Prevalence of Levator Ani Defects in Urogynecological Patients.

Introduction: Defects of the levator ani muscle complex could represent a pathophysiological link between vaginal birth trauma and urogynecological symptoms many years later. The aim of our study was to determine the prevalence of levator ani muscle defects using 3D or 4D ultrasound and palpation in urogynecological patients. Material and Methods: Urogynecological patients were retrospectively investigated using 3D or 4D ultrasound. Clinical examination consisted of palpation and 3D or 4D imaging of the levator ani muscle. Results: A total of 319 women were included in the analysis. Mean age was 64.9 years, average parity was 2.1. Stress incontinence was present in 50.8 %, overactive bladder symptoms in 69.3 % and pelvic organ prolapse in 42.3 % of patients. A levator ani defect was found on ultrasound in 76 patients (23.8 %) and on palpation in 64 women (20.0 %). In the group of patients with pelvic organ prolapse, levator ani defects were found in 32.6 % of patients using ultrasound and in 26.7 % of patients using palpation. The odds ratio (OR) for levator ani defects in women with pelvic organ prolapse was 2.3 (95 % CI [CI: confidence interval]: 1.36-3.88], p = 0.002). Conclusion: In a cohort of urogynecological patients seen at a tertiary urogynecological unit, the prevalence of levator ani defects was significantly higher in women with pelvic organ prolapse compared to women with stress incontinence or urge symptoms.

[Oral health conditions in women with or without occupation--results from a regional examination and survey]. / Mundgesundheit von berufstätigen und nicht berufstätigen Frauen--Ergebnisse einer regionalen Untersuchung und Umfrage.

AIM: In the present study oral health conditions and oral hygiene measures of women with and without occupation were examined and compared. In addition to a dental assessment, oral hygiene measures and socio-demographic data were collected by means of a questionnaire. METHOD: A total of 415 subjects (210 women with and 205 women without occupation) with an age range of 25-65 years were enrolled in this study. All women underwent a dental assessment, including a radiographic examination (orthopanthomogram). The dental assessment comprised the number of teeth, caries frequency (DMFT index), type and frequency of restorations, quality of oral hygiene (API), degree of gingival inflammation (SBI), probing depths and the presence of recessions. In addition, a questionnaire, concerning anamnestic data and information about the familial situation, level of education and occupation, was filled in. The study was approved by the ethics commission (Rhineland-Palatinate). RESULTS: Of the women without occupation (mean age: 38.1±9.7 years) 90% were married, only 3% were heavy smokers, and only 2% had a university degree. Of the working women (mean age: 43.2 ±11 years) 73% were married, 17% were heavy smokers (> 20 cigarettes/day), and 10% had a university degree. Oral hygiene of the working women was slightly better than that in women without occupation; however, severe periodontal disease was seen more frequently in working women (15% vs. 3.3%; p<0.027). With respect to the periodontal situation, the probability of developing an aggressive periodontitis was with an odds ratio of 4.23 (95% CI: 0.77-23.17) considerably higher for the group of working women. CONCLUSION: The oral health of women with or without occupation differed slightly. These findings suggest that occupation, level of education and life style of the women have an influence on oral hygiene measures and on oral health.

Comparative analysis of in situ versus ex situ perfusion on micro circulation in liver procurement--an experimental trial in a porcine model.

INTRODUCTION: The Achilles heel of liver transplantation remains the biliary system. The crucial step for liver preservation is effective rinsing and perfusion of the peribiliary plexus (PBP). Due to the physiology of the vascular tree, it seems almost impossible to achieve the necessary physiologic ranges of pressure and flow by the in situ perfusion technique. We investigated the role of additional ex situ perfusion via the hepatic artery in this animal model. MATERIALS AND METHODS: Fifteen German Landrace pigs underwent standardized multiorgan procurement. In situ perfusion and additional ex situ perfusion were performed consecutively. Meanwhile the external pressure applied to the perfusion system was increased stepwise. To visualize the effects on the liver parenchyma and PBP, we administered colored microparticles (MPs; 10 µm). Frozen sections of the explanted liver were studied histologically by quantitative evaluation of the MPs. RESULTS: Ex situ perfusion was able to build up significantly higher values of pressure (P < .001) and flow (P < .001) than in situ perfusion. Those of ex situ perfusion reached physiological levels under application of an external pressure of 200 mm Hg. Considering the liver parenchyma, significantly higher amounts of MPs originating from ex situ perfusion were evident (P < .001) and PBP (P < .001). CONCLUSION: MPs provide an appropriate tool to determine organ perfusion quantitatively in experimental models. Considering flow, pressure, and microcirculation, we consider that additional ex situ perfusion of the liver is more effective than in situ perfusion.

Measuring corneal clouding in patients suffering from mucopolysaccharidosis with the Pentacam densitometry programme.

AIM: To identify a means to objectively measure corneal clouding in patients with mucopolysaccharidosis in a prospective controlled clinical trial. METHODS: Corneal haze was assessed by slit lamp examination and measured using the densitometry programme of the Pentacam, a rotating Scheimpflug camera in 33 mucopolysaccharidoses (MPS) patients and 32 controls. RESULTS: Pentacam measurements were available in 31 right and 31 left eyes of 32 patients and in 32 left and right eyes of 32 subjects in the control group. Slit lamp findings correlated very well with corneal density measurements (Spearman correlation right eye (OD)/left eye (OS)=0.782/0.791). MPS patients had higher density units (median OD/OS=14.1/14.7) than control subjects (median OD/OS=6.7/6.9, p<0.001). In patients, the corneal centre density values (median OD/OS=13.8/14.0) did not differ from corneal periphery values (median OD/OS=14.3/14.7). CONCLUSIONS: The densitometry programme of the Pentacam provides objective measurement of corneal haze in mucopolysaccharidosis patients.