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The Journal of Obstetrics and... Jun 2024Endometriosis, affecting 6%-10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is...
Endometriosis, affecting 6%-10% of women of reproductive age, can lead to severe symptoms such as chronic pelvic pain and infertility. Among its rarer manifestations is abdominal wall endometriosis (AWE), which has been increasingly reported following cesarean deliveries. This case discusses a 39-year-old woman who presented with a 13-year history of cyclical pain at her cesarean section scar, exacerbated over the last year by the development of a painful abdominal mass. Medical evaluations indicated endometriosis at the scar, with further investigations including ultrasound and magnetic resonance imaging showing involvement of the rectus abdominis muscle. Elevated tumor markers HE4 and CA-125, along with a biopsy, confirmed adenocarcinoma. The patient underwent extensive surgical treatment, including the resection of the mass, hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pathology confirmed moderately differentiated infiltrative adenocarcinoma originating from endometriosis. Despite the absence of postoperative chemotherapy, the patient showed no recurrence, emphasizing the effectiveness of comprehensive surgical management. This case highlights the critical importance of recognizing the potential for malignant transformation in AWE, particularly following cesarean deliveries, and underscores the necessity for vigilant monitoring and personalized treatment strategies. The management of AWE, especially when malignant transformation is suspected, necessitates a multidisciplinary approach similar to that used in ovarian cancer, focusing on rigorous surgical intervention and the potential for adjuvant therapies.
PubMed: 38880948
DOI: 10.1111/jog.16000 -
Journal of Bodywork and Movement... Jul 2024Morphological differences in the trunk muscles between adolescent athletes with lumbar spondylolysis (LS) and nonspecific low back pain (NSLBP) have not been fully...
INTRODUCTION
Morphological differences in the trunk muscles between adolescent athletes with lumbar spondylolysis (LS) and nonspecific low back pain (NSLBP) have not been fully elucidated. This study aimed to investigate the differences in physiological cross-sectional areas (CSA) of the trunk muscles between athletes with acute LS and those with acute NSLBP.
METHODS
Magnetic resonance images of 48 patients aged 13-14 years diagnosed with acute LS or NSLBP were retrospectively evaluated. The CSA of the paraspinal, psoas major, and rectus abdominis muscles at the L4-5 intervertebral disc level were measured.
RESULTS
CSA of the left and right paraspinal muscles in the acute LS group were significantly larger than those in the acute NSLBP group (left: mean difference, 276.0 mm; 95% confidence interval [CI], 68.5-483.6 mm; P = 0.01; right: mean difference, 228.8 mm; 95% CI, 7.6-450.1 mm; P = 0.04). The ratio between the left paraspinal muscles and left psoas major in the acute LS group was significantly larger than that in the acute NSLBP group (mean difference, 0.2; 95% CI, 0.0-0.4; P = 0.03).
CONCLUSIONS
Trunk muscle size may differ between adolescent athletes with acute LS and those with NSLBP. Future research involving healthy controls is required to better understand the morphological characteristics of these injuries.
Topics: Humans; Low Back Pain; Adolescent; Spondylolysis; Male; Female; Magnetic Resonance Imaging; Retrospective Studies; Paraspinal Muscles; Lumbar Vertebrae; Psoas Muscles; Rectus Abdominis
PubMed: 38876642
DOI: 10.1016/j.jbmt.2024.02.005 -
Clinical Practice and Cases in... May 2024Rectus abdominis muscle strains are common and can be debilitating in both professional and amateur athletes who engage in strenuous activity.
INTRODUCTION
Rectus abdominis muscle strains are common and can be debilitating in both professional and amateur athletes who engage in strenuous activity.
CASE REPORT
We report a rare case of rectus abdominis muscle tear in an amateur bodybuilder diagnosed by point-of-care ultrasound (POCUS) in the emergency department (ED). The patient had presented to the ED three separate times after strenuous exercise, received costly diagnostic workups, and ultimately was diagnosed on the third visit with grade 2 bilateral rectus abdominis tear. The patient was given appropriate education and sports medicine follow-up. He underwent rehabilitation focused on trunk and core stability. At eight-week follow-up, the patient had made a full recovery.
CONCLUSION
To our knowledge, a case of bilateral rectus abdominis tear diagnosed by ultrasound in the emergency setting has not been previously published. Our case report highlights the utility of POCUS in diagnosing musculoskeletal pathology and preventing costly bounce-back visits.
PubMed: 38869342
DOI: 10.5811/cpcem.1670 -
Journal of Ultrasound in Medicine :... Jun 2024This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound...
OBJECTIVES
This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility.
METHODS
We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment.
RESULTS
The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%.
CONCLUSIONS
This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.
PubMed: 38864261
DOI: 10.1002/jum.16508 -
Frontiers in Physiology 2024To compare the inter-rectus distance (IRD), rectus abdominis thickness (RAT), and stiffness in women during pregnancy and postpartum and identify the risk and protective...
OBJECTIVES
To compare the inter-rectus distance (IRD), rectus abdominis thickness (RAT), and stiffness in women during pregnancy and postpartum and identify the risk and protective factors affecting diastasis recti abdominis (DRA).
MATERIALS AND METHODS
A total of 171 pregnant women who volunteered to participate in this study were recruited. Using an ultrasonographic diagnostic instrument with shear wave elastography function, IRD, RAT and the Young's modulus of the rectus abdominis muscles were measured at 12 weeks, 37 weeks of pregnancy, and 6 weeks postpartum.
RESULTS
The IRD at 37 weeks was significantly higher than that at 12 weeks and then decreased at 6 weeks postpartum, but it was still higher than that at 12 weeks ( < 0.001). RAT and Young's modulus decreased significantly at 37 weeks compared with those at 12 weeks and then recovered at 6 weeks postpartum, but they were lower than those at 12 weeks ( < 0.001). IRD at 12 weeks was significantly higher in multiparae than in primiparae ( < 0.001). Moreover, positive correlation between the RAT and Young's modulus of rectus abdominis muscles at 12 and 37 weeks of gestation and 6 weeks postpartum ( < 0.001) was observed. Multiple linear regression analysis showed that the regression equation was significant (f = 24.856, < 001).
CONCLUSION
Our study identified differences in IRD, thickness and stiffness of the rectus abdominis muscle between early and advanced pregnancy and the postpartum period. The risk and protective factors of DRA may guide pregnant women's protection and treatment.
PubMed: 38860113
DOI: 10.3389/fphys.2024.1382982 -
Frontiers in Bioengineering and... 2024Simulations of human-technology interaction in the context of product development require comprehensive knowledge of biomechanical behavior. To obtain this knowledge...
Simulations of human-technology interaction in the context of product development require comprehensive knowledge of biomechanical behavior. To obtain this knowledge for the abdomen, we measured the continuous mechanical responses of the abdominal soft tissue of ten healthy participants in different lying positions anteriorly, laterally, and posteriorly under local compression depths of up to 30 mm. An experimental setup consisting of a mechatronic indenter with hemispherical tip and two time-of-flight (ToF) sensors for optical 3D displacement measurement of the surface was developed for this purpose. To account for the impact of muscle tone, experiments were conducted with both controlled activation and relaxation of the trunk muscles. Surface electromyography (sEMG) was used to monitor muscle activation levels. The obtained data sets comprise the continuous force-displacement data of six abdominal measurement regions, each synchronized with the local surface displacements resulting from the macro-indentation, and the bipolar sEMG signals at three key trunk muscles. We used inverse finite element analysis (FEA), to derive sets of nonlinear material parameters that numerically approximate the experimentally determined soft tissue behaviors. The physiological standard values obtained for all participants after data processing served as reference data. The mean stiffness of the abdomen was significantly different when the trunk muscles were activated or relaxed. No significant differences were found between the anterior-lateral measurement regions, with exception of those centered on the linea alba and centered on the muscle belly of the rectus abdominis below the intertubercular plane. The shapes and areas of deformation of the skin depended on the region and muscle activity. Using the hyperelastic Ogden model, we identified unique material parameter sets for all regions. Our findings confirmed that, in addition to the indenter force-displacement data, knowledge about tissue deformation is necessary to reliably determine unique material parameter sets using inverse FEA. The presented results can be used for finite element (FE) models of the abdomen, for example, in the context of orthopedic or biomedical product developments.
PubMed: 38854855
DOI: 10.3389/fbioe.2024.1384062 -
BMC Anesthesiology Jun 2024Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists,... (Randomized Controlled Trial)
Randomized Controlled Trial
Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial.
BACKGROUND
Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores.
METHODS
The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events.
RESULTS
There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events.
CONCLUSION
Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.
Topics: Humans; Cholecystectomy, Laparoscopic; Female; Male; Ultrasonography, Interventional; Nerve Block; Middle Aged; Pain, Postoperative; Abdominal Muscles; Ropivacaine; Adult; Anesthetics, Local; Pain Measurement; Rectus Abdominis; Patient Satisfaction; Analgesia, Patient-Controlled; Aged
PubMed: 38851689
DOI: 10.1186/s12871-024-02590-x -
Medicine Jun 2024Stair-climbing (SC) is an essential daily life skill, and stair-climbing exercise (SCE) serves as a valuable method for promoting physical activity in older adults. This... (Randomized Controlled Trial)
Randomized Controlled Trial
The effects of various stair-climbing exercises on functional mobility and trunk muscle activation in community-dwelling older adults: A pilot randomized controlled trial.
BACKGROUND
Stair-climbing (SC) is an essential daily life skill, and stair-climbing exercise (SCE) serves as a valuable method for promoting physical activity in older adults. This study aimed to compare the impact of SCEs with heel contact (HC) and heel off (HO) during SC on functional mobility and trunk muscle (TM) activation amplitudes in community-dwelling older adults.
METHODS
In the pilot randomized controlled trial, participants were randomly allocated to either the HC group (n = 17; mean age 75.9 ± 6.3 years) or the HO group (n = 17; mean age 76.5 ± 4.6 years). The HC participants performed SCE with the heel of the ankle in contact with the ground, while the HO participants performed SCE with the heel of the ankle off the ground during SC. Both groups participated in progressive SCE for one hour per day, three days per week, over four consecutive weeks (totaling 12 sessions) at the community center. We measured timed stair-climbing (TSC), timed up and go (TUG), and electromyography (EMG) amplitudes of the TMs including rectus abdominis (RA), external oblique (EO), transverse abdominus and internal oblique abdominals (TrA-IO), and erector spinae (ES) during SC before and after the intervention.
RESULTS
Both groups showed a significant improvement in TSC and TUG after the intervention (P < .01, respectively), with no significant difference between the groups. There was no significant difference in the EMG activity of the TMs between the groups after the intervention. The amplitude of TMs significantly decreased after the intervention in both groups (P < .01, respectively).
CONCLUSION
Both SCE methods could improve balance and SC ability in older adults while reducing the recruitment of TMs during SC. Both SCE strategies are effective in improving functional mobility and promoting appropriate posture control during SC in older adults.
Topics: Humans; Aged; Male; Pilot Projects; Female; Stair Climbing; Independent Living; Electromyography; Aged, 80 and over; Torso; Muscle, Skeletal
PubMed: 38847683
DOI: 10.1097/MD.0000000000038446 -
Eplasty 2024Abdominal donor site complications in bilateral pedicled transverse rectus abdominis muscle (TRAM) have been a concern when compared with bilateral deep inferior...
BACKGROUND
Abdominal donor site complications in bilateral pedicled transverse rectus abdominis muscle (TRAM) have been a concern when compared with bilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study aimed to assess the strength, endurance, and motor control in patients undergoing DIEP and TRAM flaps.
METHODS
A prospective, cohort study was performed at a single institution including patients who underwent pedicled TRAM and DIEP flap reconstruction after mastectomy from August 2017 to August 2018. Patients underwent pre- and postoperative testing involving rectus abdominis, prone plank, side bridge, and trunk flexor tests. Descriptive analyses and multivariate linear regressions were performed.
RESULTS
The final analysis included a total of 9 patients, 4 of whom underwent TRAM flap reconstruction while 5 underwent DIEP flap reconstruction. The tests were not statistically significant between the TRAM versus DIEP groups, including rectus abdominis mean time decrease (0.25 vs 0.60 sec, = .51), prone plank time increase (1.38 vs 1.38 sec, = .51), right side bridge time increase (7.54 sec vs 32.15 sec, = 1.00), left side bridge time increase (2.14 vs 44.5 sec, = .37), and trunk flexor time decrease (4.68 vs 1.68 sec, = .44). Overall complications were similar between the 2 groups.
CONCLUSIONS
No significant difference in abdominal donor site morbidity was found when comparing the 2 groups. This article provides a point of conversation with patients when discussing available reconstruction options.
PubMed: 38846507
DOI: No ID Found -
Plastic and Reconstructive Surgery.... Jun 2024Free flap monitoring is more difficult in patients with dark skin because ischemia and congestion can be masked by pigmentation. For this reason, adjunct methods such as...
BACKGROUND
Free flap monitoring is more difficult in patients with dark skin because ischemia and congestion can be masked by pigmentation. For this reason, adjunct methods such as cutaneous near-infrared spectroscopy are of elevated importance in patients with highly pigmented skin. The purpose of this experiment is to determine if ViOpitx T.Ox performance is affected by cutaneous pigmentation.
METHODS
Swine with naturally occurring areas of nonpigmented and pigmented skin were used. Pigmentation of each animal was assessed using spectrophotometry and histopathology. During normoxemia, tissue oxygenation (StO) measurements were taken of nonpigmented and pigmented skin using the T.Ox device. A bicolor pedicled rectus abdominis myocutaneous flap was raised, and T.Ox probe was adhered to adjacent areas of opposite coloration on the same flap. StO was measured continuously during reversible episodes of flap ischemia and congestion (n = 4 swine, n = 6 flaps).
RESULTS
There was not a significant difference between baseline StO values of nonpigmented (49% ± 7.9%) and pigmented skin (47% ± 6.2%). The absolute change in StO was significantly larger during both ischemia (6%) and congestion (16%) in nonpigmented skin compared with adjacent pigmented skin.
CONCLUSIONS
T.Ox detects flap ischemia and congestion in both highly pigmented and nonpigmented skin. However, surgeons need to be aware that StO changes related to complete flap ischemia or congestion may be much more subtle than what is seen in nonpigmented skin. This study establishes a novel internally controlled porcine model that isolates the impact of skin pigmentation when assessing cutaneous devices measuring tissue oxygenation.
PubMed: 38841531
DOI: 10.1097/GOX.0000000000005865