Very Common Condition In Women That Often Goes Undiagnosed Now Identifiable By Medical Imaging Technique

In women with lower urinary tract symptoms, a medical imaging technique called dynamic MRI allows clinicians to diagnose pelvic organ prolapse - a condition that often goes undiagnosed on static MRI and at physical examination, according to a study published in the December issue of the American Journal of Roentgenology.



Pelvic organ prolapse is relatively common and occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. If left untreated, living with prolapse can be a challenge, both physically and emotionally, as the symptoms can disrupt day-to-day life. Dynamic MRI is performed while the patient performs a straining maneuver, such as bearing down. Static MRI is performed while the patient is at rest.



The study, performed at NYU Langone Medical Center in New York, included 84 women with lower urinary tract symptoms who underwent dynamic and static MRI scans for a suspected urethra abnormality. Ten of the 84 patients were found to have an abnormality of the urethra. "However 33 patients were diagnosed with pelvic organ prolapse, of whom 29 were diagnosed exclusively on dynamic imaging," said Genevieve L. Bennett, M.D., assistant professor of radiology at NYU Langone Medical Center and lead author of the study.



"Dynamic imaging allows for the detection of pelvic organ prolapse, which may not be evident at rest but only detected when the woman strains," said Bennett.



"The results of our study show that in women with lower urinary tract symptoms who undergo MRI for evaluation of a suspected urethra abnormality, the addition of dynamic MRI permits detection of pelvic organ prolapse that may not be evident on static at rest images and that may also go undetected at physical examination," she said.



Source: Heather Curry


American College of Radiology / American Roentgen Ray Society

Pennsylvania Legislator Seeks 'Middle Ground' On Emergency Contraception Bill

Pennsylvania state Rep. Dan Frankel (D) has said he has reached a "middle ground" in legislation that seeks to ensure patient access to emergency contraception and give pharmacists the right to decline to dispense the drugs based on their moral or religious beliefs, the Pittsburgh Post-Gazette reports. Under the legislation, if a pharmacist refused to dispense a prescription on moral or religious grounds, another pharmacist at the store would be required to fill it or refer the patient to a nearby pharmacy where the patient could obtain the prescription. The measure also would prohibit pharmacists from "humiliating or intentionally violating" the privacy of customers seeking the prescription, according to the Post-Gazette. Pharmacists who violate the law would be fined up to $5,000. "Emergency contraception is critical in cases of rape or accidents like condom breaks," Frankel said, adding, "But it has to be taken within 72 hours to be effective so a busybody pharmacist can be a serious problem." John Yakim, a pharmacist at Plum, Pa.-based Yakim Pharmacy, said that that he has "a moral problem" with EC. He added that taking EC is "stopping a life, and [his] job is to protect that life." Frankel's bill is a companion to another measure that was proposed in October. That bill would require hospitals to offer EC to rape survivors in the state (Mauriello, Pittsburgh Post-Gazette, 12/12).


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Opinion Pieces Examine Conservative 'Feminism'

Opinion pieces in the Washington Post and Los Angeles Times examined issues related to former Alaska Gov. and 2008 Republican vice presidential candidate Sarah Palin's recent speech to the Susan B. Anthony List. Summaries appear below.

~ Nancy Cohen, Los Angeles Times: Palin said in her speech that recent polls show "more Americans proudly proclaiming themselves as pro-life." According to historian and author Cohen, although Palin is "not entirely wrong, ... that doesn't mean she's right." Cohen writes that "this new conventional wisdom ... stems from misleading media reporting abetted by partisan hype." She adds that "the three polls on which the so-called trend in public opinion is based include one outlier and two with inconclusive results," making the "complete picture ... nuanced." According to Cohen, "A majority of Americans do not want to see abortion criminalized, but the nation is evenly divided between those who call themselves pro-life and those who call themselves pro-choice." However, the antiabortion-rights movement "seems to be winning the framing war with its 'pro-life' label," as "'pro-choice' has turned into a tone-deaf rallying cry," she continues. The phrase "pro-choice" is "inadequate to our actual policy preferences and to the philosophical values Americans hold on the subject of abortion," Cohen writes. She adds, "It essentially cedes the moral high ground to the antiabortion movement" and "doesn't do enough to communicate ... the belief that, in a free and democratic nation, the decision to have a child should rest with the individual woman and those with whom she freely consults." Cohen continues, "Perhaps 'pro-choice' was once good enough shorthand for liberty, human dignity, individualism, pluralism, self-government and women's equality," but "anyone who thinks it is still self-sufficient ... hasn't been paying attention" (Cohen, Los Angeles Times, 5/29).

~ Jessica Valenti, Washington Post: Palin's recent adoption of the term "feminist" is "not a realization of the importance of women's rights" but "part of a larger conservative move to woo women," Valenti, an author and founder of the blog Feministing, writes. "Just as consumer culture tries to sell 'Girls Gone Wild'-style sexism as 'empowerment,' conservatives are trying to sell anti-women policies shrouded in pro-women rhetoric," Valenti continues. She adds, "But, of course, Palin isn't a feminist -- not in the slightest." Valenti writes that what Palin calls "the emerging conservative feminist identity" is actually "an empty rallying call to women who are disdainful of or apathetic to women's rights, who want to make abortion and emergency contraception illegal, who would cut funding to the Violence Against Women Act and who fight same-sex marriage rights." Palin's "'feminism' isn't just co-opting the language of the feminist movement, it's deliberately misrepresenting real feminism to distract from the fact that she supports policies that limit women's rights," Valenti writes. Palin's brand of feminism is "a manipulated buzzword being used to garner support for a party that time and time again votes against women's rights," she continues, adding that "feminists -- or anyone who cares about women's progress -- need to stop Palin from turning feminism into yet another empty slogan" (Valenti, Washington Post, 5/30).


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Puberty Timing And Body Fat In Women Linked By Genes

Scientists have discovered 30 new genes that control the age of sexual maturation in women. Notably, many of these genes also act on body weight regulation or biological pathways related to fat metabolism. The study, which appears in Nature Genetics, was a collaborative effort by the international ReproGen consortium, which included 175 scientists from 104 worldwide institutions, including Boston University School of Medicine (BUSM) and Boston University School of Public Health.



Menarche, the onset of first menstruation in girls, indicates the attainment of reproductive capacity and is a widely used marker of pubertal timing. Age of menarche varies widely and is highly dependent on nutritional status. Early menarche is associated with many adverse health outcomes later in life, including breast cancer, endometrial cancer, obesity, type 2 diabetes and cardiovascular disease, as well as shorter adult stature.



To identify loci for age at menarche, the researchers performed a meta-analysis of 32 genome-wide association studies on more than 87,000 women from the U.S., Europe and Australia and performed replication studies in nearly 15,000 additional women. In addition to the known loci at LIN28B and 9q31.2, the researchers identified 30 new menarche loci and found suggestive evidence for a further 10 loci. According to the researchers, the new loci included four previously associated with body mass index, three in or near other genes implicated in energy homeostasis and three in or near genes implicated in hormonal regulation. Ingenuity and gene-set enrichment pathway analyses identified coenzyme A and fatty acid biosynthesis as biological processes related to timing of menarche.



"Our study found genes involved in hormone regulation, cell development and other biological pathways associated with mechanisms age at menarche, which shows that the timing of puberty is controlled by a complex range of biological processes," said senior author Joanne Murabito, MD ScM, an associate professor of medicine at BUSM and Clinic Director and Investigator of the Framingham Heart Study.



"Several of the genes for menarche have been associated with body weight and obesity in other studies suggesting some women may have a genetic susceptibility to weight gain and early puberty. It is important to understand that these 'genetic factors' can be modified by changes in lifestyle. Efforts to reduce or prevent childhood obesity should in turn help reduce the early onset of puberty in girls," added Murabito.



The next steps according to the researchers are to examine the findings in women of other race/ethnic groups, as well as to examine whether these genetic loci influence growth and to determine whether the associations are driven by measures of body fatness. This future work will help to unravel the biologic mechanism underlying the associations.



The researchers are extremely grateful to all study participants including women participating in the Framingham Heart Study for making this research possible. The investigators would also like to acknowledge the support provided by the National Institute on Aging and the National Heart, Lung and Blood Institute.



Source:

Gina DiGravio

Boston University Medical Center