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Anatomical Sciences Education Sep 2020Progressive curricular changes in medical education over the past two decades have resulted in the diaspora of gross anatomy content into integrated curricula while...
Progressive curricular changes in medical education over the past two decades have resulted in the diaspora of gross anatomy content into integrated curricula while significantly reducing total contact hours. Despite the development of a wide range of alternative teaching modalities, gross dissection remains a critical component of medical education. The challenge posed to modern anatomists is how to maximize and integrate the time spent dissecting under the current curricular changes. In this study, an alternative approach to the dissection of the pelvis and perineum is presented in an effort to improve content delivery and student satisfaction. The approach involves removal of the perineum en bloc from the cadaver followed by excision of the pubic symphysis, removal and examination of the bladder and associated structures, examination and bisection of the midline pelvic organs in situ, and midsagittal hemisection of the pelvis for identification of the neurovasculature. Results indicate that this novel dissecting approach increases the number of structures identified by 46% ± 14% over current dissecting methods. Survey results indicate that students were better able to integrate lecture and laboratory concepts, understand the concepts, and successfully identify more structures using the new approach (P < 0.05). The concept of anatomic efficiency is introduced and proposed as a standard quantitative measure of gross dissection proficiency across programs and institutions. These findings provide evidence that innovative solutions to anatomy education can be found that help to maintain critical content and student satisfaction in a modern medical curriculum.
Topics: Anatomy; Dissection; Female; Humans; Male; Pelvis; Perineum; Young Adult
PubMed: 31758729
DOI: 10.1002/ase.1932 -
International Urogynecology Journal Mar 2022Deficient perineum is a disruption of the perineal body and distal rectovaginal septum presenting with anal incontinence and a range of urogenital symptoms. There is...
INTRODUCTION AND HYPOTHESIS
Deficient perineum is a disruption of the perineal body and distal rectovaginal septum presenting with anal incontinence and a range of urogenital symptoms. There is scarce reported outcome of this condition with management often delayed and with a variety of surgical alternatives. This study aims to determine faecal continence outcomes after long-term surgical repair.
METHODS
Patients were included for analysis after surgical repair between 1989 and 2012. Cases were preoperatively assessed by endosonography and anorectal manometry with a record of their continence with the Cleveland Clinic Incontinence Score (CCIS). Surgical repair comprised an overlapping repair of the external anal sphincter (EAS) with levatorplasty. There was selective use of internal anal sphincter (IAS) suture and/or advancement perineoplasty for soft tissue reconstruction. Patients were clinically evaluated for functional outcomes with comparison of their postoperative CCIS.
RESULTS
There were 20 patients (median age 55.5 years; range 29-81 years) with a median duration of incontinence symptoms of 174 (range 1-540) months. All patients had an EAS and IAS defect with 14 (70%) undergoing an IAS suture and 10 (50%) a Corman-style anoplasty. Over a median follow-up of 137.2 (range 13-322) months, there was a significant decrease in the recorded median preoperative vs. postoperative CCIS 18, range 13-20 vs. 2, range 0-10, respectively; p < 0.001) with 18 (90%) satisfied with the functional outcome. Faecal diversion was not used in any of the patients.
CONCLUSIONS
Experienced delayed repair of a traumatic cloaca is associated with an acceptable functional outcome at medium- to long-term follow-up.
Topics: Anal Canal; Child; Child, Preschool; Defecation; Fecal Incontinence; Female; Humans; Manometry; Perineum; Rectum; Treatment Outcome
PubMed: 33914119
DOI: 10.1007/s00192-021-04803-0 -
Acta Dermatovenerologica Croatica : ADC Dec 2022Dowling-Degos disease (DDD) is a benign, rare genodermatosis (reticulate pigmented anomaly) of flexure sites with autosomal dominant inheritance (1,2).The disease is...
Dowling-Degos disease (DDD) is a benign, rare genodermatosis (reticulate pigmented anomaly) of flexure sites with autosomal dominant inheritance (1,2).The disease is caused by a loss-of-function mutation of keratin 5 (KRT5) present on the chromosome 12q gene (3). It usually affects the younger population, most commonly 20-30 years of age, with some patients being older and with a predominance in the female population (4). The disease is characterized by formation of dark, hyperpigmented macules which are confined to the flexure sites, most commonly over the axillae, groin area, and neck, along with scattered, comedo-like lesions and pitted acneiform scars (3,5).The diagnosis is established based on clinical and histopathological correlation. We report the case of a 39-year-old patient who presented with a dark brown discoloration of the skin in the area of vulva, perineum, and perianal region (Figure 1) with occasional itching sensation that had suddenly appeared a year before presentation at our Department. Additionally, sparce brown macules were found in the left axillary region that had appeared a few months earlier. Histopathology of the skin showed fine and irregular elongation of the interpapillary cones with hyperpigmentation. Based on her clinical presentation and histopathology, the diagnosis of DDD was established. The patient was unsuccessfully treated with adapalene gel and refused the recommended oral retinoid therapy, as well as laser therapy. Dowling-Degos disease can present as an isolated disease or can be linked to other clinical entities. Usually, it presents with flat macules which are 3-5 mm in diameter and can vary in color from light brown to black (6). Furthermore, the disease is almost always asymptomatic, but pruritus has been reported in some cases (6), as observed in our patient. Even though DDD is primary a disease of the flexures, there have been reports of patients that have presented with hyperpigmented macules on the dorsum of the hands and feet (7). The affected areas in our patient were the anogenital region and left axillary region, and even though this combination of areas is rather uncommon, to our knowledge two similar cases have been reported in the literature (6,8). The most notable histopathological findings of DDD are elongation of rete ridges of the epidermis as well as hyperpigmentation, usually found in the lower third of the elongated rete ridges (6); both of those features were present in the skin biopsy specimen of our patient. Both the clinical picture and pathohistological findings are crucial for the diagnosis of DDD, and we can conclude that the findings of our patient were consistent with DDD. There are a number of closely related entities to Dowling-Degos disease: Galli-Galli disease (GGD), reticulate acropigmentation of Kitamura (RAPK), Haber disease, and symmetrical acropigmentation of Dohi. Galli-Galli disease has an almost identical clinical presentation, the only difference between those two entities being the presence of acantholysis on biopsy in GGD (9). RAPK presents with hyperpigmentation on the dorsum on the hands and feet, and that pattern has been observed in some patients with DDD as well as GGD (6,7,10-12). However, it differs from DDD in the presence of palmar and plantar pits and slight depression of pigmented lesions (6). Haber disease also has a very similar clinical presentation to DDD, with the presence of dark papules on flexure sites; however, central facial telangiectatic erythema was observed only in Haber disease (13). The clinical features of symmetrical acropigmentation of Dohi are the presence of hyperpigmented macules on the dorsum of the hands and feet, but intermingled areas of hypopigmented macules can also be observed, and the onset of the disease is earlier (infancy and early childhood) when compared with DDD (6,14). There are no successful treatments for DDD. Topical steroids may reduce the itching. Hydroxyquinone, a topical retinoid (adapalene gel), can be used for fading the pigmentation, but there rapid recurrence was reported when treatment was ceased (15). Systemic retinoids have also been unsuccessful. Er:YAG laser treatment has been reported to be effective, but only in a few cases (6,16,17). The goal of this paper was to present the case of a patient with DDD on the vulva, perineum, and perianal region as well as to describe the relationship of DDD with other members of the hyperpigmentative disease family.
Topics: Child, Preschool; Humans; Female; Adult; Perineum; Hyperpigmentation; Pruritus; Retinoids; Adapalene
PubMed: 36919394
DOI: No ID Found -
The Journal of Maternal-fetal &... Jul 2021To evaluate the relevance of the angle of progression (AOP) and head-perineum distance (HPD) for predicting the type of delivery and duration of the second stage of...
OBJECTIVE
To evaluate the relevance of the angle of progression (AOP) and head-perineum distance (HPD) for predicting the type of delivery and duration of the second stage of labor using intrapartum ultrasonography.
METHODS
In total, 221 women in labor with a single gestational sac at ≥37 weeks of gestation and fetuses in cephalic presentation underwent two-dimensional ultrasonography by transperineal route for measurements of AOP and HPD. Correlations between the type of delivery (vaginal or surgical (cesarean section and forceps)), duration of the second stage of labor, and fetal and maternal characteristics were assessed. AOP and HPD variables were separately studied in the first and second stages of labor. Multivariate logistic regression was followed in stages to identify the predictors for the surgical delivery outcome - stepwise forward method.
RESULTS
In total, 153 (69.2%) women underwent vaginal deliveries, 7 (3.2%) underwent forceps deliveries, and 61 (27.6%) underwent cesarean deliveries. AOP was a statistically significant parameter in first and second stages of labor (107.8 ± 12.1° versus 100.8 ± 13.7°; = .017), with an inverse correlation with the occurrence of vaginal delivery. HPD was a statistically significant parameter in the second stage of labor (3.42 ± 0.84 cm versus 4.17 ± 0.54 cm; < .003), with a direct correlation with the occurrence of surgical delivery. The value of AOP that optimized the curve was 129.9° with 85% specificity and 63% sensitivity for the vaginal delivery endpoint. The value of HPD that optimized the curve was 4.3 cm with 69% specificity and 89% sensitivity for the surgical delivery endpoint. In the first phase, the variables defining the type of delivery were the following: height, body mass index, and AOP. In the second phase, the variables defining were the following: height, labor analgesia, HPD, and position of the fetal occiput.
CONCLUSION
AOP and HPD determined by intrapartum ultrasonography were associated with duration of labor, which may aid in predicting the type of delivery in association with clinical parameters.
Topics: Cesarean Section; Delivery, Obstetric; Female; Humans; Labor Presentation; Perineum; Pregnancy; Prospective Studies; Ultrasonography; Ultrasonography, Prenatal
PubMed: 31505974
DOI: 10.1080/14767058.2019.1666818 -
European Journal of Obstetrics,... Apr 2023To investigate the effectiveness of interventions to prevent the occurrence of perineal trauma in parturients. (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate the effectiveness of interventions to prevent the occurrence of perineal trauma in parturients.
METHODS
A bibliographic search was carried out in Cochrane Library, MEDLINE via PUBMED, LILACS via Virtual Health Library (VHL), Embase, Scopus, CINAHL, Scielo, Web of Science, and PEDro databases. Randomized clinical trials evaluating the effects of any intervention to prevent perineal trauma during pregnancy and/or childbirth were included. There were no temporal or language restrictions. The risk of bias assessment was performed using the Revised Cochrane Risk-of-bias Tool for Randomized Trials.
RESULTS
Fifty studies, with a total of 17,221 participants, were included in this meta-analysis. No intervention during childbirth was effective for the prevention of perineal trauma (RR = 1.07, 95% CI [0.98.1.18], p < 0.01, I = 83%) when compared to no intervention. However, a lower risk of perineal laceration was verified with techniques performed during pregnancy, when compared to no intervention (RR = 0.81, 95% CI [0.71, 0.93], p = 0.05, I = 47%). Among them, highlight the effects of perineal massage in preventing lacerations (RR = 0.69, 95% CI [0.54, 0.87], p < 0.01) when compared to no intervention.
CONCLUSIONS
The techniques performed during pregnancy, especially perineal massage, are associated with a lower risk of perineal laceration.
Topics: Pregnancy; Female; Humans; Lacerations; Obstetric Labor Complications; Delivery, Obstetric; Parturition; Risk; Perineum; Episiotomy
PubMed: 36827751
DOI: 10.1016/j.ejogrb.2023.02.008 -
Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis.International Journal of Gynaecology... May 2022Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear.
OBJECTIVE
To investigate the effectiveness of PFMT in the prevention of perineal laceration.
SEARCH STRATEGY
Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery.
SELECTION CRITERIA
We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations.
DATA COLLECTION AND ANALYSIS
We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R.
MAIN RESULTS
Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration.
CONCLUSION
Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.
Topics: Delivery, Obstetric; Exercise Therapy; Female; Humans; Lacerations; Pelvic Floor; Perineum; Pregnancy
PubMed: 34270799
DOI: 10.1002/ijgo.13826 -
International Urogynecology Journal Jun 2022The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in...
INTRODUCTION AND HYPOTHESIS
The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth.
METHODS
Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations.
RESULTS
We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum.
CONCLUSIONS
A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.
Topics: Adult; Delivery, Obstetric; Female; Humans; Lacerations; Perineum; Postpartum Period; Pregnancy; Prospective Studies; Sexual Behavior; Surveys and Questionnaires
PubMed: 34973088
DOI: 10.1007/s00192-021-05029-w -
Journal of Pediatric Hematology/oncology Jul 2021
Topics: Biopsy; Female; Humans; Infant; Perineum; Rhabdomyosarcoma, Embryonal; Subcutaneous Tissue
PubMed: 34001786
DOI: 10.1097/MPH.0000000000002194 -
Annali Italiani Di Chirurgia 2021To investigate the clinical effects of different anesthesia methods in lateral episiotomy. Providing the guidance of choosing the appropriate anesthesia method in... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To investigate the clinical effects of different anesthesia methods in lateral episiotomy. Providing the guidance of choosing the appropriate anesthesia method in clinical operation.
METHODS
A total of 300 primiparas with vaginal delivery were enrolled into this study. These primiparas were divided into three groups (n=100, each), according to the different methods of anesthesia: group A (pudendal nerve block anesthesia + stepwise dissection and incisional local anesthesia), group B (bilateral pudendal nerve block anesthesia), and group C (pudendal nerve block anesthesia + local infiltration anesthesia). The pain score of these primiparas at the time of perineal dissection and suturing, as well as suturing time and bleeding volume, were observed and compared among these three groups.
RESULTS
In respect of pain scores at the time of suturing in lateral episiotomy, maternal pain score was significantly lower in group A than in groups B and C; and the difference was statistically significant (P<0.05). In respect of the time required for suturing in lateral episiotomy, suturing time was shorter in group A than in groups B and C; and the difference was statistically significant (P<0.05). In respect of the bleeding volume in lateral episiotomy, maternal bleeding volume was lesser in group A than in groups B and C; and the difference was statistically significant (P<0.05).
CONCLUSIONS
Among these three commonly used methods of anesthesia in lateral episiotomy, the pudendal nerve block anesthesia + stepwise dissection and incisional local anesthesia method used in group A had the best analgesic effect, the shortest suturing time, and the lowest wound blood loss.
KEY WORDS
Lateral episiotomy, Pudendal nerve block anesthesia, Local anesthesia, Pain score.
Topics: Adult; Anesthesia, Local; Delivery, Obstetric; Episiotomy; Female; Humans; Nerve Block; Pain; Parity; Perineum; Pregnancy; Young Adult
PubMed: 34031278
DOI: No ID Found -
JPMA. the Journal of the Pakistan... Jul 2020Aggressive Angiomyxoma (AA) is a soft tissue tumour that principally affects women of the reproductive age, primarily involving the pelvis and the perineum. Despite...
Aggressive Angiomyxoma (AA) is a soft tissue tumour that principally affects women of the reproductive age, primarily involving the pelvis and the perineum. Despite being slow growing, it is classified as aggressive due to its locally infiltrative nature and high recurrence. It is rare, often asymptomatic and is misdiagnosed. However, it has characteristic features on radiographic imaging. Complete surgical resection is the ideal approach to treat AA. We report a case of an aggressive angiomyxoma in a 17 year old female, located in the ischiorectal fossa and diagnosed incidentally on a magnetic resonance imaging (MRI). The lesion was excised without complication.
Topics: Adolescent; Female; Humans; Magnetic Resonance Imaging; Myxoma; Neoplasm Recurrence, Local; Perineum; Rectum
PubMed: 32799303
DOI: 10.5455/JPMA.30242