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Scientific Reports Apr 2024This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy...
This study aimed to evaluate the impact of shear stress on surgery-related sacral pressure injury (PI) after laparoscopic colorectal surgery performed in the lithotomy position. We included 37 patients who underwent this procedure between November 2021 and October 2022. The primary outcome was average horizontal shear stress caused by the rotation of the operating table during the operation, and the secondary outcome was interface pressure over time. Sensors were used to measure shear stress and interface pressure in the sacral region. Patients were divided into two groups according to the presence or absence of PI. PI had an incidence of 32.4%, and the primary outcome, average horizontal shear stress, was significantly higher in the PI group than in the no-PI group. The interface pressure increased over time in both groups. At 120 min, the interface pressure was two times higher in the PI group than in the no-PI group (PI group, 221.5 mmHg; no-PI group, 86.0 mmHg; p < 0.01). This study suggested that shear stress resulting from rotation of the operating table in the sacral region by laparoscopic colorectal surgery performed in the lithotomy position is the cause of PI. These results should contribute to the prevention of PI.
Topics: Humans; Laparoscopy; Female; Male; Aged; Middle Aged; Pressure Ulcer; Stress, Mechanical; Rotation; Pressure; Colorectal Surgery; Sacrum; Operating Tables
PubMed: 38679609
DOI: 10.1038/s41598-024-60424-9 -
The Surgical Clinics of North America Jun 2024Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached... (Review)
Review
Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.
Topics: Humans; Hidradenitis Suppurativa; Pilonidal Sinus; Hair Removal
PubMed: 38677816
DOI: 10.1016/j.suc.2023.11.003 -
Medicine Apr 2024Adult sacrococcygeal teratoma (SCT) is a rare disease that is not easily detected or easily missed, and its treatment is based on surgery, including transabdominal,...
INTRODUCTION
Adult sacrococcygeal teratoma (SCT) is a rare disease that is not easily detected or easily missed, and its treatment is based on surgery, including transabdominal, transsacral, or a combination of both, but there are no clear guidelines for diagnosis and treatment. We share a case of Altman type III SCT in order to provide more reference protocols for the diagnosis and treatment of adult SCT, and more importantly to increase our understanding of different types of SCT cases in adults.
PATIENT CONCERNS
Our patient was a 31-year-old adult woman who underwent complete surgical resection of a cystic mature teratoma of the right ovary 8 years ago and is currently 13 months postpartum without menstruation, usually with a feeling of anal bulge, with symptoms such as constipation.
DIAGNOSIS
We diagnosed SCT by vaginal ultrasonography, computed tomography and magnetic resonance imaging (MRI); benign tumors were considered in the results of serum tumor markers.
INTERVENTIONS
We chose the surgical approach of laparoscopic transabdominal-sacrococcygeal approach to completely remove the patient SCT and coccyx.
OUTCOMES
The location of SCT is concealed and the clinical symptoms are not obvious. Vaginal ultrasonography, CT and MRI can not only improve the diagnostic rate of SCT, but also understand the size and mass of SCT, providing an exact basis for clinicians to select the laparoscopic transabdominal-sacrococcygeal approach.
CONCLUSION
Our sharing increases the reports of rare cases of teratoma with the same histological findings in different organ tissues of the same patient at different times, whether this occurs incidentally requires more case reports and further basic research; in addition, the laparoscopic transabdominal-sacrococcygeal approach is a safe and effective surgical approach for the treatment of Altman type III SCT in adults; finally, this case reminds us that SCT may not affect pregnancy and pregnancy outcomes and provides a reference for the selection of interventions for SCT with pregnancy.
Topics: Humans; Female; Teratoma; Adult; Laparoscopy; Sacrococcygeal Region; Ovarian Neoplasms; Magnetic Resonance Imaging
PubMed: 38669424
DOI: 10.1097/MD.0000000000037887 -
Journal of Anaesthesiology, Clinical... 2024The use of ultrasound has immensely increased the safety toward regional blocks and central venous access and has been considered as the standard of care for securing...
BACKGROUND AND AIM
The use of ultrasound has immensely increased the safety toward regional blocks and central venous access and has been considered as the standard of care for securing central access. The aim of this study is to estimate the prevalence of occult spinal dysraphism using ultrasound in children less than 2 years of age undergoing elective urogenital or anorectal surgery.
MATERIAL AND METHODS
The lumbosacral region of 159 American Society of Anesthesiologists (ASA) category I/II patients, posted for elective urogenital and anorectal surgery was scanned with ultrasound, prior to giving caudal block.
RESULTS
The prevalence of occult spina bifida was 3% in our study. There was no statistically significant association of cutaneous marker with abnormal scan.
CONCLUSION
Prevalence of occult spina bifida was ten-times higher in our study than in the general population. Perioperative ultrasound screening of the lower spinal anatomy by anesthesiologist done prior to performing neuraxial block is worthwhile in ruling out occult spinal anomalies in high-risk children of occult spinal dysraphism.
PubMed: 38666156
DOI: 10.4103/joacp.joacp_254_22 -
BMJ Case Reports Apr 2024A man in his mid-40s presented to the colorectal surgery clinic with complaints of chronic perianal pain for over 20 years. He had episodes of urinary incontinence...
A man in his mid-40s presented to the colorectal surgery clinic with complaints of chronic perianal pain for over 20 years. He had episodes of urinary incontinence associated with pain. There were no other symptoms to suspect bowel pathology. On examination, he was found to have a tender mass in the retro-rectal plane without any evidence of rectal mucosal irregularity. He underwent an MRI of the pelvis, which showed a well-defined T2 hyperintense partly cystic lesion in the presacral region abutting the mesorectal fascia and a normal prostate gland. With a suspicion of a tailgut cyst or a duplication cyst, he underwent an excision of the presacral mass. Intraoperatively, there was a 2 × 2 cm well-defined firm, cystic lesion anterior to the fifth sacral vertebra and coccyx. The lesion was adherent to the mesorectum and was excised. On histopathology, there were features of muscular stroma and bilayered glandular epithelium with clear cytoplasm conclusive of a benign ectopic prostate.
Topics: Humans; Male; Prostate; Choristoma; Diagnosis, Differential; Magnetic Resonance Imaging; Adult
PubMed: 38649245
DOI: 10.1136/bcr-2023-257319 -
Clinical Case Reports Apr 2024Plasma cell myeloma is a rare entity in the pediatric population. The peak incidence is in the seventh decade, with less than 2% of cases occurring in patients under the...
KEY CLINICAL MESSAGE
Plasma cell myeloma is a rare entity in the pediatric population. The peak incidence is in the seventh decade, with less than 2% of cases occurring in patients under the age of 40. It is worth noting that any destructive bony lesion in a child should be investigated.
ABSTRACT
Plasma cell myeloma (multiple myeloma) is the most common form of plasma cell neoplasm. It is a rare entity in young patients. The peak incidence is in the seventh decade, with less than 2% of cases occurring in patients under the age of 40. A male patient aged 9 years old with a progressive pain in lower back for about 1 month, aggravated by bending, associated with inability to stand upright, no any history of trauma. He complained about left pin-point chest pain, no any history of febrile illness. MRI showed a mass lesion of the L3 vertebra; CT scan revealed osteolytic lesions in the left T12, S2-sacral region, and left calvarium. Histology report of L3 lesion revealed cells with an eccentric nucleus, prominent Golgi apparatus and Flow cytometry revealed cells stained positive for CD 138 and CD56 and negative for CD45 expression. In situ hybridization identified k-light chain band restriction. Bone marrow evaluation was normal. A small serum monoclonal immunoglobin A spike of k-light chain type was noted. Other tests like complete blood count, lactate dehydrogenase levels, renal functional tests, and B2-microglobulin were normal. A diagnosis of plasma cell myeloma was made and the patient was started on emergent radiation to L3 lesion due to progressive neurological symptoms followed systemic therapy which resulted int reduction of L3 lesion. Plasma cell myeloma is extremely rare form of liquid tumor in the pediatric population, and it is important for any destructive bony lesion in a child to have appropriate work up.
PubMed: 38645602
DOI: 10.1002/ccr3.8801 -
Journal of Pediatric Urology Mar 2024Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP...
Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction- a randomized prospective trial.
INTRODUCTION
Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections.
OBJECTIVE
This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP.
METHOD
A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n = 27) and Manual Therapy (MG; n = 27) groups. TENS application was performed 2 sessions in a week for 20 min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5 × 5 cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20 min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used.
RESULTS
The decrease in the episodes of incontinence was higher in the TG (p = 0.037; p < 0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p = 0.683; p > 0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p = 0.001; p < 0.01).
CONCLUSION
Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.
PubMed: 38641452
DOI: 10.1016/j.jpurol.2024.03.027 -
Brain, Behavior, and Immunity Jul 2024Vestibulodynia is a complex pain disorder characterized by chronic discomfort in the vulvar region, often accompanied by tactile allodynia and spontaneous pain. In...
Vestibulodynia is a complex pain disorder characterized by chronic discomfort in the vulvar region, often accompanied by tactile allodynia and spontaneous pain. In patients a depressive behaviour is also observed. In this study, we have used a model of vestibulodynia induced by complete Freund's adjuvant (CFA) focusing our investigation on the spinal cord neurons and microglia. We investigated tactile allodynia, spontaneous pain, and depressive-like behavior as key behavioral markers of vestibulodynia. In addition, we conducted in vivo electrophysiological recordings to provide, for the first time to our knowledge, the characterization of the spinal sacral neuronal activity in the L6-S1 dorsal horn of the spinal cord. Furthermore, we examined microglia activation in the L6-S1 dorsal horn using immunofluorescence, unveiling hypertrophic phenotypes indicative of neuroinflammation in the spinal cord. This represents a novel insight into the role of microglia in vestibulodynia pathology. To address the therapeutic aspect, we employed pharmacological interventions using GABApentin, amitriptyline, and PeaPol. Remarkably, all three drugs, also used in clinic, showed efficacy in alleviating tactile allodynia and depressive-like behavior. Concurrently, we also observed a normalization of the altered neuronal firing and a reduction of microglia hypertrophic phenotypes. In conclusion, our study provides a comprehensive understanding of the CFA-induced model of vestibulodynia, encompassing behavioral, neurophysiological and neuroinflammatory aspects. These data pave the way to investigate spinal cord first pain plasticity in vestibulodynia.
Topics: Animals; Disease Models, Animal; Spinal Cord; Freund's Adjuvant; Mice; Hyperalgesia; Vulvodynia; Female; Microglia; Neurons; Neuroinflammatory Diseases; Gabapentin; Amitriptyline; Depression; Mice, Inbred C57BL
PubMed: 38636564
DOI: 10.1016/j.bbi.2024.04.012 -
European Spine Journal : Official... Apr 2024Dural ectasia (DE) may significantly impact Marfan syndrome (MFS) patients' quality of life due to chronic lower back pain, postural headache and urinary disorders. We...
PURPOSE
Dural ectasia (DE) may significantly impact Marfan syndrome (MFS) patients' quality of life due to chronic lower back pain, postural headache and urinary disorders. We aimed to evaluate the association of quantitative measurements of DE, and their evolution over time, with demographic, clinical and genetic characteristics in a cohort of MFS patients.
METHODS
We retrospectively included 88 consecutive patients (39% females, mean age 37.1 ± 14.2 years) with genetically confirmed MFS who underwent at least one MRI or CT examination of the lumbosacral spine. Vertebral scalloping (VS) and dural sac ratio (DSR) were calculated from L3 to S3. Likely pathogenic or pathogenic FBN1 variants were categorized as either protein-truncating or in-frame. The latter were further classified according to their impact on the cysteine content of fibrillin-1.
RESULTS
Higher values of the systemic score (revised Ghent criteria) were associated with greater DSR at lumbar (p < 0.001) and sacral (p = 0.021) levels. Patients with protein-truncating variants exhibited a greater annual increase in lumbar (p = 0.039) and sacral (p = 0.048) DSR. Mutations affecting fibrillin-1 cysteine content were linked to higher VS (p = 0.009) and DSR (p = 0.038) at S1, along with a faster increase in VS (p = 0.032) and DSR (p = 0.001) in the lumbar region.
CONCLUSION
Our study shed further light on the relationship between genotype, dural pathology, and the overall clinical spectrum of MFS. The identification of protein-truncating variants and those impacting cysteine content may therefore suggest closer patient monitoring, in order to address potential complications associated with DE.
PubMed: 38615299
DOI: 10.1007/s00586-024-08252-3 -
Healthcare (Basel, Switzerland) Mar 2024The evaluation of the lumbopelvic region is a crucial point during postural assessment in childhood and adolescence. Photogrammetry (PG) and Spinal Mouse (SM) are two of...
The evaluation of the lumbopelvic region is a crucial point during postural assessment in childhood and adolescence. Photogrammetry (PG) and Spinal Mouse (SM) are two of the most debated tools to properly analyze postural alignment and avoid misleading data. This study aims to find out the best linear regression model that could relate the analytic measurements of the SM with one or more PG parameters in adolescents with kyphotic postures. Thirty-nine adolescents (female = 35.9%) with structural and non-structural kyphosis were analyzed (13.2 ± 1.8 years; 1.59 ± 0.12 m; 47.6 ± 11.8 kg) using the SM and PG on the sagittal plane in a standing and forward-bending position, allowing for the measurement of body vertical inclination, lumbar and pelvic alignment, trunk flexion, sacral inclination during bending, and hip position during bending. Lordosis lumbar angles (SM) were significantly (r = -0.379, r = -0.328) correlated with the SIPS-SIAS angle (PG) during upright standing, while in the bending position, the highest correlation appeared among the sacral-hip (SM) and the sacral tangent (ST_PG; r = -0.72) angles. The stepwise backward procedure was assessed to estimate the SM variability in the bending and standing positions. Only in the bending position did the linear regression model reach high goodness-of-fit values with two regressors (ST_PG η2=0.504, BMI η2=0.252; =0.558, < 0.001, CCC = 0.972, r = 0.763). Despite gold-standard methods reducing error evaluation, physicians and kinesiologists may consider photogrammetry as a good method for spinal curve prediction.
PubMed: 38610160
DOI: 10.3390/healthcare12070738