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Journal of Obstetrics and Gynaecology :... Dec 2024The aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe...
BACKGROUND
The aim is to investigate the risk of short-term maternal morbidity caused by the selective clinical use of episiotomy (rate < 0.02), and to compare the risk of severe perineal tears with the statewide risk.
METHODS
In this retrospective cohort study, we investigated the effect of selective episiotomy on the risk of severe perineal tears and blood loss in singleton term deliveries, using propensity scores with inverse probability weighting.
RESULTS
This study included 10992 women who delivered vaginally between 2008-2018. Episiotomy was performed in 171 patients (1.55%), three of whom (1.75%) experienced severe perineal tears compared to 156 (1.44%) in the control cohort. The adjusted odds ratio of severe perineal tears was 2.06 (95% confidence interval [CI]: 0.51, 8.19 with 0.3 value). Multivariate linear regression showed that episiotomy increased blood loss by 96.3 ml (95% CI: 6.4, 186.2 with 0.03 value). Episiotomy was performed in 23% (95% CI: 0.228, 0.23) of vaginal deliveries in the state of Hessen, with a risk of severe perineal tears of 0.0143 (95% CI: 0.0139, 0.0147) compared to 0.0145 (95% CI: 0.0123, 0.0168) in our entire cohort.
CONCLUSIONS
Selective use of episiotomy does not increase the risk of higher-grade perineal tears. However, it may be associated with maternal morbidity in terms of increased blood loss.
Topics: Humans; Female; Episiotomy; Retrospective Studies; Pregnancy; Adult; Perineum; Obstetric Labor Complications; Delivery, Obstetric; Risk Factors; Lacerations; Propensity Score; Postpartum Hemorrhage; Young Adult
PubMed: 38917046
DOI: 10.1080/01443615.2024.2369664 -
The American Journal of Dermatopathology Jun 2024Extramammary Paget disease (EMPD) is a rare cutaneous malignancy, typically presenting as eczema-like lesions in areas rich in apocrine glands such as the perineum....
Extramammary Paget disease (EMPD) is a rare cutaneous malignancy, typically presenting as eczema-like lesions in areas rich in apocrine glands such as the perineum. Here, we report a case of EMPD presenting as a prominent pedunculated neoplasm in a 65-year-old woman. Despite initial misdiagnosis and treatment, biopsy confirmed EMPD infiltration. Following surgical excision, the patient developed brain metastases, indicating a poor prognosis. EMPD's pathogenesis remains unclear, but distinguishing primary from secondary forms is crucial for prognosis and treatment. Our case underscores the importance of recognizing atypical EMPD presentations for timely intervention and improved outcomes.
PubMed: 38916239
DOI: 10.1097/DAD.0000000000002764 -
BMC Pregnancy and Childbirth Jun 2024Perineal lacerations are a very common complication of post-partum. Usually, the repair of 1st and 2nd-grade lacerations is performed after the administration of local... (Randomized Controlled Trial)
Randomized Controlled Trial Comparative Study
BACKGROUND
Perineal lacerations are a very common complication of post-partum. Usually, the repair of 1st and 2nd-grade lacerations is performed after the administration of local anesthesia. Despite the great relevance of the problem, there are only a few studies about the best choice of local anesthetic to use during suturing. We performed a randomised controlled trial to evaluate the efficacy and safety of the use of a local anesthetic spray during the suturing of perineal lacerations in the post-partum.
METHODS
We compared the spray with the standard technique, which involves the infiltration of lacerated tissues, using the NRS scale. 136 eligible women who had given birth at University Hospital of Udine were enrolled and randomly assigned to receive nebulization of Lidocaine hydrochloride 10% spray (experimental group) or subcutaneous/submucosal infiltration of mepivacaine hydrochloride (control group) during suturing of perineal laceration.
RESULTS
The lacerations included 84 1st-grade perineal traumas (61.7%) and 52 2nd-grade perineal traumas (38.2%). All the procedures were successfully completed without severe complications or serious adverse reactions. There were no statistically significant differences between the two groups in terms of blood losses or total procedure time. Moreover, there were no statistically significant differences in terms of NRS to none of the intervals considered. Regarding the application of the spray in the B group, in 36 cases (52.9%) it was necessary to improve the number of puffs previously supposed to be sufficient (5 puffs). Just in 3 cases, an additional injection was necessary (4.4%).
CONCLUSIONS
Our study demonstrates that lidocaine spray alone can be used as a first line of local anesthetic during the closure of I-II-grade perineal lacerations, as it has comparable efficacy to mepivacaine infiltration.
TRIAL REGISTRATION
The trial was recorded on https://clinicaltrials.gov . Identification number: NCT05201313. First registration date: 21/01/2022. Unique Protocol ID: 0042698/P/GEN/ARCS.
Topics: Humans; Female; Perineum; Lidocaine; Lacerations; Anesthetics, Local; Adult; Mepivacaine; Suture Techniques; Pregnancy; Treatment Outcome
PubMed: 38914976
DOI: 10.1186/s12884-024-06640-7 -
Journal of Biomechanics Jun 2024The perineum is a layered soft tissue structure with mechanical properties that maintain the integrity of the pelvic floor. During childbirth, the perineum undergoes...
The perineum is a layered soft tissue structure with mechanical properties that maintain the integrity of the pelvic floor. During childbirth, the perineum undergoes significant deformation that often results in tears of various degrees of severity. To better understand the mechanisms underlying perineal tears, it is crucial to consider the mechanical properties of the different tissues that make up the perineum. Unfortunately, there is a lack of data on the mechanical properties of the perineum in the literature. The objective of this study is to partly fill these gaps. Hence sow perineums were dissected and the five perineal tissues involved in tears were characterized by uniaxial tension tests: Skin, Vagina, External Anal Sphincter, Internal Anal Sphincter and Anal Mucosa. From our knowledge, this study is the first to investigate all these tissues and to design a testing protocol to characterize their material properties. Six material models were used to fit the experimental data and the correlation between experimental and predicted data was evaluated for comparison. As a result, even if the tissues are of different nature, the best correlation was obtained with the Yeoh and Martins material models for all tissues. Moreover, these preliminary results show the difference in stiffness between the tissues which indicates that they might have different roles in the structure. These obtained results will serve as a basis to design an improved experimental protocol for a more robust structural model of the porcine perineum that can be used for the human perineum to predict perineal tears.
Topics: Animals; Perineum; Swine; Female; Biomechanical Phenomena; Models, Biological; Anal Canal; Vagina; Stress, Mechanical
PubMed: 38908107
DOI: 10.1016/j.jbiomech.2024.112175 -
Techniques in Coloproctology Jun 2024Four patients with rectal cancer required reconstruction of a defect of the posterior vaginal wall. All patients received neoadjuvant (chemo)radiotherapy, followed by an...
Four patients with rectal cancer required reconstruction of a defect of the posterior vaginal wall. All patients received neoadjuvant (chemo)radiotherapy, followed by an en bloc (abdomino)perineal resection of the rectum and posterior vaginal wall. The extent of the vaginal defect necessitated closure using a tissue flap with skin island. The gluteal turnover flap was used for this purpose as an alternative to conventional more invasive myocutaneous flaps (gracilis, gluteus, or rectus abdominis). The gluteal turnover flap was created through a curved incision at a maximum width of 2.5 cm from the edge of the perineal wound, thereby creating a half-moon shape skin island. The subcutaneous fat was dissected toward the gluteal muscle, and the gluteal fascia was incised. Thereafter, the flap was rotated into the defect and the skin island was sutured into the vaginal wall defect. The contralateral subcutaneous fat was mobilized for perineal closure in the midline, after which no donor site was visible.The duration of surgery varied from 77 to 392 min, and the hospital stay ranged between 3 and 16 days. A perineal wound dehiscence occurred in two patients, requiring an additional VY gluteal plasty in one patient. Complete vaginal and perineal wound healing was achieved in all patients. The gluteal turnover flap is a promising least invasive technique to reconstruct posterior vaginal wall defects after abdominoperineal resection for rectal cancer.
Topics: Humans; Female; Vagina; Buttocks; Rectal Neoplasms; Middle Aged; Plastic Surgery Procedures; Surgical Flaps; Aged; Perineum; Operative Time; Treatment Outcome
PubMed: 38907171
DOI: 10.1007/s10151-024-02941-3 -
Journal of Robotic Surgery Jun 2024This study aims to compare the perioperative, oncological, and functional outcomes of perineal hydrodissection (HD) with standard treatment (ST) in patients undergoing... (Meta-Analysis)
Meta-Analysis Review
A systematic review and meta-analysis of the role of perineal hydrodissection in perioperative, oncologic, and functional outcomes for patients undergoing robot-assisted radical prostatectomy.
This study aims to compare the perioperative, oncological, and functional outcomes of perineal hydrodissection (HD) with standard treatment (ST) in patients undergoing robot-assisted radical prostatectomy. We performed an exhaustive search in databases such as PubMed, Embase, Web of Science, and the Cochrane Library, seeking English-language studies relevant to our research question, with a cutoff date of April 2024. The pooled results were assessed using the weighted mean differences (WMDs), standardized mean differences (SMDs), and odds ratios (ORs) metrics. We also performed a sensitivity analysis. The meta-analysis was conducted utilizing Stata/MP version 18 software. The study was registered with PROSPERO (ID: CRD 42024536400). We included a total of five studies (three RCTs and two retrospective studies). According to the data from the Meta-analysis, the HD group showed positive effects in promoting urinary continence (OR 2.64, 95% CI 1.36, 5.12; p = 0.004 < 0.05) and erectile function (SMD 0.92, 95%CI 0.56, 1.27; p < 0.05) within 3 months after surgery. However, no notable disparities were observed in terms of operative time, estimated blood loss, bilateral nerve-sparing rate, or the rate of positive surgical margin. Perineal hydrodissection can be safely applied in robot-assisted radical prostatectomy (RARP), offering a distinct advantage in functional outcomes compared to those who undergo standard robot-assisted prostatectomy alone.
Topics: Humans; Prostatectomy; Robotic Surgical Procedures; Male; Perineum; Prostatic Neoplasms; Treatment Outcome; Urinary Incontinence; Postoperative Complications
PubMed: 38904929
DOI: 10.1007/s11701-024-02028-z -
Zhonghua Wei Chang Wai Ke Za Zhi =... Jun 2024To study the influence of neoadjuvant chemoradiotherapy on peritoneal wound recovery after abdominoperineal resection (APR). This was a retrospective cohort study of...
To study the influence of neoadjuvant chemoradiotherapy on peritoneal wound recovery after abdominoperineal resection (APR). This was a retrospective cohort study of data of 219 patients who had been pathologically diagnosed with low rectal cancer and undergone APR in the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2018 and December 2021. Of these patients, 158 had undergone surgery without any pre-surgical treatment (surgery group), 35 had undergone surgery after neoadjuvant chemotherapy (neoadjuvant chemotherapy group), and 26 had undergone surgery after neoadjuvant chemoradiotherapy (neoadjuvant chemoradiotherapy group). The primary outcome was perineal wound complications occurring within 30 days. The status of wound healing was classified into the following three levels: Level A: abnormal wound seepage that improved after wound discharge; Level B: wound infection and dehiscence; and Level C: Level B plus fever. The patients' general condition, tumor status, perianal wound healing level, and intra- and post-operative recovery were recorded. None of the study patients had any complications during surgery. The duration of surgery was 240.0 (180.0-300.0) minutes, 240.0 (225.0-270.0) minutes and 270.0 (240.0-356.2) minutes in the surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy groups, respectively (=6.508, =0.039). The rates of perineal wound complications were 34.6% (9/26) and (22.9%, 8/35)in the neoadjuvant chemoradiotherapy group and the neoadjuvant chemotherapy group, being significantly higher than that in the surgery group (10.1%, 16/158). After adjusting for patient age and sex using a logistic regression model, the risk of complications was still higher in the neoadjuvant chemoradiotherapy than in the surgery group (OR=4.6, 95%CI: 1.7-12.7; OR=2.6, 95%CI: 1.0-6.8), these differences being statistically significant (both <0.05). The duration of hospital stay was 9.5 (7.0-12.0) days, 10.0 (8.0-17.0) days and 11.5 (9.0-19.5) days for patients in the surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy groups, respectively (=0.569, =0.752). However, after adjusting for patient age and sex by using a generalized linear model, hospital stay was longer in the neoadjuvant chemoradiotherapy than in the surgery group (β [95% CI]: 4.4 [0.5-8.4], =0.028). After surgery, 155 of 219 patients required further adjuvant chemotherapy. A higher proportion of patients with than without wound complications did not attend for follow-up (32.2% [10/31] vs. 16.1% [20/124]); this difference is statistically significant (χ=4.133, =0.023). In patients with low rectal cancer, neoadjuvant radiotherapy may be associated with an increased risk of perineal wound infection and non-healing.
Topics: Humans; Proctectomy; Retrospective Studies; Male; Female; Rectal Neoplasms; Neoadjuvant Therapy; Wound Healing; Middle Aged; Perineum; Peritoneum; Aged; Operative Time
PubMed: 38901995
DOI: 10.3760/cma.j.cn441530-20230724-00013 -
International Journal of Gynaecology... Jun 2024This study aims to construct and evaluate a model to predict spontaneous vaginal delivery (SVD) failure in term nulliparous women based on machine learning algorithms.
OBJECTIVE
This study aims to construct and evaluate a model to predict spontaneous vaginal delivery (SVD) failure in term nulliparous women based on machine learning algorithms.
METHODS
In this retrospective observational study, data on nulliparous women without contraindications for vaginal delivery with a singleton pregnancy ≥37 weeks and before the onset of labor from September 2020 to September 2021 were divided into a training set and a temporal validation set. Transperineal ultrasound was performed to collect angle of progression, head-perineum distance, subpubic arch angle, and their levator hiatal dimensions. The cervical length was measured via transvaginal ultrasound. The delivery methods were later recorded. Through LASSO regression analysis, indicators that can affect SVD failure were selected. Seven common machine learning algorithms were selected for model training, and the optimal algorithm was selected based on the area under the curve (AUC) to evaluate the effectiveness of the validation model.
RESULTS
Four indicators related to SVD failure were identified through LASSO regression screening: angle of progression, cervical length, subpubic arch angle, and estimated fetal weight. The Gaussian NB algorithm was found to yield the highest AUC (0.82, 95% confidence interval [CI] 0.65-0.98) during model training, and hence it was chosen for verification with the temporal validation set, in which an AUC of 0.79 (95% CI 0.64-0.95) was obtained with accuracy, sensitivity, and specificity rates of 80.9%, 72.7%, and 75.0%, respectively.
CONCLUSION
The Gaussian NB model showed good predictive effect, proving its potential as a clinical reference for predicting SVD failure of term nulliparous women before actual delivery.
PubMed: 38899565
DOI: 10.1002/ijgo.15739 -
Nutrients May 2024(1) Background: With the aging population, effective interventions are needed to enhance the health of older adults. This study investigated the combined effects of yoga... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of a Yoga Program Combined with a Mediterranean Diet on Nutritional Status and Functional Capacity in Community-Dwelling Older Adults: A Randomized Controlled Clinical Trial.
(1) Background: With the aging population, effective interventions are needed to enhance the health of older adults. This study investigated the combined effects of yoga and the Mediterranean diet on various health outcomes in community-dwelling older adults; (2) Methods: The study employed a randomized controlled trial design with a total of 116 older adults randomized to an experimental group ( = 57) that underwent a combined yoga and Mediterranean diet program and a control group ( = 59) that did not receive any intervention. Nutritional status was assessed using the Mini Nutritional Assessment, flexibility with the Back Scratch Test and the Chair Sit-and-Reach Test, balance, gait, and fall risk with the Tinetti Scale, and muscle strength with a dynamometer and the 30 s Chair Stand Test; (3) Results: Regarding nutritional status, there were significant differences between the experimental group and the control group (Cohen's d = 0.02). The participants in the experimental group showed greater balance (11.12 ± 3.01 vs. 10.03 ± 2.35, Cohen's d = 0.41 and gait (7.63 ± 1.96 vs. 6.69 ± 2.50, Cohen's d = 0.44) with respect to the control group. In terms of flexibility, the experimental group showed statistically significant improvements in the right arm (Cohen's d = 0.43), left arm (Cohen's d = 0.64), right perineum (Cohen's d = 0.42), and left leg (Cohen's d = 0.37) Finally, in terms of strength, participants in the experimental group experienced statistically significant improvements in grip strength and lower body strength (Cohen's d = 0.39 and 0.81, respectively); (4) Conclusions: The study highlights the potential benefits of a 12-week intervention combining yoga with a Mediterranean diet to improve the health and functional capacities of community-dwelling older adults.
Topics: Humans; Diet, Mediterranean; Aged; Yoga; Male; Female; Nutritional Status; Independent Living; Muscle Strength; Postural Balance; Gait; Aged, 80 and over; Geriatric Assessment; Functional Status; Nutrition Assessment; Accidental Falls
PubMed: 38892534
DOI: 10.3390/nu16111601 -
Animals : An Open Access Journal From... Jun 2024Ultrasonographic evaluation of canine and feline anal sacs is a practical promising modality to identify anal sac disease. However, limited data are available about...
Ultrasonographic evaluation of canine and feline anal sacs is a practical promising modality to identify anal sac disease. However, limited data are available about normal ultrasound morphology of the anal sacs. This study describes the ultrasound morphology of presumed normal anal sacs in a larger sample of client-owned dogs and cats. A single-institutional prospective cross-sectional descriptive study was performed, and 137 dogs and 131 cats were included. The most common ultrasound features of the evaluated anal sacs in the dorsal plane were oval shape (99.3% of dogs and 98.5% of cats) and bilaterally similar content (94.2% of dogs and 95.4% of cats), mostly hypoechoic with diffusely hyperechoic points or unformed echogenic material (42.6% of dogs and 44% of cats). Gas in the lumen of the anal sac was detected in two dogs and mineralization in one dog. There was a statistically significant positive correlation between body weight and the size of anal sacs in dogs ≤15 kg and cats and a correlation between age and the size of anal sacs in cats. This simple method provides additional clinically significant information in detecting abnormal findings in asymptomatic patients and could contribute to the early detection of anal sac disease.
PubMed: 38891731
DOI: 10.3390/ani14111684