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Background/Objectives: Multiple sclerosis (MS) frequently results in both urinary and sexual dysfunction, which significantly impairs quality of life. Conventional treatments for bladder dysfunction often prove insufficient, leading to the exploration of alternative therapies such as percutaneous tibial nerve stimulation (PTNS). This study aimed to assess the impact of PTNS on sexual function and bladder symptoms in female MS patients with neurogenic detrusor overactivity (NDO) and female sexual dysfunction (FSD). Methods: A total of 65 female MS patients with NDO were evaluated and underwent 12 weeks of standardized PTNS treatment. Sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R), while bladder symptoms were evaluated using the OAB-v8 questionnaire. Participants were grouped based on the presence of sexual dysfunction and distress and compared to a control group of 20 patients who declined PTNS. Results: Significant improvements were observed in FSFI scores across multiple domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) in the treatment groups (p < 0.05). Additionally, 58.46% of patients showed positive responses to PTNS regarding overactive bladder symptoms (OAB-v8 score), while the control group showed no significant changes. Conclusions: PTNS appears to be an effective therapeutic option for improving sexual function and urinary symptoms in female MS patients with NDO and FSD, offering a promising non-invasive alternative for managing these conditions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Rotational malformation after intramedullary nailing of intertrochanteric fractures is a relatively common, possibly severe, and difficult-to-detect complication, since intraoperative radiographic imaging allows for the assessment of the quality of reduction in the frontal and sagittal planes, but not in the transverse plane. The purpose of this study is to evaluate the rotational malalignment after intramedullary nailing of intertrochanteric fractures and to investigate a possible connection with specific patients' or fractures' characteristics. Materials and Methods: 74 patients treated with intramedullary nailing due to an intertrochanteric fracture underwent a postoperative CT of the pelvis-hips and knees. The value of the anteversion was measured both in the operated-on (angle 1) and in the healthy hip (angle 2) based on the technique described by Jeanmart et al. and the difference in anteversion (D angle = angle 1 minus angle 2) was calculated. A positive D angle indicated the presence of excessive internal overcorrection of the distal fragment during fracture reduction, while a negative D angle indicated the presence of excessive external overcorrection. The absolute value of the D angle represents the postoperative difference in anteversion between the two hips. The patients were divided into three groups according to this value: group A, with D < 5° (physiological difference); group B, with 5° < D < 15° (acceptable rotational alignment); and group C, with D ≥ 15° (rotational deformity). Results: Group A constitutes 56.8%, group B 12.2%, and group C 31.1% of the study population. Overall, 79.7% of the patients presented a positive angle D, while, for group C, the percentage was even higher at 91.3%. According to the AO/OTA classification system, 37.8% of the cases were stable fractures, 47.3% were unstable fractures, and 14.9% were reverse oblique fractures. Based on our analysis, the type of fracture has a serious impact on the rotational alignment, since the statistical significance of the mean angle D for the three types of fracture is reliable (p = 0.029). Stable fractures present the lowest anteversion difference values, while reverse oblique fractures present the highest difference. Conclusions: Our study reveals that the percentage of rotational malalignment after the intramedullary nailing of intertrochanteric fractures remains high (31.1%), despite the proper use of radiographic imaging during the intraoperative fracture reduction. In most cases (91.3%), this malalignment appears to be a matter of internal overcorrection. A clear correlation between hip's rotational deformity and patients′ functional outcome has yet to be proven, and constitutes our objective in the near future. [ABSTRACT FROM AUTHOR]

Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty is indubitably one of the most performed operations worldwide. On the other hand, especially in the western world, the average age that women get pregnant has raised confoundedly. Consequently, a steadily increasing number of women become pregnant after they had hip arthroplasty surgery, with copious potential implications. The amount of knowledge on this particular field is considered inadequate in the existing literature. This paper aims to augment clinicians understanding surrounding this topic. A systematic literature review was conducted in accordance with the PRISMA guidelines. Papers from various computerized databases were scrutinized. Article selection was carried out by three authors independently employing specific pre-determined inclusion and exclusion criteria, while disagreements were elucidated with the contribution of other authors. A patently limited number of research articles were detected from our rigorous literature review, with only 12 papers meeting the inclusion criteria. The vast majority of studies were small-scale and examined confined population groups. Most studies had been performed in Finland, utilizing data from nationwide registries. Women with previous history of total hip arthroplasty feature increased rates of c-section delivery, although vaginal labor can be attempted with certain precautions. Hip implants' survival does not appear to be affected from gestation, which is predominately well-tolerated from these women. Metal ion circulation in mothers' blood has not been proven to trigger substantial complications concerning either mothers or offspring. It can be considered safe for women with such medical history to get pregnant; however, further multinational studies and pertinent research on this field are vital to attain more solid inferences. [ABSTRACT FROM AUTHOR]

Background & Aims : Rotational malalignment after intramedullary nailing of intertrochanteric fractures is a relatively common complication that may have a crucial impact on both functional outcome and a fracture's healing properties, ultimately affecting the patient's postoperative morbidity and mortality. Methods : 74 patients treated with intramedullary nailing due to an intertrochanteric fracture underwent a postoperative computed tomography (CT) scan of the hips and knees. The femoral anteversion difference (D angle) between the operated and healthy hip was calculated using the technique described by Jeanmart et al. The patients were divided into two groups according to their D angle values: a D angle less than 15° was considered an acceptable rotational alignment (group A), while a D angle equal to or more than 15° was considered a rotational deformity (group B). Postoperatively, the functional level of each patient was evaluated at the 6-month and 1-year follow-up visits and compared to the pre-fracture status using the modified Harris hip score (mHHS). Also, fracture union, other postoperative complications, and patient mortality were noted. Results : The mean femoral anteversion difference was 12.3° with a standard deviation of 10.3°. Of the 74 patients, 51 (68.9%) were assigned to group A and 23 (31.1%) to group B. At the 6-month postoperative follow-up, 67 (90.5%) patients had survived and 7 (9.5%) were deceased, with our statistical analysis indicating a linear trend ( p -value = 0.048) between the presence of rotational malalignment and 6-month mortality. At the 1-year postoperative follow-up, 63 (85.1%) patients survived and 11 (14.9%) were deceased, with the statistical analysis indicating a significant relationship ( p -value = 0.031) between the presence of rotational malalignment and the 1-year mortality. Regarding the functional outcome six months after the operation, the difference between the pre-fracture and the postoperative mHHS was 8.7/100 with a standard deviation of 6.1 for the 49 patients in group A and 14.5/100 with a standard deviation of 12.4 for the 18 patients in group B, with the statistical analysis indicating a significant difference ( t = -2.536, significance < 0.05) in the functional level between the two groups. As for the functional outcome one year after the operation, the difference between the pre-fracture and the postoperative mHHS was 4.9/100 with a standard deviation of 7.8 for the 47 patients in group A and 8.3/100 with a standard deviation of 13 for the 16 patients in group B, with the statistical analysis indicating no significant difference ( t = -1.266, significance > 0.05) in the functional level between the two groups. The only postoperative complication noted was fracture non-union, presenting in two patients (3%), with the statistical analysis indicating no significant relationship ( p -value = 0.698) between this complication and the presence of rotational malalignment. Conclusions : In this study, rotational malalignment after intertrochanteric fracture intramedullary nailing presents in 31.1% of cases. The correlation between this malalignment and functional outcomes shows a decline in patients' functional abilities during the first six postoperative months, a condition that improves over time, with most patients returning to their preoperative functional status one year after the operation. Furthermore, our results indicate a possible relationship between rotational malalignment and mortality within one year. Future research should focus on creating a more detailed, functional evaluation system for the elderly and applying it to a larger sample to confirm these findings.