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In this randomized trial, the addition of Burch colposuspension to abdominal sacrocolpopexy (performed for the treatment of pelvic-organ prolapse) decreased postoperative urinary stress incontinence in women without preoperative stress incontinence, without increasing urge incontinence. These findings will help inform decisions about surgical treatment of women with pelvic-organ prolapse.
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In epidemiologic studies, the plasma total homocysteine level has been found to be a risk factor for cardiovascular disease. In the HOPE-2 trial of high-risk patients, treatment with folic acid, vitamin B12, and vitamin B6 reduced plasma total homocysteine levels. However, treatment with B vitamins was not associated with a reduction in cardiovascular risk.
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Observational reports have found that lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Treatment with folic acid and vitamin B12, with or without vitamin B6, lowers plasma homocysteine levels. In the NORVIT trial in patients after myocardial infarction, such therapy did not decrease the rate of recurrent infarction, stroke, and sudden death.
Antibiotics have a limited role in the treatment of acute exacerbations of asthma. In this study, a macrolide antibiotic, telithromycin, was administered for 10 days after an acute exacerbation of asthma and led to improvements in symptoms but not in home-measured peak expiratory flow rates. There was no relationship between bacteriologic status and the response to asthma treatment, and the mechanism of the effect is unknown.
The intake of trans fat has been associated with coronary heart disease, sudden death from cardiac causes, and diabetes. This article reviews the evidence for physiological and cellular effects of trans fatty acids, unsaturated fatty acids with at least one double bond in the trans configuration. The authors consider the feasibility and potential implications of reducing or eliminating the consumption of trans fatty acids from partially hydrogenated vegetable oils in the United States.
A 54-year-old woman was seen in the gynecologic oncology clinic because of a pelvic mass that was associated with urinary frequency and urgency, pelvic pain, fever, and weight loss. A large, central pelvic mass was noted on examination, and imaging studies showed a complex solid and cystic mass with ascites. The evaluation and management of malignant tumors of the ovaries and fallopian tubes are discussed by a multidisciplinary team.
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