scholarly journals Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS)—a nested case-controlled study

2020 ◽  
Vol 31 (11) ◽  
pp. 2405-2410
Author(s):  
Nicola Adanna Okeahialam ◽  
Ranee Thakar ◽  
Madhu Naidu ◽  
Abdul H. Sultan

Abstract Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a significant risk factor for developing anal incontinence. It can therefore be hypothesised that recurrent OASI in a subsequent delivery may predispose women to further anal sphincter dysfunction. Methods A nested case-controlled study based on data collected prospectively between 2006 and 2019. Women matched for age and ethnicity, with a history of one OASI and no sphincter damage in a subsequent delivery (control) were compared to women sustaining a second OASI. Assessment was carried out using the St Mark’s score (SMIS), anorectal manometry and endoanal ultrasound scan (findings quantified using the modified Starck score). Results Eighty-four women were included and equally distributed between the two groups, who were followed up 12 weeks postnatally. No difference in SMIS scores was found. Maximum resting pressure (MRP, mmHg) and maximum squeeze pressure (MSP, mmHg) were significantly reduced in the study group. Median (IQR) MRP in the study group was 40.0 (31.3–54.0) versus 46.0 (39.3–61.5) in the control group (p = 0.030). Median (IQR) MSP was 73.0 (58.3–93.5) in the study group versus 92.5 (70.5–110.8) (p = 0.006) in the control group. A significant difference (p = 0.002) was found in the modified Starck score between the study group (median 0.0 [IQR 0.0–6.0]) and control group (median 0.0 [IQR 0.0–0.0]). Conclusions We have demonstrated that women with recurrent OASI do not have significant anorectal symptoms compared to those with one OASI 12 weeks after delivery, but worse anal sphincter function and integrity. Therefore, on long-term follow-up, symptoms may possibly develop. This information will be useful when counselling women in a subsequent pregnancy.

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Benjamin Kivlan ◽  
Shane Nho ◽  
Andrew Wolff ◽  
John Salvo ◽  
John Christoforetti ◽  
...  

Paste abstract here and remove the remaining text. *For structured abstracts, begin each section under a separate, bolded subheading. Suggested subheadings are below Objectives: The iliopsoas is a major hip flexor that provides anterior hip stability. Recent studies report significant compromise to these important functions with iliopsoas tenotomy. The purpose of this study is to report the prevalence, associated findings, rendered procedures, and outcomes of hips with iliopsoas involvement undergoing hip arthroscopy for FAI and/or chondrolabral pathology. The hypothesis is that there is a decrease in the incidence of tenotomy compared with historic controls and that tenotomy compromises patient-reported outcomes. Methods: Level of evidence 3 controlled study with prospectively-collected multicenter database from 7 centers. Enrolled patients that underwent isolated hip arthroscopy that reached 2-year minimum follow-up with iHOT-12 were assigned to Iliopsoas group defined as pre-operative diagnosis of iliopsoas tendonitis, internal snapping symptoms, intra-operative anteroinferior labral pathology (below 3 O’clock location) and/or preoperative psoas injection or the control group. The prevalence of iliopsoas pathology, radiographic and intra-operative findings, and rendered procedures between groups were compared using Chi square analysis. Minimum 2-year outcomes of Iliopsoas group versus control group were compared using analysis of variance (a priori alpha set at 0.05). Subanalysis within the Iliopsoas group was performed of patients with versus without tenotomy. Results: There were 97 study group subjects and 1053 control group subjects. There was no statistical difference in demographics between the groups (p>0.05) nor was there a difference in length of preoperative symptom duration (p=0.51). There were no significant differences in the incidence of cam impingement, pincer impingement or dysplasia between cohorts, nor were there significant differences between radiographic measures. There was a similar incidence of femoroplasty, acetabuloplasty, chondroplasty, microfracture, and synovectomy (p>0.05) regardless of iliopsoas involvement. There was not a significant effect on the surgical treatment of the labrum based on psoas involvement (p>0.16). Labral repair was performed in 55% of patients with iliopsoas involvement and 62% of patients without iliopsoas involvement. Although there was not a significant difference in capsular closure between cohorts (96% vs 93%, p=0.121), the overwhelming majority of patients with psoas involvement received capsular repair (87%) or plication (9%). Pre-operative iHOT-12 scores were similar 34 (SD: 18) for the iliopsoas group and 35 (SD 18) for the control group groups (p=0.51). Post-operative iHOT-12 scores improved to 72 for both the groups. The iliopsoas group achieved MCID, SCB, and PASS scores established for the iHOT-12 of 83%, 62%, and 58% which were similar to the control group. Ten subjects (10%) in the iliopsoas group received iliopsoas tenotomy. Subjects with tenotomy had lower 2-year post-op iHOT-12 scores compared to the non-tenotomy subgroup (55 vs 72, respectively; p=0.03) . This corresponded with lower achievement of MCID scores (60% vs 86%; p=0.03) and SCB scores (30% vs 70%, p=0.01) of patients with tenotomy compared to those without tenotomy. Conclusion: Iliopsoas tenotomy is rarely performed relative to its prevalence in patients undergoing hip arthroscopy by high volume surgeons for FAI and/or chondrolabral pathology. Surgical outcomes are not worsened with iliopsoas involvement but are worsened with tenotomy.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ali Ahmed Naga ◽  
Mohammed Ismaeil Abdel Fattah ◽  
Walid Hamed Nofal ◽  
Mohammed Abd-elsalam AlMenshawe

Abstract Background Challenges of diagnosing and treating sepsis only seem more difficult as incidence increases, patients become older and sicker, and pathogenic organisms evolve. New understanding of inflammatory mediators and pathways, immunity, and genetic variability in this disease state suggests that the current definitions of SIRS, sepsis, severe sepsis, and septic shock are oversimplified. Objective The aim of our study is to evaluate the level of RDW, CRP and clinical scores "SOFA and APACHI" as markers in patients with sepsis and their levels on the outcome and resolution of sepsis in ICU. Methodology We conducted a prospective observational controlled study on 90 adult persons of both sex, 45 of them are adult patients and served as the study group (Group I), and the other 45 are healthy adult volunteers and served as the control group (Group II). The study group represented patients admitted to the ICU of Intensive Care Unit at Damanhour Medical National Institute who fulfilled the diagnostic criteria for sepsis, severe sepsis and septic shock on arrival to ICU according to the SCCM/ ESICM/ ACCP/ ATS/SIS International Sepsis Definitions Conference. Results. In the present study we found that CRP measured on admission was not a predictor of mortality, while that measured at day 5 and day 10 predicted mortality, where there was no statistically significant difference in CRP levels between survivors and non-survivors at the day of admission while there were statistically significant differences between survivors and non survivors according to CRP levels at day 5 (p = 0.001*) and at day 10 (p = 0.001*). It was found also that there were statistically significant differences between survivors and non-survivors according to RDW at day 1(p = 0.011*) and at day 5(p = 0.009*), at day 10 was found there was no statistically significant difference between survivors and non-survivors (p = 0.338). Conclusion RDW is a new promising cheap and readily available biomarker that can be able to diagnose patients with sepsis with accuracy comparable to CRP. Also, RDW at admission is able to predict mortality.


Author(s):  
Nicola Adanna Okeahialam ◽  
Ranee Thakar ◽  
Abdul H. Sultan

Abstract Introduction and hypothesis Endoanal ultrasound (EAUS) and anal manometry are used in the assessment women with a history of obstetric anal sphincter injury (OASI), both postpartum and in a subsequent pregnancy, to aid counselling regarding mode of delivery (MOD). Methods A prospective observational study between 2012 to 2020 was completed. Women were reviewed 3 months postpartum following OASI and in the second half of a subsequent pregnancy. Anorectal symptoms were measured using the validated St Mark’s Incontinence Score (SMIS: asymptomatic to mild symptoms = ≤ 4). Anal manometry (incremental maximum squeeze pressure [iMSP: normal = > 20 mmHg]) and EAUS (abnormal = sphincter defect > 1 h in size) were performed. Results One hundred forty-six women were identified and 67.8% had an anal sphincter defect ≤ 1 h in size postnatally. In those with a defect ≤ 1 h, postpartum mean iMSP and SMIS significantly improved in a subsequent pregnancy (p = 0.04 and p = 0.01, respectively). In women with a defect > 1 h, there was no significant difference between the mean iMSP or SMIS score postnatally compared to a subsequent pregnancy. At both time points, significantly more women had an anal sphincter defect ≤ 1 h and SMIS of ≤ 4 (p = 0.001 and p < 0.001 respectively) compared to those with a defect < 1 h. In addition, significantly more women had an anal sphincter defect ≤ 1 h and iMSP ≥ 20 mmHg (p < 0.001). Overall, out of the 146 women included in this study, 76 (52.1%) with a defect ≤ 1 h also had an iMSP ≥ 20 mmHg and SMIS ≤ 4 at 3 months postpartum. Conclusions Women who remain asymptomatic with normal anal manometry and no abnormal sphincter defects on EAUS postnatally do not need to have these investigations repeated in a subsequent pregnancy and can be recommended to have a vaginal delivery. If our protocol was modified, over half of the women in this study could have had their MOD recommendation made in the postnatal period alone.


2021 ◽  
Vol 12 ◽  
pp. 204201882110585
Author(s):  
Justyna Czubilińska-Łada ◽  
Aleksandra Gliwińska ◽  
Elżbieta Świȩtochowska ◽  
Lucyna Nowak-Borzȩcka ◽  
Beata Sadownik ◽  
...  

Introduction: Gestational hypertension is one of the most common complications of pregnancy and childbirth worldwide and may be associated with metabolic disorders. Adiponectin is an adipocyte-specific plasma protein with insulin-sensitizing, vascular-protective, anti-inflammatory properties, and its role in metabolic disorders in prenatal and postnatal development in neonates remains unclear. The primary purpose of this study was to determine whether gestational hypertension is a condition lowering cord blood adiponectin level. Next, we have evaluated whether cord blood adiponectin level correlates with selected anthropometric parameters in neonates. Material and methods: The case–control study included 89 newborns divided into two groups: 30 neonates in the study group whose mothers were diagnosed with gestational hypertension and 59 healthy neonates born from normotensive pregnancies. Adiponectin determinations were performed in both groups, and neonatal anthropometric measurements and perinatal data were collected. Results: There was no statistically significant difference ( p = 0.27) between adiponectin concentration in cord blood of newborns from the study group [median (Q1–Q3) 9.86 μg/ml (8.16–13.26 μg/ml)] compared with the control group [median (Q1–Q3) 10.65 μg/ml (8.69–14.29 μg/ml)]. No statistically significant correlations were observed between adiponectin level and gestational age, body weight, body length, and chest circumference. A significant correlation was observed between adiponectin level and head circumference among newborns in the control group and among the entire population of newborns included in the study. Conclusion: No significant influence of gestational hypertension on cord blood adiponectin levels or their correlation with neonatal anthropometric measurements was observed.


2022 ◽  
Vol 30 (1) ◽  
pp. 230949902110696
Author(s):  
Necip GÜVEN ◽  
Sezai ÖZKAN ◽  
Tulin TURKOZU ◽  
Adem YOKUS ◽  
Cihan ADANAS ◽  
...  

Purpose Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall–Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears. Methods The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed. Results The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 ± 8.2 years and 31.8 ± 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values ( p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears ( p = 0.009). The ATT was 8.61 ± 4.68 mm in the study group and 3.80 ± 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group ( p = 0.001) Conclusions As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.


2007 ◽  
Vol 35 (6) ◽  
pp. 972-978 ◽  
Author(s):  
Ching-Jen Wang ◽  
Jih-Yang Ko ◽  
Yi-Sheng Chan ◽  
Lin-Hsiu Weng ◽  
Shan-Lin Hsu

Background Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Hypothesis Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Study Design Randomized controlled clinical trial; Level of evidence, 2. Methods This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm 2 energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. Results At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 ± 10.22 and 39.25 ± 10.85, respectively, before treatment (P = .129) and 92.0 ± 10.17 and 41.04 ± 10.96, respectively, after treatment (P < .001). Satisfactory results were observed in 90% of the study group versus 50% of the control group (P < .001). Recurrence of symptoms occurred in 13% of the study group and 50% of the control group (P = .014). Ultrasonographic examination showed a significant increase in the vascularity of the patellar tendon and a trend of reduction in the patellar tendon thickness after shockwave treatment compared with conservative treatments. However, no significant difference in the appearance, arrangement, and homogeneity of tendon fibers was noted between the 2 groups. There were no systemic or local complications or device-related problems. Conclusion Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.


Author(s):  
Ashwini Vishalakshi L. ◽  
Reddi Rani P.

Background: Outcome of oligohydramnios has been studied at a large. Varying results have been projected in each study. This study has been done to establish the obstetric and perinatal outcome in pregnancy associated with oligohydramnios as compared to women with normal liquor.Methods: This was a prospective case controlled study done which included 100 women with oligohydramnios who were compared with 100 women with normal liquor. Maternal and perinatal outcome was compared between the two groups.Results: There was a significant difference in the obstetric and perinatal outcomes among the study and control groups. Significant variation was seen in the obstetric outcome with regards to the incidence of induction of labor and mode of delivery (by caesarean section). Both were increased among the study group as compared to the control group. CTG changes, meconium stained liquor, neonatal admissions and observations were more among the study group as compared to control group.Conclusions: Athough there is an increased rate of caesarean section, NICU admission and observation, thick meconium stained liquor and NST changes there is no significant increase in the perinatal morbidity and mortality.


2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Juliette C. Slieker ◽  
Steve Aellen ◽  
Philippe Eggimann ◽  
Valentine Guarnero ◽  
Markus Schäfer ◽  
...  

Background. Serum procalcitonin (PCT) is a useful biomarker to tailor the duration of antibiotics in respiratory infections. The objective of this study was to determine whether PCT levels could tailor postoperative antibiotic therapy in patients operated for peritonitis. Method. Patients with peritonitis were randomized postoperatively. The control group received antibiotics for a defined duration according to institutional guidelines. In the study group, antibiotics were stopped based on serum PCT levels. Patients were stratified into three categories: (1) gastrointestinal perforation, (2) perforated appendicitis, and (3) postoperative complication. Primary outcome was duration of antibiotics. Results. We included 162 patients: 83 and 79 patients in the control group and study group, respectively. In the subgroup of patients with peritonitis due to gastrointestinal perforation, we found 7 days of antibiotics in the PCT group versus 10 days in the control group (p value 0.065). There was no difference in infectious complications, mortality, median length of hospital stay, and necessity to restart antibiotics. Conclusion. No significant differences were found in duration of antibiotics when applying PCT guidance. However, in the subgroup of primary perforation of the gastrointestinal tract, there was a difference in duration of antibiotics in favor of the PCT group without obtaining significance, as the study was not powered for subgroup analysis. Further studies including only this subgroup should be performed.


Author(s):  
Songul Ece Gonen ◽  
Pınar Kadirogullari ◽  
Kerem Doga Seckin ◽  
Bunyamin Borekci

<p><strong>Objective:</strong> We aimed to investigate the effect of acupuncture performed as an adjuvant therapy to in vitro fertilization, on pregnancy rates by performing acupuncture on the day of embryo transfer, one hour before the procedure and one hour after the procedure.</p><p><strong>Study Design:</strong> In this open-label randomized prospective controlled study, 60 unexplained infertility patients enrolled for in vitro fertilization treatment were randomized by a computer-based number generator for acupuncture performance and no-treatment. All patients received rFSH (Gonal-F®) for ovulation induction and the antagonist Cetrorelix (Cetrotide®) to prevent premature ovulation. Ovulation was triggered by using hCG (Ovitrelle®) and egg collection was done after 36-48 hours. In the study group, acupuncture was performed by intradermal needling, bilaterally with a sterile needle, both one hour before and one hour after the embryo transfer. Acupuncture was not performed on the control group. The results of the treatment were evaluated 12 days after embryo transfer.</p><p><strong>Results:</strong> Thirty patients were randomized into the study group and 30 patients were randomly placed in the control group. Although there was no statistically significant difference between groups in terms of β-hCG positivity, it was 43.3% in the study group and 36.7% in the control group (p&gt;0.05).</p><p><strong>Conclusion:</strong> The success rate of in vitro fertilization was higher in terms of pregnancy rate in the patient group who received acupuncture procedure as well, but the difference was not statistically significant. This may be due to the type of acupuncture procedure selected or insufficient sample size. As a result, further studies involving larger numbers of participants and using different acupuncture techniques are needed.</p>


2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Teodor Świdziński ◽  
Kamila Linkowska-Świdzińska ◽  
Hanna Czerniejewska-Wolska ◽  
Bożena Wiskirska-Woźnica ◽  
Maciej Owecki ◽  
...  

Background. Objective electrophysiological methods for investigations of the organ of smell consist in recordings of olfactory cortex responses to specific, time restricted odor stimuli. In hypothyroidism have impaired sense of smell.Material and Methods. Two groups: control of 31 healthy subjects and study group of 21 with hypothyroidism. The inclusion criterion for the study group was the TSH range from 3.54 to 110 μIU/mL.Aim. Assessment of the latency time of evoked responses from the olfactory nerve N1 and the trigeminal nerve N5 using two smells of mint and anise in hypothyroidism.Results. The smell perception in subjective olfactory tests was normal in 85% of the hypothyroid group. Differences were noticed in the objective tests. The detailed intergroup analysis of latency times of recorded cortical responsesPN5andPN1performed by means between the groups of patients with overt clinical hypothyroidism versus subclinical hypothyroidism demonstrated a significant difference (p<0.05) whereas no such differences were found between the control group versus subclinical hypothyroidism group (p>0.05).Conclusion. We can conclude that registration of cortex potentials at irritation of olfactory and trigeminal nerves offers possibilities for using this method as an objective indicator of hypothyroidism severity and prognostic process factor.


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