A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

A cross sectional study assessing six different methods to predict the ideal position of umbilical venous catheters in neonates of different weight categories

Background: This was a cross sectional study done to find the most suitable method of assessing umbilical venous catheter (UVC) length in seventy two neonates of four different weight categories using six methods.Methods: Neonates were grouped into A (upto 1 kg), B (>1-1.5 kg), C (>1.5-2.5 kg) or D (>2.5 kg) based on their birth weight. UVC was placed using Shukla-Ferrara method and x-ray taken to finalize the catheter length. The predicted catheter length was also measured by Dunn method, umbilicus to nipple length, umbilicus to xiphisternum length, umbilicus to midpoint of inter mammary distance, and umbilicus to symphysis pubis length. ANOVA test was used to find the methods which did not have statistically significant difference with the final length from x-ray (p>0.5). The method with the least mean difference from final length was taken as the most suitable.Results: UVC length assessed by Shukla Ferrara method and umbilicus to midpoint of inter mammary distance did not have statistically significant difference with final catheter length on x-ray in all groups. UVC length assessed by Dunn method did not have statistically significant difference with final catheter length on x-ray in group A, C and D while UVC length assessed by umbilicus to nipple length did not have statistically significant difference in group D.Conclusions: Umbilicus to the midpoint of inter-mammary distance was the most suitable method to estimate length of insertion of UVC in neonates.

Efficacy of Modified Thoracoabdominal Nerves Block Through Perichondrial Approach in Open Gynecological Surgery: A Prospective Observational Study and a Cadaveric Evaluation

BACKGROUNDː Modified thoracoabdominal nerve block through perichondrial approach (M-TAPA) was first described as a peripheral nerve block by Tulgar in 2019. This technique provides an analgesic effective range from Th7–11 with a single puncture per side. Although the efficacy and effective duration of M-TAPA have been reported, further examination is required. Therefore, this study aimed to evaluate the analgesic range and effective duration of M-TAPA in open gynecologic surgery.METHODSː Following approval, 10 adult female patients scheduled for open radical hysterectomy via a vertical incision or laparotomy using a midline incision from under the xiphoid process to the symphysis pubis were enrolled. The primary outcome was the number of anesthetized dermatomes at 2 and 24 h postoperatively. Secondary outcomes included numerical rating scale scores and the total amount of fentanyl used. Cadaveric evaluation was performed to assess the spread of the dye. RESULTSː The median numbers (interquartile range) of anesthetized dermatomes at 2 and 24 h postoperatively were 6 (5–7) and 6.5 (5–7) in the anterior cutaneous branch area and 5 (4–7) and 7 (5–7) in the lateral cutaneous branch area, respectively. There was an 85% chance of simultaneously acquiring analgesia in areas innervated by Th8–Th11, including complete block in areas innervated by the anterior cutaneous branches of Th9–10. Cadaveric evaluation showed the spread of the dye in Th8–11.CONCLUSIONSːM-TAPA may have analgesic effects in the areas supplied by the anterior cutaneous branches of Th8–11.TRAIL REGISTRATION:IRB approval (No.2700; registered on July 10, 2020) and registration (UMIN Clinical Trials Registry: UMIN000041137; registered on July 17, 2020)

Deliberate self-harm in a patient with hyperthyroidism with acute psychosis

A woman in her 30s with underlying Graves’ disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient’s own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.

Perinatal Sacroiliitis Diagnostic Challenges: A Case Report

Background: Lumbo-pelvic (LPP) pain is common and non specific problem during pregnancy and post partum. Despite the fact that perinatal pyogenic sacroiliitis (PSI) during this period is rare, it should be considered as a vital differential diagnosis in women who have debilitating lower back and pelvic girdle pain. Case: A 34 years old primigravida presented to the emergency department with extreme right sided lower back pain radiating to the right gluteal region and down to the back of the right thigh. This pain began twelve days prior to her presentation and eventually worsened to the point that she couldn't stand or walk. Her vital signs were within normal limits, and she was febrile. Apart from a slight widening of the symphysis pubis, her pelvic and lumbo-sacral plain x-rays revealed no important findings. With the clinical impression of right LPP, the patient was admitted for pain management and further inquiries. Conclusion: Despite the fact that lower back and pelvic girdle pain are normal throughout pregnancy and the postpartum period, perinatal PSI is uncommon. It's a tough diagnosis to make because the symptoms and signs aren't clear, and the tests aren't definitive. When pathognomonic clinical and radiologic signs indicate an infectious process and isolation of pathogenic bacteria is not possible, medical management with empirical antibiotics should not be delayed.

Experimental study of the strength characteristics of fixation of the symphysis pubis with an original plate for the reconstruction of the anterior pelvic semi-ring

The destabilization of bone fixators has led to repeated surgical interventions that increased the risk of migrations of metal fixators, infectious and inflammatory complications as well. The modern trends in hip bone injury surgery are related to developing and using of metal fixators, which are effective in acute injury; however, sometimes the condition of the patient and the technical support of hospitals don’t allow performing surgery in the acute period, and these metal fixators are ineffective for chronic damage. Consequently, until now, the problem of finding the optimal design of structures for fixing chronic damage of anterior pelvic semi-ring which will be able to exclude its destabilization, is still of current interest.The purpose of the study: developing and experimental researching of durable features of original plate for reconstruction of the anterior pelvic semi-ring.Materials and methods: In order to ensure stable fixation of chronic pelvic injuries, the original metal plates have been worked out. They are made individually in accordance with the anatomical and functional structures of the anterior pelvic semi-ring of the patient with using additive technologies. The study of the reliability of the different variants of ostiosynthesis of the anterior pelvic semi-ring with using well-known pelvic plates and a new original design was carried out. Stability tests for different plate fixing methods and mechanical strength of metallophyxators were carried out on a universal test machine of LFM-50kN series.Results: one plate fixation in tensile test showed the lowest result – 0.341 kN, a low result of shear loads was received with the same object. The best result was shown by the polyaxial monolithic plate fixation in case of stretching – 0.51 kN at the shear loads – 0.591 kN. Necessary force applied to destabilizing of the metal structure while using a polyaxial monolithic plate was a half-higher than stretched, and a third higher than at shear loads, it demonstrates the benefits of using these metal fixators.Conclusion: It is experimentally confirmed that the polyaxial monolithic plate provides the highest stability of fixing anterior pelvic semi-ring indicator in contrast with fixing of one or two plates.

Measurement of Rectal Diameter and Anterior Wall Thickness by Ultrasonography in Children With Chronic Constipation

Introduction: Measurement of rectal diameter by ultrasonograpy helps the clinician in the diagnosis of chronic constipation in children for whom rectal examination cannot be performed. The aim of the study is to determine the rectal diameter and anterior wall thickness values with constipated and healthy subjects, and to evaluate the usability of ultrasonography in the diagnosis of functional constipation in children for whom refuse digital rectal examination Materials and Methods: The constipated group included 140 children, while the control group included 164 children. All patients were divided into four subgroups according to their ages and were referred to the radiology department for rectal measurements. Results: At the symphysis pubis plane the rectal diameter measurement of the constipated patients with fecal retention positive group was statistically greater than the control group. At the ischial spine plane, rectum diameter of constipated children with fecal retention positive or negative was found to be statistically greater than the control group. At the bladder neck plane rectum diameter of constipated patients with fecal retention positive was statistically greater than the control group. Rectum anterior wall thickness measurement was found to be higher in constipated patients with fecal retention positive compared to the control (p = 0.000). It’s measurements of constipated patients in group II, group III, and group IV with empty rectum were found to be statistically higher than the control group. Conclusion: Measurement of rectal diameter and anterior wall thickness by ultrasonograpy as a noninvasive method in children who do not want the digital rectal examination and may be useful in the diagnosis of constipation.