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Introduction: It is unheard of in the present day to cure prolapse without the use of medication by using plastic balls. A 70-year-old woman who has been 20 years into menopause and visited our OPD complaining of foul-smelling vaginal discharge. In addition, she occasionally had lower abdominal pain and social humiliation because of the offensive odor. There were no evident vulval/cervicovaginal growths or uterovaginal prolapses identified, and there was no history of fever or vaginal hemorrhage. On per speculum and per vaginal examination, a ring-shaped foreign body with a diameter of around 8 cm followed by a ball of 12 cm diameter was visualized and felt. She described an insertion that had been performed 20 years prior as prolapse therapy. There was no trauma associated with the removal of the foreign body. Following that, she received supportive care and a cautious approach to management. Conclusion: Gynecologist ought to be mindful of this and understand how it is extracted. [ABSTRACT FROM AUTHOR]

Background: Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy. Methods: In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively. Results: The median follow-up duration after colostomy was 12.5 months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61–46.72; p = 0.012) and having a thin rectus abdominis penetration of the stoma (< 8.9 mm; OR, 8.22; 95% CI, 2.50–27.05; p < 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development. Conclusions: Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP. [ABSTRACT FROM AUTHOR]

Background: A common complication of bicanalicular intubation is dislocation of the silicone tube. Methods: Eleven patients with prolapsed silicone tubes who had undergone bicanalicular nasal intubation were injected with a 2 per cent lidocaine solution to infiltrate the lacrimal duct mucosa. A memory wire probe was used to pull a 4-0 suture through the lacrimal passage retrogradely, allowing the suture to grab the silicone tube. Paraffin oil was applied to the contact part of the rope and the silicone tube, then the distal end of the silk thread was removed from the nostril until the tube was pulled into place. Results: The prolapsed silicone tubes were restored by surgery in nine patients, with the drainage tube in the correct position in the eye and the lacrimal duct irrigation unobstructed. Conclusion: The optimisations made in this study are considered effective adjustments of reduction surgery for a prolapsed silicone tube. [ABSTRACT FROM AUTHOR]

Background: Accidental injuries sustained during helocasting remain unexamined. Methods: Conditions prevalent during a helocasting exercise performed at a still water body and the resulting casualties were analyzed. Results: Despatch from greater-than-ideal height (>7 m) and speed (>5 knots) causes a high-velocity impact of the body with water in a non-aerodynamic configuration, exposing maximal body area at penetration. The brunt is borne by the torso/back, specifically, the lungs, ribs, and posterior aspect of the spine. The injuries result from direct trauma, sudden deceleration, barotrauma, and hyperflexion. Computerized tomography (CT) is the imaging of choice in the assessment of these injuries. Prompt evacuation to an equipped center, whilst stabilizing the spine in the suspected, proves pivotal to the outcome. Conclusions: Adverse slamming dynamics cause accidental injuries in helocasting. Thorax and spine are predominantly traumatized, both directly and indirectly, and are assessed best using CT. Timely spine stabilization and evacuation prove vital. Accurate assessment of height/ speed and adherence to their ideal limits, at despatch, may avert such injuries. [ABSTRACT FROM AUTHOR]

Objective • This study was to analyze and compare the clinical efficacy of open reduction and internal fixation through posterolateral and the posterior medial approach to treat Haraguchi Type II posterior malleolar fracture. Methods • The clinical data of 91 patients with trimalleolar fractures sent to our hospital from January 2018 to January 2020 were analyzed. All of the patients were the result of traumatic injuries, such as sprains or car accidents. All patients were treated with open reduction and internal fixation and divided into control group and observation group according to different surgical approaches. Forty-five cases were treated with the posterolateral approach(control group) and forty-six cases treated with the posteriormedial approach(observation group) . The operation status of the two groups (operating time, intraoperative blood loss, postoperative drainage, and hospital stay), postoperative status (visual analogue scale (VAS) before the operation, 1d, 3d and 7d after operation), the score of patient’s American orthopedic foot and ankle society (AOFAS) at the time of discharge, fracture healing time and full weight-bearing time), efficacy and safety were recorded. Results • All cases underwent surgery, with no significant difference in the time from fracture to surgery between the control and observation groups (P > .05). Compared to the control group, the operating time, intraoperative blood loss, postoperative drainage, and hospital stay in the observation group were significantly reduced (P < .05). One day after the operation, no significant difference was shown in VAS between 2 groups (P > .05), while AOFAS score in the observation group was significantly increased (P < .05). Three and 7 days after the operation, VAS, fracture healing time, and full weight-bearing time were significantly decreased in both groups (P < .05). In the control group, the cases with excellent, good, fair, and poor efficacy were 26, 8, 5, 6, with an acceptable rate of 86.67% (39/45). In the observation group, the cases with excellent, good, fair, and poor efficacy were 29, 10, 5, and 2, with an acceptable rate of 95.65% (44/46). There was no significant difference in efficacy between the 2 groups (P > .05). During the follow-up time of 12~27 months (the median time of 18.5 months), all patients showed first-stage grade A healing, and osseous union with good fixation position and no fracture, deformation, loosening or prolapse, and no sural nerve injury or incision infection occurred. Conclusion • Both the posterolateral approach and posterior medial approach open reduction and internal fixation can be used to treat Haraguchi type II posterior malleolus fractures, with good efficacy and safety. The posterior medial approach showed faster recovery and less damage than the posterolateral approach. Overall, the posterolateral approach is more dominant in the treatment of Haraguchi Type II posterior malleolar fracture. [ABSTRACT FROM AUTHOR]

Objectve: Functional endoscopic sinus surgery is primarily aimed at restoring the natural physiology of the paranasal sinuses to achieve efective mucociliary clearance and proper ventilation. This can be hindered by various factors, including host-related, environmental, and iatrogenic factors. Preservation of the sinus mucosa is fundamental for the success of the surgery. Sinus mucosal prolapse, resulting from intraoperative mucosal trauma, can lead to sinus ostium obstruction and impaired drainage. Methods: In this pilot study, the authors describe a novel technique for the intraoperative management of sinus mucosal prolapse arising from endoscopic sinus surgery. This method entails the use of a balloon catheter expander to infate and support the maxillary sinus mucosa, thereby limiting the occurrence of preventable prolapse-related complications. Results: The authors applied this surgical technique to a cohort of 11 patients. All patients developed prolapse afecting the posterosuperior region of the maxillary sinus mucosa. Each patient was followed up for at least 3 weeks following the surgery, and endoscopic assessment postoperatively revealed absent mucosal prolapse in all patients, highlighting the success and positive outcomes of the technique. The sinus mucosa retained its appropriate positioning, efectively draping the sinus wall in uninterrupted continuity with the maxillary antrostomy. Conclusion: The authors advocate the use of a Foley catheter as a cost-efective and readily available alternative to the traditional balloon sinus catheter expander. [ABSTRACT FROM AUTHOR]

Introduction: When performed by a skilled provider appropriately, induced abortion is a very safe medical procedure. However, a series of complications such as uterine perforation can still occur rarely. Case presentation: We present a case of tinea coli evisceration through a uterine perforation that occurred during a manual vacuum aspiration (MVA) procedure for uterine evacuation. The case presented with crampy lower abdominal pain 2 days after she had an MVA procedure for an incomplete abortion. The diagnosis of uterine perforation was considered on ultrasonography (USG) examination. Explorative laparoscopy was subsequently done and a posterior uterine wall perforation of ~2 cm was identified. A tinea coli of the sigmoid colon was seen sucked into the uterus through the perforation but no wall of the colon was lacerated or sucked in. The tinea coli was pulled out and the uterine defect was repaired laparoscopically. Conclusion: This unique case, the first of its kind to be reported to our knowledge, could be a reminder to consider tinea coli evisceration in suspected uterine perforation but without typical manifestations of bowel injury. [ABSTRACT FROM AUTHOR]

Women with symptomatic pelvic organ prolapse are offered a choice of conservative and surgical treatment options. Two thirds of women choose a vaginal pessary, a support device inserted in the vagina. This article reports the finding of a randomized controlled trial published in 2023 evaluating the cost-effectiveness of self-management of pessary compared to clinic-based care. Women were recruited in 21 centres across the UK and 340 women were randomized to pessary self-management or clinic-based care. The primary outcome measure was prolapse-specific quality of life and secondary outcomes were generic quality of life, pelvic floor symptoms, sexual function, self-efficacy, pessary complications, pessary use and pessary confidence. Participants' health care resource use was measured. The trial showed that at 18 month follow-up self-management was not associated with better or worse quality of life than clinic-based care. Women in the self-management group reported fewer pessary complications and lower healthcare resource use. [ABSTRACT FROM AUTHOR]

We describe the case of a male heavy machinery operator who presented from work with a rapidly evolving spinal cord syndrome. Spinal MRI revealed thoracic vertebral body and cord infarction and evolving mild disc prolapse attributed to fibrocartilaginous disc embolism (FCDE). FCDE should be considered as one of the aetiological mechanisms of acute spinal cord infarction in pile-driver/heavy machinery operators, especially in association with adjacent vertebral body infarction and intervertebral disc prolapse. Magnetic resonance imaging (MRI) changes may evolve, warranting early follow-up MRI in appropriate cases. [ABSTRACT FROM AUTHOR]

Background: Coatis are mammals of the order Carnivora, Procyonidae family. Despite the animals being widely distributed in Brazil, the species is classified as threatened in the Rio Grande do Sul state. The main threat factor for the species is deforestation and fragmentation of forests, as well as hunting and being run over on highways. Captivity coatis are subject to nutritional disorders, with adipose tissue accumulation in the abdominal region and obesity. In addition, procionids can present ectoparasites, such as fleas, lice, and ticks. Since there is a lack of information regarding diseases in captivity animals, this report aimed to describe a case of rectal prolapse in a coati. Case: An approximately 2-year-old captivity ring-tailed coati (Nasua nasua) male, 1.7 kg of body mass, was restless and uncomfortable when sitting down after fighting with other animals in the group. Physical examination revealed a 5 cm prolapse, initially managed by manual reduction and purse-string suture around the anus. The copro-parasitological exams using the Willis-Mollay and Faust techniques were negative. Complete blood count showed mild normochromic normocytic anemia, hypoproteinemia, thrombocytopenia, and leukocytosis due to neutrophilia and monocytosis. Biochemical examination revealed hypocalcemia, and the animal was treated with calcium. Rectal prolapse recurred even after the purse-string suture. Therefore, incisional colopexy was performed through a ventral midline celiotomy to promote a permanent adhesion between the colon and abdominal wall. The animal evolved uneventfully and returned to its original enclosure 30 days after surgery. However, the coati was kept separate from the others until complete readaptation. In the last evaluation 6 months after colopexy, the animal showed no signs of recurrence and had a total integration into the group. Discussion: Several factors may contribute to the development of complete rectal prolapse in domestic dogs and cats, such as prostatic diseases, cystitis, urolithiasis, constipation, rectal foreign bodies, and perineal surgeries. However, these factors have not been identified in the current case. Furthermore, the lesion may occur secondary to colitis, enteritis, or endoparasitism in young domestic dogs and cats. In the present case, the animal was an adult whose coproparasitological examination was negative, eliminating these causes. On the other hand, 2 factors may have contributed, including the fight with other individuals of the same species and hypocalcemia. Although these 2 factors resolved with the separation of the animal and calcium replacement treatment, the prolapse recurred even after the purse-string suture. It is also worth mentioning that the animal had no clinical signs related to hypocalcemia, which is associated with several diseases in domestic dogs and cats, including traumatic processes. Colopexy was the 2nd treatment option in the current case. The technique promotes a permanent adhesion between the colon and abdominal wall, thus preventing caudal movement of the colon and rectum. Colopexy has been used in domestic dogs and cats with recurrent rectal prolapse without the identification of predisposing factors, which include the present case. In conclusion, the present case showed a good evolution of the incisional colopexy technique in the recurrence of rectal prolapse in the ring-tailed coati, whose underlying cause could not be established. To the best of the authors' knowledge, this is the 1st report of the condition in coatis. [ABSTRACT FROM AUTHOR]

The purpose of the present study aims to describe 16 clinical cases of pet lizards with hemipenile prolapse - 11 leopard geckos (Eublepharis macularius), 3 chameleons (2 Chamaeleo calyptratus and 1 Furcifer pardalis), and 2 bearded dragons (Pogona vitticeps). After an unsuccessful attempt of manual repositioning of the everted hemipenes, unilateral or bilateral surgical amputation was performed to avoid future complications. All patients were anesthetized with a combination of medetomidine hydrochloride and ketamine hydrochloride. In the bearded dragons, a local block with lidocaine hydrochloride was additionally used. The authors' clinical experience with this surgical procedure confirmed the view that the hemipenectomy is an appropriate attempt in hemipenile prolapse in pet lizards from the Eublepharidae, Chamaeleonidae, and Agamidae families. [ABSTRACT FROM AUTHOR]

Background: Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression. Case presentation: A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset. Conclusion: This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required. [ABSTRACT FROM AUTHOR]

Although dextrocardia is a rare congenital anomaly, it may be accompanied by numerous pathologies. Tricuspid valve prolapse is an extremely uncommon cause of primary tricuspid valve disease, as is its association with dextrocardia. In this instance, we wished to share our knowledge of tricuspid commissural prolapse together with dextrocardia, which we augmented with 3D images. [ABSTRACT FROM AUTHOR]

Background: Hemorrhoidal problems are common causes of patient complaints. Most of the hemorrhoid-related issues can be managed conservatively; however, some patients with grade III and IV hemorrhoids are referred for surgical management. Several techniques including classic hemorrhoidectomy and dearterialization with or without Doppler guidance have been described. Although not as frequently performed, the Whitehead procedure remains occasionally utilized. Objectives: The goal of this study is to assess the short- and long-term outcomes of the Whitehead procedure in comparison to the Milligan–Morgan procedure. Design: Retrospective review. Patients and Methods: A review of all patients undergoing surgical treatment for grade III and IV hemorrhoids at 7th city hospital in Kyiv, Ukraine, between 2015 and 2021 was conducted. The rates of perioperative complications of the Whitehead procedures and overall outcomes were compared to the Milligan–Morgan techniques. Main Outcome Measures: Primary outcome included postoperative pain and secondary outcomes included short- and long-term postoperative complications. Sample Size: Three hundred and twenty-three patients were included in the study. Results: One hundred and seventy-three patients underwent the Whitehead procedure and 140 patients underwent the Milligan–Morgan procedure. There was no difference in age, sex, and comorbidities between the groups. There were no statistical differences between short-term complications, but the Whitehead group experienced less pain throughout the 14 days after surgery. All the patients were seen and examined 6 months after surgery; the patients who underwent the Whitehead procedure showed less prolapse when compared to those in the Milligan–Morgan group without increase in other complications. Conclusions: Whitehead hemorrhoidectomy is safe and shows less pain during recovery without remarkable increase in long-term complications. Limitations: This was a retrospective review and non-validated instruments were used in surveys. Conflict of Interest: The authors have no conflict of interest to declare. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to compare the use of unilateral apical sling versus laparoscopic sacrocolpopexy in the treatment of the apical form of pelvic organ prolapse in women. Material and methods:A prospective, single-center randomized trial included 100 patients who were alternately assigned to treatment. Each patient had a ≥ III stage of apical or anterior-apical prolapse determined by the POP-Q system. 45 accepted for unilateral apical sling (UAS) and 55 accepted for laparoscopic sacrocolpopexy (LS). Data were compared by the One-way ANOVA test using IBM SPSS stats 19. Results: Mean operating time was significantly greater in the LS group versus UAS group, 194.6 vs 42.4 minutes, respectively (p < 0.05). The amount of intraoperative bleeding was significantly higher in the UAS group, compared to the LS group (p = 0.01). Within the follow-up period, 2 patients in UAS group and 3 patients in LS group (4.4% vs 5.4%, respectively; p = 0.9) had recurrent cystocoele. HRQoL and sexual outcomes did not differ significantly between the two treatment groups. Conclusions: Our data demonstrate the non-superiority one on each other of the two different approaches, except in terms of shorter operating time and higher intraoperative bleeding when UAS used. These findings raise questions about the need for long-term results of quality of life outcomes for women with genital prolapse, especially in resource-limited settings similar to Kazakhstan. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the presence of defects in the pelvic muscles, muscle configuration, and the relationship of pelvic organs using magnetic resonance imaging (MRI) in women with apical pelvic organ prolapse (POP), and compare these findings with measurements from women without POP. Materials and Methods: The study analyzed computer-based medical records of patients diagnosed with POP prolapse at İzmir Bakırçay University Çiğli Training and Research Hospital between March 2022 and May 2023. Forty-five patients diagnosed with apical POP were matched with 45 patients of the same age group without prolapse. Pelvic MRI images of all patients were examined, and the pubococcygeal line, H line, and M line were marked. Additionally, measurements of the uterocervical angle, genital hiatus width, obturator internus muscle area, and levator ani defect were assessed. Results: The demographic characteristics of patients with POP were similar to those in the control group. There were no statistical differences in the POP group regarding pubococcygeal distance, genital hiatus length, vaginal length, uterocervical length, and puborectal distance (H). The presence of unilateral and bilateral levator ani muscle defects was more common in the POP group (p=0.02 and p=0.03). The obturator internus muscle area was lower in the POP group compared to the control group (1770±293.4 mm² vs. 2104±303.5 mm², p=0.02). M length was higher in women with POP (27.3±5.8 mm vs. 15±4.2 mm, p=0.02). Conclusion: MR images revealed defects in pelvic floor muscles and descent of pelvic organs in patients with POP. MRI has the potential to become a standard preoperative examination for pelvic floor abnormalities, assisting in surgical planning. [ABSTRACT FROM AUTHOR]

The most common predisposing factor for low back pain is a prolapsed lumber intervertebral disc. It is the most prevalent symptom in the modern population, albeit it was formerly the ancient curse of society, and it affects 80% of the population at some time in their lives. The goal of this study was to assess the efficacy of physiotherapy versus surgery for patients with prolapsed intervertebral disc. A thorough search of Medline, Embase, CINAHL, CENTRAL, and PEDro was done. Randomized control trial and prospective cohort study relevant to physiotherapy versus surgery, physiotherapy management alone, surgery among the lumbar disc herniation patients were included. Studies that were written in English and came out between 2006 and 2018 were enlisted using inclusion criteria. For screening, identified similar types of articles, avoid duplicate articles, and finally compare and contrast 5 articles. In the short-term, according to the majority of the articles, surgery was more beneficial than conservative treatment. However, there was no discernible difference between physiotherapy and surgery after a long period of observation, and the re-operation rate after surgery was 3%-20% within the first 1-2 years. Physiotherapy intervention had no adverse effects, whereas surgery had some adverse effects. In all circumstances, physiotherapy intervention is more effective than surgery. Physiotherapy interventions should be prescribed in a structured way. [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]

Objectives: As in Greek settings there is a need to develop validated patient-reported outcomes (PROs) for pelvic floor dysfunction, this study's aim was to cross-culturally adapt and validate the Australian Pelvic Floor Questionnaire (APFQ) into Greek, a 42-item PRO for routine urogynaecological evaluation of four domains; bladder, bowel, prolapse and sexual function.Study Design: Cross-cultural translation was completed through official multistage forward and back-translation process. Validation involved administering the adapted APFQ (APFQ_GR) to women visiting Greek community-based healthcare settings. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was also administered. Comparison between women with and without pelvic floor dysfunction (symptomatic versus control) was also undertaken for exploring discriminatory validity. Test-retest reliability was explored by re-administering APFQ_GR 10-15 days following initial testing and internal consistency was explored against each domain separately as well as total items' score.Results: Greek APFQ translation was successfully performed and piloted to a women sample with varying levels of education for comprehensibility, thus, satisfying the questionnaire's face validity. 100 women (53.7 ± 13.1 years-old) participated in validation, 63 of which predominantly complained of urinary incontinence (UI) and 37 were asymptomatic. There were no ceiling effects. Floor effects were detected for women without symptoms. Moderate to very strong correlations were yielded between APFQ_GR total score and bladder domain, respectively, with ICIQ-UI SF single-item and total score (ρ = 0.403-0.758, p < 0.001), indicating satisfactory criterion-related validity. Moderate correlations were yielded for the sexual function domain with APFQ_GR total score and weaker correlations were found in the other two domains. Independent samples t-test yielded significant differences across the questionnaire's scores (p < 0.001), indicating good discriminatory validity between symptomatic and asymptomatic women. Test-retest reliability was excellent (ICC3,1 = ≥0.998). Internal consistency was very good for each domain and total items' score (Cronbach's α = 0.714-0.924).Conclusions: The Greek APFQ was proven appropriate, comprehensible, valid and reliable for women with urinary incontinence and can thus, be used across Greek healthcare settings. Prolapse and bowel domains merit further research. [ABSTRACT FROM AUTHOR]

Background: Anterior mitral leaflet prolapse repair is a highly effective procedure, but despite excellent operative results still has an inferior long-term durability when compared to posterior leaflet repair.Methods: We analysed mitral repair durability in 74 consecutive patients operated for anterior leaflet prolapse between 2010 and 2021. Their pre- and postoperative clinical, echocardiographic data and repair durability as well, were compared with 74 randomly assigned posterior leaflet prolapse patients who underwent valve repair during the same period.Results: While groups were of similar age, patients with anterior leaflet prolapse had an inferior preoperative status in terms of functional reserve, atrial fibrillation, operative risk, ejection fraction and had more dilated left heart chambers as well. 1, 5, and 10-year freedom from repair failure was 87.1 ± 4.6%, 79.8 ± 6.5% and 50.7 ± 12.5% in the anterior, and 98.5 ± 1.5% respectively in the posterior leaflet group. Atrial fibrilation (hazard ratio [HR] 5.365; 95%; confidence interval [CI] 1.093-26.324 p = .038) and left ventricle end-systolic diameter (HR 1.160 95%; CI 1.037-1.299 p = .010) independently predicted anterior leaflet repair failure. Receiver Operating Curve analysis established left ventricle end-systolic diameter ≤42 mm as a cut-off value associated with improved anterior leaflet repair durability. Accordingly, 10-year repair durability in a subset of patients, with preserved left ventricle end-systolic diameter (≤42 mm) was 86.4 ± 7.8%.Conclusion: Better long-term repair durability in patients with anterior mitral leaflet prolapse and preserved sinus rhytm and left-ventricle diameters justifies early reconstructive approach. [ABSTRACT FROM AUTHOR]

Introduction Recent publications of interstitial cystitis (IC)/bladder pain syndrome cure by a gynecological prolapse protocol, run counter to traditional treatments such as bladder installations which do not offer such cure. The prolapse protocol, uterosacral ligament (USL) repair, is based on the 'Posterior Fornix Syndrome' (PFS). PFS was described in the 1993 iteration of the Integral Theory. PFS comprises predictably co-occurring symptoms of frequency, urgency, nocturia, chronic pelvic pain, abnormal emptying and post-void residual urine, caused by USL laxity and cured or improved by repair thereof. Material and methods analysis and interpretation of published data showing cure of IC by USL repair. Results In many women, USL pathogenesis of IC can be explained by the effect of weak or loose USLs weakening two pelvic muscles which contract against them, levator plate (LP) and conjoint longitudinal muscle of the anus (LMA). The now weakened pelvic muscles cannot stretch the vagina sufficiently to prevent afferent impulses from urothelial stretch receptors 'N' reaching the micturition centre where they are interpreted as urge. The same unsupported USLs cannot support the visceral sympathetic/parasympathetic visceral autonomic nerve plexuses (VP). The pathway of multiple referred pelvic pains is explained as follows: groups of afferent VP axons stimulated by gravity or muscle movements fire off 'rogue' impulses, which are interpreted by the cortex as end-organ chronic pelvic pain (CPP) from several end organs; this explains how CPP is invariably perceived in several sites. Reports of cure of non-Hunner's and Hunner's IC are analysed with diagrams which explain co-occurrence of IC with urge and phenotypes of chronic pelvic pain from several different sites. Conclusions A gynecological schema cannot explain all IC phenotypes, especially male IC. However, for those women who obtain relief from the predictive speculum test, there is a significant possibility of cure of both the pain and the urge by uterosacral ligament repair. In this context, it may well be in such female patients' interests, at least in the exploratory diagnostic phase, for ICS/BPS to be subsumed into the PFS disease category. It would give such women a significant chance of cure, something denied to them for now. [ABSTRACT FROM AUTHOR]

Introduction and Aim Of the Study: Urinary incontinence and prolapse are debilitating conditions significantly affecting quality of life. They are extremely prevalent, affecting a significant number of women attending gynaecology clinics with complex symptoms. ePAQ-PF offers a user-friendly clinical tool, which provides valid and reliable data. The system offers comprehensive symptoms and quality of life evaluation which is an advantage over history and may enhance the clinical episodes detection as well as the quality of care for women with pelvic floor disorders. The aim of the study is to compare effectiveness of ePAQ-PF against history for diagnosis in complex urogynaecology patients.Materials and Methods: Data was collected retrospectively from ePAQ-PF and history in a tertiary level urogynaecology unit and collated onto microsoft excel. 40 patients were selected randomly from 56 eligible (administered and succeessfully completed ePAQ-PF) patients attending Urogynaecology and PEARL (combined urogynaecology and colorectal) clinics between July 2018 and July 2021. Fisher's exact test was used for inferring on statistical significance in the comparative analysis. The software used for this analysis was SAS version 9.4.Results: Thirty-four out of the forty patients were eligible for analysis for overactive bladder and stress urinary incontinence; twenty-four for prolapse and twenty-six patients for voiding difficulty. Patients were between 18 and 80 years of age with highest participants between 40 and 69 years. Four scored symptom domain was chosen for statistical analysis due to adequate power of comparative data in these domains. The additional diagnostic yield by ePAQ-PF for overactive bladder (OAB), stress urinary incontinence (SUI), voiding difficulty (VD) and prolapse was 26.47%, 0%, 67% and 16.67% respectively. P value for OAB, VD and prolapse was 0.0294, 0.0031 and 0.01 respectively. Apart from these four symptoms ePAQ-PF contributed additional symptoms over and above history in all 40 patients due to its wide range of symptom domains. History provided additional symptoms in 3 women with recurrent urinary tract infection which was not identified on ePAQ-PF.Interpretation Of Results: ePAQ-PF has shown significant additional diagnostic yield for overactive bladder, voiding difficulty and prolapse. P value for each has supported this statement. Although there was no additional diagnostic yield for stress urinary incontinence by ePAQ-PF, it has shown an accuracy of 96.97% (n = 33) for diagnosing the cases like history taking for SUI. ePAQ-PF enabled us to identify more symptoms in 100% cases (n = 40) which includes body image, general sex life, pain and altered sensation of vagina, reduced capacity of vagina etc, in comparison to history, for complex urogynaecology patients. History contributed to additional symptom diagnosis such as recurrent urinary tract infection in 7.5% (n = 40) of cases.Conclusion: ePAQ-PF is a useful diagnostic tool providing additional benefit for the diagnosis of the complex urogynaecology patient. Overall recommendation is to implement a policy of using ePAQ-PF evaluation in all complex urogynaecology patients in addition to history. Further studies are needed to assess the pattern of the yield across age, parity, disease severity related to complex urogynaecology symptoms. [ABSTRACT FROM AUTHOR]

Background: There is still much controversy about whether transforaminal or interlaminar fully endoscopic spine surgery can better treat lumbar 4/5 disc herniation. Therefore, this study intends to compare the clinical efficacy of fully endoscopic spine surgery through transforaminal and interlaminar approaches in the treatment of lumbar 4/5 disc herniation. Methods: Seventy-six patients with lumbar 4/5 disc herniation admitted from March 2019 to June 2020 were divided into the transforaminal approach group (endoscopic transforaminal lumbar discectomy, ETLD; 54 cases) and the interlaminar approach group (endoscopic interlaminar lumbar discectomy, EILD; 22 cases) according to different surgical methods. The general clinical data and clinical evaluation scale of the patients were compared. Results: The post-operative ODI and VAS scores were significantly better in the EILD group (P < 0.05). The VAS and ODI scores of patients with upper-shoulder and sub-axillary types in the EILD group were superior to those in the ETLD group (P < 0.05), while the VAS and ODI scores of patients with the pre-radicular type were better when they underwent ETLD rather than EILD (P < 0.05). Patients with Lee zone III type in the EILD group had better post-operative ODI scores than those in the ETLD group (P < 0.05), but there was no significant difference in VAS scores (P > 0.05). Patients with Lee zone IV type who underwent EILD had better VAS and ODI scores than those who underwent ETLD (P < 0.05). Conclusions: For patients with a prolapsed intervertebral disc that belongs to the upper-shoulder type, sub-axillary type, or Lee III or IV type, EILD can achieve better outcomes. [ABSTRACT FROM AUTHOR]

Introduction: LDH, defined as the localized displacement of disc material beyond the margins of the intervertebral disc space is considered the most common cause of lumbosacral radiculopathy. Compared with nonspecific low back pain without radiating leg pain, LDH is associated with radiating pain/ radiculopathy,severe pain, disability, healthcare use and intervention. Objectives: To explorethe risk-factors associated with PLID/ LDH. Literature: In this review, best evidence synthesis included systemic reviews, cohort studies and case-control studies that investigated the risk factors for LDH/ PLID. Critiques: LDH with radiculopathy results from complex relationships between individual, behavioural, and work-related variables. Evidence revealed that- age, sex, education, BMI, cardiovascular risk factors, smoking, occupational lumbar load by forward bending postures and manual materials handling, perceived risk of work injury, decision freedom at work, regular or irregular three-shift work or regular night work in and time pressure at work are associated with the development. It is also found that manual occupation, genetics, and previous back pain may contribute to the development of LDH with radiculopathy in adults. Conclusion: Although the literature is varying quality and heterogeneous, but the evidence revealed that LDH/ PLID is an important source of pain and disability in society. Future research should focus on prospective designs examining modifiable risk factors and prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Birth asphyxia is the inability of a newborn to start and conserve breathing immediately after birth. Globally, 2.5 million infants die within their first month of life every year, contributing nearly 47% of all deaths of children. It is the third cause of neonatal deaths next to infections and preterm birth. Ethiopia is one of the countries with the highest neonatal mortality and high burden of birth asphyxia in the world. The state of birth asphyxia is about 22.52% in Ethiopia, with incidence of 18.0% in East Africa Neonatal mortality incidence ratio was 9.6 deaths per 1000 live births among which 13.5% of neonatal mortality cases were due to birth asphyxia in southern Ethiopia. The effect of birth asphyxia is not only limited to common clinical problems and death; it also has a socio-economic impact on the families. Therefore, this study is aimed to identify determinants of birth asphyxia among newborn live births in public hospitals Southern Ethiopia.Methods: An Institution based unmatched case-control study was conducted among newborn live births in public hospitals of Gamo & Gofa zones, with a total sample size of 356 (89 cases and 267 controls, 1:3 case to control ratio) from March 18 to June 18, 2021, after obtaining ethical clearance from Arba Minch University. Cases were selected consecutively and controls were selected by systematic random sampling method. Data were collected using an adapted pretested semi-structured questionnaire through face-to-face interviews and record reviews using an extraction checklist for intrapartum & neonatal-related information. The collected data were entered into Epi data version 4.4 and exported to STATA version 14 for analysis. Finally, bi-variable and multivariable logistic regression analyses were performed to identify determinants of birth asphyxia. Statistical significance was declared at p-value ≤ 0.05 along with corresponding 95% CI of AOR used to declare statistical significance.Results: Anemia during pregnancy [AOR = 3.87, 95% CI (1.06- 14.09)], breech presentation [AOR = 3.56, 95% CI (1.19-10.65)], meconium stained amniotic fluid [AOR = 6.16, 95% CI (1.95-19.46)], cord prolapse [AOR = 4.69, 95%CI (1.04-21.05)], intrapartum fetal distress [AOR = 9.83, 95% CI (3.82-25.25)] and instrumental delivery [AOR = 5.91, 95% CI (1.51-23.07)] were significantly associated with birth asphyxia.Conclusion: The study revealed that anemia during pregnancy, breech presentation, meconium-stained amniotic fluid, cord prolapse, intrapartum fetal distress, and instrumental delivery were identified as determinants of birth asphyxia. Therefore, health professional and health institutions should give emphasis on care of mother and the newborn in actively detecting and managing asphyxia. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old male patient with a congenital Gerbode defect and aortic valve non-coronary cusp prolapse. Topics discussed include the association between a direct Gerbode defect and aortic valve prolapse, emphasizing the rarity of this occurrence, and highlighting the anatomical factors contributing to the relationship between these conditions, providing valuable insights for clinicians.

Introduction and hypothesis: Health literacy underpins informed consent and shared decision-making. In gynaecology, this includes understanding of normal anatomy and urogenital disease. This study evaluated public knowledge of external female genital anatomy and pelvic organ prolapse (POP). Methods: A questionnaire study asked participants for their demographics and to label a female external genitalia diagram and included free-text questions on POP, its symptoms and treatment. Questionnaires were distributed at general outpatient (OPD) and urogynaecology (UG) departments at a UK teaching hospital. Differences in the number of correct anatomy labels between participant genders were assessed via chi-squared tests and, within female participants, multivariable linear and logistic regressions assessed associations with increasing correct anatomical labels and an understanding (versus no understanding) of POP, respectively. Results: Within 191 (n = 160 OPD, n = 31 UG), 9/103 (9%) labelled all anatomical structures correctly. Females had more correct labels (median 1, IQR 0,3) versus males (median 0, IQR 0,1), P = 0.022). Higher education (vs. < secondary) and white ethnicity were associated with greater numbers of correct labels [coefficient (95% CI): 1.05 (0.14, 1.96), P = 0.024, 1.45 (0.58, 2.33), P = 0.001 respectively]. Fifty-three per cent understood POP. POP understanding increased with increasing age, white ethnicity (OR: 4.38, 95% CI: 1.36, 14.08, P = 0.013) and more correct anatomy labels (OR: 1.43, 95% CI 1.14, 1.79, P = 0.002). Of those who understood POP, only 35% identified "bulge" as a symptom and 7% physiotherapy as a treatment option. Conclusion: There was poor public understanding of external female genital anatomy and POP, which may have significant implications for health-seeking, shared decision-making and informed consent. [ABSTRACT FROM AUTHOR]

In cervical spine, the anatomical course of medial branch in significantly different and thermal radiofrequency ablation (RFA) of the cervical median branch though proven effective is technically challenging. Cooled RFA (CRFA) is a newer revolutionary technique that creates a larger spherical lesion and thus compensates for the anatomical variability of the medial branches in the cervical spine. Our case report is aimed to discuss the technique of CRFA for the treatment of cervical facetogenic pain. Right C2–C5 medial branch CRFA was done under fluoroscopic guidance under monitored anesthesia care using 17G with 75 mm length and 2 mm active tip cooled radiofrequency cannula. After 8 weeks of follow-up, the patient reported 80% pain relief. [ABSTRACT FROM AUTHOR]

A 58‐year‐old male patient was admitted with chest pain and was diagnosed with coronary heart disease. He was scheduled for coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Intraoperative real‐time transesophageal echocardiography (TEE) showed that the tricuspid valves were well‐aligned and subtle regurgitation. Real‐time TEE after separation from CPB showed severe tricuspid regurgitation and prolapsed chordae tendineae. The tricuspid chordae tendineae rupture due to a right atrial venous return cannula. The use of negative pressure to improve venous drainage during CPB may result in the tricuspid valve being adsorbed to the cannula, increasing the likelihood of injury to the tricuspid valve. [ABSTRACT FROM AUTHOR]

Posttraumatic herniation of brain and CSF into the eyelid is a rare entity with few reported cases in the literature. A 5-year-old girl presented to us with severe periorbital edema and conjunctiva prolapse after 7 days of head trauma. Clinical suspicion of CSF leakage accumulating in lid and periorbita was suspected. CT and MRI scan brain showed multiple comminuted frontal bones, orbital roof, and orbital rim fractures with contused brain tissue herniation through the dural defect. Craniotomy with dural repair was done after which patient improved and within 2 weeks both periorbital edema and conjunctiva prolapse subsided. [ABSTRACT FROM AUTHOR]

Background: Sweet's syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare neutrophilic dermatitis characterized by pyrexia, neutrophilia and painful papulonodular lesions with a neutrophilic dermal infiltrate.Case Presentation: We presented a case report of classical SS associated with ulcerative colitis (UC) and mucosal prolapse polyps (MPPs) in a male patient.Conclusions: The particularity of this case is the occurrence of MPPs in a male patient with UC and classical SS. We also discussed whether this patient with concurrent Epstein-Barr virus infection could be treated with corticosteroids. [ABSTRACT FROM AUTHOR]

Background: The incidence of early complications after stoma formation (within 30 days of surgery) is difficult to determine and has been reported to be in a range of 3%–82%. Aim: The aim of this study was to analyse the onset of stomal, peristomal and skin complications one month (30 days) after ostomy creation. Method: This review analysed enteral stoma therapy nurse reports on patients who had an ostomy created between January 2016 and December 2020. Findings: Complications were analysed according to ostomy type: colostomy, ileostomy and urostomy. There were 1292 incidences of complications: skin complications were the most common (26%), and abscess the least common (0%). Conclusion: A majority (63%) of patients experienced at least one or more complications within 30 days of surgery. Haemorrhage was reported as a complication (2%) but the authors found no data on its incidence in the literature. In addition to early complications, late complications were detected. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Oral y Maxilofacial is the property of Sociedad Espanola de Cirugia Oral y Maxilofacial (SECOM) 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.)

A juvenile goliath tigerfish (Hydrocynus goliath) was presented with a traumatic full‐thickness corneal laceration and associated iris prolapse. Debridement and corneal flap repair using N‐butyl cyanoacrylate tissue glue was performed under general anaesthesia. This article describes the initial ocular surgery and documents the recovery and healing process over the following 3‐week period. The fish was discharged from treatment at this point, and there were no complications over the ensuing 1‐year period. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi 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.)

Introduction The aim of this article was to study the effect of native tissue cardinal/uterosacral ligament repair on overactive bladder (OAB) and pelvic organ prolapse (POP). Material and methods Inclusion criteria included decrease of urge symptoms following insertion of a gauze tampon in the posterior fornix of vagina ('simulated operation'). Exclusion criteria included SUI, POP grades 3-4. The surgery consisted of plication of cardinal/uterosacral ligaments. Post-operative assessment was performed at3, 6, 12 and 18 months after surgery and included evaluation by stage of prolapse, Urinary Distress Inventory Short Form 6 (UDI-6), Overactive Bladder Questionnaire (OAB-q), Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), and International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-SF) questionnaires and voiding diary. Results At 3 months, cure rates for frequency, urgency, nocturia and prolapse were comparable. By the 6-month review, catastrophic failure commenced in the postmenopausal group, parallel for all pa-rameters, starkly contrasting with premenopausal group. At 18 months, % cure rates for pre-menopausal (post-menopausal in brackets) were 79.6 (15.4) for POP, 67.3 (20.5) for urgency, 87.7 (20.5) for nocturia and 59.2 (15.4) for frequency. Conclusions We hypothesize the stepwise parallel recurrence of POP and symptoms in the menopausal group was a consequence of collagen deficiency in the plicated ligaments. Nevertheless, plication of uterosacral-cardinal ligament complex is simple, inexpensive, effective, especially applicable premenopausally for POP and as an alternative treatment option in that difficult group of pre-menopausal women who have major OAB/nocturia symptoms but only minimal prolapse. [ABSTRACT FROM AUTHOR]

Background: Pediatric mitral regurgitation (MR), especially with bileaflet prolapse, is relatively rare, of high complexity, and frequently associated with other congenital cardiac abnormalities. It remains a major therapeutic challenge for surgeons. This study reports our experience of surgical treatment of this mitral disease and midterm follow-up results.Methods: Between January 2016 and April 2020, nine pediatric patients, six females and three males, age ranged from 3 to 12 years (median age was 6 years) with a weight range of 12-36 kg (median weight was 25 kg), who all had over moderate regurgitation caused by bileaflet prolapse with mean distance of leaflet coaptation beyond annular plane 5.89 ± 1.66 mm (4-9 mm), received mitral valve (MV) repair. Various surgical techniques were used to repair MV.Results: The median follow-up period was 23(6-51) months, only one patient had moderately severe recurrent of MR, no patient developed systolic anterior motion (SAM) or mitral stenosis. Freedom from reoperation was 100% during the follow-up period. Compared to preoperation, the left atrial (LA) diameter and left ventricular end-diastolic diameter (LVEDD) decreased significantly from 2.94 ± 0.49 cm to 2.37 ± 0.38 cm (LA, p < .01) and from 4.13 ± 0.73 cm to 3.62 ± 0.49 cm (LVEDD, p < .01) respectively, ejection fraction (EF) decreased significantly (p < .05) from 68.56 ± 3.98% to 62.89 ± 4.48% before discharged.Conclusion: We share our experience of surgical repair of mitral valve bileaflet prolapse in pediatric patients. Several surgical methods are considered to be used to repair the MV due to the high complexity of lesions. Anatomic correction or functional correction in our reports almost reaches the same result, while functional correction means simpler operation. [ABSTRACT FROM AUTHOR]

Background: Large prolapse-related lesions (LPRL) of the sigmoid colon have been documented histologically but may not be readily recognized endoscopically.Methods: Colonic lesions referred for endoscopic mucosal resection (EMR) were enrolled prospectively. Endoscopic features were carefully documented prior to resection. Final diagnosis was made based on established histologic criteria, including vascular congestion, hemosiderin deposition, fibromuscular hyperplasia, and crypt distortion.Results: Of 134 large ( ≥ 20 mm) sigmoid lesions, 12 (9.0 %) had histologic features consistent with mucosal prolapse. Distinct endoscopic features were: broad-based morphology; vascular pattern obscured by dusky hyperemia; blurred crypts of varying size and shape; and irregular spacing of sparse crypts. Focal histologic dysplasia was identified in 6 of 12 lesions (50.0 %).Conclusions: LPRL of the sigmoid colon exhibit a distinct endoscopic profile. Although generally non-neoplastic, dysplasia may be present, warranting consideration of EMR. [ABSTRACT FROM AUTHOR]

Aims Mitral annular disjunction is fibrous separation between the attachment of the posterior mitral leaflet and the basal left ventricular myocardium initially described in dissected hearts. Currently, it is commonly evaluated by echocardiography, and potential relationships with mitral valve prolapse and ventricular arrhythmia have been suggested. However, controversy remains as its prevalence and extent have not been fully elucidated in normal living subjects. Methods and results Systolic datasets of cardiac computed tomography obtained from 98 patients (mean age, 69.1 ± 12.6 years; 81% men) with structurally normal hearts were assessed retrospectively. Circumferential extent of both mitral leaflets and disjunction was determined by rotating orthogonal multiplanar reconstruction images around the central axis of the mitral valvar orifice. Distribution angle within the circumference of the mitral valvar attachment and maximal height of disjunction were quantified. In total, 96.0% of patients demonstrated disjunction. Average distribution angles of the anterior and posterior mitral leaflets were 91.3 ± 9.4° and 269.8 ± 9.7°, respectively. Average distribution angle of the disjunction was 105.1 ± 49.2°, corresponding to 39.0 ± 18.2% of the entire posterior mitral valvar attachment. Median value of the maximal height of disjunction was 3.0 (1.5–7.0) mm. Distribution prevalence map of the disjunction revealed characteristic double peaks, with frequent sites of the disjunction located at the anterior to antero-lateral and inferior to infero-septal regions. Conclusion Mitral annular disjunction is a rather common finding in the normal adult heart with bimodal distribution predominantly observed involving the P1 and P3 scallops of the posterior mitral leaflet. [ABSTRACT FROM AUTHOR]

To determine the frequency of symptoms (bleeding, pain, rectal swelling, itching, soiling, constipation) in subjects consulting for hemorrhoidal disease and assess the possible concomitance between hemorrhoids and chronic venous disease (CVD). CHORUS is a multinational cross-sectional survey carried out in seven countries. Consecutive patients consulting for hemorrhoidal disease were screened to confirm the presence of chronic venous disease. Data collected exclusively from India is analyzed here. Of the 2511 eligible patients, 63.8% were male and the mean age was 43.3 ± 12.2 years. Overall, 95.7% patients had physician-confirmed hemorrhoidal disease. Bleeding, swelling, prolapse, and fecal incontinence were significantly associated with the presence of hemorrhoidal disease (p < 0.0001). About one third of patients (37.5%) had reported simultaneous occurrence of hemorrhoidal disease and CVD and the occurrence of hemorrhoidal disease was significantly correlated with the presence of CVD (p = 0.004). Moreover, 70.4% patients with CVD had recurrent hemorrhoidal disease (p < 0.0001). Venoactive drug was the most commonly (95.7% cases) prescribed treatment; micronized purified flavonoid fraction was the most widely used (86.2%) venoactive drug. More than one third individuals with hemorrhoidal disease in our study had CVD, which highlights the importance of investigating signs of CVD in patient with hemorrhoids during daily clinical practice which could help better understand the disease and optimize the management. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and complications of early, intermediate, or late removal of the urinary catheter after vaginal hysterectomy, pelvic floor repair and anterior colporrhaphy. Materials and Methods: Seventy-three Women with primary uterine or vaginal prolapse ≥ stage II according to Pelvic Organ Prolapse Quantifications System without stress urinary incontinence and without recurrent urinary tract infections, candidates for vaginal repair surgery were included. A urinary catheter (Foley 16) was inserted at the time of the intervention and it was removed at random in three groups, 24 (27 patients), 48 (23 patients) and 72 hours (23 patients) after surgery. Prophylactic intravenous antibiotics were administered for 72 hours. Urinary tract infection (UTI) was diagnosed by urine culture after surgery and acute urinary retention (AUR) during hospitalization. Percentage frequencies were calculated, and the chi-square test (x2) was used to search for differences. Results: UTI was observed in 7.4%, 17.4% and 13% in groups 1, 2 and 3 respectively. No statistically significant association was found between the presence of UTI and urinary catheterization time (x²=1.3 p=0.512). AUR was found in 4.1% of all patients, most of them from group 2. Conclusion: Early removal of the urinary catheter in the first 24 hours after vaginal surgery decreased catheterization time, hospital stay and urinary tract infection. Extended catheterization does not offer benefits to patients and prolongs hospital stay unnecessarily. [ABSTRACT FROM AUTHOR]

Giant papillae (1.0 mm or greater in diameter) on the upper tarsal conjunctiva are one of the most common findings in cases of vernal keratoconjunctivitis (VKC). Presently described is the case of a 3-year-old female with a unilateral giant papilla formation prolabing from the medial side of the upper tarsal conjunctiva toward the ocular surface in the left eye. A brief review of the recent literature concerning the etiology, associated risk factors, surgical options, and management of patients with giant papillae is also discussed. A significant reduction in the size of the papilla was observed after a week of medical treatment with a topical steroid and antiallergic eye drops. To the best of our knowledge, this case demonstrates the first time that a giant papilla appeared in the form of a prolapsed mass extending from the tarsal conjunctiva in a child with VKC. Ophthalmologists should keep in mind that a giant papilla can look like another form of conjunctival mass, and should not rush to excise or biopsy, as it may respond to medical treatment. [ABSTRACT FROM AUTHOR]

We here describe a case of the prolapse of pedunculated submucosal leiomyoma through the cervix during the treatment of a gonadotropin‐releasing hormone (GnRH) antagonist relugolix. We also present the literature review of the cases of leiomyoma prolapse during GnRH modulators. A 55‐year‐old woman with atypical vaginal bleeding diagnosed submucosal uterine fibroid 6 cm in diameter, and daily oral administration of relugolix was conducted. On the 35th day of the administration, heavy vaginal bleeding suddenly occurred due to leiomyoma prolapse. Finally, she underwent abdominal hysterectomy to treat heavy bleeding. To date, six cases of leiomyoma prolapse during GnRH modulators have been reported, in which all the previous cases were treated with GnRH agonists. This is the first case report of leiomyoma prolapse during GnRH antagonist treatment. Notably, leiomyoma prolapse is a possible common adverse effect of GnRH modulators for the treatment of submucosal leiomyoma, which is caused by rapid decrease in its volume. [ABSTRACT FROM AUTHOR]

Among Australian females, sexual assault affects 1 in 5 Australian women [1], and 1 in 10 girls [2]. While it is well known that females who experience sexual assault have an increased risk of future pelvic pain, there is limited knowledge regarding the occurrence of other gynaecological morbidity. We performed systematic review and meta-analysis for the relationship between sexual assault and gynaecological morbidity. We searched online electronic databases for observational studies on the subject published between 1993 and 2018. Search terms included variants of 'sexual abuse', 'sexual assault' and a range of gynaecological morbidity. Two independent reviewers completed study selection, quality assessment and data extraction. For each gynaecological symptom we calculated common odds ratios and 95 % confidence intervals in relation to sexual abuse history. Our search identified 1846 studies, of which 38 studies were included. A history of sexual assault was significantly associated with overall gynaecological morbidity (RR 1.42; 95%CI, 1.27-1.59), pelvic pain (RR 1.60; 95%CI, 1.36-1.89), 'dyspareunia' (pooled RR 1.74, 95%CI, 1.50-2.02); 'dysmenorrhea' (pooled RR 1.20; 95%CI, 1.11-1.29); 'abnormal menstrual bleeding' (pooled RR 1.29; 95%CI, 1.12-1.49)) and 'urinary incontinence' (pooled RR 1.31; 95%CI, 1.12-1.53)), while association was not statistically significant for 'vaginismus'(pooled RR 1.71; 95%CI, 0.87-3.36) and 'vulvodynia' (pooled RR 1.49; 95%CI, 0.76-2.91). There was no relation with 'prolapse' (pooled RR 1.10; 95%CI, 0.53-2.30). Females with a history of sexual assault have a significantly increased risk of different gynaecological disorders later in life. [ABSTRACT FROM AUTHOR]

Complications after major bowel surgery, such as a stomal prolapse, can be distressing for a patient and inhibit their recovery and successful rehabilitation. A stomal prolapse occurs when a segment of bowel intussuscepts and protrudes through the stomal orifice to a greater degree than expected. Stomal prolapse can be associated with complications such as serosal or mucosal ulceration, incarceration and strangulation. Some cases of prolapse can be managed conservatively, especially if the stoma is temporary; however, others require surgical reconstruction. The challenge for the stomal therapy nurse is to provide a caring, informed approach which may involve the implementation of practical 'tricks of the trade' should this distressing problem occur. [ABSTRACT FROM AUTHOR]

Objective: Central defects in the stability of the pelvic floor present an anatomical problem that afflict women frequently at an advanced age, but also are observed in young women with typical risk factors i.e. obesity and high parity. Materials and Methods: Based on the encouraging results of the transperineal bilateral sacrospineous colpofixation technique (TPBCF). the vaginal minimally invasive single incision Bilateral Sacrospineous Colposuspension (BSC) using the extremely macroporous lightweight HexaPro polypropylene tape in combination with the i-Stitch instrumentation was developed in order to minimize the amount of foreign body implanted into the patient, facilitate ingrowth of the mesh and for the first time add elasticity and a self-adjusting character to the profile of apical suspension. Results: In a study of 132 patients with vaginal prolapse surgical and functional outcomes of BSC have been evaluated with 6 months followup. No rectal injury was observed nor was any re-intervention required for any complications. Apical support was reliably achieved. These results were stable when compared with follow-up data at six months postoperatively. No erosion was seen with the exception of a traumatic mesh exposure after vaginal delivery. Conclusion: The authors conclude, that BSC is an efficient minimally invasive technique for the treatment of female genital prolapse with a very favourable risk/benefit ratio. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the short-term anatomical results of laparoscopic high uterosacral ligament suspension (LHUSLS) in the surgical treatment of apical prolapse. Materials and Methods: Medical records of thirty women with stage 2 or higher cuff or uterine apical prolapse who underwent LHUSLS operations were retrospectively analysed. Preoperative, intraoperative, and 6- and 12-month short-term postoperative data were recorded. Anatomical success was defined as no prolapse for any Pelvic Organ Prolapse Quantification (POP-Q) point at or below 1 cm above the hymen. To evaluate prolapse symptoms, we used the Pelvic Organ Prolapse Distress Inventory (POPDI)-6 questionnaire. Results: Based on stage II of POP-Q as the recurrence criteria, the anatomical success rate was 100%. The POP-Q point C, Aa, Ap, Ba and Bp measurements were significantly higher after surgery than the preoperative values. There was no recurrence or ureteral injury in any case. The scores of POPDI-6 before and after LHUSLS were significantly lower in all patients after surgery (p<0.001). Conclusion: LHUSLS is a simple and effective procedure that has been found to provide successful anatomical outcomes and reduced ureteral injury for apical prolapse. However, the long-term results of this procedure require further investigation. [ABSTRACT FROM AUTHOR]

Children with spinal problems present to a wide range of healthcare providers. These providers include the emergency department, their GPs, physiotherapy and the paediatric medical and surgical clinics (including orthopaedics). They may present with a variety of symptoms, but the common complaints are: back pain, leg pain or a change in back shape (spinal deformity). Some children may experience a combination of these problems. A systematic approach to the history and examination with knowledge of the common spinal conditions in children will allow you to select the best investigations. This will maximize the chance of making the correct diagnosis and providing appropriate care. This article aims to give an overview, appropriate for surgeons in the early years of their training. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery such as laparoscopic sacrocolpopexy, pectopexy and cervicosacropexy are widely performed for the treatment of the vaginal vault/cuff prolapse using prosthetic mesh implants to strengthen lax apical ligaments. Depending on the patient's anatomy and the surgeon's preference, implants of different shapes, pore architectures and polymers can be selected. In this article, a 3D model of the pelvis was built and the pectopexy technique was reproduced. The finite element model of the textile implant was sutured to the cervical stump with a bilateral fixation to the iliopectineal ligament on either side of the pelvic walls. Pelvic soft tissues and prosthetic implants were modelled as hyperelastic and linearly elastic orthotropic materials, respectively. Numerical simulations were performed after surgery at rest and during Valsalva manoeuvre. The positions and the orientation of the vagina, during increased abdominal pressure were calculated in relation to the pubococcygeal line (PCL). We found from our simulation-model that the structure of the DynaMesh®-PRP Soft (17.18 mm above PCL line) provides better support to the vaginal cuff compared to GYNEMESH (11.95 mm) and ARTISYN (6.72 mm). And the treatment with, the stiffer DynaMesh seems to provide better urethral axis (24°) than the flexible Ethicon meshes (28.5° and 29°). [ABSTRACT FROM AUTHOR]