Pelvic pain in Maigne’s syndrome—a multi-segmental approach

Background Maigne’s syndrome is a poorly understood condition that affects the thoracolumbar junction. The symptoms can range from pain in the low back, pelvis, hip, lower abdomen, and groin. These symptoms can have bio-mechanical and neurophysiological attributions due to the complexity of spinal mechanics. Thoraco-lumbar junction (T12-L1) is a transitional zone with a higher degree of mean angular motion and a mean translation motion than T10-T11 and T11-T12. This higher degree of translational and rotation mobility predisposes these segments to a higher degree of stress, making them more prone to biomechanical faults such as dysfunctions and positional faults. These altered static and dynamic mechanics can create a cascade of problems along the biomechanical chain. The co-existence of thoracolumbar junction problems with pelvic pain and dysfunctions strengthens the idea of regional interdependence. Case presentation The patient is a 44-year-old Caucasian male who reported pain in the low back with symptoms radiating to the right hip, iliac region, lower abdomen, and gluteal region. The patient tested positive for Sacroiliac joint dysfunction with both Laslett’s cluster testing and palpatory sacroiliac examination. In addition, the segmental examination showed restriction in thoracolumbar junction with positive skin rolling test and hypomobility in manual segmental testing. Thus, the manual therapy treatment targeted the thoracolumbar junction and sacroiliac joint to address the underlying biomechanical dysfunctions. Conclusions The manual therapy targeting both sacroiliac and thoracolumbar spine can improve pelvic and thoracic spine mobility. In addition, therapeutic exercises can focus on enhancing anterior and posterior chain force generation capacity. This combined approach helped improve functional outcomes with a significant decrease in the Modified Oswestry Disability index and significant improvement on Visual analog scale.

Necrolytic erythema migrans in celiac disease

Erythema migrans necrolytica is a red, blistering rash that spreads over the skin. It particularly affects the skin around the mouth and distal extremities, but can also be found on the lower abdomen, buttocks, perineum and groin. It is strongly associated with glucagonoma, a glucagon-producing tumor of the pancreas, but is also seen in a number of other conditions, including liver disease and intestinal malabsorption such as celiac disease. We present a case of a patient with a history of poorly followed celiac disease presenting with a clinical picture of ENM. This rare case adds to our understanding of the clinical presentation of NME, as well as highlights the importance of acting in a timely manner to avoid the most redoubtful complications.

Giant hysteromyoma after vaginoplasty in a woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: case report and review of the literature

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder characterized by congenital absence of both the uterus and vagina. Some patients require surgery to create a neovagina, however, the preservation of a nonfunctional rudimentary uterus after surgery may lead to long-term complications. Herein, a rare case of a giant hysteromyoma after vaginoplasty, in a 31-year-old Chinese female patient who was diagnosed with MRKH syndrome, is reported. The patient, who had undergone vaginal reconstruction 4 years previously, presented with abdominal distension for the previous 2 weeks. Transabdominal ultrasonography showed a firm mass of approximately 10 × 10 cm in the lower abdomen. The patient subsequently underwent an exploratory laparotomy, and a leiomyoma from her rudimentary uterus was removed. Beside this case, seven cases, published between 2004 and 2020, were identified during a literature search. Findings of the present and previously published cases suggest that gynaecologists should pay particular attention to the risks of pelvic complications in female patients with MRKH syndrome who have previously undergone surgery, and select appropriate therapeutic methods.

Pengaruh Leaflet Terhadap Pengetahuan Dan Sikap Siswi Dalam Swamedikasi Dismenore Dengan Obat Tradisional (Jamu Kunyit Asam) Di Sma Negeri 3 Pemalang Tahun 2021

Dysmenorrhea is a problem that is quite often experienced by young women. This pain usually occurs in the lower abdomen, some even experience nausea, vomiting, or diarrhea. How to overcome dysmenorrhea by consuming herbal ingredients such as sour turmeric drink (jamu kunyit asam). The sour turmeric drink contains curcumin, essential oils, anthocyanins which can reduce pain levels. The purpose of this study was to determine the knowledge and attitudes of female students during the pretest and posttest in self-medication of dysmenorrhea with traditional medicine (jamu kunyit asam) at SMA Negeri 3 Pemalang. The method used in this study is a qualitative method with a simple random sampling design using a pretest and posttest with a total of 196 students in class X and XI at SMA Negeri 3 Pemalang. Data were analyzed by univariate and bivariate. The results showed that firstly, there was a significant difference between students knowledge during the pretest and after the posttest with the value of Sig. (2-tailed) 0.000 < (0.05), which means that there is an effect of leaflet media on students' knowledge of self-medication of dysmenorrhea with traditional medicine (jamu kunyit asam). Second, there is a significant difference between the attitudes of the students during the Pretest and after the Posttest with the value of sig. (2-tailed) 0.046 < (0.05), which means that there is an influence of leaflet media on students' attitudes in overcoming dysmenorrhea self-medication with traditional medicine (jamu turmeric acid). From the results of this study, it was concluded that the role of leaflet media as a means of supporting education for self-medication of dysmenorrhea gave an influence in increasing the knowledge and attitudes of students in self-medication of dysmenorrhea with traditional medicine (jamu kunyit asam). Keywords: Dysmenorrhea, Traditional Medicine, Knowledge, Attitude, Self-medication AbstrakDismenore merupakan salah satu permasalahan yang cukup sering dialami oleh remaja putri. Rasa nyeri atau rasa sakit ini biasanya terjadi pada perut bagian bawah. Cara mengatasi dismenore dengan mengkonsumsi bahan herbal seperti minuman kunyit asam. Minuman kunyit asam mengandung curcumin, minyak atsiri, anthocyanin yang dapat menurunkan tingkat nyeri. Tujuan dari penelitian ini untuk mengetahui pengetahuan dan sikap siswi saat Pretest dan Posttest dalam swamedikasi dismenore dengan obat tradisional (jamu kunyit asam) di SMA Negeri 3 Pemalang. Metode yang digunakan adalah metode kualitatif dengan rancangan simple rondom sampling menggunakan pretest dan postest dengan responden berjumlah 196 siswi kelas X dan XI di SMA Negeri 3 Pemalang. Data dianalisis secara univariat dan bivariat. Hasil penelitian menunjukkan bahwa pertama terdapat perbedaan yang signifikan antara pengetahuan siswi saat Pretest dan sesudah dilakukan Posttest dengan nilai Sig. (2-tailed) 0,000 < (0,05), Kedua terdapat perbedaan yang signifikan antara sikap siswi saat Pretest dan sesudah dilakukan Posttest dengan nilai Sig. (2-tailed) 0,046 < (0,05), yang berarti ada pengaruh media leaflet terhadap pengetahuan dan sikap siswi dalam mengatasi swamedikasi dismenore dengan obat tradisional (jamu kunyit asam). Dari hasil penelitian ini disimpulkan bahwa peran media Leaflet sebagai alat pendukung edukasi swamedikasi dismenore memberikan pengaruh dalam peningkatan pengetahuan dan sikap siswi dalam swamedikasi dismenore dengan obat tradisional (jamu kunyit asam).Kata kunci: Dismenore, Obat Tradisional, Pengetahuan, Sikap, Swamedikasi

Polip Fibroepithelial di Leher Kandung Kemih Pada Anak : Laporan kasus

Latar Belakang : Fibroepithelial polyps (FEP) adalah tumor jinak non-epitel yang sangat jarang yang berasal dari mesodermal di sistem perkemihan. Insidensi FEP tersering pada Dewasa muda (40%). Sebagian besar FEP ditemui di ureter distal, 15% terletak di pelvis renalis; FEP lebih jarang ditemukan di uretra, kandung kemih, dan ureter proksimal. Polip dengan fitur ini jarang ditemukan pada anak-anak. Kasus ini diharapkan dapat menjadi gambaran untuk menangani kasus FEP terutama bila predileksi di vesika urinaria. Laporan Kasus : seorang anak umur dua tahun dengan keluhan sulit buang air kecil disertai nyeri. Pasien pernah mengeluh buang air kecil disertai darah. Dilakukan pemeriksaan ultrasonography pada lower abdomen didapatkan massa dan hidronefrosis bilateral. Pasien dilakukan cystoscopy dengan pengambilan sampel biopsi. Hasil patologi anatomi menunjukan gambaran FEP. Diskusi :. Kasus tumor vesica urinaria primer jinak jarang ditemukan dan di antara tumor jinak vesica urinaria, polip fibroepitel dianggap sebagai lesi yang paling umum. Guideline konsensus dalam tatalaksana manajemen optimal tumor FEP masih jarang, saat ini eksisi melalui cystoscopy paling sering digunakan. Modalitas baru dengan menggunakan Laser baik Thalium maupun Holmium. Kesimpulan : FEP merupakan penyakit yang jarang prevalensinya tetapi tetap menjadi diferensial diagnosis pada pasien anak dengan nyeri pinggang dan hematuria.prosedur endoskopik sebagai modalitas penatalaksaan pilihan utama pada pasien FEB.

A gastrointestinal Stromal Tumor of the Small Bowel Presenting as an Acute Peritonitis: A Case Report

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, GISTs of the small bowel presenting as an acute peritonitis are rare, which necessitates emergency surgery. Presentation of Case: A 44-year-old women presented with severe abdominal pain and nausea. Physical examination revealed a tenderness and muscular defense around the lower abdomen. Laboratory data showed an elevated white blood cell count and C-reactive protein level. An enhanced computed tomography (CT) scan showed a 8 × 10 cm cystic mass in the lower abdomen, which contained air. Emergency laparotomy showed a giant perforated tumor that arose from the ileum, the tumor and affected segment of ileum were resected. the tumor was diagnosed as GIST in low-risk category, and imatinib mesylate was initiated, The patiente had an uneventful postoperative course and remains well. Discussion and Conclusion: Such rare cases can be diagnosed and treated properly with careful clinical evaluation, Computed tomography (CT) is the gold standard for imaging that is used to characterize any abdominal mass. Surgical resection is still the first-line treatment for patients with primary localized and resectable small bowel GIST and adjuvant chemotherapy with imatinib mesylate is indicated in patients with high-risk small bowel GIST.

Resuscitative Endovascular Balloon Occlusion of the Aorta in the Management of a Gunshot Wound and Rupture of the Uterus

Trauma is the leading cause of non-obstetrical maternal death. A 19-year-old woman at 20 weeks’ gestation was brought to the emergency room after suffering a gunshot wound to the lower abdomen. Upon arrival, she was hemodynamically stable and imaging was obtained. CT revealed a rupture of the uterus with a partially extrauterine fetus, and the patient was immediately taken for an explorative laparotomy. Prior to the surgical start, the patient’s blood pressure declined and, subsequently, a resuscitative endovascular balloon occlusion of the aorta (REBOA) was placed. The fetus and placenta were delivered and both uterine arteries and the inferior epigastric artery were ligated. Following an unremarkable postoperative course, she was discharged on hospital day 17. The mainstay approach to trauma in pregnancy should be to utilize focused imaging techniques to assess extent of trauma and provide adequate circulation to vital organs. Aortic balloon occlusion may be considered as a viable strategy to enhance resuscitation.

948. Ventricular Assist Device Infection due to Non-tuberculous Mycobacteria Leading to Successful Heart Transplantation: A Case Report and Literature Review

Background A 59-year-old man with acute myelogenous leukemia and matched allogeneic hematopoietic stem-cell transplant and non-ischemic cardiomyopathy requiring a left ventricular assist device (LVAD; HeartMate II™) was admitted after the spontaneous rupture of an abdominal fistula in his lower abdomen, and cloudy discharge from the driveline (DL) exit site for months. Figure 1 Denied systemic symptoms but had leukocytosis. CT scan of the abdomen revealed soft tissue enhancement around the LVAD DL Figure 2. Cultures from DL discharge grew Mycobacterium chelonae. He underwent incision and drainage (I&D) of the abdominal fistula, with unroofing of the tissue over the DL. Antimicrobial course is summarized in Table. He was thought to be an appropriate heart transplant candidate one month later. Cultures from the LVAD sites were negative. He completed antimicrobials for 10 weeks after transplant. 32 months after heart transplant he has no signs of M. chelonae infection. Figure 1. Driveline exit site with scant cloudy discharge and a shallow 3 x 2-centimeter open lesion inferior to the umbilicus. Driveline track in dotted line. Figure 2. CT scan of the abdomen revealed soft tissue enhancement (red arrows) around the LVAD driveline in the lower abdomen. Methods We performed a literature review of all published cases involving Non-Tuberculous Mycobacteria (NTM) and LVADs. Collected: date, sex and age, onset, organism, type of LVAD, transplant, surgical debridement, antimicrobials, outcome. Results A total of 11 patients with LVAD infection due to NTM have been described in the literature. Four cases of NTM LVAD infection culminated in heart transplantation. Cases are summarized in Table 1. All transplanted cases had an indolent presentation and driveline discharge, without systemic symptoms. All underwent I&D and/or de-roofing of the driveline and were treated with at least two active antimicrobials for an extended course ranging from 4 months and up to 17 months after transplant. All cases did well from the infection standpoint. One died within 12 months from transplant rejection. Conclusion Treatment with a combination with at least two active agents is recommended and continued for many months. Effective surgical debridement of affected tissue and unroofing of the driveline beyond the affected velour, along with the removal of the infected device at the time of cardiac transplant, is key to success. Disclosures Susan J. Rehm, MD, Lilly (Individual(s) Involved: Self): Shareholder; Merck (Individual(s) Involved: Self): Shareholder; Pfizer (Individual(s) Involved: Self): Shareholder

Chromobacterium violaceum: A Rare Cause of Urinary Tract Infection

A 41-year-old man with a neurogenic bladder due to spinal cord injury (SCI) attended the outpatient department with chief complaints of fever, pain in the lower abdomen, and persistent hematuria for 10 days. From the urine culture and the microbiological and biochemical tests, the causative organism was identified as Chromobacterium violaceum. The isolate was resistant to cephalosporins, while it was sensitive to ofloxacin, gentamicin, and imipenem. Clinicians should be aware of this rare cause of urinary tract infection (UTI), the choice of antibiotic, length of treatment, and necessity of prompt treatment in SCI patients.