Serotonin Deficiency Rescues Lactation on Day 1 in Mice Fed a High Fat Diet.

Obesity is an inflammatory state associated with delayed lactogenesis stage II and altered mammary gland morphology. Serotonin mediates inflammation and mammary gland involution. The objective of this study was to determine if a genetic deficiency of tryptophan hydroxylase 1, the rate-limiting enzyme in peripheral serotonin synthesis, would result in an improved ability to lactate in dams fed a high fat diet. Twenty-six female mice were fed a high (HFD) or low fat (LFD) diet throughout pregnancy and lactation. Fourteen mice were genetically deficient for Tph1 (Tph1-/-), and twelve were wild type. Milk yield, pup mortality, and dam weights were recorded and milk samples were collected. On day 10 of lactation, dams were sacrificed and mammary glands were harvested for RT-PCR and histological evaluation. HFD dams weighed more than LFD dams at the onset of lactation. WT HFD dams were unable to lactate on day 1 of lactation and exhibited increased pup mortality relative to all other treatments, including Tph1-/- HFD dams. mRNA expression of immune markers C-X-C motif chemokine 5 and tumor necrosis factor alpha were elevated in WT HFD mammary glands. Mammary gland histology showed a reduced number of alveoli in WT compared to Tph1-/- dams, regardless of diet, and the alveoli of HFD dams were smaller than those of LFD dams. Finally, fatty acid profile in milk was dynamic in both early and peak lactation, with reduced de novo synthesis of fatty acids on day 10 of lactation in the HFD groups. Administration of a HFD to C57BL/6 dams produced an obese phenotype in the mammary gland, which was alleviated by a genetic deficiency of Tph1. Serotonin may modulate the effects of obesity on the mammary gland, potentially contributing to the delayed onset of lactogenesis seen in obese women.

A case of ruptured splenic artery aneurysm in pregnancy.

Background. Rupture of a splenic artery aneurysm is rare complication of pregnancy that is associated with a significant maternal and fetal mortality. Case. A multiparous female presented in the third trimester with hypotension, tachycardia, and altered mental status. A ruptured splenic artery aneurysm was discovered at the time of laparotomy and cesarean delivery. The patient made a full recovery following resection of the aneurysm. The neonate survived but suffered severe neurologic impairment. Conclusion. The diagnosis of ruptured splenic artery aneurysm should be considered in a pregnant woman presenting with signs of intra-abdominal hemorrhage. Early intervention by a multidisciplinary surgical team is key to preserving the life of the mother and fetus.

Rectal mesh erosion after robotic sacrocolpopexy.

We report an unusual case of rectal mesh erosion presenting 16 months after robotic sacrocolpopexy. The patient initially underwent a robotic sacrocolpopexy, lysis of adhesions, midurethral sling, and posterior colporrhaphy for symptomatic grade 2 pelvic organ prolapse and urodynamic stress incontinence. Her postoperative recovery was uneventful. Sixteen months later, an anterior 2 × 2-cm rectal mesh erosion was noted on the colonoscopy performed when she presented with hematochezia.

Acute chorioamnionitis at term caused by the oral pathogen Fusobacterium nucleatum.

Fusobacterium nucleatum is an oral pathogen associated with preterm birth. Presented is a case of acute chorioamnionitis that progressed to maternal sepsis in a term patient with intact membranes. In addition to its role in periodontal disease and preterm birth, our case demonstrates that intrauterine infection with Fusobacterium nucleatum can result in severe disease at term.

Pelvic nerve injury following gynecologic surgery: a prospective cohort study.

OBJECTIVE: The purpose of this study was to determine the incidence and time course of postoperative neuropathy resulting from gynecologic surgery. STUDY DESIGN: A single cohort of 616 female patients undergoing elective gynecologic surgery for benign or malignant conditions at a tertiary care academic medical center underwent a postoperative neurologic evaluation to identify postoperative neuropathy of the lower extremities. RESULTS: Fourteen peripheral nerve injuries were observed in 11 patients, making the overall incidence of postoperative neuropathy 1.8% (95% confidence interval, 1.0-3.2). Injury to the lateral femoral cutaneous (5), femoral (5), common fibular (1), ilioinguinal/iliohypogastric (1), saphenous (1), and genitofemoral (1) nerves were detected. Complete resolution of neuropathic symptoms occurred in all but 1 patient (91%). Median time to resolution of symptoms was 31.5 days (range, 1 day to 6 months). CONCLUSION: The incidence of lower extremity neuropathy attributable to gynecologic operations is low, and these neuropathies resolve in the great majority of cases.

Incidence and risk factors for surgical intervention after uterine artery embolization.

OBJECTIVE: To determine the incidence and risk factors for surgical intervention after uterine artery embolization for symptomatic uterine fibroids. STUDY DESIGN: Electronic medical records of all patients who underwent uterine artery embolization for symptomatic uterine leiomyomata were reviewed. Logistic regression was used to identify independent risk factors for any surgical intervention and for hysterectomy alone after uterine artery embolization. RESULTS: Uterine artery embolization was performed in 454 patients during the study period, with a median follow-up time (range) of 14 (0-128) months. Overall, 99 patients (22%) underwent any surgical intervention after uterine artery embolization in the operating room. Risk factors for any surgical intervention included younger age (P < .003), bleeding as an indication for uterine artery embolization (P < .01), presence of significant collateral ovarian vessel contribution to the uterus (P < .01), or use of 355-500 mum particles (P < .008). CONCLUSION: Patients undergoing uterine artery embolization have a 22% risk for requiring additional surgical intervention, but overall uterine artery embolization is an effective minimally invasive option.

Pudendal neuropathy involving the perforating cutaneous nerve after cystocele repair with graft.

BACKGROUND: Pudendal neuropathy is a documented complication of sacrospinous ligament fixation, but it is infrequently reported with other types of gynecologic surgery. CASE: A woman developed neuropathic symptoms of the right vulva, perianal area, and gluteal fold after vaginal surgery with graft for anterior pelvic organ prolapse. Pudendal nerve entrapment with involvement of the perforating cutaneous nerve was suspected. Suture removal 1 year after the operation resulted in improved pain symptoms and sexual function. CONCLUSION: Pudendal nerve entrapment is one potential complication of anterior vaginal repair with biologic graft. Removal of sutures, even long after surgery, can result in clinically significant improvement in pain symptoms and sexual function in patients with pudendal nerve entrapment.

The genetics of ray pattern variation in Caenorhabditis briggsae.

BACKGROUND: How does intraspecific variation relate to macroevolutionary change in morphology? This question can be addressed in species in which derived characters are present but not fixed. In rhabditid nematodes, the arrangement of the nine bilateral pairs of peripheral sense organs (rays) in tails of males is often the most highly divergent character between species. The development of ray pattern involves inputs from hometic gene expression patterns, TGFbeta signalling, Wnt signalling, and other genetic pathways. In Caenorhabditis briggsae, strain-specific variation in ray pattern has provided an entree into the evolution of ray pattern. Some strains were fixed for a derived pattern. Other strains were more plastic and exhibited derived and ancestral patterns at equal frequencies. RESULTS: Recombinant inbred lines (RILs) constructed from crosses between the variant C. briggsae AF16 and HK104 strains exhibited a wide range of phenotypes including some that were more extreme than either parental strain. Transgressive segregation was significantly associated with allelic variation in the C. briggsae homolog of abdominal B, Cb-egl-5. At least two genes that affected different elements of ray pattern, ray position and ray fusion, were linked to a second gene, mip-1. Consistent with this, the segregation of ray position and ray fusion phenotypes were only partially correlated in the RILs. CONCLUSIONS: The evolution of ray pattern has involved allelic variation at multiple loci. Some of these loci impact the specification of ray identities and simultaneously affect multiple ray pattern elements. Others impact individual characters and are not constrained by covariance with other ray pattern elements. Among the genetic pathways that may be involved in ray pattern evolution is specification of anteroposterior positional information by homeotic genes.