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International Journal of Environmental... Jan 2023This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance...
This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass ( ≤ 0.001) and concomitant reduction in fat mass ( = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.
Topics: Female; Humans; Urinary Incontinence, Stress; Resistance Training; Pelvic Floor; Exercise Therapy; Urinary Incontinence; Treatment Outcome
PubMed: 36674234
DOI: 10.3390/ijerph20021481 -
BioMed Research International 2020To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for...
BACKGROUND
To correlate body weight, body mass index (BMI), and water-equivalent diameter ( ) and to assess size-specific dose estimates (SSDEs) based on body weight and BMI for chest and abdomen-pelvic CT examinations.
METHODS
An in-house program was used to calculate , size-dependent conversion factor (), and SSDE for 1178 consecutive patients undergoing chest and abdomen-pelvic CT examinations. Associations among body weight, BMI, and were determined, and linear equations were generated using linear regression analysis of the first 50% of the patient population. SSDEs (SSDE and SSDE) were calculated based on body weight and BMI as surrogates on the second 50% of the patient population. Mean root-mean-square errors of SSDE and SSDE were computed with SSDE from the axial images as reference values.
RESULTS
Both body weight and BMI correlated strongly with for the chest ( = 0.85, 0.87, all < 0.001) and abdomen-pelvis ( = 0.85, 0.86, all < 0.001). Mean values of SSDE and SSDE based on the linear equations for body weight, BMI, and were in close agreement with SSDE from the axial images, with overall mean root-mean-square errors of 0.62 mGy (6.10%) and 0.57 mGy (5.65%), for chest, and 0.76 mGy (5.61%) and 0.71 mGy (5.22%), for abdomen-pelvis, respectively.
CONCLUSIONS
Both body weight and BMI, serving as surrogates, can be used to calculate SSDEs in the chest and abdomen-pelvis CT examinations, providing values comparable to SSDEs from the axial images, with an overall mean root-mean-square error of less than 0.76 mGy or 6.10%.
Topics: Abdomen; Body Mass Index; Body Size; Body Weight; Dose-Response Relationship, Radiation; Female; Humans; Male; Middle Aged; Pelvis; Radiation; Thorax; Tomography, X-Ray Computed
PubMed: 32733946
DOI: 10.1155/2020/6046501 -
Human Movement Science Aug 2020Maintaining balance during gait allows subjects to minimize energy expenditure and avoid falls. Gait balance can be measured by assessing the relationship between the...
INTRODUCTION
Maintaining balance during gait allows subjects to minimize energy expenditure and avoid falls. Gait balance can be measured by assessing the relationship between the center of mass (COM) and center of pressure (COP) during gait. Demographics, skeletal and postural parameters are known to influence gait balance.
PURPOSE
What are the determinants of dynamic balance during gait in asymptomatic adults among skeletal and demographic parameters?
METHODS
115 adults underwent 3D gait analysis and full-body biplanar X-rays. Angles between the COM-COP line and the vertical were calculated in frontal and sagittal planes during gait: maxima, minima, and ROM were evaluated. Full-body 3D reconstructions were obtained; skeletal and postural parameters of the spine (lumbar lordosis, thoracic kyphosis, sagittal vertical axis SVA), pelvis (pelvic tilt and incidence, acetabular orientation in the 3 planes) and lower limbs (neck shaft angle femoral and tibial torsions) were calculated. A univariate followed by a multivariate analysis were computed between the COM-COP parameters and skeletal and demographic parameters.
RESULTS
The univariate analysis showed that in the frontal plane, maximum (4.6°) of the COM-COP angle was significantly correlated with weight (r = 0.53), age (r = 0.28), height (r = 0.35), SVA (r = 0.23), T1T12 (r = 0.24) and pelvic width (r = 0.25).In the sagittal plane, maximum COM-COP (19.7 ± 2.8°) angle was significantly correlated to acetabular tilt (r = 0.25) and acetabular anteversion (r = 0.21). The multivariate analysis showed that, in the frontal plane, an increase in the maximum of the COM-COP angle was determined by a decreasing height (β = -0.28), an increasing weight (β = 0.48), being a male (β = -0.42), and an increasing posterior acetabular coverage (β = 0.22). In the sagittal plane, an increasing maximum COM-COP angle was determined by a decreasing height (β = -0.38) and an increasing SVA (β = 0.19).
CONCLUSION
Frontal imbalance appeared to be mainly correlated to demographic parameters. Sagittal imbalance was found to be correlated with weight, height, acetabular parameters and SVA. These results suggest that in addition to demographic parameters, acetabular parameters and SVA are important determinants of balance during gait.
Topics: Accidental Falls; Adolescent; Adult; Bone and Bones; Cross-Sectional Studies; Female; Gait; Humans; Imaging, Three-Dimensional; Lower Extremity; Male; Middle Aged; Pelvis; Postural Balance; Posture; Radiography; Spine; Walking; Young Adult
PubMed: 32721376
DOI: 10.1016/j.humov.2020.102658 -
Journal of Strength and Conditioning... Oct 2022Skaug, KL, Bø, K, Engh, ME, and Frawley, H. Prevalence of pelvic floor dysfunction, bother, and risk factors and knowledge of the pelvic floor muscles in Norwegian male...
Prevalence of Pelvic Floor Dysfunction, Bother, and Risk Factors and Knowledge of the Pelvic Floor Muscles in Norwegian Male and Female Powerlifters and Olympic Weightlifters.
Skaug, KL, Bø, K, Engh, ME, and Frawley, H. Prevalence of pelvic floor dysfunction, bother, and risk factors and knowledge of the pelvic floor muscles in Norwegian male and female powerlifters and Olympic weightlifters. J Strength Cond Res 36(10): 2800-2807, 2022-Strenuous exercise has been suggested as a risk factor of pelvic floor dysfunction (PFD). Powerlifters and Olympic weightlifters compete with high external loads. To date, knowledge of PFD in these athletes has been sparse. The aim of this study was to investigate prevalence, risk factors, and bother of PFD in powerlifters and Olympic weightlifters and their knowledge of the pelvic floor muscles (PFM). All athletes aged ≥18 years competing in ≥1 National Championship in powerlifting or Olympic weightlifting in 2018/2019 were invited. The International Consensus on Incontinence Questionnaires were used to assess PFD. One hundred eighty women and 204 men participated. The prevalence of urinary incontinence (UI), anal incontinence (AI), and pelvic organ prolapse in women was 50.0, 80.0, and 23.3%, respectively. Stress UI (SUI) was reported by 41.7% of the women and 87.8% reported a negative influence on sport performance. The prevalence of UI and AI in men was 9.3 and 61.8%. In women, increasing body mass index was significantly associated with SUI (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.01-1.17) and international level of competition (OR: 3.27, 95% CI: 1.32-8.07) and weightlifting ≥4 d·wk -1 (OR: 0.26, 95% CI: 0.08-0.86) with AI. In men, increasing age (OR: 1.03, 95% CI: 1.00-1.07) and frequently straining to void (OR: 4.84, 95% CI: 1.02-22.94) were significantly associated with AI. Forty-three percent of the women and 74% of the men did not know why and 44.4 and 72.5% how to train the PFM. In conclusion, the prevalence of PFD was high, and the athletes had limited knowledge of the PFM.
Topics: Adolescent; Adult; Fecal Incontinence; Female; Gastrointestinal Diseases; Humans; Male; Pelvic Floor; Prevalence; Risk Factors; Urinary Incontinence; Weight Lifting
PubMed: 33278274
DOI: 10.1519/JSC.0000000000003919 -
British Journal of Hospital Medicine... Oct 2020Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an...
Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an intrauterine device. The constellation of signs and symptoms associated with its typical clinical presentation include palpable mass, weight loss and malaise. It can be misdiagnosed as a result and often as a malignant process. Left unrecognised, pelvic actinomycosis can lead to sequelae such as severe abscess, fistula formation and even infertility. Removal of the intrauterine device and a prolonged course (6-12 months) of antibiotic treatment form the cornerstone of management. Surgery can be required in select cases. This article provides an overview of pelvic actinomycosis, including its background, presentation, investigations and management.
Topics: Abscess; Actinomycosis; Female; Humans; Intrauterine Devices; Pelvic Pain; Pelvis
PubMed: 33135910
DOI: 10.12968/hmed.2020.0190 -
International Journal of Gynecological... Feb 2022Venous thromboembolism is a preventable cause of postoperative mortality in patients undergoing surgery for malignancy. Current standard of care based on international... (Review)
Review
Venous thromboembolism is a preventable cause of postoperative mortality in patients undergoing surgery for malignancy. Current standard of care based on international guideline recommends 28 days of extended thromboprophylaxis after major abdominal and pelvic surgery for malignancies with unfractionated heparin or low molecular weight heparin. Direct oral anticoagulants have been approved for the treatment of venous thromboembolism in the general population. This regimen has a significant advantage over other types of anticoagulation regimens, particularly being administered by non-parenteral routes and without the need for laboratory monitoring. In this review, we evaluate the role of direct anticoagulation and provide an update on completed and ongoing clinical trials.
Topics: Anticoagulants; Factor Xa Inhibitors; Female; Genital Neoplasms, Female; Heparin, Low-Molecular-Weight; Humans; Medical Oncology; Postoperative Complications; Venous Thromboembolism
PubMed: 34992129
DOI: 10.1136/ijgc-2021-003006 -
Journal of Gastrointestinal Surgery :... Jan 2024High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction. However, there is currently no consensus...
BACKGROUND
High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction. However, there is currently no consensus on the ideal flap choice or patient for whom this is necessary. This study aimed to evaluate the long-term outcomes of using pedicled gracilis flaps for pelvic reconstruction and to analyze predictors of postoperative complications.
METHODS
This was a retrospective review of a single reconstructive surgeon's cases between January 2012 and June 2021 identifying patients who underwent perineal reconstruction secondary to oncologic resection. Preoperative and outcome variables were collected and analyzed to determine the risk of developing minor and major wound complications.
RESULTS
A total of 101 patients were included in the study with most patients (n = 88) undergoing unilateral gracilis flap reconstruction after oncologic resection. The mean follow-up period was 75 months. Of 101 patients, 8 (7.9%) developed early major complications, and an additional 13 (12.9%) developed late major complications. Minor complications developed in 33 patients (32.7%) with most cases being minor wound breakdown requiring local wound care. Most patients (n = 92, 91.1%) did not develop donor site complications. Anal cancer was significantly associated with early major complications, whereas younger age and elevated body mass index were significant predictors of developing minor wound complications.
CONCLUSIONS
This study builds on our previous work that demonstrated the long-term success rate of gracilis flap reconstruction after large pelvic oncologic resections. A few patients developed donor site complications, and perineal complications were usually easily managed with local wound care, thus making the gracilis flap an attractive alternative to abdominal-based flaps.
Topics: Humans; Surgical Flaps; Plastic Surgery Procedures; Postoperative Complications; Pelvis; Anus Neoplasms; Retrospective Studies; Perineum; Rectal Neoplasms
PubMed: 38353075
DOI: 10.1016/j.gassur.2023.11.006 -
European Journal of Orthopaedic Surgery... Apr 2021Prevention and detection of thromboembolism with pelvic and acetabular fractures remains controversial. The aim of this study was to evaluate a protocol using LMWH...
BACKGROUND
Prevention and detection of thromboembolism with pelvic and acetabular fractures remains controversial. The aim of this study was to evaluate a protocol using LMWH prophylaxis and duplex screening both pre-operatively (if there is a delay > 72 h to surgery) and post-operatively at day 5-7. We assessed the incidence of thromboembolism and associated risk factors.
METHODS
A total of 255 consecutive patients who underwent pelvic and/or acetabular reconstruction in a major trauma and tertiary referral centre between January 2013 and December 2015 were studied. Forty-three patients were excluded due to non-adherence to protocol leaving 212 patients included in the study.
RESULTS
Patients were of mean age 49 years (15-94) and mean ISS 24.5 (4-66). Pre-operative screening detected two patients with asymptomatic above-knee DVT who then underwent pre-operative IVC filter insertion. Post-operative screening detected seven patients (3%) with lower limb DVTs (3 proximal and 4 below knee). The three patients with proximal DVTs were fully anticoagulated and did not develop symptomatic PE. Six patients (2.8%) developed post-operative PE, four of which were symptomatic and confirmed by CT angiography. Seven patients (3%) died in the post-operative period due to non-VTE-related causes. The overall rate of VTE was 6%, including DVT 4% and PE 2.8%. PE was associated with administration of tranexamic acid in ED (p > 0.03) and total amount of blood transfused during admission (p > 0.001). VTE was not associated with age, injury type, ISS, delay to surgery or associated injuries.
CONCLUSION
A protocol-based approach to VTE prophylaxis and screening in trauma patients with pelvic and/or acetabular reconstruction resulted in no VTE-related mortality. Pre- and post-operative screening for DVT changed the management in five patients, with none developing PE. Patients requiring more aggressive resuscitation had a higher rate of PE. The VTE rate was lower than previously reported.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Heparin, Low-Molecular-Weight; Hip Fractures; Humans; Incidence; Middle Aged; Pulmonary Embolism; Risk Factors; Venous Thromboembolism; Venous Thrombosis; Young Adult
PubMed: 32955697
DOI: 10.1007/s00590-020-02795-z -
Journal of Vascular Surgery. Venous and... Mar 2022The use of iliac vein stenting for the treatment of pelvic pain secondary to pelvic venous insufficiency has significantly increased. In women of childbearing age, the...
BACKGROUND
The use of iliac vein stenting for the treatment of pelvic pain secondary to pelvic venous insufficiency has significantly increased. In women of childbearing age, the effect of the gravid uterus on stent function and patency is unclear. The purpose of this investigation was to determine the effect of pregnancy on stent patency and reintervention rate in women with iliac vein stents.
METHODS
A retrospective chart review and email survey was performed to identify women treated at the Center for Vascular Medicine who were treated with iliac vein stenting and who had subsequent pregnancies. Medical and surgical comorbidities, stent type, location, length, number of stents, reintervention rates, number of pregnancies after stenting, anticoagulation usage during pregnancy, and type of delivery were assessed.
RESULTS
From January 2014 to December 2020, 15 women with 16 iliac vein stents and who had 17 subsequent pregnancies were identified. The average age at stenting was 35.3 ± 4.13 years. The average interval between stenting and conception was 350 ± 287 days. Before pregnancy, stent location was in the right common/right external iliac veins in 1 patient and left common/external iliac veins in 14 patients. The average stent diameter and length were 19.6 ± 3 and 79.5 ± 20.3 mm, respectively. Thirteen Boston Scientific Wallstents and three Bard Venovo stents were used before pregnancy. One patient with a Wallstent required a stent extension before pregnancy and one patient had two stents placed at the initial procedure. Two women were pregnant twice after stenting for a total of 17 pregnancies. There were 16 term and 1 premature delivery of single infants. Patients were treated with enoxaparin (Lovenox) for stent-related thrombosis prophylaxis in 11 of 17 pregnancies, 5 had no prophylaxis, and the status of 1 pregnancy is unknown. One asymptomatic patient underwent a stent venoplasty after delivery.
CONCLUSIONS
Iliac vein stents tolerate a gravid uterus well. No stents thrombosed during or after pregnancy and none required reintervention secondary to pregnancy-related compression. Anticoagulation with low-molecular-weight heparin should be considered for stent thrombosis prophylaxis. Potential pregnancy should not be considered a contraindication to iliac vein stenting for the treatment of symptomatic pelvic venous insufficiency.
Topics: Adult; Anticoagulants; Electronic Health Records; Endovascular Procedures; Female; Humans; Iliac Vein; Parity; Pelvis; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Risk Assessment; Risk Factors; Stents; Time Factors; Time-to-Pregnancy; Treatment Outcome; United States; Vascular Patency; Venous Insufficiency
PubMed: 34587526
DOI: 10.1016/j.jvsv.2021.09.005 -
American Journal of Human Biology : the... Aug 2022Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides...
OBJECTIVES
Imaging methods to measure the human pelvis in vivo provide opportunities to better understand pelvic variation and adaptation. Magnetic resonance imaging (MRI) provides high-resolution images, but is more expensive than dual-energy X-ray absorptiometry (DXA). We sought to compare pelvic breadth measurements collected from the same individuals using both methods, to investigate if there are systematic differences in pelvic measurement between these imaging methods.
METHODS
Three pelvic breadth dimensions (bi-iliac breadth, bi-acetabular breadth, medio-lateral inlet breadth) were collected from MRI and DXA scans of a cross-sectional sample of healthy, nulliparous adult women of South Asian ancestry (n = 63). Measurements of MRI and DXA pelvic dimensions were collected four times in total, with one baseline data collection session and three replications. Data collected from these sessions were averaged, used to calculate technical error of measurement and entered into a Bland-Altman analysis. Linear regression models were fitted with a given MRI pelvic measurement regressed on the same measurement collected from DXA scans, as well as MRI mean bias regressed on DXA mean bias.
RESULTS
Technical error of measurement was higher in DXA measurements of bi-iliac breadth and medio-lateral pelvic inlet breadth and higher for MRI measurements of bi-acetabular breadth. Bland Altman analyses showed no statistically significant relationship between the mean bias of MRI and DXA, and the differences between MRI and DXA pelvic measurements.
CONCLUSIONS
DXA measurements of pelvic breadth are comparable to MRI measurements of pelvic breadth. DXA is a less costly imaging technique than MRI and can be used to collect measurements of skeletal elements in living people.
Topics: Absorptiometry, Photon; Adult; Body Mass Index; Cross-Sectional Studies; Female; Humans; Magnetic Resonance Imaging; Pelvis
PubMed: 35460113
DOI: 10.1002/ajhb.23753