Although it is commonly believed that recovery from subtotal abdominal hysterectomy (SH) is associated with fewer complications and less pelvic organ dysfunction than total abdominal hysterectomy (TH), there is little data supporting this belief in the literature. Previous studies have found no difference in the postoperative recovery time between these procedures. Overall recovery after hysterectomy depends on treatment of postoperative physical symptoms and complications. Some studies have shown that recovery also depends on preoperative psychological well being and postoperative overall well being. The impact of these factors on the postoperative day-by-day recovery has not been investigated.This prospective randomized, controlled, open, multicenter study assessed possible differences between SH and TH in the day-by-day postoperative recovery, and also analyzed factors associated with postoperative recovery and sick leave. The study was conducted at 7 hospitals and 1 private gynecological clinic in Sweden between 1998 and 2004. The study subjects were 200 women who were scheduled for hysterectomy because of benign gynecological conditions. Of the 178 patients who completed the study, 94 were randomized to a SH group and 84 to a TH group. Assessment of day-by-day recovery of general well being was made using a patient diary with daily entries initiated at 1 week before surgery and continuing until the 35th postoperative day; the results were calculated on a visual analogue scale. Psychometric measurements included depression and anxiety; general psychological well being was also assessed. The primary study outcome measures were the associations between day-by-day recovery of general well being and duration of sick leave with mode of hysterectomy.The data showed no significant difference in the SH and TH groups for the day-by-day recovery of general well being in the preoperative and postoperative periods. A strong association was found between both postoperative day-by-day recovery of general well being and the duration of sick leave, with the occurrence of minor complications, but there was no significant association for major complications. The postoperative day-by-day recovery of general well being and duration of sick leave were strongly associated with the level of preoperative psychological well being.These findings show no difference in the speed of day-by-day recovery of general well being between the 2 procedures, but demonstrate an association between postoperative recovery of general well being and the duration of sick leave with preoperative psychological well being. Strong determinants for a prolonged sick leave include minor postoperative complications and a low preoperative level of psychological well being. GYNECOLOGY Volume 65, Number 6 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTPrevious studies have shown that the new minimally invasive mid-urethral tape procedures are as effective or even more effective in curing female stress urinary incontinence (SUI) than the traditional methods. An esse...

Second University of Naples.

OBJECTIVETo assess the long-term effects of dietary interventions on glycemic control, need for diabetes medications, and remission of type 2 diabetes. RESEARCH DESIGN AND METHODSOriginally, in a two-arm trial design, overweight, middle-aged men and women with newly diagnosed type 2 diabetes were randomized to a low-carbohydrate Mediterranean diet (LCMD; n = 108) or a low-fat diet (n = 107). After 4 years, participants who were still free of diabetes medications were further followed up until the primary end point (need of a diabetic drug); remission of diabetes (partial or complete) and changes in weight, glycemic control, and cardiovascular risk factors were also evaluated. RESULTSThe primary end point was reached in all participants after a total follow-up of 6.1 years in the low-fat group and 8.1 years in the LCMD group; median survival time was 2.8 years (95% CI 2.4-3.2) and 4.8 years (4.3-5.2), respectively. The unadjusted hazard ratio for the overall follow-up was 0.68 (0.50-0.89; P < 0.001). LCMD participants were more likely to experience any remission (partial or complete), with a prevalence of 14.7% (13.0-16.5%) during the first year and 5.0% (4.4-5.6%) during year 6 compared with 4.1% (3.1-5.0%) at year 1 and 0% at year 6 in the low-fat diet group. CONCLUSIONSIn patients with newly diagnosed type 2 diabetes, an LCMD resulted in a greater reduction of HbA 1c levels, higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet.Type 2 diabetes is now pandemic and shows no signs of abatement. The estimated worldwide prevalence of diabetes among adults aged 20-79 years was 366 million (8.3%) in 2011, and this value is predicted to rise to ;562 million (9.9%) by 2030 (1). This increase in type 2 diabetes is inextricably linked to changes toward a Western lifestyle (high-energy diets with reduced physical activity) in developing countries and the rise in the prevalence of overweight and obesity (2). Nutritional epidemiology has established the associations of overall dietary patterns with diabetes risk

We assessed the long-term effects of a Mediterranean diet on circulating levels of endothelial progenitor cells (EPCs) and the carotid intima-media thickness (CIMT) in patients with type 2 diabetes. Design: This was a parallel, two-arm, single-centre trial. Methods: Two hundred and fifteen men and women with newly diagnosed type 2 diabetes were randomized to a Mediterranean diet (n ¼ 108) or a low-fat diet (n ¼ 107). The primary outcome measures were changes in the EPC count and the CIMT of the common carotid artery after the treatment period defined as the end of trial (EOT). Results: At the EOT, both the CD34þ counts had increased with the Mediterranean diet compared with the low-fat diet (p < 0.05 for both). At the EOT evaluation, there was a significant (p ¼ 0.024) difference of À0.025 mm in the CIMT favouring the Mediterranean diet. Compared with the low-fat diet, the rate of regression in the CIMT was higher in the Mediterranean diet group (51 vs. 26%), whereas the rate of progression was lower (25 vs. 50%) (p ¼ 0.032 for both). Changes in the CIMT were inversely correlated with the changes in EPC levels (CD34At the EOT, changes in levels of HbA1c, HOMA, total cholesterol, high-density lipoprotein cholesterol and systolic blood pressure were significantly greater with the Mediterranean diet than with the low-fat diet. Conclusion: Compared with a low-fat diet, a long-term trial with Mediterranean diet was associated with an increase in circulating EPCs levels and prevention of the progression of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes.