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Biomedical Papers of the Medical... Dec 2023The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and...
AIMS
The aim of this retrospective study was to try to find correlations between different diagnoses established by clinical examination, anorectal manometry and MRI-defecography and, the association with psychiatric disorders.
METHODS
44 patients (median age 53.81 years) presenting with intestinal motility disorders and who underwent clinical, biological and psychiatric examination, dynamic defecographic-MRI (resting, squeezing, straining, defecation and evacuation phases), anorectal manometry, colonoscopy. MRI was performed using the 1,5 T.
RESULTS
MRI-defecography revealed the following changes: anismus (16), rectocele (12), pelvic floor dysfunction (6), peritoneocele (2), cervical-cystic-ptosis (1), rectal prolapse (6), and in 1 case the examination was normal. Hypertonic anal sphincter (16) and lack of defecation reflex (12) at anorectal manometry correlated with anismus in all patients at MRI-defecography. Lack of inhibitor anal reflex (6) was associated with rectocele (4), cervix-cysto-ptosis (1) and peritoneocele (2). Anxiety (11), depression (6) and anxiety-depressive disorders (10) were found in 27/44, somatization disorders in 9/44 and no psychiatric changes in 8/44 cases.
CONCLUSION
As multiparous women are at risk for outlet obstruction constipation, MRI-defecography is suggested in this category. There is good correlation between diagnosis using anorectal manometry and MRI-defecography in patients with terminal constipation and anismus. Lower defecation dysfunction is often associated with psychiatric disorders.
Topics: Humans; Female; Middle Aged; Defecation; Rectocele; Defecography; Retrospective Studies; Constipation; Magnetic Resonance Imaging
PubMed: 35582728
DOI: 10.5507/bp.2022.023 -
Journal of Clinical Medicine Sep 2023The management of pelvic fractures is a significant challenge. Surgical site infection can result in the need for revision surgery, cause functional impairment, and lead...
BACKGROUND
The management of pelvic fractures is a significant challenge. Surgical site infection can result in the need for revision surgery, cause functional impairment, and lead to a prolonged length of stay and increased treatment costs. Although reports on fracture-related infection (FRI) after pelvic fracture fixation are sparsely reported in the literature, it is a serious complication. This study analysed patients with FRIs after pelvic fracture regarding patient characteristics, treatment strategies, and an evaluation of risk factors for FRI.
METHODS
In this retrospective single-centre study, FRI was diagnosed based on clinical symptoms of infection and a positive culture of a bacterial infection. Depending on the severity and acuteness of the infection, osseous stabilization was restored either via implant retention (stable implant, no osteolysis), exchange (loose implant or bony defect), or external fixation (recurrence of infection after prior implant retaining revision). Healing of infection was defined as no sign of recurring infection upon clinical, radiological, and laboratory examination in the last follow-up visit.
RESULTS
The FRI rate in our patient population was 7.5% (24/316). In 8/24 patients, the FRI occurred within the first three weeks after initial surgery (early) and 16/24 presented with a late onset of symptoms of FRI. A strategy of debridement, antibiotics, and implant retention (DAIR) was successful in 9/24 patients with FRI after pelvic fracture. A total of 10 patients required an exchange of osteo-synthetic implants, whereof three were exchanged to an external fixator. In five patients, we removed the implant because the fracture had already consolidated at the time of revision for infection. A total of 17/24 patients had a poly-microbial infection after a pelvic fracture and 3/24 patients died from post-traumatic multi-organ failure within the first 6 months after trauma. There were no cases of persistent infection within the remaining 21 patients.
CONCLUSIONS
Although poly-microbial infection is common in FRI after pelvic fracture, the recurrence rate of infection is relatively low. A complex pelvic trauma with significant soft tissue injury is a risk factor for recurrent infection and multiple revisions. A strategy of DAIR can be successful in patients with a stable implant. In cases with recurrent infection or an unstable fracture site, the exchange of implants should be considered.
PubMed: 37834865
DOI: 10.3390/jcm12196221 -
International Journal of Gynaecology... May 2024Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination. (Review)
Review
BACKGROUND
Recent recommendations from the French High Authority of Health on pelvic organ prolapse (POP) management underline the value of a pelvic examination.
OBJECTIVES
The aim of this paper was to analyze the literature and identify the best evidence available regarding pelvic examination for women presenting prolapse-associated symptoms in terms of diagnosis and predictability of treatment success.
SEARCH STRATEGY
The databases were queried similarly using Medical Subject Headings (MeSH) and non-MeSH terms broadly related to pelvic examination and POP management.
SELECTION CRITERIA
We included studies assessing the diagnostic contribution of pelvic examination (correlation with symptoms) and its value for assessing the risk of pessary failure or recurrence after reconstructive surgery.
DATA COLLECTION AND ANALYSIS
We assessed peer-reviewed articles on PubMed, Embase, and Cochrane database up to May 2023. The methodological quality of all the included studies was assessed using the ROBINS-E or RoB2 tools.
MAIN RESULTS
In all, 67 studies were retained for the review. Prolapse-associated symptoms are poorly correlated with POP diagnosis. The symptom that is best correlated with the POP stage is the presence of a vaginal bulge (moderate to good correlation). The factors most strongly associated with the risk of recurrence after surgery or pessary failure are clinical: essentially a higher POP stage before surgery, levator ani muscle avulsion, and vaginal and genital measurements.
CONCLUSIONS
In women complaining of prolapse-associated symptoms, a pelvic examination (vaginal speculum and digital vaginal examination) can confirm the presence of POP and identify risk factors for treatment failure or recurrence after surgical management or pessary placement. A higher stage of POP and levator ani muscle avulsion-discernible on pelvic examination-are major risk factors for POP recurrence or treatment failure. These features must be taken into account in the treatment choice and discussed with the patient.
PubMed: 38778697
DOI: 10.1002/ijgo.15697 -
Archives of Gynecology and Obstetrics Dec 2023Chronic pelvic pain (CPP) is one of the main problems of endometriosis, leading to a significant impairment of quality of life. Understanding the pain mechanisms and the...
PURPOSE
Chronic pelvic pain (CPP) is one of the main problems of endometriosis, leading to a significant impairment of quality of life. Understanding the pain mechanisms and the pelvic floor muscles (PFM) changes in these patients is essential to integrate additional therapeutic strategies. We hypothesize that endometriosis patients have changes in PFM and that targeted vaginal electrostimulation can be a treatment option for CPP in this disease.
METHODS
Fifteen patients with endometriosis and chronic acyclical pelvic pain were included. PFM electromyography with the Multiple Array Probe Leiden (MAPLe) was performed. Mapping of PFM was utilized and targeted electrostimulation of the hypertensive muscles was conducted. Control electromyography was performed afterward to evaluate the electrostimulation therapeutic effect.
RESULTS
In 12/15 (80%) patients, the myofascial trigger point could be localized by digital examination. The most frequently affected muscle was the puborectalis (10/15-66.7%). Most of the patients showed serious changes in the average resting tone (aRT) of PFM. aRT was significantly increased in all patients and decreased after stimulation, whereby the difference prior to and after stimulation was not significant (p = 0.064). The detailed separated analysis of the hypertensive muscles showed a significant (p = 0.026) reduction in their resting tone (hRT), after targeted stimulation.
CONCLUSION
Vaginal electrostimulation is a promising and feasible complementary treatment option for CPP in endometriosis patients. Targeted treatment of pelvic floor dysfunction should be included in clinical trials.
Topics: Female; Humans; Pelvic Floor; Pilot Projects; Endometriosis; Quality of Life; Muscle Contraction; Electromyography; Pelvic Floor Disorders; Pelvic Pain
PubMed: 37672087
DOI: 10.1007/s00404-023-07192-5 -
Injury Dec 2023Civilian gunshot fractures of the pelvic ring represent a unique challenge for orthopaedic surgeons due to a high incidence of complicating associated injuries.... (Review)
Review
INTRODUCTION
Civilian gunshot fractures of the pelvic ring represent a unique challenge for orthopaedic surgeons due to a high incidence of complicating associated injuries. Internationally accepted guidelines for these injuries are not available. The aim of this review is to summarize the available literature and to provide concise management recommendations.
METHODS
Literature search was performed using PubMed. The review focuses on civilian gunshot fractures of the pelvic ring and includes the acetabulum and hip joint only where it was deemed necessary for the understanding of the management of these patients.
RESULTS
The management of civilian transpelvic gunshot fractures is complicated by potentially life-threatening associated injuries, the risk of contamination with bowel content and retained bullets in joints. The infection risk is higher compared to extremity gunshot fractures. There is no clear evidence for the use of antibiotics available. The studies focusing on civilian pelvic ring gunshot fractures reported no case of orthopaedic fracture fixation in their series. Routine wash-out and debridement of fractures is not warranted based on the literature but conflicting recommendations for surgical interventions exist.
CONCLUSION
There is limited evidence available for civilian transpelvic gunshot fractures. The high frequency of associated injuries requires a thorough clinical examination and multidisciplinary management. We recommend routine antibiotic prophylaxis for all transpelvic gunshots. For fractures with a high risk of infection, a minimum of 24 h broad-spectrum antibiotics is recommended. The indication for orthopaedic fixation of civilian transpelvic gunshot fractures is based on the assessment of the stability of the fracture and is rarely necessary. Although conflicting recommendations exist, routine wash-out and debridement is not recommended based on the literature. Bullets buried in bone without contact to synovial fluid do not warrant removal, unless they have traversed large bowel and are accessible without undue morbidity. Furthermore, bullets should be routinely removed if they are retained in the hip joint, if mechanical irritation of soft tissues by projectiles is expected or if the bullet traversed large bowel before entering the hip joint.
Topics: Humans; Fractures, Bone; Fracture Fixation; Pelvic Bones; Pelvis; Wounds, Gunshot; Anti-Bacterial Agents; Retrospective Studies
PubMed: 37827874
DOI: 10.1016/j.injury.2023.111086 -
The Journal of the American Academy of... Sep 2023Pelvic ring injuries and acetabular fractures can be complex and challenging to treat. Orthopaedic trauma surgeons scrutinize pelvic radiographs and accompanying CT...
Pelvic ring injuries and acetabular fractures can be complex and challenging to treat. Orthopaedic trauma surgeons scrutinize pelvic radiographs and accompanying CT images for the osseous details that help create a thorough patient-specific preoperative plan. While the osseous details are incredibly important, the surrounding soft-tissue structures are equally as critical and can have a tremendous effect on both the patient and the surgeon. These findings may change surgery timing, dictate the need for additional surgeons or multidisciplinary teams, and determine the treatment sequence. The structures and potential clinical findings reviewed and demonstrated through example images should be sought out during physical examination and correlative preoperative imaging review. Combining all the available osseous and nonosseous information with a detailed approach helps the surgeon predict potential pitfalls and adjust surgical plans before incision. Maximizing the accuracy of the preoperative planning process can streamline treatment algorithm development and ultimately contribute to the best possible clinical patient outcome.
Topics: Humans; Fractures, Bone; Acetabulum; Fracture Fixation, Internal; Pelvis; Radiography; Hip Fractures; Pelvic Bones
PubMed: 37450836
DOI: 10.5435/JAAOS-D-23-00190 -
La Revue Du Praticien Feb 2024URINARY INCONTINENCE IN CHILDREN. Urinary incontinence in children and adolescents is most often of functional origin. Questioning and clinical examination with a...
URINARY INCONTINENCE IN CHILDREN. Urinary incontinence in children and adolescents is most often of functional origin. Questioning and clinical examination with a bladder diary should look for underlying urological or neurological causes. The type of incontinence, daytime or nocturnal, must be specified to adapt treatments. Renal and bladder ultrasound is recommended, and urodynamic studies are not routinely used. Lifestyle advice and bowel management are prerequisites for treatment. Depending on the type of symptoms, drug treatment, pelvic floor treatment, behavioral measures or stimulation of the posterior tibial nerve can be proposed. The evolution can sometimes be slow with a significant impact on quality of life, and neurocognitive aspects need to be considered.
Topics: Child; Adolescent; Humans; Quality of Life; Urinary Incontinence; Pelvic Floor; Physical Examination; Life Style
PubMed: 38415424
DOI: No ID Found -
Radiologie (Heidelberg, Germany) Nov 2023Pelvic floor dysfunction is common in women. (Review)
Review
BACKGROUND
Pelvic floor dysfunction is common in women.
OBJECTIVES
To describe the role of ultrasound in the urogynecological examination and imaging of the pelvic floor.
MATERIALS AND METHODS
Analysis and summary of current recommendations and literature on the role of pelvic floor ultrasound.
RESULTS
Pelvic floor ultrasound is a dynamic and real-time imaging modality. It is readily available, allows for a realistic assessment of anatomy and morphology, and poses minimal patient burden.
CONCLUSIONS
Pelvic floor ultrasound is of great value in preoperative diagnostics as well as in the postoperative management of complications.
Topics: Female; Humans; Pelvic Floor; Pelvic Organ Prolapse; Ultrasonography; Pelvic Floor Disorders; Postoperative Period
PubMed: 37789193
DOI: 10.1007/s00117-023-01215-7 -
Journal of Pediatric and Adolescent... Jun 2024The aim of this study was to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were...
STUDY OBJECTIVE
The aim of this study was to identify factors that influence the first pelvic exam experiences of sexual and gender minority (SGM) adolescents and young adults who were assigned female at birth (AFAB).
METHODS
Using purposive sampling, we recruited SGM AFAB individuals, ages 18-24, who had had at least 1 pelvic examination. Semi-structured interviews and an iterative approach allowed for the emergence of factors influencing the first pelvic exam experience. Items included in the final code directory had a Krippendorff's alpha intercoder reliability score greater than 0.7. Interviews were analyzed using ATLAS.ti.
RESULTS
Thirty participants completed interviews. Fourteen participants identified as bisexual, 2 as gay, 1 as lesbian, 3 as pansexual, 8 as queer, and 2 as straight/heterosexual. Sixteen participants identified as cisgender, 9 as genderqueer/gender nonconforming, and 5 as transgender. Factors influencing the first pelvic exam experience were organized as patient- or clinician-level factors. The patient-level factors of gender identity, sexual orientation, history of sexual trauma, and participant's relationship to their body were central factors influencing the exam experience. Speculum insertion during the exam induced anxiety and pain for some. The clinician-level factors of gender, age, and race or ethnicity influenced the exam experience. Most participants preferred detailed communication. Participants offered recommendations to ensure gender-affirming, patient-centered care during the first pelvic exam.
CONCLUSION
SGM AFAB individuals identified patient- and clinician-level factors influencing their first pelvic exam experiences. This study underscores the need for changes in medical education and health systems to ensure that SGM AFAB individuals have their needs met and feel comfortable in reproductive health settings.
Topics: Humans; Female; Gynecological Examination; Sexual and Gender Minorities; Adolescent; Young Adult; Male; Adult
PubMed: 38012980
DOI: 10.1016/j.jpag.2023.11.008 -
Scientific Reports Dec 2023This study aimed to investigate the relationship between the dietary approaches to stop hypertension (DASH) dietary patterns and bone mineral density (BMD) in adults...
The association between dietary approaches to stop hypertension diet and bone mineral density in US adults: evidence from the National Health and Nutrition Examination Survey (2011-2018).
This study aimed to investigate the relationship between the dietary approaches to stop hypertension (DASH) dietary patterns and bone mineral density (BMD) in adults residing in the United States. To achieve this, data from the National Health and Nutrition Examination Survey (NHANES) database for 2011-2018 were utilized. This study utilized the NHANES database from 2011 to 2018, with a sample size of 8,486 US adults, to investigate the relationship between the DASH diet and BMD. The DASH diet was assessed based on nine target nutrients: total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium and potassium. The primary outcome measures were BMD values at the total BMD, thoracic spine, lumbar spine, and pelvis. Multivariable linear models were employed to analyze the association between the DASH diet and BMD. Interaction tests, subgroup, and sensitivity analysis were also followed. A negative correlation was observed between the DASH diet and total BMD (OR: - 0.003 [95%CI: - 0.005, - 0.001), pelvic (OR: - 0.005 [95%CI: - 0.007, - 0.002]), and thoracic BMD (OR: - 0.003 [95%CI: - 0.005, - 0.001]). However, the DASH diet does not appear to have a particular effect on lumbar spine BMD (OR: - 0.002 [95%CI: - 0.004, 0.001]). Similarly, when the DASH diet was categorized into tertiles groups, the relationship with total BMD, pelvic BMD, thoracic BMD, and lumbar spine BMD remained consistent. Furthermore, we performed a sensitivity analysis by converting BMD to Z-scores, and the results remained unchanged. Subgroup analyses and interaction tests indicated no significant dependence of BMI, gender, smoking, hypertension, and diabetes on the observed association (all p for interactions > 0.05). The DASH diet has been identified as potentially reducing total BMD, while specifically impacting thoracic and pelvic BMD. However, it appears to have no significant effect on lumbar spine BMD.
Topics: Adult; Humans; United States; Dietary Approaches To Stop Hypertension; Nutrition Surveys; Bone Density; Diet; Hypertension
PubMed: 38155299
DOI: 10.1038/s41598-023-50423-7