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American Journal of Translational... 2023To explore and analyze the clinical effect and potential value of a double-capsule fecal catheter device in patients with fecal incontinence in the intensive care unit...
OBJECTIVE
To explore and analyze the clinical effect and potential value of a double-capsule fecal catheter device in patients with fecal incontinence in the intensive care unit (ICU).
METHODS
A total of 107 patients with fecal incontinence who were admitted to the ICU of the First Affiliated Hospital of Gannan Medical University from May 2017 to April 2023 were selected and randomly divided into the observation group and the control group, with 68 cases in the observation group and 39 cases in the control group. The observation group was given a double-capsule fecal catheter device, and the control group was given an ordinary fecal catheter device for drainage. The clinical baseline data, adverse events, skin conditions, changes of patients' quality of life (QoL), indicators from laboratory test, working pressure and burden of nursing, average length of stay (ALOS) and prognosis of patients were compared between the two groups.
RESULTS
There was no significant difference in age, gender, body mass index (BMI), hypertension history, diabetes mellitus history and smoking history between the observation group and the control group (all >0.05). The occurrence probability of the number of catheter obstructions, perianal leakage, catheter prolapse and the incidence of discomfort reactions in the observation group were significantly lower than those in the control group, and the difference was statistically significant (<0.01). After the use of the double-capsule fecal catheter device, the skin condition of the patient's perineum and perianal area was significantly improved and remained dry and comfortable for a long time, and the recovery of the primary disease in patients with fecal incontinence was also more optimistic. After application of the double-capsule fecal catheter device, the scores of QoL significantly increased in patients from the observation group (<0.05). After using the double-capsule fecal catheter device, the levels of WBC, neutrophils count, PCT and IL-6 in the observation group were significantly lower than those in the control group after nursing (<0.05). However, there was no significant difference in levels of CRP, TNF-α, albumin and prealbumin between the two groups (>0.05). The responsible nurses of the patients in the control group expressed significantly higher nursing work burden than the observation group (<0.05). Patients in the observation group had shorter ALOS and lower mortality than those in the control group (<0.01).
CONCLUSION
The application of the novel double-capsule fecal catheter device can reduce the adverse events and working pressure and burden of nursing, it also improved skin condition and patients' QoL. Correspondingly, it improved relevant prognostic indicators during the patient's hospitalization. It has beneficial clinical practicability and popularity for fecal incontinence in patients, and it is worthy of use and promotion.
PubMed: 37854203
DOI: No ID Found -
Clinics and Practice Dec 2023The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe... (Review)
Review
The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.
PubMed: 38248429
DOI: 10.3390/clinpract14010005 -
Langenbeck's Archives of Surgery Nov 2023Many pouch complications following ileoanal pouch surgery have an inflammatory or mechanical nature, and specialist colorectal surgeons are required to assess the...
INTRODUCTION
Many pouch complications following ileoanal pouch surgery have an inflammatory or mechanical nature, and specialist colorectal surgeons are required to assess the anatomy of the ileoanal pouch in multiple settings. In this study, we report our stepwise clinical and endoscopic assessment of the patient with an ileoanal pouch.
METHODS
The most common configuration of the ileoanal pouch is a J-pouch, and the stapled anastomosis is more frequently performed than a handsewn post-mucosectomy. A structured clinical and endoscopic assessment of the ileoanal pouch must provide information on 7 critical areas: anus and perineum, rectal cuff, pouch anal anastomosis, pouch body, blind end of the pouch, pouch inlet and pre-pouch ileum.
RESULTS
We have developed a structured pro forma for step-wise assessment of the ileoanal pouch, according to 7 essential areas to be evaluated, biopsied and reported. The structured assessment of the ileoanal pouch in 102 patients allowed reporting of abnormal findings in 63 (61.7%). Strictures were diagnosed in 27 patients (26.4%), 3 pouch inlet strictures, 21 pouch anal anastomosis strictures, and 3 pre-pouch ileum strictures. Chronic, recurrent pouchitis was diagnosed in 9 patients, whilst 1 patient had Crohn's disease of the pouch.
CONCLUSIONS
Detailed clinical history, assessment of symptoms and multidisciplinary input are all essential for the care of patients with an ileoanal pouch. We present a comprehensive reporting pro forma for initial clinical assessment of the patient with an ileoanal pouch, with the aim to guide further investigations and inform multidisciplinary decision-making.
Topics: Humans; Proctocolectomy, Restorative; Colitis, Ulcerative; Constriction, Pathologic; Colonic Pouches; Anastomosis, Surgical; Colorectal Neoplasms; Surgeons
PubMed: 37910244
DOI: 10.1007/s00423-023-03151-5 -
Healthcare (Basel, Switzerland) Jun 2024During cycling, prolonged compression by the bicycle saddle on the anatomical structures located in the perineum area occurs. An additional factor that may have a...
During cycling, prolonged compression by the bicycle saddle on the anatomical structures located in the perineum area occurs. An additional factor that may have a negative impact on organs located in the pelvic area may be a prolonged sitting position resulting in increased intraabdominal pressure. This situation has the potential to adversely affect pelvic floor function. Therefore, the aim of this study was to assess the incidence of lower urinary tract symptoms (LUTSs) in female competitive road cyclists and cross-country cyclists. The study included 76 female competitive road cyclists and cross-country cyclists and 76 women not practising competitive sport. The Core Lower Urinary Tract Symptom Score (CLSS) questionnaire was used to assess the lower urinary tract condition. Female competitive cyclists had a statistically significantly higher LUTSs score (95% CI: 3.12-4.2 vs. 2.31-3.16; < 0.05) compared to women not practising competitive sports. Female cyclists had a statistically significantly higher overall CLSS score (95% CI: 3.99-5.61 vs. 2.79-3.97; < 0.05). Female cyclists had a statistically significantly higher incidence and severity of urinary frequency ( < 0.05 and < 0.02), urge ( < 0.001 and < 0.02) and stress incontinence ( < 0.001 and < 0.001), and pain in the bladder ( < 0.01 and < 0.01), while physically inactive women recorded a statistically higher incidence of slow urinary stream ( < 0.01 and < 0.04). A statistically significant association was recorded between the years of cycling and the number of hours per week spent on training and the number of symptoms and their severity. The number of natural births experienced by women involved in competitive cycling significantly affects the severity of LUT symptoms. Compared to women not practising competitive sports, competitive female cyclists are found to have a higher prevalence of LUTSs and a greater degree of severity. LUTSs in competitive female cyclists are negatively influenced by years of competitive career and weekly number of training hours and the number of natural births experienced.
PubMed: 38921278
DOI: 10.3390/healthcare12121163 -
American Journal of Obstetrics and... Mar 2024Fetal head descent can be expressed as fetal station and engagement. Station is traditionally based on clinical vaginal examination of the distal part of the fetal skull... (Review)
Review
Fetal head descent can be expressed as fetal station and engagement. Station is traditionally based on clinical vaginal examination of the distal part of the fetal skull and related to the level of the ischial spines. Engagement is based on a transabdominal examination of the proximal part of the fetal head above the pelvic inlet. Clinical examinations are subjective, and objective measurements of descent are warranted. Ultrasound is a feasible diagnostic tool in labor, and fetal lie, station, position, presentation, and attitude can be examined. This review presents an overview of fetal descent examined with ultrasound. Ultrasound was first introduced for examining fetal descent in 1977. The distance from the sacral tip to the fetal skull was measured with A-mode ultrasound, but more convenient transperineal methods have since been published. Of those, progression distance, angle of progression, and head-symphysis distance are examined in the sagittal plane, using the inferior part of the symphysis pubis as reference point. Head-perineum distance is measured in the frontal plane (transverse transperineal scan) as the shortest distance from perineum to the fetal skull, representing the remaining part of the birth canal for the fetus to pass. At high stations, the fetal head is directed downward, followed with a horizontal and then an upward direction when the fetus descends in the birth canal and deflexes the head. Head descent may be assessed transabdominally with ultrasound and measured as the suprapubic descent angle. Many observational studies have shown that fetal descent assessed with ultrasound can predict labor outcome before induction of labor, as an admission test, and during the first and second stage of labor. Labor progress can also be examined longitudinally. The International Society of Ultrasound in Obstetrics and Gynecology recommends using ultrasound in women with prolonged or arrested first or second stage of labor, when malpositions or malpresentations are suspected, and before an operative vaginal delivery. One single ultrasound parameter cannot tell for sure whether an instrumental delivery is going to be successful. Information about station and position is a prerequisite, but head direction, presentation, and attitude also should be considered.
Topics: Pregnancy; Female; Humans; Ultrasonography, Prenatal; Prospective Studies; Delivery, Obstetric; Ultrasonography; Labor Presentation; Head
PubMed: 34461079
DOI: 10.1016/j.ajog.2021.08.030 -
Prostate International Mar 2024To address the limitations and challenges associated with transrectal (TR) biopsy and to present transperineal (TP) biopsy as a viable and potentially safer alternative... (Review)
Review
To address the limitations and challenges associated with transrectal (TR) biopsy and to present transperineal (TP) biopsy as a viable and potentially safer alternative to TR biopsy. Prostate cancer (PCa) is a significant global health concern. The prevalence of advanced-stage prostate cancer in Asia is higher than that in the United States, emphasizing the need for effective screening and diagnosis methods. The gold standard of diagnosis is a TR biopsy. However, it has limitations due to the risk of infection and potential complications, such as injury to the rectal artery. Efforts have been made to address issues such as false-negative biopsies, under-sampling, and over-sampling through MRI-guided biopsies. However, the TR approach makes it difficult to access the apical and anterior regions of the prostate. TP biopsy has emerged as an alternative to address the limitations of TR biopsy. Nevertheless, a TP biopsy is a painful procedure, requiring the use of general anesthesia and expensive equipment. As a result, it has been perceived as costly and time-consuming. In addition, it requires a steep learning curve. The introduction of local anesthesia such as pudendal nerve block and the adoption of freehand techniques have contributed to the feasibility of performing TP biopsy. Recent research indicates that freehand TP biopsy can yield comparable diagnostic results to template-guided approaches. The diagnostic performance, cancer detection rates, and complication rates of TP biopsy have demonstrated its potential as a safe and effective diagnostic method.
PubMed: 38523899
DOI: 10.1016/j.prnil.2023.11.003