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International Journal of Health Sciences 2023The aim of the study was to determine the intra- and inter-rater reliability of palpation technique, digital calipers, and diastometer, as well as their concurrent...
OBJECTIVE
The aim of the study was to determine the intra- and inter-rater reliability of palpation technique, digital calipers, and diastometer, as well as their concurrent validity against ultrasound imaging.
METHODS
Ninety consenting parous women (20-45 years), recruited from a postnatal clinic in Enugu, Nigeria, participated in this observational study. Two physiotherapists and a sonographer measured their inter rectus distance at the level of the umbilicus, 4.5 cm above and below it, respectively, using each of the four modalities. The intra-rater measurements were taken at a week's interval. Data were analyzed with descriptive and inferential statistics of intraclass correlation coefficient and paired samples T-test, at an alpha level set at < 0.05.
RESULTS
It showed the palpation technique (r = 0.749-0.967 and 0.658-0.917), digital calipers (r=0.750-0.955 and 0.685-0.904), and diastometer (r=0.762-0.958 and 0.471-0.902) demonstrated good inter- and intra-rater reliability. The concurrent validity of the palpation technique, digital calipers, and diastometer against the USI was poor at all three reference points.
CONCLUSION
Palpation technique, digital calipers, and diastometer are reliable tools but not valid substitutes to ultrasound imaging for the clinical measurement of diastasis rectus abdominis.
PubMed: 37929234
DOI: No ID Found -
Saudi Journal of Medicine & Medical... 2023Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body... (Review)
Review
Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m, altered collagen metabolism, and diabetes.
PubMed: 37533654
DOI: 10.4103/sjmms.sjmms_235_22 -
JNMA; Journal of the Nepal Medical... Feb 2024A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as...
UNLABELLED
A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes.
KEYWORDS
case reports; rectus abdominis; ventral hernia.
Topics: Female; Humans; Middle Aged; Hernia, Ventral; Laparoscopy; Fascia; Tomography, X-Ray Computed; Abdominal Pain
PubMed: 38409978
DOI: 10.31729/jnma.8440 -
Innovative Surgical Sciences Jun 2023The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific... (Review)
Review
INTRODUCTION
The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons.
CONTENT
- Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or "tensor-fascia-lata" (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). - Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. - Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. - Abdominoperineal rectum extirpation (APE): Holm's procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. - Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. - Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. - Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time - plastic surgery expertise has to be included into interdisciplinary tumor concepts. - Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. - Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). - Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. - Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surgery coverage can prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life.
SUMMARY
The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice.
OUTLOOK
An interdisciplinary approach of abdominal and plastic surgery is characterized by a highly developed cooperation in common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.
PubMed: 38058780
DOI: 10.1515/iss-2023-0042 -
International Urogynecology Journal Mar 2024Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research.
METHODS
For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification.
RESULTS
Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design.
CONCLUSIONS
Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.
Topics: Female; Humans; Rectus Abdominis; Postpartum Period; Exercise Therapy; Diastasis, Muscle; Pelvis
PubMed: 38340172
DOI: 10.1007/s00192-024-05727-1 -
JPRAS Open Sep 2024Restoring oral intake through oropharyngeal reconstruction is vital for patients undergoing total glossolaryngectomy. Despite its importance, research in this area is...
INTRODUCTION
Restoring oral intake through oropharyngeal reconstruction is vital for patients undergoing total glossolaryngectomy. Despite its importance, research in this area is limited, leaving clinicians with few guidelines. The debate regarding the optimal shape of the reconstructed oropharynx highlights the need for further research.
METHODS
This retrospective study analysed data from 16 consecutive patients who underwent primary reconstruction with a free rectus abdominis musculocutaneous flap after total glossolaryngectomy at the University of the Ryukyus Hospital between April 2015 and March 2022. Parameters assessed included reconstructed oropharynx shape (flat or funnel-shaped), demographics, flap characteristics, post-operative course and oral intake outcomes.
RESULTS
Among the 16 patients, 10 had flat oropharynx, whereas 6 had a funnel-shaped oropharynx. At 6 months post-surgery, 13 patients resumed oral feeding, whereas 3 did not. Significant differences were observed between the groups in preoperative body mass index (21.1 kg/m² vs 17.8 kg/m², Welch's t-test, p=0.035) and days until the first oral intake (34.2 days vs 19.2 days, Welch's t-test, p=0.01). However, no significant differences were found in the form of oral intake at 6 months after surgery (Fisher's exact test, p=0.518).
CONCLUSION
This study suggests that the shape of the reconstructed oropharynx (flat or funnel-shaped) does not significantly impact long-term post-operative oral intake. These findings provide valuable insights into oropharyngeal reconstruction outcomes after total glossolaryngectomy and offer guidance for future research in this area. Nevertheless, further studies are warranted to elucidate the clinical implications of these findings and address any limitations of this study, particularly those regarding sample size constraints.
PubMed: 38882599
DOI: 10.1016/j.jpra.2024.04.009 -
Journal of Cachexia, Sarcopenia and... May 2024Cancer cachexia is a multifactorial metabolic syndrome characterized by systemic inflammation and ongoing skeletal muscle loss resulting in weakness, poor quality of...
BACKGROUND
Cancer cachexia is a multifactorial metabolic syndrome characterized by systemic inflammation and ongoing skeletal muscle loss resulting in weakness, poor quality of life, and decreased survival. Whereas lipid accumulation in skeletal muscle is associated with cancer cachexia as well as the prognosis of cancer patients, surprisingly little is known about the nature of the lipids that accumulate in the muscle during cachexia, and whether this is related to inflammation. We aimed to identify the types and distributions of intramyocellular lipids in patients with and without cancer cachexia.
METHODS
Rectus abdominis muscle biopsies were collected during surgery of patients with pancreatic ductal adenocarcinoma (n = 10 without cachexia, n = 20 cachectic without inflammation (CRP < 10 mg/L), n = 10 cachectic with inflammation (CRP ≥ 10 mg/L). L3-CT scans were analysed to assess body composition based on validated thresholds in Hounsfield units (HU). Muscle sections were stained with Oil-Red O and H&E to assess general lipid accumulation and atrophy. Untargeted lipidomic analyses were performed on laser-microdissected myotubes using LC-MS/MS. The spatial distribution of intramyocellular lipids with differential abundance between groups was visualized by mass-spectrometry imaging. Genes coding for inflammation markers and enzymes involved in de novo ceramide synthesis were studied by qPCR.
RESULTS
Muscle radiation attenuation was lower in cachectic patients with inflammation (median 24.3 [18.6-30.8] HU) as compared with those without inflammation (34.2 [29.3-38.7] HU, P = 0.033) or no cachexia (37.4 [33.9-42.9] HU, P = 0.012). Accordingly, intramyocellular lipid content was lower in non-cachectic patients (1.9 [1.6-2.1]%) as compared with those with cachexia with inflammation (5.5 [4.5-7.3]%, P = 0.002) or without inflammation (4.8 [2.6-6.0]%, P = 0.017). Intramyocellular lipid accumulation was associated with both local IL-6 mRNA levels (r = 0.57, P = 0.015) and systemic CRP levels (r = 0.49, P = 0.024). Compared with non-cachectic subjects, cachectic patients had a higher relative abundance of intramyocellular glycerophospholipids and a lower relative abundance of glycerolipids. Furthermore, increases in several intramyocellular lipids such as SM(d36:1), PC(34:1), and TG(48:1) were found in cachectic patients with inflammation and correlated with specific cachexia features. Altered intramyocellular lipid species such as PC(34:1), LPC(18:2), and TG(48:1) showed an uneven distribution in muscle sections of cachectic and non-cachectic patients, with areas featuring abundance of these lipids next to areas almost devoid of them.
CONCLUSIONS
Intramyocellular lipid accumulation in patients with cachexia is associated with both local and systemic inflammation, and characterized by changes in defined lipid species such as glycerolipids and glycerophospholipids.
PubMed: 38725139
DOI: 10.1002/jcsm.13474 -
Frontiers in Physiology 2024To compare the inter-rectus distance (IRD), rectus abdominis thickness (RAT), and stiffness in women during pregnancy and postpartum and identify the risk and protective...
OBJECTIVES
To compare the inter-rectus distance (IRD), rectus abdominis thickness (RAT), and stiffness in women during pregnancy and postpartum and identify the risk and protective factors affecting diastasis recti abdominis (DRA).
MATERIALS AND METHODS
A total of 171 pregnant women who volunteered to participate in this study were recruited. Using an ultrasonographic diagnostic instrument with shear wave elastography function, IRD, RAT and the Young's modulus of the rectus abdominis muscles were measured at 12 weeks, 37 weeks of pregnancy, and 6 weeks postpartum.
RESULTS
The IRD at 37 weeks was significantly higher than that at 12 weeks and then decreased at 6 weeks postpartum, but it was still higher than that at 12 weeks ( < 0.001). RAT and Young's modulus decreased significantly at 37 weeks compared with those at 12 weeks and then recovered at 6 weeks postpartum, but they were lower than those at 12 weeks ( < 0.001). IRD at 12 weeks was significantly higher in multiparae than in primiparae ( < 0.001). Moreover, positive correlation between the RAT and Young's modulus of rectus abdominis muscles at 12 and 37 weeks of gestation and 6 weeks postpartum ( < 0.001) was observed. Multiple linear regression analysis showed that the regression equation was significant (f = 24.856, < 001).
CONCLUSION
Our study identified differences in IRD, thickness and stiffness of the rectus abdominis muscle between early and advanced pregnancy and the postpartum period. The risk and protective factors of DRA may guide pregnant women's protection and treatment.
PubMed: 38860113
DOI: 10.3389/fphys.2024.1382982 -
Medicina (Kaunas, Lithuania) Dec 2023Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic...
Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 -value: 0.009) IRD compared to the symptomatic group. The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.
Topics: Pregnancy; Humans; Female; Urinary Incontinence, Stress; Rectus Abdominis; Case-Control Studies; Pelvic Floor; Exercise Therapy
PubMed: 38138285
DOI: 10.3390/medicina59122182 -
International Wound Journal Dec 2023A meta-analysis research was implemented to appraise the perineal wound complications (PWCs) after vertical rectus abdominis myocutaneous (VRAM) flap and mesh closure... (Meta-Analysis)
Meta-Analysis
Perineal wound complications after vertical rectus abdominis myocutaneous flap and mesh closure following abdominoperineal surgery and pelvic exenteration of anal and rectal cancers: A meta-analysis.
A meta-analysis research was implemented to appraise the perineal wound complications (PWCs) after vertical rectus abdominis myocutaneous (VRAM) flap and mesh closure (MC) following abdominoperineal surgery (AS) and pelvic exenteration (PE) of anal and rectal cancers. Inclusive literature research till April 2023 was done and 2008 interconnected researches were revised. Of the 20 picked researches, enclosed 2972 AS and PE of anal and rectal cancers persons were in the utilized researchers' starting point, 1216 of them were utilizing VRAM flap, and 1756 were primary closure (PC). Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequence of VRAM flap in treating AS and PE of anal and rectal cancers by the dichotomous approach and a fixed or random model. VRAM flap had significantly lower PWCs (OR, 0.64; 95% CI, 0.42-0.98, p < 0.001), and major PWCs (OR, 0.50; 95% CI, 0.32-0.80, p = 0.004) compared to PC in AS and PE of anal and rectal cancers persons. However, VRAM flap and PC had no significant difference in minor PWCs (OR, 1; 95% CI, 0.54-1.85, p = 1.00) in AS and PE of anal and rectal cancer persons. VRAM flap had significantly lower PWCs, and major PWCs, however, no significant difference was found in minor PWCs compared to PC in AS and PE of anal and rectal cancers persons. However, caution needs to be taken when interacting with its values since there was a low sample size of most of the chosen research found for the comparisons in the meta-analysis.
Topics: Humans; Myocutaneous Flap; Pelvic Exenteration; Rectus Abdominis; Surgical Mesh; Wound Healing; Rectal Neoplasms; Perineum; Postoperative Complications
PubMed: 37539486
DOI: 10.1111/iwj.14284