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Scientific Reports Jun 2024Whilst pharmacological therapies remain the cornerstone of pain management in chronic pain, factors including the current opioid epidemic have led to non-pharmacological... (Meta-Analysis)
Meta-Analysis
Whilst pharmacological therapies remain the cornerstone of pain management in chronic pain, factors including the current opioid epidemic have led to non-pharmacological techniques becoming a more attractive proposition. We explored the prevalence of medical device use and their treatment efficacy in non-cancer pain management. A systematic methodology was developed, peer reviewed and published in PROSPERO (CRD42021235384). Key words of medical device, pain management devices, chronic pain, lower back pain, back pain, leg pain and chronic pelvic pain using Science direct, PubMed, Web of Science, PROSPERO, MEDLINE, EMBASE, PorQuest and ClinicalTrials.gov. All clinical trials, epidemiology and mixed methods studies that reported the use of medical devices for non-cancer chronic pain management published between the 1st of January 1990 and the 30th of April 2022 were included. 13 studies were included in systematic review, of these 6 were used in the meta-analysis. Our meta-analysis for pain reduction showed that transcutaneous electrical nerve stimulation combined with instrument-assisted soft tissue mobilization treatment and pulsed electromagnetic therapy produced significant treatment on chronic lower back pain patients. Pooled evidence revealed the use of medical device related interventions resulted in 0.7 degree of pain reduction under a 0-10 scale. Significant improvement in disability scores, with a 7.44 degree reduction in disability level compared to a placebo using a 50 score range was also seen. Our analysis has shown that the optimal use of medical devices in a sustainable manner requires further research, needing larger cohort studies, greater gender parity, in a more diverse range of geographical locations.
Topics: Humans; Chronic Pain; Pain Management; Bayes Theorem; Low Back Pain; Transcutaneous Electric Nerve Stimulation; Equipment and Supplies; Treatment Outcome
PubMed: 38866854
DOI: 10.1038/s41598-024-63499-6 -
BMJ Open Jun 2024Primary dysmenorrhoea (PD) is a common menstrual concern with significant physical and psychosocial impacts. The effectiveness and safety of transcutaneous electrical... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Primary dysmenorrhoea (PD) is a common menstrual concern with significant physical and psychosocial impacts. The effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) in alleviating PD symptoms remain uncertain due to insufficient evidence. This single-centre, parallel, randomised controlled study intends to evaluate the efficacy and safety of TEAS for PD management.
METHODS AND ANALYSIS
60 participants aged 18-40 years diagnosed with moderate to severe PD will be recruited from Tai'an Hospital of Traditional Chinese Medicine (TCM) and randomly assigned to either a TEAS group or a TEAS-sham group (1:1). The TEAS group will undergo 12 sessions of TEAS treatment over two menstrual cycles, with 30 min per session, three sessions weekly. Participants in the TEAS-sham group will receive TEAS stimulation using identical devices and protocols but without current output. The primary outcome is the Visual Analogue Scale (VAS) for pain assessment. Secondary outcomes are Short-Form McGill Pain Questionnaire, total effective rate, uterine artery haemodynamics, prostaglandin and β-endorphin level, mental well-being and quality of life. Adverse events and their potential reasons and the use of analgesics will also be recorded.
ETHICS AND DISSEMINATION
This study was approved by the Medical Ethics Committee of Tai'an Hospital of TCM. Written informed consent will be obtained from each participant. The results will be submitted for publication in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER
ChiCTR2300071686.
Topics: Humans; Dysmenorrhea; Female; Transcutaneous Electric Nerve Stimulation; Acupuncture Points; Adult; Young Adult; China; Adolescent; Pain Measurement; Treatment Outcome; Randomized Controlled Trials as Topic; Quality of Life
PubMed: 38866569
DOI: 10.1136/bmjopen-2023-078895 -
Surgical Case Reports Jun 2024The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or...
BACKGROUND
The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.
CASE PRESENTATION
A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.
CONCLUSIONS
This was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.
PubMed: 38865023
DOI: 10.1186/s40792-024-01937-3 -
Journal of Obstetrics and Gynaecology :... Dec 2024The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy...
BACKGROUND
The pre-treatment characteristics of the patient and ectopic pregnancy to determine the patients who are likely to successfully respond to methotrexate (MTX) therapy remain controversial. This study investigated the outcomes of ectopic pregnancy after one and two MTX doses and their independent predictors.
METHODS
Retrospective cross-sectional study of women who consented to MTX treatment in 2017-2018 at our institution ( = 317). Of these, patients with Caesarean scar pregnancies were excluded because they require different treatment protocols ( = 25). All patients were treated according to our institution's protocol based on international guidelines and standardised across the three hospitals included in the current study. We retrieved patients' demographics, laboratory, ultrasonography, and clinical characteristics from our hospital database. Serum β-human chorionic gonadotropin (β-hCG) was measured using electrochemiluminescence immunoassay; ectopic pregnancy was diagnosed using ultrasonography (transvaginal probe).
RESULTS
Two ninety-two patients were included in the current analysis. Age, pre-treatment β-hCG levels, sonographic presence of yolk sac, presence of foetal cardiac activity, and pelvic pain were significantly different between patients with successful and unsuccessful outcomes. Younger age (adjusted odds ratio [aOR] 2.33, 95% confidence interval (CI) 1.16-4.66, = .017), no pelvic pain (aOR 2.65, 95%CI 1.03-6.83, = .043), lower initial β-hCG level (aOR 1.32, 95%CI 1.08-1.59, = .005), and absence of foetal cardiac activity (aOR 12.63; 95% CI 1.04-153.6; = .047) were independently associated with success. Treatment failure odds were >2 folds higher for each 10-year age increase ( = .017), 32% higher for each 1000 IU/L increase in initial β-hCG level ( = .005), and >2 folds higher in presence of pelvic pain ( = .043).
CONCLUSIONS
MTX is effective in most patients, averting invasive surgery, which might affect fertility. Pre-treatment β-hCG levels, age, pelvic pain, and foetal cardiac activity was independently associated with outcomes. Research should assess the relationship between the ectopic pregnancy size and treatment outcomes and refine β-hCG titres where treatment would be ineffective.
Topics: Humans; Female; Methotrexate; Pregnancy; Adult; Retrospective Studies; Cross-Sectional Studies; Abortifacient Agents, Nonsteroidal; Chorionic Gonadotropin, beta Subunit, Human; Pregnancy, Tubal; Treatment Outcome
PubMed: 38864434
DOI: 10.1080/01443615.2024.2361456 -
Congenital cervico-vaginal aplasia with a functional uterus: A case report and review of literature.SAGE Open Medical Case Reports 2024Maldevelopment of the vagina and cervix is frequently accompanied by uterine aplasia or hypoplasia. Complete cervico-vaginal aplasia with a normally developing uterus is...
Maldevelopment of the vagina and cervix is frequently accompanied by uterine aplasia or hypoplasia. Complete cervico-vaginal aplasia with a normally developing uterus is a very uncommon type of developmental failure. Failure to treat the condition can result in complications such as hematometra and hematosalpinx caused by the retrograde flow of blood into the fallopian tubes. In this case report, we describe the case of a 32-year-old woman experiencing cyclic abdominal pain and primary amenorrhea. The patient exhibited cervico-vaginal agenesis, with a functional uterus that was complicated by hematometra and bilateral hematosalpinx.
PubMed: 38864032
DOI: 10.1177/2050313X241260217 -
BMJ Open Jun 2024
Meta-Analysis
Topics: Humans; Pregnancy; Female; Pelvic Pain; Low Back Pain; Acupuncture Therapy; Randomized Controlled Trials as Topic; Pregnancy Complications
PubMed: 38862225
DOI: 10.1136/bmjopen-2021-056878ret -
International Journal of Surgery Case... Jul 2024Abdominal pregnancy is a rare and potentially fatal variant of ectopic pregnancy, presenting unique clinical challenges. This report discusses an unusual case of...
INTRODUCTION AND IMPORTANCE
Abdominal pregnancy is a rare and potentially fatal variant of ectopic pregnancy, presenting unique clinical challenges. This report discusses an unusual case of abdominal pregnancy associated with uterine and high rectal perforations, complications that are rarely reported in clinical practice.
CASE PRESENTATION
We report a case involving a 31-year-old woman from a rural area, with a psychiatric history, presenting severe abdominal pain, vomiting, and constipation. Initial investigations revealed a hemopneumoperitoneum and a fetal skeleton in the pelvic area by CT, leading to a diagnosis of abdominal pregnancy. Surgical findings included a nonviable fetus, approximately 5 months gestational age, and perforations in both the rectum and the posterior uterine wall.
CLINICAL DISCUSSION
The patient underwent extensive surgery, including placental dissection, anterior rectal resection, Hartmann's colostomy, hysterorrhaphy, and drainage of the peritoneal cavity. The complexity of managing abdominal pregnancy, especially with additional complications such as organ perforations, poses significant surgical challenges. This case emphasizes the need to consider abdominal pregnancy in differential diagnoses of abdominal pain in women, due to the risk of misdiagnosis and complex surgical requirements.
CONCLUSION
This case highlights the critical importance of prompt diagnosis and comprehensive care in managing rare and life-threatening presentations of abdominal pregnancy. It underscores the need to increase awareness among clinicians for timely intervention and provides information on the complexities of surgical management in cases with additional organ perforations.
PubMed: 38861813
DOI: 10.1016/j.ijscr.2024.109823 -
Journal of Surgical Case Reports Jun 2024Colorectal cancer typically metastasizes to the peritoneum, liver, and lungs. However, metastases to the fallopian tube and uterus are uncommon. This case report delves...
Colorectal cancer typically metastasizes to the peritoneum, liver, and lungs. However, metastases to the fallopian tube and uterus are uncommon. This case report delves into this rare occurrence of metastasis and discusses its characteristics, diagnostic methods, and treatments based on an extensive literature review. We present the case of a 61-year-old female patient who underwent her initial hospitalization for da Vinci robotic surgery to address colorectal cancer, stage pT3N0M0. However, during routine postoperative follow-up 6 months later, a localized rectal recurrence was detected. The patient commenced chemoradiotherapy with full response. Subsequently, the patient was readmitted due to pelvic pain again, and a magnetic resonance imaging scan revealed an abnormal mass in the patient's left fallopian tube and uterine corpus, infiltrating the myometrium. Consequently, total hysterectomy with bilateral adnexectomy was performed, along with omentectomy, which confirmed metastatic involvement from rectal cancer upon postoperative pathological examination. This case may inform further diagnosis and treatment of colorectal cancer metastasis to the fallopian tube.
PubMed: 38859968
DOI: 10.1093/jscr/rjae400 -
Chinese Clinical Oncology Jun 2024Neutrophilia is an increase in the number of neutrophils over 7.5×103 /μL. An increase in leukocytes over 50×103 /μL is called a leukemoid reaction; and when it is...
BACKGROUND
Neutrophilia is an increase in the number of neutrophils over 7.5×103 /μL. An increase in leukocytes over 50×103 /μL is called a leukemoid reaction; and when it is associated with a solid tumor, it is considered a paraneoplastic syndrome called paraneoplastic leukemoid reaction (PLR). It is a very rare clinical condition and it is very unusual for it to be associated with carcinosarcoma. We present two cases of a leukemoid reaction observed in the Medical Oncology Department of the University Hospital of Salamanca between May and September 2023. The main objectives of our article are to describe the unusual appearance of paraneoplastic leukocytosis at the diagnosis of carcinosarcoma carcinosarcoma, explain in a detailed way its diagnostic procedure and to show the poor prognosis to which it is associated.
CASE DESCRIPTION
In our presentation, we describe two similar cases: first of all, a 60-year-old woman without relevant medical history. She was referred by her primary physician to the Department of Internal Medicine in August 2023 with asthenia, lumbar pain, and weight loss of 12 kg of 3 months of evolution. The physical examination revealed a palpable hypogastric mass. An abdominal, pelvic, and thoracic computed tomography (CT) scan revealed a heterogenous solid mass with necrotic areas originating in the uterus. The anatomopathological diagnosis was carcinosarcoma. The patient showed a progressive worsening in her renal function associated with hyperviscosity secondary to hyperleukocytosis caused by 170×103 /μL neutrophils. In the second case we describe the diagnosis of a PLR secondary to a kidney carcinosarcoma. When the patient started chemotherapy, he presented 55.08×103 /μL leukocytes, 53.16×103 /μL neutrophils. Eight days after receiving chemotherapy, the patient was admitted as an emergency with oligoanuria and decreased consciousness. He presented creatinine 6.25 mg/dL, phosphate 12.4 mg/dL, leukocytes 1.05×103 /μL, and neutrophils 0.71×103 /μL. The clinical diagnosis was acute exacerbation of multifactorial mixed (renal and prerenal) chronic kidney disease associated with tumor lysis syndrome and grade 3 neutropenia. The patient presented a poor evolution, dying after 2 months.
CONCLUSIONS
PLR is a severe paraneoplastic syndrome associated with different types of solid tumors. Its appearance at the time of diagnosis of a tumor implies a poor vital prognosis.
PubMed: 38859609
DOI: 10.21037/cco-23-146 -
Translational Andrology and Urology May 2024Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition characterized by lower urinary tract symptoms and persistent pelvic pain or...
Traditional Chinese herbal medicine retention enema combined with perineal massage (THREM): a promising therapeutic strategy for refractory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).
BACKGROUND
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a debilitating condition characterized by lower urinary tract symptoms and persistent pelvic pain or discomfort lasting for more than three months. Currently available oral drug therapies exhibit limited efficacy in the treatment of CP/CPPS. Therefore, personalized and combination therapies are recommended by Chinese CP/CPPS guidelines, which primarily include traditional Chinese medicine, radiofrequency therapy, urethral lavage, transrectal prostate massage, extracorporeal shock wave therapy. However, a significant number of patients do not respond well to all types of these therapeutic methods. Among those who have sequentially or simultaneously undergone at least three different treatment modalities, in addition to oral medications, for more than 1 year, they are defined as patients with refractory CP/CPPS. This retrospective study aims to evaluate the clinical effect of traditional Chinese herbal medicine retention enema combined with perineal massage (THREM) in managing refractory CP/CPPS.
METHODS
A total of 20 patients with refractory CP/CPPS, who did not show significant improvement despite receiving multiple conventional treatments, including oral medications, were included in this study. Following THREM therapy, the International Prostate Symptom Score (IPSS), visual analogue scale (VAS), and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) quality of life (QoL) score were used to assess treatment efficacy.
RESULTS
Six months after THREM therapy, a significant decrease in IPSS, VAS, and QoL scores was observed (P<0.01). Importantly, 85% of the patients experienced a reduction in symptoms of ≥60%, with an average degree of alleviation reaching 70.25%±24.20%.
CONCLUSIONS
THREM treatment demonstrated excellent efficacy in managing refractory CP/CPPS at least for 6 months. It has promising clinical application prospects. Further research is warranted to validate these results and explore the underlying mechanisms of THREM therapy.
PubMed: 38855610
DOI: 10.21037/tau-23-386