The impact of gestational diabetes mellitus on postpartum urinary incontinence: a longitudinal cohort study on singleton pregnancies.

OBJECTIVE: To determine whether gestational diabetes mellitus (GDM) is an independent risk factor for postpartum urinary incontinence in singleton pregnancies. DESIGN: A longitudinal cohort study. SETTING: A single tertiary-care hospital in Taiwan. POPULATION: Pregnant women with term deliveries between 2002 and 2007 (n = 6653) were consecutively recruited. METHODS: Logistic regression models were fitted based on generalised estimating equation methods to derive odds ratios for occurrences of type-specific urinary incontinence in the third trimester and at four time-points over 2 years during the postpartum period. MAIN OUTCOME MEASURES: Evaluation of whether GDM is an independent risk factor for postpartum urinary incontinence. RESULTS: The full model analysis revealed that GDM was an independent risk factor for all type-specific urinary incontinence (odds ratio [95% confidence interval]: 1.97 [1.56-2.51], 3.11 [2.18-4.43] and 2.73 [1.70-4.40] for stress, urge and mixed incontinence, respectively]. Compared with women without GDM, women with GDM tended to exhibit more severe symptoms of stress incontinence for up to 2 years postpartum, whereas for urge or mixed incontinence, more severe symptoms were found only for 6 months postpartum. Evaluation of quality of life using the Incontinence Impact Questionnaire 7 suggested that women with GDM requiring insulin treatment had a higher likelihood of functional impairment than women with GDM requiring conservative treatment only or women without GDM (P < 0.05, by the chi-square test for trend). CONCLUSIONS: GDM was found to be an independent risk factor for postpartum urinary incontinence and had a significant impact on quality of life. Women with GDM should be provided with timely consultation and support once urinary incontinence occurs.

Pre-medication with intravenous clonidine suppresses fentanyl-induced cough.

BACKGROUND: A reflex cough is often observed after an intravenous bolus of fentanyl. This study was conducted to determine whether pre-treatment with intravenous clonidine could effectively attenuate fentanyl-induced cough. METHODS: Three hundred ASA I-II patients, aged between 18 and 80 years, undergoing various elective surgeries, were enrolled in this study. All patients were randomly assigned to one of two groups treated with intravenous clonidine 2 microg/kg (clonidine group) or the same volume of normal saline (control group). Intravenous fentanyl (2 microg/kg in 2 s) was injected 2 min after the clonidine or normal saline injection. Changes in the hemodynamics, auditory evoked potentials (AEPs) and Observer Assessment of Alertness/Sedation (OAA/S) rating scale were recorded before and 2 min after the clonidine or normal saline injection and 1 min after the fentanyl injection. The number of coughs 1 min after the fentanyl injection was also recorded. RESULTS: Patients in the clonidine group showed a significantly lower incidence of cough than those in the control group (17.3% vs. 38.7%, respectively; P < 0.01). The blood pressure was lower in the clonidine group than in the control group. There were no significant differences in AEP or OAA/S rating scale. CONCLUSIONS: Pre-treatment with intravenous clonidine (2 microg/kg) suppressed the reflex cough induced by fentanyl, with mild hemodynamic changes. Therefore, intravenous clonidine may be a clinically useful method of suppressing fentanyl-induced cough.

Presumed Stage IA primary epithelial ovarian carcinoma: the role of complete staging surgery.

PURPOSE: Proper staging is warranted in any patient with primary epithelial ovarian carcinoma (PEOC), but sometimes it cannot always be performed. The prognosis of patients with and without complete staging surgery is to be determined. METHODS: We retrospectively evaluated 61 patients with presumed Stage IA PEOC between January 1970 and December 1993. Inclusion criteria were: being referred patients; no ascites; an intact ovarian tumor without extra-spillage or rupture before, during or after operation; conventional regular exploratory laparotomy without urgency; more than a 5-year follow-up, except for recurrent diseases; a detailed pathology review; and no other systemic disease. Tumors of lower malignant potential (LMP) and cystectomy for removing tumor were excluded. Of the 61 patients, 17 patients received a close observation (Group A), and the others (44 patients) received a re-exploratory laparotomy to complete the staging surgery (Group B). RESULTS: The mean follow-up time was 7.4 years, ranging between 5.4 and 11.1 years, in Group A, and 8.1 years, ranging from 5.6 to 12.7 years, in Group B. Two patients (11.8%) in Group A and seven patients (15.9%) in Group B suffered from recurrence. Two patients finally died of disease, and both were in Group B. CONCLUSIONS: Based on the observation in this study that the recurrence rate of the two groups was not statistically different, close follow-up for patients with presumed Stage IA EOC, but without complete surgical staging surgery, might be acceptable when these patients are treated with postoperative adjuvant chemotherapy.

Adenomyosis and risk of preterm delivery.

OBJECTIVE: To evaluate the risk of preterm delivery in patients with adenomyosis. DESIGN: A 1:2 nested case-control study. SETTING: Tertiary-care institution. POPULATION: A base cohort population of 2138 pregnant women who attended routine prenatal check-up between July 1999 and June 2005. METHODS: From this base cohort population, gravid women with singleton pregnancy who delivered prior to the completion of 37 weeks of gestation were identified and formed the study group. Singleton gravid women who had term delivery and who matched with age, body mass index, smoking, and status of previous preterm delivery were recruited concurrently and served as control group. Preterm delivery cases were further divided into spontaneous preterm delivery and preterm premature rupture of membranes (PPROM) cases. MAIN OUTCOME MEASURES: Risk analysis of preterm delivery between gravid women with and without adenomyosis. RESULTS: One-hundred and four preterm delivery case subjects and 208 control subjects were assessed. Overall, gravid women with adenomyosis were associated with significantly increased risk of preterm delivery (adjusted odds ratio 1.96, 95% CI 1.23-4.47, P=0.022). For subgroup analysis, gravid women with adenomyosis had an adjusted 1.84-fold risk of spontaneous preterm delivery (95% CI 1.32-4.31, P=0.012) and an adjusted 1.98-fold risk of PPROM (95% CI 1.39-3.15, P=0.017). CONCLUSIONS: Gravid women with adenomyosis were associated with increased risk of both spontaneous preterm delivery and PPROM. A common pathophysiological pathway may exist in these two disorders. Further in-depth biochemical and molecular studies are necessary to explore this phenomenon.

Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma.

PURPOSE: Most comparisons between uterine leiomyoma and uterine leiomyosarcoma have been based on postoperative pathological or molecular analyses. Very few reports have investigated preoperative differentiation between uterine leiomyoma and uterine leiomyosarcoma. METHODS: Between January 1990 and December 2003, 42 consecutive patients with uterine leiomyosarcoma treated at index hospitals were analyzed. Meanwhile, 84 patients with uterine leiomyomas were used as controls. The diagnostic performance of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma using receiver operating characteristic (ROC) curves was evaluated. Data presentations were categorized into premenopausal and postmenopausal groups. Diagnostic efficiency was calculated as the sensitivity multiplied by the specificity. RESULTS: Values of preoperative serum CA125 were significantly higher in the uterine leiomyosarcoma group than those in the uterine leiomyoma group. There was significant overlapping of preoperative serum CA125 between the uterine leiomyoma group and early-stage uterine leiomyosarcoma. For both the premenopausal and postmenopausal group, there was a significant difference in the distribution of preoperative serum CA125 in early-stage and advanced-stage uterine leiomyosarcoma. The optimal cutoff values of serum CA125 for the premenopausal group and postmenopausal group was 162 U/mL and 75 U/mL, respectively. CONCLUSION: These findings demonstrated that preoperative serum CA125 had a potential role in the differential diagnosis between early-stage and advanced-stage uterine leiomyosarcoma. Further investigation with a larger sample size at adequate power is necessary to verify the current study.

An outbreak of Salmonella infection after a Chinese year-end party in central Taiwan.

An outbreak of food poisoning caused by Salmonella O7 serogroup C1 and O8 serogroup C2, occurred in Taichung City after a Chinese year-end buffet party with 127 attendees including employees, relatives and guests of the Psychiatry Department of Changhua Christian Hospital (CCH). Among the 114 attendees interviewed, 96 (84.2%) reported developing symptoms within 120 h after the dinner on February 4, 1999. The time of onset ranged from 2 h to 101 h after the dinner with an average of 20 +/- 16 h. The median and mode incubation periods were 17 h and 16 h, respectively. Salmonella C1 and C2 serogroups were isolated from the stool samples of 45 attendees. Based on the results of interview questionnaire, the most likely contaminated food was eel kabayaki (OR = 4.8, 95% CI:1.6-14.9, p < 0.01) followed by baked mussels (OR = 4.04, 95% CI:1.3-12.1, p = 0.01). However, this result could not be confirmed by food sample investigation due to the lack of leftover food. Possible techniques for the prevention of food-borne disease transmission, enhancement of communication about foodborne disease outbreaks within the health reporting system, and the reduction of response time during an outbreak of infection are required.