapse (POP) is a debilitating condition of unknown aetiology affecting > 50% of women over 40 years of age. In POP patients, the vaginal walls are weakened allowing descent of pelvic organs through the vagina. We sought to determine if sphingosine-1-phosphate (S1P) signalling, which regulates smooth muscle contractility and apoptosis via the RhoA/Rho-kinase (ROK) pathway, is altered in the vagina of women with POP. Utilising anterior vaginal wall specimens, we provide novel demonstration of the S1P pathway in this organ. Additionally, comparing specimens from women having pelvic reconstructive surgery for POP and control subjects, we reveal increases in mRNA expression of the three major mammalian S1P receptors (S1P1-S1P3), and RhoA and the ROK isoforms: ROKα and ROKß in POP patients, which correlates with a decrease in elastic fibre assembly pathway constituents. Taken together, our data suggest the S1P/ROK pathway as a novel area for future POP research and potential therapeutic development.
Subject(s)
Lysophospholipids/metabolism , Pelvic Organ Prolapse/metabolism , RNA, Messenger/metabolism , Sphingosine/analogs & derivatives , Vagina/metabolism , rho-Associated Kinases/metabolism , Adult , Aged , Case-Control Studies , Female , Humans , Isoenzymes , Middle Aged , Pelvic Organ Prolapse/genetics , Receptors, Lysosphingolipid/genetics , Signal Transduction , Sphingosine/metabolism , Sphingosine-1-Phosphate Receptors , rho-Associated Kinases/genetics , rhoA GTP-Binding Protein/geneticsABSTRACT
OBJECTIVE: To assess the adequacy of a third- or a fourth-degree laceration repair by comparing digital and trans-perineal ultrasound measurements. METHOD: During a 4-year period, 34 subjects without prior history of anal sphincter injury or fecal incontinence underwent ultrasound measurements of external anal sphincter muscle diameter and perineal length, which were compared to measurements obtained by digital examination. RESULTS: Pearson's correlation coefficients for comparing the digital external sphincter examination to trans-perineal ultrasonography, and the digital perineal examination to trans-perineal ultrasonography were 0.88 and 0.40, respectively. Patients (n=4/34) whose external sphincter was identified as less than 1 cm by digital examination were found to have an external sphincter diameter of less than 1 cm by trans-perineal ultrasound. CONCLUSION: The digital perineum examination is a reliable method of measuring the external sphincter thickness and perineal body length immediately after primary repair.
Subject(s)
Anal Canal/injuries , Delivery, Obstetric/adverse effects , Perineum/injuries , Physical Examination , Adult , Anal Canal/diagnostic imaging , Anal Canal/surgery , Fecal Incontinence/etiology , Fecal Incontinence/prevention & control , Female , Humans , Perineum/diagnostic imaging , UltrasonographyABSTRACT
Transurethral collagen injection is both safe and effective when used for the treatment of genuine stress urinary incontinence. It is associated with a minimal inflammatory response, and virtually no foreign body reaction. Most allergic reactions occur within 72 hours of treatment (immediate hypersensitivity). Although uncommon, delayed hypersensitivity reactions may occur and it is advisable to administer a collagen skin test 30 days prior to the procedure. Adverse effects may cause long-term sequelae, such as severe trigonal tenderness, urgency, frequency, hematuria, urinary retention and persistent stress urinary incontinence. A case of a prolonged delayed hypersensitivity reaction following negative collagen skin testing after transurethral collagen injection is presented. Treatment of stress incontinence could not be initiated until symptoms decreased significantly after 1 year.
Subject(s)
Collagen/adverse effects , Collagen/therapeutic use , Drug Hypersensitivity/etiology , Hypersensitivity, Delayed/chemically induced , Urethra/drug effects , Urinary Incontinence, Stress/drug therapy , Collagen/administration & dosage , Female , Humans , Injections , Middle Aged , Time FactorsABSTRACT
Mycosis fungoides complicating pregnancy is rarely encountered. As it is a form of cutaneous T-cell lymphoma, some of the treatment options are contraindicated in pregnancy, and the disease may become unresponsive to safer conventional therapies. We report a patient who, in her third trimester of pregnancy, failed to respond to the treatment options available. Left with little choice, a trial of alpha-interferon was undertaken. The patient responded with remission, and prolongation of pregnancy was achieved.
Subject(s)
Antineoplastic Agents/therapeutic use , Interferon-alpha/therapeutic use , Mycosis Fungoides/drug therapy , Pregnancy Complications, Neoplastic/drug therapy , Skin Neoplasms/drug therapy , Adult , Female , Humans , Infant, Newborn , Male , Pregnancy , Pregnancy Trimester, ThirdABSTRACT
BACKGROUND: Most fistulas communicating with the bladder are large enough to be diagnosed easily, or small enough to close spontaneously without clinical sequel. A vesicocervical fistula is an uncommon event and may be difficult to diagnose. TECHNIQUE: During an operative cystourethroscopy procedure, suspicious areas of the bladder can be probed with a cone tip catheter and injected with contrast dye to visualize the suspected fistula communicating with the bladder. EXPERIENCE: This technique was employed when a double dye test, an intravenous urogram, a cystogram, a computed tomography scan, and a hysterogram failed to localize the fistulous tract in a patient who was 3 weeks postpartum after a repeat cesarean with complaint of persistent urinary incontinence. CONCLUSION: Cystoscopic catheterization of suspicious lesions in the bladder may visualize an otherwise elusive fistulous tract.
