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Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling.IJU Case Reports May 2024We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.
INTRODUCTION
We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.
CASE PRESENTATION
At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1-h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmHO. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1-h pad test resulted in 0 g of leakage.
CONCLUSION
We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.
PubMed: 38686068
DOI: 10.1002/iju5.12719 -
JPRAS Open Jun 2024Diastasis recti abdominis is an increase in the distance between the medial borders of the two rectus muscles. It is most often triggered after intra-abdominal pressure...
PURPOSE
Diastasis recti abdominis is an increase in the distance between the medial borders of the two rectus muscles. It is most often triggered after intra-abdominal pressure increases, such as postpartum or in obesity. Most publications are based on radiological studies or are done in certain subgroups, without unanimous reference values of the distance between the rectus abdominis or standardization.
METHODS
Forty-one cadavers were studied. Exclusion criteria: signs of abdominal trauma, major burns, presence of scar from previous abdominal surgery, clinical signs of abdominal hernia, and identification of hernia during cadaver dissection. Linea alba (LA) length, width, and thickness were measured with a flexible tape measure and digital caliper. Anatomical landmarks were established, and subdivisions were described based on them to compare the cadavers.
RESULTS
Sex and age had little effect on LA width, thickness, or length. Obesity (compared to normal weight) was the only variable that promoted an increase in the LA width ( < 0.01). The supraumbilical length varied with the total height of the evaluated cadavers ( < 0.01), but the infraumbilical length did not ( = 0.11).
CONCLUSION
The general statistical results of this study, regarding the evaluation of LA measurements in cadavers, showed that ethnicity, sex, and age have little effect on the width, thickness, or length of the LA. LA width differed significantly with abdominal circumference.
PubMed: 38681533
DOI: 10.1016/j.jpra.2024.03.005 -
Medicina (Kaunas, Lithuania) Apr 2024: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the... (Observational Study)
Observational Study
The Relationship between Abdominal Diastasis and Lumbar Pain Pressure Threshold in Women Who Have Given Birth between the Ages of 30 and 45 Years-An Observational Pilot Study.
: Current evidence confirms that the magnitude of the inter-rectus distance (IRD) is associated with the severity of abdominal pain. Furthermore, evidence exists in the literature about the impact abdominal muscles have on low back pain, lumbopelvic pain, breathing and lumbar abdominal strength; however, no studies analysing the level of association between abdominal diastasis and lumbar pain pressure threshold (PPT) exist. The aim of this study was to analyse the level of association between the rectus abdominis distance and pain pressure threshold in the lumbar spinous processes in women who have given birth between the ages of 30 and 45 years. Secondly, it was to study the level of association between the time elapsed since the last delivery and low back pain in women who have given birth between 30 and 45 years of age. : This was a pilot observational study in which 21 females participated. The abdominal diastasis was measured by ultrasound, the pain pressure threshold was assessed by an algometer and the pain perception by the Mc Gill questionnaire. : There was no significant relationship between increased abdominal distance and increased lumbopelvic pain in women who gave birth between the ages of 30 and 45 years. However, there was a correlation between the time that had elapsed since the last delivery and low back pain. : there was a correlation between the time that had elapsed since the last delivery and low back pain. Further studies analysing factors that may perpetuate the chronicity of symptoms, such as lifestyle and intrinsic factors, are needed.
Topics: Humans; Female; Pilot Projects; Adult; Low Back Pain; Middle Aged; Pain Threshold; Rectus Abdominis; Pain Measurement; Diastasis, Muscle; Pressure; Surveys and Questionnaires; Lumbosacral Region
PubMed: 38674236
DOI: 10.3390/medicina60040591 -
Medicina (Kaunas, Lithuania) Mar 2024: Our report contributes a unique case of a non-neural GCT occurring in an unusual location, with its development during pregnancy adding to its rarity. : Granular cell...
: Our report contributes a unique case of a non-neural GCT occurring in an unusual location, with its development during pregnancy adding to its rarity. : Granular cell tumors (GCTs), also known as Abrikossoff's tumors, are rare neoplasms of Schwann cell origin with predominantly benign behavior. We present a case of a 29-year-old female with a non-neural variant of a GCT discovered incidentally during a cesarean section, situated on the posterior surface of the rectus abdominis muscle. : Histologically, the tumor exhibited features consistent with a benign non-neural GCT, confirmed through an immunohistochemical analysis. Despite the atypical presentation and challenging surgical removal due to prior scarring, the patient experienced no postoperative complications and showed no signs of recurrence during follow-up. : This case highlights the importance of considering GCTs in differential diagnoses, particularly in unusual anatomical locations, and underscores the favorable prognosis associated with timely surgical intervention.
Topics: Humans; Female; Rectus Abdominis; Adult; Granular Cell Tumor; Pregnancy; Muscle Neoplasms; Cesarean Section; Granulosa Cell Tumor
PubMed: 38674222
DOI: 10.3390/medicina60040576 -
Cancers Apr 2024Patients with aggressive cancer, e.g., gastrointestinal cancer, are prone (≥50% chance) to developing cancer cachexia (CC). Little is known about the effects of CC on...
Patients with aggressive cancer, e.g., gastrointestinal cancer, are prone (≥50% chance) to developing cancer cachexia (CC). Little is known about the effects of CC on the biomechanical function of muscle. A promising prevention strategy was found in the form of a multi-modal therapy combining mild resistance exercise (e.g., whole-body electro-myostimulation, WB-EMS) and a protein-rich diet. In a previous study of ours, this was effective in counteracting the loss of muscle mass, yet a systematic and comprehensive assessment of active and passive single muscle fibre functions was so far absent. This pilot study investigated the biomechanical function of single muscle fibres () from the biopsies of conventionally treated (pre-)cachectic cancer ((pre-)CC) patients (m = 9), those receiving the multi-modal therapy comprising WB-EMS training and protein-rich nutrition (m = 3), and a control group (m = 5). Our findings not only align with previous findings showing the absolute force loss in CC that is accelerated by atrophy but also speak in favour of a different, potentially energy- and Ca-homeostasis-related effect that compromises muscle contraction (F ~0.9 mN vs. F ~0.6 mN in control patients). However, myofibrillar Ca sensitivity and the quality of contraction were unaltered (pCa50: 5.6-5.8). Single fibres from the (pre-)CC patients receiving WB-EMS training and protein supplementation were significantly more compliant ( < 0.001 at ≥130% of resting length L). Those fibres displayed a similar softness to the ones from the control patients (axial compliance ~15 m/N at ≥130% L), while single fibres from the patients with (developing) cachexia were significantly stiffer (axial compliance ~7 m/N, < 0.001 at ≥130% L). Adjuvant multi-modal therapy (WB-EMS training and nutritional support) contributes to maintaining the axial compliance of single fibres and potentially improves the quality of life for patients at risk of developing CC.
PubMed: 38672689
DOI: 10.3390/cancers16081608 -
Bioengineering (Basel, Switzerland) Apr 2024Given there are no known studies which have examined multiple lower extremity muscles between different ankle positions during bridging activities, the objective was to...
Given there are no known studies which have examined multiple lower extremity muscles between different ankle positions during bridging activities, the objective was to assess how employing two different ankle positions (PF versus DF) while performing five common bridging exercises (three bipedal and two unipedal) used in rehabilitation and athletic performance affect core and select lower extremity muscle EMG recruitment. Twenty healthy subjects performed a 5 s isometric hold during five two- and one-leg bridge exercises: (1) on right leg with left knee to chest (1LB-LFlex); (2) on right leg with left knee extended (1LB-LExt); (3) standard two-leg bridge (2LB); (4) two-leg bridge with resistance band around knees (2LB-ABD); and (5) two-leg bridge with ball between knees (2LB-ADD). Surface electromyographic (EMG) data were collected using a Noraxon Telemyo Direct Transmission System from fourteen muscles: (1) three superficial quadriceps (VM, VL, and RF); (2) three hip abductors (TFL, GMED, and GMAX); (3) medial hamstrings (ST) and lateral hamstrings (BF); (4) hip adductors (ADD); (5) erector spinae (ES); (6) latissimus dorsi (LATS); (7) upper rectus abdominis (RA); and (8) external oblique (EO) and internal oblique (IO). EMG data were normalized by maximum voluntary isometric contractions (MVICs). A paired -test ( < 0.01) was used to assess differences in normalized mean EMG activities between DF and PF for each exercise. EMG activities were significantly greater in DF than PF for the (a) VM, VL, and RF during 1LB-LFlex; (b) ADD during 1LB-LFlex, 1LB-LExt; (c) EO during 1LB-LFlex; and (d) IO during 1LB-LFex. In contrast, EMG activities were significantly greater in PF than DF for ST and BF during all five bridge exercises. Bridging with PF (feet flat) was most effective in recruiting the hamstrings, while bridging with DF (feet up) was most effective in recruiting the quadriceps, hip adductors, and internal and external obliques.
PubMed: 38671779
DOI: 10.3390/bioengineering11040356 -
Medicine Apr 2024Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postoperative pain continues to represent an important problem even after minimally invasive robotic-assisted laparoscopic radical prostatectomy, which results in discomfort in the postoperative period and sometimes prolongs hospital stays. Regional anesthesia and analgesia techniques are used in addition to systemic analgesics with the multimodal approach in postoperative pain management. Ultrasound-guided fascial plane blocks are becoming increasingly important, especially in minimally invasive surgeries. Another important cause of discomfort is urinary catheter pain. The present randomized controlled study investigated the effect of rectus sheath block on postoperative pain and catheter-related bladder discomfort in robotic prostatectomy operations.
METHODS
This randomized controlled trial was conducted from March to August 2022. Written informed consent was obtained from all participants. Approval for the study was granted by the Clinical Research Ethics Committee. All individuals provided written informed consent, and adults with American Society of Anesthesiologists Physical Condition classification I to III planned for robotic prostatectomy operations under general anesthesia were enrolled. Following computer-assisted randomization, patients were divided into 2 groups, and general anesthesia was induced in all cases. Rectus sheath block was performed under general anesthesia and at the end of the surgery. No fascial plane block was applied to the patients in the non-rectus sheath block (RSB) group.Postoperative pain and urinary catheter pain were assessed using a numerical rating scale. Fentanyl was planned as rescue analgesia in the recovery room. In case of numerical rating scale scores of 4 or more, patients were given 50 µg fentanyl IV, repeated if necessary. The total fentanyl dose administered was recorded in the recovery room. IV morphine patient-controlled analgesia was planned for all patients. All patients' pain (postoperative pain at surgical site and urethral catheter discomfort) scores and total morphine consumption in the recovery unit and during follow-ups on the ward (3, 6, 12, and 24 hours) in the postoperative period were recorded.
RESULTS
Sixty-one patients were evaluated. Total tramadol consumption during follow-up on the ward was significantly higher in the non-RSB group. Fentanyl consumption in the postanesthesia care unit was significantly higher in the non-RSB group. Total morphine consumption was significantly lower in the RSB group at 0 to 12 hours and 12 to 24 hours. Total opioid consumption was 8.81 mg in the RSB group and 19.87 mg in the non-RSB group. A statistically significant decrease in urethral catheter pain was noted in the RSB group at all time points.
CONCLUSION
RSB exhibits effective analgesia by significantly reducing postoperative opioid consumption in robotic prostatectomy operations.
Topics: Humans; Prostatectomy; Pain, Postoperative; Male; Robotic Surgical Procedures; Nerve Block; Middle Aged; Ultrasonography, Interventional; Aged; Pain Measurement; Analgesics, Opioid; Rectus Abdominis
PubMed: 38669407
DOI: 10.1097/MD.0000000000037975 -
Sports (Basel, Switzerland) Apr 2024The effect of electromyographic (EMG) activity on agonist muscles during exercises performed on stable and unstable surfaces remains uncertain. We aimed to review the... (Review)
Review
The effect of electromyographic (EMG) activity on agonist muscles during exercises performed on stable and unstable surfaces remains uncertain. We aimed to review the literature regarding the comparison of the EMG activity of the agonist muscles of exercises performed on stable and unstable surfaces. Eighty-six studies that evaluated the EMG activity of 1783 individuals during exercises for the lower limbs, upper limbs, and core were included. The EMG activities of the pectoralis major (SMD = 0.28 [95% CI 0.09, 0.47]) and triceps brachii muscles (SMD = 0.45 [95% CI 0.25, 0.66]) were significantly increased when the unstable device was added to the exercise. Likewise, the EMG activity of all core muscles showed a significant increase with the unstable surface during the exercises, such as the rectus abdominis (SMD = 0.51 [95% CI 0.37, 0.66]), external oblique (SMD = 0.44 [95% CI 0.28, 0.61]), internal oblique (SMD = 1.04 [95% CI 0.02, 2.07]), erector spinae (SMD = 0.37 [95% CI 0.04, 0.71]), and lumbar multifidus (SMD = 0.35 [95% CI 0.08, 0.61]). However, the lower limb muscles did not show greater EMG activity during the exercise with unstable surfaces compared to the stable surface. In conclusion, unstable conditions increase the EMG activity of some upper limb and core muscles compared to a stable surface.
PubMed: 38668579
DOI: 10.3390/sports12040111 -
Journal of Surgical Case Reports Apr 2024We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm...
Surgical technique for epigastric incisional hernia after omphalocele repair: bilateral modified composite flaps using the upper rectus abdominis muscle and the vertically inverted flap of the lower rectus abdominis fascia.
We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm defect with significant rectus abdominis muscle diastasis at the costal arch attachment point. At 6 years of age, the abdominal wall defect in the umbilical region was closed using the components separation technique. For the muscle defect of the epigastric region, composite flaps were made by suturing together the flap of the upper rectus abdominis muscle, after peeling it away from the costal arch attachment point, and the vertically inverted flap of the lower rectus abdominis fascia, created with a U-shaped incision. The composite flaps from each side were reversed in the midline to bring them closer and then sutured; the abdominal wall and skin were then closed. Five months after surgery, the patient had no recurrent incisional hernia and no wound complications.
PubMed: 38666103
DOI: 10.1093/jscr/rjae259 -
International Journal of Exercise... 2024The 'loaded carry' is a popular resistance training activity that activates core musculature across multiple movement planes while the body is in locomotion. 'Hold'...
The 'loaded carry' is a popular resistance training activity that activates core musculature across multiple movement planes while the body is in locomotion. 'Hold' exercises are similar to carry exercises but lack the locomotive aspect. Both carry and hold exercises can be completed bilaterally (farmer's carry (FC) and hold (FH)) or unilaterally (suitcase carry (SC) and hold (SH)). A deeper understanding of muscle activation between the FC and SC and intensity-matched FH and SH might improve their application. Healthy, college-aged individuals were recruited and surface electromyography of the rectus abdominis (RA), external oblique (EO), longissimus (LT), and multifidus (MF) was measured bilaterally using standard procedures. Participants completed time- and intensity-matched randomized sets of the plank, FC, SC, FH, and SH separated by 5-minute rests. A one-way ANOVA was utilized to compare exercises. The FC/FH load averaged 50.7±1.9 kg, where it was used across equally weighted dumbbells. The FC elicited higher activation bilaterally in the LT, MF, RA, and EO, compared to the FH. The SC/SH single-dumbbell load averaged 25.3±0.95 kg. There was greater activation bilaterally in the LT and MF during the SC compared to the SH. However, on the ipsilateral side of the SC, the RA and EO displayed greater activation compared to the SH, but this was not different on the contralateral side. The FC and SC were characterized by increased core muscle activation bilaterally, with the SC exhibiting unique additions to ipsilateral muscle activation.
PubMed: 38665162
DOI: No ID Found