Mechanical ileus in a pregnant woman at term pregnancy accompanied by labor pains.

Intestinal obstruction in pregnancy is a rare, but serious complication of pregnancy with significant maternal and fetal mortality. We herein report a case of intestinal strangulation in a pregnant woman with a history of pelvic surgery due to an ectopic pregnancy. Epigastric pain occurred at term pregnancy with concomitant onset of labor pains. The epigastric pain disappeared transiently, and she gave a birth to a healthy child. However, the pain appeared again after the vaginal delivery. She immediately underwent ileo-ileostomy with a diagnosis of mechanical ileus, and the postoperative course was uneventful. Mechanical ileus should be considered when examining epigastric pain in a pregnant woman with a history of abdominal or pelvic surgery even after the onset of labor pains.

Difference in segmental lean and fat mass components between pre- and postmenopausal women.

OBJECTIVE: To investigate the differences in segmental body composition (lean and fat mass components) between pre- and postmenopausal women. DESIGN: Participants were 413 premenopausal women aged 20 to 53 years old and 229 postmenopausal women aged 50 to 75 years old with right-side dominance. Age, height, weight, body mass index, age at menopause, and years since menopause were recorded. The percentages of fat mass in the arms, trunk, legs, and total body were measured by dual-energy x-ray absorptiometry. The ratio of trunk to leg fat mass (trunk-leg fat mass ratio) was also measured by dual-energy x-ray absorptiometry. RESULTS: The percentage of trunk fat mass and the trunk-leg fat mass ratio were significantly higher in postmenopausal women, but the percentages of leg fat mass did not differ. In the two groups, percentage of trunk fat mass and trunk-leg fat mass ratio were similarly and positively correlated with age. However, percentage of leg fat mass did not correlate with age. The percentage of fat mass at each segmental site and the trunk-leg fat mass ratio did not differ between premenopausal women aged 50 to 53 years old (n=52) and age-matched postmenopausal women (n=43, years since menopause=2.8+/-1.8). CONCLUSIONS: Aging rather than menopause contributes to the increase in the percentage of trunk fat mass. However, the percentage of leg fat mass does not change with aging. Upper body fat distribution in postmenopausal women may be more attributable to aging than to menopause.

Precedence of the shift of body-fat distribution over the change in body composition after menopause.

AIM: This study investigated the sequence of certain phenomena after menopause: decrease in bone mineral density (BMD), change in body composition (lean and fat components), and the shift toward upper body fat distribution. METHODS: Subjects were 188 postmenopausal women aged 50-65 years old. They were divided into four subgroups based on 4-year increments in age. Regularly menstruating women (n = 51) aged 50-53 years old served as controls. Age, height, weight, and years since menopause were recorded. Body fat mass, percentage of body fat (%fat), lean body mass (LBM), lumbar spine (L2-4), total body BMD, and the trunk-leg fat mass ratio were measured by dual-energy X-ray absorptiometry. RESULTS: In postmenopausal women (n = 42) aged 50-53 years, BMD was lower compared to age-matched controls (P < 0.05), while other variables did not differ. Trunk-leg fat mass ratio in women aged 54-57 years or more was significantly higher than that in control. LBM was significantly lower while percentage fat was significantly higher in women aged 58-61 years old or more. CONCLUSION: An initial event during the menopausal process is BMD loss, which is followed by body fat distribution shift, then LBM loss and reciprocal increase in body fat mass.

Discordance in the decline in regional lean and bone mass with advancing age.

AIM: To investigate whether regional mineral-free lean mass (lean mass) and bone mineral density (BMD) decrease equally with advancing age. METHODS: Subjects were 420 premenopausal women and 239 postmenopausal women with right-side dominance. Age, height, weight, and body mass index were recorded. Lean mass of the arms, trunk and legs were measured by dual-energy X-ray absorptiometry (DEXA). BMD of the same segmental regions was measured by DEXA. RESULTS: Trunk and bilateral leg lean mass were inversely correlated to age (r = -0.240, P < 0.0001, -0.167, P < 0.0001, and -0.183, P < 0.0001, respectively), but arm lean mass did not decrease with aging. Regional lean mass was positively correlated to regional BMD (r = 0.284-0.449, P < 0.0001). BMD was inversely correlated to age in all segmental regions (r = -0.586 to -0.449, P < 0.0001). CONCLUSIONS: Decline in regional lean mass and decline in BMD with advancing age are discordant. Arm lean mass may not contribute to 'age-related decline' in arm BMD, because arm lean mass does not decrease with advancing age in the general population of women.

Age-related change in the strength of correlation of lumbar spine bone mineral density with other regions.

OBJECTIVES: To investigate whether the strength of correlation of lumbar spine bone mineral density (BMD) with other regions differs with age. METHODS: Subjects were 336 premenopausal women aged 20-49 years and 218 postmenopausal women aged 50-69 years with right-side dominance. Age, height, weight, and years since menopause (YSM) were recorded. Subjects were classified into five subgroups at 10-year increments. BMD of the arms, lumbar spine (L2-4), pelvis, legs, and total body were measured by dual-energy X-ray absorptiometry (DEXA). RESULTS: Regional and total body BMD did not differ among women aged in their 20s, 30s, and 40s. However, in women aged over 50, regional and total body BMD gradually decreased with age. The strength of correlation of lumbar spine BMD with the left arm, right arm, left leg, right leg, and total body BMD gradually increased with advancing age (r=0.422-0.715, 0.376-0.714, 0.476-0.721, 0.491-0.734, and 0.642-0.800, respectively). However, the strength of correlation of lumbar spine BMD with pelvis BMD remained unchanged (r=0.512-0.622). CONCLUSIONS: Correlation of lumbar spine BMD with extremities BMD gradually strengthens with advancing age, while higher correlation of lumbar spine BMD with pelvis BMD remains unchanged. When lumbar spine BMD is predicted using values at sites such as forearm BMD, we should consider the patient's age.

Relationship of head lean mass to regional bone mineral density in elderly postmenopausal women.

OBJECTIVES: This study investigated the relationship of head lean mass to bone mineral density (BMD). METHOD: Subjects were 102 elderly women (> or =65-years-old) and 123 middle-aged postmenopausal women (<65-years-old) with right-side dominance. Age, height, weight, and years since menopause (YSM) were recorded. Lean mass of the head, arm, trunk, leg, and total body were measured by dual-energy X-ray absorptiometry (DEXA). BMD of the same regions were measured by DEXA. RESULTS: In elderly women, head lean mass was positively correlated with BMD of the head (r=0.389, P<0.01), left arm (r=0.235, P<0.05), right arm (r=0.280, P<0.05), lumbar spine (L2-4) (r=0.411, P<0.001), pelvis (r=0.490, P<0.001), left leg (r=0.572, P<0.001), right leg (r=0.558, P<0.001), and total body (r=0.529, P<0.001). These relationships remained significant after adjusting for age, height, and YSM. In addition, the strength of correlation of head lean mass with BMD was higher than those of other regional lean mass with respective BMD. In middle-aged women, strength of correlation of head lean mass with BMD was loose (r< or =0.238), while regional lean mass was more correlated with respective regional BMD. CONCLUSION: Factors related to lifestyle associated with higher (lower) head lean mass may contribute to higher (lower) BMD in elderly postmenopausal women.

Changes in serum leptin levels during GnRH agonist therapy.

The purpose of the present study was to investigate changes in serum leptin levels during GnRH agonist therapy. Twenty regularly menstruating women with uterine leiomyomas were enrolled. These subjects were given GnRH agonist (leuprorelin acetate, 3.75 mg) monthly for 4 months. Serum leptin and estradiol (E2) levels were measured at the two time points of day 1 or 2 of the menstrual cycle and the end of GnRH agonist therapy. Weight, total body fat mass, percentage of body fat, and total body lean mass were measured by whole body scanning with dual-energy X-ray absorptiometry. The ratio of serum leptin levels to total body fat mass (leptin-fat mass ratio), and the ratio of serum leptin levels to total body lean mass (leptin-lean mass ratio) were calculated. All subjects became amenorrheic after the initial administration of GnRH agonist. Baseline E2 levels were 45.4 +/- 21.0 pg/mL, which significantly decreased after GnRH agonist therapy (13.3 +/- 4.2 pg/mL, p<0.01). Baseline leptin levels were 8.7 +/- 8.1 ng/mL, which did not differ from the values after 4 months of GnRH agonist administration (8.9 +/- 6.8 ng/mL). Total body fat mass significantly increased from 20.0 +/- 10.4 to 21.0 +/- 9.4 kg (p<0.05), while total body lean mass significantly decreased (34.5 +/- 4.2 kg to 33.3 +/- 3.9 kg, p<0.01). However, leptin-fat mass ratio after GnRH agonist therapy did not differ from the baseline values (0.39 +/- 0.16 ng/mL/kg vs 0.38 +/- 0.16 ng/mL/kg). Hypogonadism does not have a major impact on circulating leptin levels.

Lean body mass and bone mineral density in physically exercising postmenopausal women.

OBJECTIVES: To investigate whether the relative contribution of body composition (lean and fat mass component) to postmenopausal bone mineral density (BMD) differs between women participating in physical exercise and sedentary women. METHODS: Subjects were 45 postmenopausal women participating in regular physical exercise and 89 sedentary controls aged 50-60 years. Baseline characteristics included age, height, weight, body mass index (BMI, Wt/Ht(2)), age at menopause, and years since menopause (YSM). Body fat mass, percentage of body fat, lean body mass, and lumbar spine BMD (L2-4) were measured by dual-energy X-ray absorptiometry. RESULTS: Although age, height, weight, BMI, and YSM did not differ between the two groups, lean body mass and lumbar spine BMD were significantly higher (P<0.05 and <0.001, respectively), while body fat mass and percentage of body fat mass were significantly lower in exercising women than in sedentary controls (P<0.05 and <0.05, respectively). In exercising women, BMD was positively correlated with lean body mass (r=0.415, P<0.01) but not with body fat mass (r=0.155, NS). Conversely, in sedentary controls, BMD was correlated with body fat mass (r=0.251, P<0.05) and lean body mass (r=0.228, P<0.05). CONCLUSIONS: Lean body mass is a more significant determinant of postmenopausal BMD in physically exercising women than in sedentary women.