Search

Hysteroscopy is an endoscopic diagnostic and therapeutic method traditionally performed under general anesthesia but increasingly under local anesthesia. Today, it is considered the gold standard in gynecology. This minimally invasive procedure allows for a detailed assessment of the uterine cavity's interior and the removal of abnormal changes within it and is applicable to patients of all ages. Background/Objectives: The purpose of the present study was to evaluate pain during hysteroscopy under local anesthesia at different stages of the procedure, identifying which stage is the most painful (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany). Methods: The study included patients between the ages of 21 and 80 years. They were divided into two groups: the diagnostic hysteroscopy (HD) and the operative hysteroscopy (HO) groups. Pain measurements on the VAS scale were taken at each stage of the hysteroscopic procedure. After each stage, the operator asked the patient to indicate the maximum perceived pain value: after pericervical anesthesia was administered (VAS1), during the installation of equipment (between the removal of the speculum and the insertion of the hysteroscope into the vagina) (VAS2), after insertion of the hysteroscope and visualization of the external orifice of the cervical canal (VAS3), after passage of the hysteroscope through the cervical canal (VAS4), and after completion of the procedure in the uterine cavity (VAS5). The duration of each stage of the procedure was measured with a stopwatch: administration of pericervical anesthesia (T1), time between the removal of the speculum and the insertion of the hysteroscope into the vagina (T2), insertion of the hysteroscope into the vagina until the outer orifice of the cervical canal became visible (T3), passage of the hysteroscope through the cervical canal (T4), and the hysteroscopy procedure itself (T5). Results: The highest pain rating was for the canal passage stage (VAS4: 2.47 ± 2.48 points), followed by the procedure itself (VAS5: 2.12 ± 2.33 points). Anesthesia was also reported as quite painful, while the lowest pain was noted during the assembly stage. Overall pain scores for the entire procedure (VASmax) ranged from 3.5 ± 2.37. Conclusion: In conclusion, we found that the passage through the cervical canal was the most painful moment. Overall, hysteroscopy under pericervical anesthesia was not associated with significant pain. Special attention should be given to postmenopausal patients, as they experience more pain during the passage of the hysteroscope through the cervical canal. This group may benefit from additional pain management strategies during the procedure. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the feasibility and acceptability of office hysteroscopic polypectomy using a new continuous-flow operative 16 Fr Gubbini's mini-resectoscope. This is a prospective clinical study (Canadian Task Force classification III)., Methods: The office hysteroscopic polypectomy was performed with a mini-resectoscope without analgesia or anesthesia. We evaluated the polyp size and the number, the effectiveness of resection, the operating time, the pelvic pain and complications., Results: The office hysteroscopic polypectomy was successfully performed in all 33 patients. The polyps ranged in size from 5 to 50 mm with a mean of 18.15 ± 11.45 mm. We analyzed the operating time with a mean of 11.45 ± 4.71 min: 29 procedures took less than 15 min from the start of vaginoscopy to the end of surgery. Overall mean visual analog scale (VAS) calculated was 2.48 ± 1.37 (range 0-6). The correlation between the size of the polyps and operating time was statistically significant (p < 0.001). No major complications were recorded., Conclusion: Our preliminary data demonstrated that can be possible to remove endometrial polyps by hysteroscopy, using the mini-resectoscope, in an office setting. All procedures were completed successfully and well tolerated with a little discomfort permitting the removal also of big sized polyps without a statistical correlation between VAS and size of polyps or operating time. The outpatient polypectomy is a less-costing procedure and represents an acceptable and effective alternative to inpatient resectoscopic polypectomy, leading to a complete polyp excision in nearly all patients.

Pain accompanying medical procedures can be considered in the "mind-body" problem of accounting for and describing the relationship between mental and physical processes (psyche and soma). Background/Objectives: The purpose of this study is to evaluate the severity of pain among patients undergoing a minihysteroscopy procedure under local anesthesia using the "GUBBINI SYSTEM" (GUBBINI Mini Hystero-Resectoscope; Tontarra Medizintechnik, Tuttlingen, Germany) and to assess the association of various covariates with pain during the procedure, including patient emotional state. Methods: This study included 171 patients admitted to the Center for Hysteroscopy under Local Anesthesia at the Heliodor Święcicki Gynecological and Obstetrical Clinical Hospital of the Karol Marcinkowski Medical University in Poznań, Poland, for hysteroscopic treatment under local anesthesia (paracervical, using lignocaine). The Center for Hysteroscopy is the first certified "CENTER OF EXCELLENCE" of The International Society for Gynecologic Endoscopy (ISGE) in Poland. Results: A positive relationship was observed between alexithymia and its trait of difficulty identifying emotions and pain, as well as between perceived pain and one of the deficits of emotional processing—signs of unprocessed emotion. Conclusions: In conclusion, before the hysteroscopy, adequate information and counseling related to the procedure can effectively reduce the pain and anxiety levels of the women, and nurses can navigate this stressful process. Providing education and counseling to all women undergoing hysteroscopy, and explaining the procedure in detail, should be the preferred approach. [ABSTRACT FROM AUTHOR]

Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the "see and treat" approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through "see and treat" hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aims to comprehensively assess the safety and efficacy of transvaginal morcellation within an enclosed bag in gynecological surgeries, with a focus on its benefits, potential risks, and recommendations for its use., Methods: We conducted a comprehensive search of Epistemonikos, Web of Science, Medline (PubMed), Scopus, and Cochrane databases for studies on transvaginal contained morcellation in adult patients undergoing gynecological surgeries. The review included 22 studies that met the inclusion criteria, encompassing diverse surgical procedures, patient profiles, and outcomes. These studies were thoroughly reviewed and analyzed to assess the safety and efficacy of the morcellation technique., Results: Key findings from the selected studies indicate that transvaginal morcellation within an enclosed bag offers several advantages in gynecological surgeries, including reduced invasiveness, shorter operative times, and minimal blood loss when compared to conventional methods. The risk of tumor recurrence or dissemination appears to be low when appropriate precautions are taken, emphasizing the technique's safety, especially when performed by experienced surgical teams. While some studies reported complications, these were generally not directly associated with the morcellation technique., Conclusion: Transvaginal morcellation within an enclosed bag demonstrates potential as a safe and effective option for gynecological surgeries. The technique offers the benefits of minimally invasive procedures, including reduced bleeding, shorter recovery times, and improved cosmetic outcomes. This review also highlights the need for standardization in study methodologies and reporting, as the heterogeneity in outcomes across the selected studies poses challenges in drawing definitive conclusions., (© 2024. The Author(s).)

Uterine fibromas are the most common benign uterine tumors. Although the majority of leiomyomas remain asymptomatic, they can cause serious clinical problems, including abnormal uterine bleeding, pelvic pain, and infertility, which require effective gynecological intervention. Depending on the symptoms as well as patients' preferences, various treatment options are available, such as medical therapy, non-invasive procedures, and surgical methods. Regardless of the extent of the surgery, the preferred option is the laparoscopic approach. To reduce the risk of spreading occult malignancy and myometrial cells associated with fragmentation of the specimen before its removal from the peritoneal cavity, special systems for laparoscopic contained morcellation have been developed. The aim of this review is to present the state-of-the-art contained morcellation. Different types of available retrieval bags are demonstrated. The advantages and difficulties associated with contained morcellation are described. The impact of retrieval bag usage on the course of surgery, as well as the effects of the learning curve, are discussed. The role of contained morcellation in the overall strategy to optimize patient safety is highlighted. [ABSTRACT FROM AUTHOR]

Endometrial polyps are one of the most common pathological conditions in gynecology. Hysteroscopy is the gold standard for the diagnosis and treatment of endometrial polyps. The purpose of this multicenter, retrospective study was to compare patients' pain perception during an operative hysteroscopic endometrial polypectomy in an outpatient setting with two different hysteroscopes (rigid and semirigid) and to identify some clinical and intraoperative characteristics that are related to worsening pain during the procedure. We included women that underwent, at the same time as an diagnostic hysteroscopy, the complete removal of an endometrial polyp (using the see-and-treat strategy) without any kind of analgesia. A total of 166 patients were enrolled, of which 102 patients underwent a polypectomy with a semirigid hysteroscope and 64 patients underwent the procedure with a rigid hysteroscope. No differences were found during the diagnostic step; on the contrary, after the operative procedure, a statistically significant greater degree of pain was reported when the semirigid hysteroscope was used. Cervical stenosis and menopausal status were risk factors for pain both in the diagnostic step and in the operative one. Our results confirm that operative hysteroscopic endometrial polypectomy in an outpatient setting is an effective, safe, and well-tolerated procedure and indicate that it might be better tolerated if a rigid rather than semirigid instrument is used. [ABSTRACT FROM AUTHOR]

Background: Vaginally assisted laparoscopic sacrocolpopexy (VALS) refers to the placement of synthetic meshes through the vagina in addition to traditional laparoscopic sacrocolpopexy. In this study, we aimed to investigate the medium- to long-term efficacy and safety of VALS for treating stage III–IV pelvic organ prolapse (POP). Methods: The study was designed as a case series at a single center. Patients with stage III–IV POP in our hospital from January 2010 to December 2018 were included. Perioperative parameters, objective and subjective outcomes, and complications were assessed. Results: A total of 106 patients completed the follow-up and were included in our study. Within a median follow-up duration of 35.4 months, the objective cure ratio of VALS reached 92.45% (98/106), and the subjective success rate was 99.06% (105/106). Patients reported significant improvements in subjective symptoms. In eight patients suffering anatomic prolapse recurrence, two posterior POP cases were treated by posterior pelvic reconstruction surgery, while six anterior POP cases did not need surgical therapies. The reoperation rate was 1.89% (2/106). No intraoperative complications occurred. Three patients (2.83%) had postoperative fever, and one (0.94%) had wound infection during hospitalization. Six patients (5.66%) had mesh exposure on the vaginal wall, and de novo urinary incontinence occurred in two patients (1.89%) during the follow-up period. Conclusion: VALS is an effective and safe surgical method for treating severe POP. Therefore, VALS should be considered in the treatment of severe POP due to its favorable subjective and objective outcomes, relatively low rate of infection and acceptable rate of mesh exposure. [ABSTRACT FROM AUTHOR]

Copyright of Bibliothecae.it is the property of University of Bologna and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The main barriers to 'vulnerable migrants' receiving good quality primary care are language and administration barriers. Little is known about the experiences of healthcare discrimination faced by migrants from different cultural groups. The aim was to explore vulnerable migrants' perspectives on primary healthcare in a UK city. Methods: Three focus groups and two semi-structured interviews were aided by interpreters. These were analysed against a pre-developed framework based on national standards of care for vulnerable migrants. Recruitment was facilitated via a community organisation. Results: In total, 13 participants took part, six women and seven men. There were five Arabic speakers, four Farsi speakers and four English speakers. Themes included access to primary care, mental health, use of interpreters, post-migration stressors and cultural competency. Conclusion: Vulnerable migrants perceived high levels of discrimination and reported the value of a respectful attitude from health professionals. Appointment booking systems and re-ordering medication are key areas where language barriers cause the most disruption to patient care. Medication-only treatment plans have limitations for mental distress for this population. Community-based therapies which manage post-migration stressors are likely to enhance recovery. [ABSTRACT FROM AUTHOR]

Copyright of Comunicação e Sociedade is the property of Universidade do Minho, Centro de Estudos de Comunicacao e Sociedade and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany.Methods: This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)).Results: Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied.Conclusions: The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers. [ABSTRACT FROM AUTHOR]

Background: Somatic and psychopathological conditions (e.g., anxiety, depression, post-traumatic stress disorder, and somatization) are frequent among immigrants belonging to various ethnic groups. Worldwide findings on the epidemiology regarding specific mental conditions still vary with respect to different migration samples and migration contexts. This inconsistency also holds true in the incidence of somatization among migrants. We carried out a systematic review analyzing the relationship between migration and somatization by providing a qualitative data synthesis of original research articles on the topic. Methods: According to PRISMA guidelines, we conducted a systematic search of the literature on PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. The articles were selected using multiple combinations of relevant search terms (e.g., defined somatization and related disorders, and migration status). Each database was searched systematically from January 2000 to December 2017. Results: The initial search identified 338 records, of which 42 research reports met the predefined inclusion criteria and were analyzed. Most studies (n = 38; 90%) were cross-sectional. The main findings of this study are that migrants with somatization exhibited more psychological distress, had an increased perceived need for healthcare service utilization, and reported more post-migration living difficulties and/or post-traumatic stress disorder than those without somatization. It was also found that specific individual features mediate the association between somatization and migration. The prevalence and correlates of somatization were found to vary across the immigrant groups, depending on cultural variation in reasons for migration, stress exposure, explanatory models of illness, coping, and other individual variables. Conclusion: Somatization is a challenge for health professionals due to its vague nature. In this regard, clinical management of immigrant patients should include further efforts to address emotional distress, with special attention to social, cultural, and linguistic differences. [ABSTRACT FROM AUTHOR]

Summary: Objective: Functional neurological disorders (FNDs) and psychogenic nonepileptic seizures (PNES) are likely as common in Sub‐Saharan Africa (SSA) as in the rest of the world, but there is a dearth of literature on the epidemiology and clinical presentation of these disorders in Africa. The purpose of this paper is to describe a case series of FNDs presenting to a referral hospital in SSA. In addition, we review the existing literature on FNDs in Africa. Methods: A hospital‐based retrospective cross‐sectional study was conducted to determine the prevalence, epidemiology, and clinical phenotype of FNDs and PNES in a referral hospital in Northern Tanzania over a 6‐year period (2007–2013). Results: Of 2,040 patients presenting with neurological complaints, 44 (2.2%) were diagnosed with FNDs. Half (n = 22) had the clinical presentation of PNES. Age of presentation for FNDs and PNES peaked in the teen years 12–19 (n = 21 48%; and n = 14, 63%, respectively), and the majority were female (n = 30, 68%; and n = 14, 63%, respectively). The majority presented acutely with short‐lived and self‐limiting symptoms (only 2 recurrent cases). Literature review revealed multiple reports of "mass hysteria" in SSA often meeting the clinical criteria of epidemic FNDs. Significance: FNDs and PNES occur in Africa with age and gender distribution comparable to that found elsewhere. Although the percentage of FND cases overall was relatively low (2.2%), it is likely to be an underestimate because not all cases were recorded, and cases may be appropriately managed locally before patients are referred to a hospital. PNES was the most common phenotype of FNDs reported, and the African phenotype may be short‐lived and self‐limiting rather than chronic and recurrent, as reported elsewhere in the world. PNES presentations may also occur in clusters, which may have cultural significance in Africa. FNDs in Africa appear to be underreported, particularly over the last 30 years. [ABSTRACT FROM AUTHOR]

Purpose: This review covers the most recent evidence to discuss the incidence of occult uterine sarcoma, whether morcellation increases tumor dissemination or mortality, and whether there is a difference between different types of morcellation. We will also discuss techniques to reduce the spread of an undiagnosed uterine sarcoma.Method: A comprehensive literature search was made in Pubmed, Medline, the Cochrane Library, and Google Scholar for articles related to the incidence of occult uterine sarcoma after morcellation.Results: Fibroids are benign uterine tumors and are a common indication for gynecologic surgery. Increasingly, gynecologists are approaching these surgeries with minimally invasive techniques. Uterine sarcomas are rare malignant mesenchymal tumors that are difficult to distinguish preoperatively from uterine fibroids.Conclusion: During a minimally invasive surgery, there is a risk of disseminating an occult sarcoma during tissue extraction. Minimally invasive gynecologists are tasked with balancing taking a minimally invasive approach, which is shown to result in better patient outcomes, with minimizing the risk of spreading an occult sarcoma. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy.Materials and Methods: The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation.Results: Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation.Conclusion: The experiences from our small pilot series prove technical feasibility in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: Mini-hysteroscopy is believed to be pain-free or in the least bearable. Office procedures are therefore usually performed without analgesia or anesthesia. Is it indeed as tolerable as papers and authors suggest?Objectives: To estimate what proportion of women reports moderate to severe discomfort during examination using the smaller diameter scopes.Search Strategy: Online sources were search with key words "hysteroscopy" and "pain" from 2000 to December 2014. Thirty-five articles were retrieved for detailed analysis.Selection Criteria: Randomized controlled trials (RCT) and well-designed prospective trials (PT) studying pain as main outcome, in office mini-hysteroscopy in at least one arm. Studies or arms within a study where conscientious sedation, anesthesia, or non-steroidal drugs were used were excluded. Chosen data collected was the number of women referring moderate to severe pain compared to total women with intervention in the arm or study. Authors were contacted to try to retrieve unpublished data for analysis.Data Collection and Analysis: We performed a meta-analysis from eight studies (six RCT and two PT) comparing pain reported as moderate or severe to total women in mini-hysteroscopy.Main Results: A meta-analysis estimated the pooled prevalence of pain (>3-10 on 10 cm visual analog scale) for all studies and by two subgroups: (1) RCT and (2) PT. Due to significant heterogeneity between studies, we used the random effects model. Results revealed a high prevalence of pain in outpatient mini-hysteroscopy.Conclusions: Office mini-hysteroscopy is painful. [ABSTRACT FROM AUTHOR]

Introduction: Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures.Material and Methods: The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies.Results: The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64-21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256).Conclusion: Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: An estimated 2.7 million Latin Americans reside in Europe, mostly in Spain. Part of a broader project aimed at developing a research agenda on the health status and determinants of this population, this qualitative study engaged Latin American migrants in the identification of research priorities. Methods: We conducted 30 group discussions between November 2012—March 2013 with 84 participants purposively selected for maximum diversity in Madrid and Barcelona (Spain). We facilitated sequences of task-oriented visual activities to explore their views on priority health concerns. We tape-recorded and transcribed discussions and developed a coding frame based on socio-ecological frameworks, which we applied to all the data using NVIVO-10. A final round of eight group discussions allowed us to triangulate and enrich interpretations by including participants’ insights. Findings: The cumulative toll of daily stresses was the major health concern perceived by a population that conceptualised ill-health as a constellation of symptoms rather than as specific diseases. Work-related factors, legislative frameworks regulating citizenship entitlements and feeling ethnically discriminated were major sources of psycho-social strain. Except for sexually transmitted infections, participants rarely referred to communicable diseases as a concern. The perception that clinicians systematically prescribed painkillers discouraged health seeking and fostered self-medication. Participants felt that the medicalised, chemicalised, sexually liberal and accelerated culture of the host society damaged their own, and the local populations’ health. Conclusion: Health systems bear a disproportionate responsibility in addressing health problems rooted in other sectors. Occupational and migration policies should be recognised explicitly as health policies. The mismatch between researchers’ emphasis on communicable infections and the health concerns of Latin American migrants highlights the need for greater interaction between different forms of knowledge. In this process, the biomedical culture of reliance on pharmacological solutions should not remain unquestioned. [ABSTRACT FROM AUTHOR]

Background: Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry. Methods: We identified systematically papers that addressed the concepts "health" and "Hispano Americans" indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process. Results: Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered "Hispano-Americans" as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed. Conclusions: Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe. [ABSTRACT FROM AUTHOR]

The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries. [ABSTRACT FROM AUTHOR]

Purpose: Somatization is a common symptom among the elderly, and even though personality disorders have been found to be associated with somatization, personality traits have not yet been explored with regard to this symptom. The aim of this study is to investigate the relationship between personality traits and somatization, and social inhibition. Patients and methods: As part of a cross-sectional study of a community sample, 126 elderly Thais aged 60 years or over completed self-reporting questionnaires related to somatization and personality traits. Somatization was elicited from the somatization subscale when using the Symptom Checklist SCL-90 instrument. Personality traits were drawn from the 16 Personality Factor Questionnaire and social inhibition was identified when using the inventory of interpersonal problems. In addition, path analysis was used to establish the influence of personality traits on somatization and social inhibition. Results: Of the 126 participants, 51% were male, 55% were married, and 25% were retired. The average number of years in education was 7.6 (standard deviation =5.2). "Emotional stability" and "dominance" were found to have a direct effect on somatization, as were age and number of years in education, but not sex. Also, 35% of the total variance could be explained by the model, with excellent fit statistics. Dominance was found to have an indirect effect, via vigilance, on social inhibition, which was also influenced by number of years in education and emotional stability. Social inhibition was not found to have any effect on somatization, although hypothetically it should. Conclusion: "Emotional stability", "dominance", and "vigilance", as well as age and the number of years in education, were found to have an effect on somatization. Attention should be paid to these factors in the elderly with somatization. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study is to determine the perioperative outcomes of minimal invasive sacrospinous ligament suspension (SSLS) in women with apical prolapse. Methods: This prospective randomized study included 1,464 patients for a 10-year period. SSLS was performed by Deschamps ligature carrier at 762 patients (Group 1) and automatic suturing instrument was applied at 702 patients (Group 2). Patients' perioperative complications, blood loss, operative time, and hospital stay were recorded. Results: Suturing took 46 s (range 31-63 s) in Group 2 and 775 s (range 585-965 s) in Group 1. Group 2 patients had shorter time for suturing process, less postoperative analgesic requirement, and shorter hospital stay ( p < 0.0001, p < 0.01, p < 0.01, respectively). Also there were no bladder, ureteral, rectum or nerve injuries in Group 2. Conclusion: Minimally invasive SSLS is a reliable procedure with less procedural complications, reduced postoperative pain, less hospital stay and shorter operation times. [ABSTRACT FROM AUTHOR]

The current ‘gold standard’ surgical repair for apical prolapse is the abdominal mesh sacrocolpopexy. Use of a robotic-assisted laparoscopic surgical approach has been demonstrated to be feasible as a minimally invasive approach and is gaining popularity amongst pelvic floor reconstructive surgeons. Although outcome data for robotic-assisted sacrocolpopexy (RASC) is only just emerging, several small series have demonstrated anatomic and functional outcomes, as well as complication rates, comparable to those reported for open surgery. The primary advantages thus far for RASC over open surgery include decreased blood loss and shorter hospital stay. [ABSTRACT FROM PUBLISHER]

Background. Rectocele is a common finding in patients with intractable evacuatory disorders. Although much rectocele surgery is conducted by gynecologists en passant with other forms of vaginal surgery, many reports lack appreciation of the importance of coincident anorectal symptoms, and do not report functional and clinical outcome data. The pathogenesis of rectocele is still controversial, as is the embryological and anatomical importance of the rectovaginal septum as well as recognizable defects in its integrity and its relevance in formal repair when rectocele is operated upon as the principal condition in patients with intractable evacuatory difficulty. Discussion. The investigation and surgical management of rectocele is controversial given the relatively small numbers of operated patients in any single specialist unit and the relative lack of prospective data concerning functional outcome in operated cases. The imaging of rectocele patients is currently in a state of change, and the newer diagnostic modalities including dynamic magnetic resonance imaging frequently display a multiplicity of pelvic floor disorders. When surgery is indicated, coloproctologists most commonly utilize an endorectal defect-specific repair, but there are few controlled randomized data regarding outcome and response criteria of specific symptoms with particular surgical approaches. A Medline-based literature search was conducted for this review to assess the clinical results of defect-specific rectocele repairs using the endorectal, transvaginal, transperineal, or combined approaches. Only the studies are included that report both pre- and postoperative symptoms including constipation, evacuatory difficulty, pelvic pain, the impression of a pelvic mass, fecal incontinence, dyspareunia or the need for assisted digitation to aid defecation. Conclusion. The history of rectocele repair, its clinical and diagnostic features and the advantages, disadvantages and indications for the different surgical techniques are presented in this review. Suggested diagnostic and surgical therapeutic algorithms for management have been included. It is recommended that a multicenter controlled randomized trial comparing surgical approaches for symptomatic evacuatory dysfunction where rectocele is the principal abnormality should be conducted. [ABSTRACT FROM AUTHOR]

Introduction: To assess intra- and postoperative complications and to look for long term follow-up results in women with sacrospinous ligament fixation.Methods: Between 1988 and 1999, 200 women (mean age 59.8 years, range 33 to 83 years) underwent vaginal unilateral sacrospinous ligament fixation. 172 patients had had prior hysterectomy. In 28 patients concomitant hysterectomy and sacrospinous ligament fixation was performed. Sacrospinous ligament fixation was combined with the following procedures: 109 enterocele repairs (54.5%), 88 anterior colporrhaphies (44%), 57 reconstructions of urogenital diaphragma (28.5%) and 23 posterior colporrhaphies (11.5%). Additional Burch colposuspension and a Stamey procedure were carried out in 7 (3.5%) and 15 (7.5%) patients, respectively.Results: All 200 patients were analysed for intra- and postoperative complications. Urinary tract infection (n = 16, 8.0%), temporary irritation of the sciatic nerve (n = 15, 7.5%), temporary partial ureteral obstruction (n = 11, 5.5%) and blood loss less than 400 ml (n = 7, 3.5%), occurred in the postoperative phase. Long-term data (range from 6 months to 9 years, mean 4.8 years) exist for 123 patients. 119 were completely cured without any signs of urinary incontinence and prolapse. At follow-up 4 patients (3.25%) showed recurrent vaginal vault prolapse. Recurrent cystoceles, rectoceles, enteroceles, were found in 10 cases (8.1%), one (0.8%) and one (0.8%), respectively. Two patients with complete recurrence of vaginal vault prolapse successfully underwent colpectomy and repeated sacrospinous ligament fixation, respectively. CONCLUSIONS. Sacrospinous ligament fixation is an effective and safe procedure with a low recurrence and complication rate. [ABSTRACT FROM AUTHOR]

Copyright of Acta Neurochirurgica is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The process of international migration causes a situation of vulnerability in people's health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations. [ABSTRACT FROM AUTHOR]