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Reproduction in Domestic Animals =... Dec 2023A ten-year-old mixed breed bitch was presented for a tissue prolapse protruding from her vulva. Following detailed examination and stabilization, the ovaries and uterine...
A ten-year-old mixed breed bitch was presented for a tissue prolapse protruding from her vulva. Following detailed examination and stabilization, the ovaries and uterine horns were removed by laparotomy, whereas the prolapsed tissue identified as uterus including cervix was removed vaginally. Histology confirmed uterine prolapse, a rare condition in bitches usually found shortly after birth especially due to dystocia. In contrast, the present case was found in a nulliparous non-pregnant bitch. Diagnostic and therapeutic approaches, including microbiological and histological findings, are described and discussed critically.
Topics: Pregnancy; Female; Dogs; Animals; Uterine Prolapse; Uterus; Ovary; Dog Diseases
PubMed: 37888850
DOI: 10.1111/rda.14495 -
Techniques in Coloproctology Oct 2023Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Surgical treatment of complete rectal prolapse can be undertaken via an abdominal or a perineal approach. The present network meta-analysis aimed to compare the outcomes of different abdominal and perineal procedures for rectal prolapse in terms of recurrence, complications, and improvement in fecal incontinence (FI).
METHODS
A PRISMA-compliant systematic review of PubMed, Scopus, and Web of Science was conducted. Randomized clinical trials comparing two or more procedures for the treatment of complete rectal prolapse were included. The risk of bias was assessed using the ROB-2 tool. The main outcomes were recurrence of full-thickness rectal prolapse, complications, operation time, and improvement in FI.
RESULTS
Nine randomized controlled trials with 728 patients were included. The follow-up ranged between 12 and 47 months. Posterior mesh rectopexy had significantly lower odds of recurrence than did the Altemeier procedure (logOR, - 12.75; 95% credible intervals, - 40.91, - 1.75), Delorme procedure (- 13.10; - 41.26, - 2.09), resection rectopexy (- 11.98; - 41.36, - 0.19), sponge rectopexy (- 13.19; - 42.87, - 0.54), and sutured rectopexy (- 13.12; - 42.58, - 1.50), but similar odds to ventral mesh rectopexy (- 12.09; - 41.7, 0.03). Differences among the procedures in complications, operation time, and improvement in FI were not significant.
CONCLUSIONS
Posterior mesh rectopexy ranked best with the lowest recurrence while perineal procedures ranked worst with the highest recurrence rates.
Topics: Humans; Rectal Prolapse; Network Meta-Analysis; Laparoscopy; Rectum; Digestive System Surgical Procedures; Fecal Incontinence; Surgical Mesh; Recurrence; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37150800
DOI: 10.1007/s10151-023-02813-2 -
Urogynecology (Philadelphia, Pa.) Dec 2023Understanding patients' perceptions of symptoms and outcomes of urogynecologic surgery is essential for providing high-quality care.
IMPORTANCE
Understanding patients' perceptions of symptoms and outcomes of urogynecologic surgery is essential for providing high-quality care.
OBJECTIVE
The aim of the study was to assess association of pain catastrophizing with pelvic floor symptom distress and impact, postoperative pain, and voiding trial in patients undergoing urogynecologic surgery.
STUDY DESIGN
Individuals whose self-identified gender was female and were undergoing surgery March 2020-December 2021 were included. Participants completed the Pain Catastrophizing Scale (range 0-52), Pelvic Floor Distress Inventory, and Pelvic Floor Impact Questionnaire preoperatively. Pain catastrophizing was score ≥30 and describes the tendency to magnify the overall threat of pain. Voiding trial failure was inability to void ≥2/3 of instilled volume (≤300 mL). The association between pain catastrophizing and symptom distress and impact was assessed with linear regression. A P < 0.05 is significant.
RESULTS
Three hundred twenty patients were included (mean age, 60 years, 87% White). Forty-six of 320 participants (14%) had a pain catastrophizing score ≥30. The pain catastrophizing group had higher body mass index (33 ± 12 vs 29 ± 5), more benzodiazepine use (26% vs 12%), greater symptom distress (154 ± 58 vs 108 ± 60), and greater urogenital (59 ± 29 vs 47 ± 28), colorectal (42 ± 24 vs 26 ± 23), and prolapse (54 ± 24 vs 36 ± 24) subscale scores, all P ≤ 0.02. The pain catastrophizing group had greater impact (153 ± 72 vs 72 ± 64, P < 0.01) and urogenital (60 ± 29 vs 34 ± 28), colorectal (36 ± 33 vs 16 ± 26), and prolapse (57 ± 32 vs 22 ± 27) subscale scores, P < 0.01. Associations remained controlling for confounders ( P < 0.01). The pain catastrophizing group had higher 10-point pain scores (8 vs 6, P < 0.01) and was more likely to report pain at 2 weeks (59% vs 20%, P < 0.01) and 3 months (25% vs 6%, P = 0.01). Voiding trial failure did not differ (26% vs 28%, P = 0.98).
CONCLUSIONS
Pain catastrophizing is associated with greater pelvic floor symptom distress and impact and postoperative pain but not voiding trial failure.
Topics: Humans; Female; Middle Aged; Pelvic Floor; Prolapse; Surveys and Questionnaires; Pain, Postoperative; Colorectal Neoplasms
PubMed: 37195629
DOI: 10.1097/SPV.0000000000001365 -
JAMA Feb 2024
Topics: Female; Humans; Gynecologic Surgical Procedures; Hysterectomy; Uterine Prolapse
PubMed: 38277160
DOI: 10.1001/jama.2023.22744 -
Pediatric Neurology Apr 2024Currently, there is no universally accepted standard treatment for ocular myasthenia gravis (OMG) in children. We aimed to investigate the possible proper regimens and...
BACKGROUND
Currently, there is no universally accepted standard treatment for ocular myasthenia gravis (OMG) in children. We aimed to investigate the possible proper regimens and timing of treatment for pediatric OMG cases based on the clinical manifestations: OMG with ptosis only and OMG with other features.
METHODS
One hundred and forty two OMG cases attended at the Department of Pediatrics, Xiangya Hospital, Central South University, from 2010 to 2019 were included, and information from medical records was reviewed and recorded. Comparisons of clinical characteristics between patients with OMG with ptosis only and patients with OMG with other features as well as between patients treated with glucocorticoid (GC) within or after six months from disease onset were performed.
RESULTS
OMG with other features constituted about 54.9% of the cases, and 66.2% of the patients achieved optimal outcome. Patients with OMG with ptosis only responded to pyridostigmine alone more than patients with OMG with other features who required several therapies (P < 0.001). Patients with OMG with ptosis only had a larger proportion of optimal outcome than the patients with OMG with other features (P = 0.002), and the difference remained significant even when the individual outcome groups were compared (P < 0.001). Patients who received GC within six months had a greater proportion of optimal outcome than those who received it after six months (P < 0.001).
CONCLUSIONS
Although OMG with other features is a more common subtype of OMG, it is also more severe than OMG with ptosis only. An earlier addition of GC leads to optimal outcome.
Topics: Humans; Child; Myasthenia Gravis; Blepharoptosis; Pyridostigmine Bromide; Glucocorticoids; Retrospective Studies
PubMed: 38382246
DOI: 10.1016/j.pediatrneurol.2024.01.014 -
Aesthetic Plastic Surgery Oct 2023Several types of surgeries have been used in the treatment of congenital ptosis, but the optimal methods and materials for this treatment are unknown. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several types of surgeries have been used in the treatment of congenital ptosis, but the optimal methods and materials for this treatment are unknown.
PURPOSE
The study aims to evaluate the comparative effectiveness and safety of various surgical methods and materials for treatment of congenital ptosis.
METHODS
We performed comprehensive searches of five databases, two clinical trial registries and one gray literature database from inception to January 2022 for related trials to include in this study. Meta-analysis was performed to evaluate the effect of surgical methods and materials on the primary outcomes: margin reflex distance 1 (MRD1), palpebral fissure height (PFH), and degree of lagophthalmos; and secondary outcomes: undercorrection, entropion, corneal epithelial defects, wound dehiscence, recurrence, infection, and cosmetic outcomes.
RESULTS
A total of 14 trials evaluating 909 eyes of 657 patients were included in our study. Compared with the levator plication, the frontalis sling significantly increased the MRD1 (MD = - 1.21; 95% CI [- 1.69, - 0.73]), and the levator resection significantly increased the PFH (MD = 1.30; 95% CI [0.27, 2.33]). For the frontalis sling surgical patterns, the fox pentagon was significantly better than the double triangle at improving the degree of lagophthalmos (MD = 0.70; 95% CI [0.32, 1.08]), while the opened pattern provided statistically better cosmetic outcome than the closed frontalis sling. Analysis of surgical material showed that absorbable sutures significantly increased the MRD1 (MD = 1.16; 95% CI [0.60, 1.72]) compared to non-absorbable sutures when used in levator plication; frontalis sling surgeries performed with silicon rods significantly increased the PFH (MD = 0.88; 95% CI [0.29, 1.47]) compared to those performed with Gore-Tex strips, while autogenous fascia lata provided statistically better aesthetic outcome for lid height symmetry and contour.
CONCLUSION
Different surgical methods and materials appear to affect different aspects of the congenital ptosis treatment outcome.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Blepharoplasty; Retrospective Studies; Oculomotor Muscles; Randomized Controlled Trials as Topic; Blepharoptosis; Eyelids; Treatment Outcome; Lagophthalmos
PubMed: 37145320
DOI: 10.1007/s00266-023-03360-9 -
Journal of Minimally Invasive Gynecology Oct 2023To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP).
STUDY OBJECTIVE
To evaluate the clinical benefits of laparoscopic pectopexy vs laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP).
DESIGN
Prospective cohort study.
SETTING
A tertiary hospital.
PATIENTS
We included 203 patients with POP.
INTERVENTIONS
Laparoscopic pectopexy or laparoscopic sacrocolpopexy.
MEASUREMENTS AND MAIN RESULTS
Anatomic effectiveness was measured using the POP Quantification system, both before and after operation. Functional recovery effectiveness was evaluated using complications and recurrence rates within 1 year. Quality of life was assessed by the Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life questionnaires at enrollment and postoperative months 3, 6, and 12. Comparisons between groups were performed using t test, chi-square test, and mixed-effects model with repeated measures. The analysis included 203 eligible patients (sacrocolpopexy, 101; pectopexy, 102). The proportion of robotic-assisted surgeries was lower in the pectopexy group than in the sacrocolpopexy group (15.7% vs 41.6%, p <.001). The average operation time of pectopexy was shorter than that of sacrocolpopexy (174.2 vs 187.7 minutes) with a mean difference of 13.5 minutes (95% confidence interval, 3.9-23.0; p = .006). Differences of intraoperative blood loss, length of hospital stay, and postoperative 7-day complications between groups were not significant. Anatomic successes were obtained in both groups with similar improvement in POP Quantification scores. The rate of urinary symptoms recurrence was higher in the pectopexy group (13.7%) than in the sacrocolpopexy group (5.0%) at the 1-year follow-up (odds ratio, 3.1; 95% confidence interval, 1.1-8.8, p = .032). The Pelvic Floor Distress Inventory-20 and Incontinence Quality of Life scores were better improved at postoperative months 3, 6, and 12 for laparoscopic pectopexy than for sacrocolpopexy.
CONCLUSION
Laparoscopic pectopexy revealed comparable anatomic success, shorter operation time, and better improvement in quality of life scores of prolapse, colorectal-anal, and urinary symptoms at 1-year follow-up, possibly being an alternative when sacrocolpopexy is not practicable. However, clinicians should pay more attention to the recurrence of urinary symptoms after pectopexy.
Topics: Humans; Female; Treatment Outcome; Prospective Studies; Quality of Life; Laparoscopy; Pelvic Organ Prolapse; Urinary Incontinence; Postoperative Complications; Gynecologic Surgical Procedures
PubMed: 37369345
DOI: 10.1016/j.jmig.2023.06.011 -
Techniques in Coloproctology Oct 2023
Topics: Humans; Rectal Prolapse; Rectum; Fecal Incontinence; Treatment Outcome
PubMed: 37278904
DOI: 10.1007/s10151-023-02829-8 -
Progres En Urologie : Journal de... Dec 2023
Topics: Female; Humans; Uterus; Hysterectomy; Prolapse; Pelvic Organ Prolapse; Gynecologic Surgical Procedures; Laparoscopy; Treatment Outcome; Surgical Mesh; Vagina
PubMed: 37661490
DOI: 10.1016/j.purol.2023.08.021 -
JAMA Aug 2023
Topics: Female; Humans; Pelvic Organ Prolapse; Treatment Outcome; Uterine Prolapse
PubMed: 37581683
DOI: 10.1001/jama.2023.13733