-
European Spine Journal : Official... Jun 2024Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number...
PURPOSE
Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number of reports have addressed spinopelvic parameters and lumbosacral transitional vertebrae (LSTV). Our primary objective was to study spinopelvic sagittal parameter changes in patients with LSTV. A secondary objective was to investigate clinical symptoms and quality of life (QOL) in patients with LSTV.
METHODS
In this study, we investigated 371 participants who had undergone medical check-ups for the spine. LSTV was evaluated using Castellvi's classification, and patients were divided into LSTV+ (type II-IV, L5 vertebra articulated or fused with the sacrum) and LSTV- groups. After propensity score matching for demographic data, we analyzed spinopelvic parameters, sacroiliac joint degeneration, clinical symptoms, and QOL for these two participant groups. Oswestry Disability Index (ODI) scores and EQ-5D (EuroQol 5 dimensions) indices were compared between the two groups.
RESULTS
Forty-four patients each were analyzed in the LSTV + and LSTV- groups. The LSTV + group had significantly greater pelvic incidence (52.1 ± 11.2 vs. 47.8 ± 10.0 degrees, P = 0.031) and shorter pelvic thickness (10.2 ± 0.9 vs. 10.7 ± 0.8 cm, P = 0.018) compared to the LSTV- group. The "Sitting" domain of ODI (1.1 ± 0.9 vs. 0.6 ± 0.7, P = 0.011) and "Pain/Discomfort" domain of EQ-5D (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.005) were larger in the LSTV + group.
CONCLUSION
There was a robust association between LSTV and pelvic sagittal parameters. Clinical symptoms also differed between the two groups in some domains. Surgeons should be aware of the relationship between LSTV assessment, radiographic parameters and clinical symptoms.
PubMed: 38922415
DOI: 10.1007/s00586-024-08378-4 -
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 -
Cureus May 2024Uterine leiomyomas, also known as uterine fibroids, are a commonly encountered condition with a diverse clinical presentation. Uterine fibroids are benign, smooth muscle...
Uterine leiomyomas, also known as uterine fibroids, are a commonly encountered condition with a diverse clinical presentation. Uterine fibroids are benign, smooth muscle tumors of the uterus arising from a single myometrial cell. The presentation can vary from asymptomatic incidental findings to causing a wide array of gynecological symptoms, including abnormal uterine bleeding, infertility, chronic pelvic pain, and bulk-related symptoms. There are several management approaches depending on the patient's clinical manifestations and goals. This is a unique case of a patient with symptomatic calcified uterine fibroids refractory to medical management and two uterine artery embolizations presenting with persistent abnormal uterine bleeding and chronic pelvic pain. Preservation of the uterus was desired, so an open myomectomy was subsequently performed. The patient was asymptomatic at two weeks follow-up, and further follow-up was unable to be obtained. When considering interventions for symptomatic uterine fibroids, it is essential to consider the patient's preference for uterine-sparing methods and desire to preserve fertility. It is necessary that all modes of treatment and their potential future implications be discussed so that patients can make well-informed decisions regarding all aspects of their care. Further studies are needed comparing the outcomes of uterine-sparing interventions for symptomatic uterine fibroids so that the best possible shared decision-making can take place.
PubMed: 38919206
DOI: 10.7759/cureus.61081 -
BMC Women's Health Jun 2024Underdiagnosis of female genital tuberculosis (FGTB) often leads to infertility. In this study, we aimed to determine the site and histopathologic patterns of FGTB and...
OBJECTIVE
Underdiagnosis of female genital tuberculosis (FGTB) often leads to infertility. In this study, we aimed to determine the site and histopathologic patterns of FGTB and its correlation with clinical presentation and acid-fast bacilli (AFB) status.
METHODS
A retrospective cross-sectional study was conducted on 122 patients with a histopathological diagnosis of FGTB at the Department of Pathology, College of Health Sciences (CHS), Tikur Anbessa Specialized Hospital (TASH), Addis Ababa University (AAU), from January 1, 2013, to August 30, 2022.
RESULTS
Female genital tuberculosis was found in 0.94% of the gynecology specimens examined. The most common presentations were menstrual disturbance, abdominopelvic pain, and infertility. Among patients with FGTB, 4.6% exhibited misleading clinical and radiologic findings, leading to suspicion of malignancy and subsequent aggressive surgical management. The endometrium was the most frequently affected organ, followed by the fallopian tube, ovary, cervix, and vulva. In the majority of tuberculous endometritis cases (53.3%), histopathology revealed early-stage granulomas. Acid-fast bacilli were found in a significant proportion (42.6%) of FGTB tissues with TB histopathology. The ovary had the highest rate of AFB detection, followed by the fallopian tube, endometrium, and cervix.
CONCLUSION
Female genital tuberculosis should be considered in reproductive-age women presenting with menstrual irregularities, abdominopelvic pain, infertility, or an abdominopelvic mass. The endometrium is commonly affected, displaying early granulomas with low AFB positivity.
Topics: Humans; Female; Tuberculosis, Female Genital; Cross-Sectional Studies; Retrospective Studies; Adult; Ethiopia; Young Adult; Middle Aged; Menstruation Disturbances; Infertility, Female; Endometrium; Adolescent; Cervix Uteri; Pelvic Pain; Fallopian Tubes; Ovary; Abdominal Pain; Vulva; Endometritis
PubMed: 38918726
DOI: 10.1186/s12905-024-03207-8 -
Irish Journal of Medical Science Jun 2024Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields...
BACKGROUND
Endometriosis is the leading cause of chronic pelvic pain in women of reproductive age with debilitating effects on quality of life, yet no cure exists. Exercise yields the potential in providing women with a non-invasive, non-pharmacological method of symptom control.
AIM(S)
Present up-to-date knowledge regarding how exercise may contribute to the management of endometriosis-related symptoms.
OBJECTIVE(S)
Discuss: 1. The pathophysiology surrounding exercise and endometriosis. 2. The role of exercise in endometriosis symptom control.
RATIONALE
Scientific literature has alluded to exercise being a favourable factor in the management of endometriosis-related symptoms. Moreover, current clinical guidelines for endometriosis fail to reflect the aforementioned benefits of exercise.
SEARCH STRATEGY
A search strategy using the terms 'endometriosis', 'endometriomas', 'exercise', and 'physical activity' was devised. Pubmed, Medline, Cochrane reviews, and Embase were reviewed.
INCLUSION CRITERIA
Interventional studies, within-subjects studies, randomised-control trials, systematic reviews, meta-analysis, cohort studies, publication since 2000.
EXCLUSION CRITERIA
Non-English publications, non-human studies.
RESULTS
Numerous studies have suggested positive effects for endometriosis patients who performed exercise exclusively or in conjunction with other therapies. Improvements in pain levels, quality of life, anxiety, and depression were noted.
DISCUSSION
Current research outlines promise regarding the potential benefit of exercise prescribing in patients with endometriosis as well as a synergy between exercise and hormonal therapies for the management of endometriosis-related symptoms. However, the current paucity of high-quality robust studies investigating these aspects of endometriosis management is an apparent obstacle to progression in this area.
CONCLUSION
For clinicians to incorporate exercise in managing endometriosis, clear recommendations regarding advice and benefits are needed.
PubMed: 38916808
DOI: 10.1007/s11845-024-03733-2 -
Radiology Jun 2024A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied...
A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied nighttime pain, fever, or chills. Laboratory investigation revealed the following normal values: hemoglobin level of 15.6 g/dL (normal range, 13-16 g/dL), platelet count of 240 × 103/µL (normal range, 140-440 × 103/µL), and total leukocyte count of 7100 cells/µL (normal range, 4500-11 000 cells/µL). The percentage of neutrophils was considered low at 44% (normal range, 54%-62%), and the percentage of eosinophils was slightly high at 3.7% (normal range, 0%-3%). An anteroposterior radiograph of the left hip is shown. Physical therapy was initiated, with no improvement after 2 weeks of therapy. The patient was referred to an orthopedist for further evaluation. At physical examination, the patient endorsed marked left hip pain with hip flexion to 90°, limited internal and external rotation (5° and 15°, respectively), and antalgic gait favoring the left leg. Hip MRI and further serologic analysis were requested for further evaluation. Although the serologic testing was performed at an outside laboratory, the physician reported positive immunoglobulin-G Lyme titers, normal C-reactive protein level, and normal erythrocyte sedimentation rate. Pelvic CT was requested. The patient was prescribed a course of doxycycline (100 mg twice daily for 28 days), with reported resolution of symptoms 2 weeks after initiation of treatment. Three weeks later, the patient presented to our department with recurrent left hip pain, which was similar in severity compared with the initial presentation. A second MRI examination of the left hip was performed 4 months after the initial presentation.
Topics: Humans; Male; Adolescent; Osteoma, Osteoid; Magnetic Resonance Imaging; Diagnosis, Differential; Bone Neoplasms; Hip Joint
PubMed: 38916512
DOI: 10.1148/radiol.230629 -
Radiology Jun 2024A 30-year-old female patient with a history of infertility and no pregnancy presented to the gynecologic endometriosis clinic for follow-up 1 month after oocyte...
A 30-year-old female patient with a history of infertility and no pregnancy presented to the gynecologic endometriosis clinic for follow-up 1 month after oocyte retrieval, to be evaluated for pelvic optimization before potential embryo transfer, with worsening dysmenorrhea, dyspareunia, and overall pelvic pain. Eleven years prior, the patient had undergone left ovarian cystectomy for treatment of endometrioma, as well as excision of deep infiltrative endometriosis. The oocyte retrieval procedure, where more than 30 eggs were retrieved, was complicated by ovarian hyperstimulation syndrome and intraperitoneal bleeding, which necessitated admission to the intensive care unit (ICU) for 3 days. Following discharge from the ICU, the patient experienced occasional on-and-off pressure of the urinary bladder and persistent aching pelvic pain. At the 1-month follow-up appointment, the patient's vital signs were assessed (blood pressure, 142/94 mm Hg; pulse rate, 95 per minute; temperature, 96.8 °F [36 °C]). Routine blood investigations, including white blood cell count, were within normal limits. Physical examination showed the abdomen was soft but there was mild pelvic tenderness. The serum β-human chorionic gonadotropin test result was negative for pregnancy, and urinalysis testing showed no leukocyte esterase or nitrites. MRI of the pelvis (Figs 1-3) was performed to evaluate the worsening pain.
Topics: Humans; Female; Adult; Magnetic Resonance Imaging; Endometriosis; Diagnosis, Differential; Pelvic Pain
PubMed: 38916503
DOI: 10.1148/radiol.231863 -
Journal of Pediatric Orthopedics Jun 2024Osteochondromas are benign osseous lesions often excised for pain, growth abnormalities, and aesthetic concerns. While characteristic clinical and radiographic features...
BACKGROUND
Osteochondromas are benign osseous lesions often excised for pain, growth abnormalities, and aesthetic concerns. While characteristic clinical and radiographic features leave little diagnostic ambiguity in most cases of osteochondroma, pathologic analysis to confirm the diagnosis and screen for malignancy is routinely performed following surgical excision. The purpose of this study was to determine the clinical and economic value of routine pathologic analysis after osteochondroma excision in a pediatric population.
METHODS
A retrospective review of clinical records from 2 pediatric orthopaedic hospitals (St. Louis Children's Hospital and Shriner's Hospital for Children, St. Louis) identified 426 osteochondroma lesions surgically resected from 201 patients. Patients with solitary and multiple lesions were included. Clinical, radiographic, and surgical data were recorded for each resection surgery. Pathologic reports were evaluated. Costs incurred for routine pathologic assessment was also noted.
RESULTS
Totally, 132 patients were treated with surgical resection of a solitary osteochondroma lesion, while an additional 291 lesions were resected from 69 patients with multiple lesions. Average age at the time of surgical resection was 13.0 years (2.1 to 17.9). The most common anatomic locations of excised lesions included the distal femur (110, 25.8%), proximal tibia/fibula (95, 22.3%), and distal radius/ulna (58, 13.6%). All resected specimens were sent for pathologic analysis. The average size of the resected lesions was 19.9 mm3 (0.02 to 385.0 mm3). In all cases, the histologic diagnosis confirmed benign osteochondroma. The total charges of pathologic analysis including processing and interpretation fees was ∼$755.00 for each lesion assessed, for a total cohort charge of $321,630.
CONCLUSION
We propose that in most cases of pediatric osteochondroma excision procedures, postoperative histologic analysis is not strictly indicated as it rarely, if ever, alters diagnosis or management. We suggest using a "gross only" analysis in these cases. However, we do believe that with preoperative diagnostic ambiguity, or if patients present with concerning features such as rapidly expansile lesions or cortical destruction, have axial skeleton or pelvic involvement, or enlarged cartilaginous caps, full histologic evaluation of the excised lesions will continue to be prudent.
LEVEL OF EVIDENCE
Level IV-case series.
PubMed: 38916216
DOI: 10.1097/BPO.0000000000002750 -
Cureus May 2024Endometrial adenocarcinoma is a prevalent malignancy among postmenopausal women, often presenting with symptoms such as abnormal vaginal bleeding and pelvic pain. We...
Endometrial adenocarcinoma is a prevalent malignancy among postmenopausal women, often presenting with symptoms such as abnormal vaginal bleeding and pelvic pain. We present a case of a 60-year-old postmenopausal female who exhibited abnormal vaginal bleeding for three months, accompanied by pelvic pain and unintentional weight loss. Clinical evaluation, including physical examination, imaging studies, and histopathological examination, led to the diagnosis of well-differentiated endometrial adenocarcinoma. The patient underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy, and histopathological analysis confirmed invasive tumor involvement in the lower uterine segment and cervix. The final pathological tumor, node, and metastasis (TNM) staging was reported as pT1b No Mx, FIGO (International Federation of Gynecology and Obstetrics) stage II. This case underscores the importance of considering endometrial adenocarcinoma in the differential diagnosis of postmenopausal bleeding and highlights the significance of timely diagnosis and multidisciplinary management for optimizing patient outcomes.
PubMed: 38915993
DOI: 10.7759/cureus.61070 -
Canadian Journal of Pain = Revue... 2024As an emerging approach, arts-based research holds potential to advance understanding of the complex and multidimensional experiences of chronic pain and means of... (Review)
Review
BACKGROUND
As an emerging approach, arts-based research holds potential to advance understanding of the complex and multidimensional experiences of chronic pain and means of communicating this experiential evidence. This scoping review aimed to map and explore the extent of arts-based research in chronic non-cancer pain, understand the rationale behind using arts-based research methods, and identify directions for future research.
METHODS
Databases PsycINFO, MEDLINE, EMBASE, and CINAHL were searched for eligible English-language articles from inception to November 2022. Out of 1321 article titles and abstracts screened for eligibility, 18 articles underwent full-text screening, with 14 ultimately meeting all inclusion criteria. We conducted a narrative synthesis of data extracted from the 14 reviewed articles.
RESULTS
The review articles focused on a wide range of chronic non-cancer pain conditions, with 12/14 employing qualitative methods (86%), one repeated measures experimental design, and another a multiphase, multimethod design. Seven articles described the use of drawing, painting, or mixed-media artwork; four used photography; two used body mapping; and one used e-book creation. The rationale for arts-based research included exploring and better understanding patients' experiences with chronic non-cancer pain, constructing an intervention, and investigating or validating a clinical tool. Nine articles reported that their arts-based research methods produced unintended therapeutic benefits for participants. Recommendations for future research included using arts-based research to better understand and communicate with patients and providers, exploring convergence with art therapy, and designing creative and flexible multiphased studies involving collaboration across disciplines.
CONCLUSIONS
Despite the wide variation in sample and art modalities across reviewed articles, arts-based methods were considered suitable and highly effective for investigating chronic non-cancer pain.
PubMed: 38915305
DOI: 10.1080/24740527.2024.2352876