Numerous trials have concluded that laparoscopic hysterectomy, compared with total abdominal hysterectomy, causes less postoperative pain and shortens the hospital stay. Many view this approach as being more cost-effective, but a recent large, randomized trial demonstrated more major complications after the laparoscopic procedure. The present study compared the length of time in the hospital, time to convalescence, and long-term patient satisfaction in 47 consecutive women who were to have supravaginal hysterectomy. Twenty-three of them were randomized to undergo abdominal supravaginal hysterectomy (ASH) and 24 laparoscopic supravaginal hysterectomy (LSH). Pre-and postoperative procedures were comparable in the 2 groups, and there were no significant differences in demographic features or physical characteristics.The postoperative hospital stay was comparable after ASH and LSH. Operating times were significantly longer with LSH, but estimated blood loss was greater in the ASH group. No intraoperative complications occurred in either group, and no patient was transfused. Self-rated pain 6 hours postoperatively was less in women having LSH. Follow up at 6 weeks showed that patients having ASH required approximately 10 more disability days than those in the LSH group. There were no differences in the number of days analgesics were required or the time needed to resume normal activities. At 6 months, 87% of women having ASH and 91% of those in the LSH group were satisfied or very satisfied with the overall results. More than 90% of women in both groups would recommend their procedure to others.When using a multimodal intervention program of postoperative care, the choice between ASH or LSH may be less important than is generally believed with regard to postoperative time in the hospital and long-term patient satisfaction. EDITORIAL COMMENT(What is with the idea of supracervical hysterectomy? There may be some patients who think that preservation of the cervix has less risk of interfering with sexual function or producing urinary incontinence. However, several prospective, randomized trials from the United States, Holland, England, and Denmark have shown that these ideas are not true-preservation of the cervix does not help with sexual, bladder, or bowel function.Learman et al reported on a relatively small, prospectively randomized series of 135 women from 4 U.S. academic medical centers who were followed for 2 years after hysterectomy (Obstet Gynecol 2003;102:453). They found no statistically significant difference in rate of complication, length of hospital stay, or clinical outcomes specifically related to symptoms of bladder or bowel dysfunction and pelvic and back pain between the total and supracervical abdominal hysterectomy GYNECOLOGY Volume 61, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Endometriosis is among the most important causes of chronic pelvic pain (CPP) in women of reproductive age; it reportedly is present in as many as one third of women having diagnostic laparoscopy for pain. This ...

The etiology of chronic periodontitis clearly includes a heritable component. Our purpose was to perform a small exploratory genome-wide association study in adults ages 18–49 years to nominate genes associated with periodontal disease−related phenotypes for future consideration. Full-mouth periodontal pocket depth probing was performed on participants (N = 673), with affected status defined as two or more sextants with probing depths of 5.5 mm or greater. Two variations of this phenotype that differed in how missing teeth were treated were used in analysis. More than 1.2 million genetic markers across the genome were genotyped or imputed and tested for genetic association. We identified ten suggestive loci (p-value ≤ 1E-5), including genes/loci that have been previously implicated in chronic periodontitis: LAMA2, HAS2, CDH2, ESR1, and the genomic region on chromosome 14q21-22 between SOS2 and NIN. Moreover, we nominated novel loci not previously implicated in chronic periodontitis or related pathways, including the regions 3p22 near OSBPL10 (a lipid receptor implicated in hyperlipidemia), 4p15 near HSP90AB2P (a heat shock pseudogene), 11p15 near GVINP1 (a GTPase pseudogene), 14q31 near SEL1L (an intracellular transporter), and 18q12 in FHOD3 (an actin cytoskeleton regulator). Replication of these results in additional samples is needed. This is one of the first research efforts to identify genetic polymorphisms associated with chronic periodontitis-related phenotypes by the genome-wide association study approach. Though small, efforts such this are needed in order to nominate novel genes and generate new hypotheses for exploration and testing in future studies.

clinicaltrials.gov Identifier: NCT00003906.

Dental caries continues to be the most common chronic disease in children today. Despite the substantial involvement of genetics in the process of caries development, the specific genes contributing to dental caries remain largely unknown. We performed separate genome-wide association studies of smooth and pit-and-fissure tooth surface caries experience in the primary dentitions of self-reported white children in two samples from Iowa and rural Appalachia. In total, 1,006 children (ages 3-12 years) were included for smooth surface analysis, and 979 children (ages 4-14 years) for pit-and-fissure surface analysis. Associations were tested for more than 1.2 million single nucleotide polymorphisms, either genotyped or imputed. We detected genome-wide significant signals in KPNA4 (p value = 2.0E-9), and suggestive signals in ITGAL (p value = 2.1E-7) and PLUNC family genes (p value = 2.0E-6), thus nominating these novel loci as putative caries susceptibility genes. We also replicated associations observed in previous studies for MPPED2 (p value = 6.9E-6), AJAP1 (p value = 1.6E-6) and RPS6KA2 (p value = 7.3E-6). Replication of these associations in additional samples, as well as experimental studies to determine the biological functions of associated genetic variants, are warranted. Ultimately, efforts such as this may lead to a better understanding of caries etiology, and could eventually facilitate the development of new interventions and preventive measures.

Congenital central hypoventilation syndrome (CCHS), also known as Ondine's curse, is characterized by idiopathic failure of autonomic breathing and is often associated with neurocristopathies such as Hirschsprung disease (HSCR). CCHS is caused by mutations in the paired-like homeobox 2B (PHOX2B) gene, often manifest as polyalanine repeat expansions. Herein, we report the cases of two unrelated Korean patients with Ondine-Hirschsprung disease. The patient's clinical manifestations were apnea and cyanosis requiring immediate endotracheal intubation, recurrent hypoventilation with hypercapnia, hypoxia after ventilator removal, and abdominal distension since birth. Intestinal biopsies were performed and the absence of ganglion cells in the colon was consistent with HSCR. We performed direct sequencing analysis in the PHOX2B and RET genes and fluorescence polymerase chain reaction in order to determine the polyalanine tract expansion in exon 3 of the PHOX2B gene. Expansion mutations were detected in both patients; one had 20/24 repeats and the other had 20/27 repeats. The 20/24 genotype has not been previously described in severe CCHS phenotypes and associated HSCR. We believe that the information in this report will improve our understanding of the phenotypic and genotypic heterogeneities of CCHS and HSCR.