- Acute Abdomen due to Mutual Tangle of Two Small Paratubal Cysts. [Journal Article]
- CRCase Rep Obstet Gynecol 2018; 2018:2351809
- A 30-year-old woman (gravida 0) visited our hospital with a complaint of right lower abdominal pain. Transvaginal ultrasonography revealed a 5-cm swollen right ovary, which was suspected to be a matu...
A 30-year-old woman (gravida 0) visited our hospital with a complaint of right lower abdominal pain. Transvaginal ultrasonography revealed a 5-cm swollen right ovary, which was suspected to be a mature cystic teratoma. Pelvic examination revealed moderate pain. Contrast-enhanced computed tomography showed a 44-mm cystic mass containing fat and calcified material in the right pelvis. Since torsion was suspected, emergent laparoscopic surgery was performed. Intraoperative findings were a swollen right ovary without torsion or congestion. Two small pedunculated 1- and 2-cm diameter paratubal cysts that grew from almost the same place of the ampulla of the right fallopian tube were observed. The thin stalk of the 1-cm paratubal cyst was entangled around the stalk of the 2-cm paratubal cyst, with its head congested. Through a small abdominal laparoscopic incision, the tumor of the right ovary and the two paratubal cysts were excised. Histopathological examination revealed that the right ovarian tumor was a mature cystic teratoma, and the two paratubal cysts had no malignancy. This case showed that only a 2-cm tumor with congestion caused the acute abdomen.
- ACR Appropriateness Criteria® Acute Nonlocalized Abdominal Pain. [Journal Article]
- JAJ Am Coll Radiol 2018; 15(11S):S217-S231
- The range of pathology in adults that can produce abdominal pain is broad and necessitates an imaging approach to evaluate many different organ systems. Although localizing pain prompts directed imag...
The range of pathology in adults that can produce abdominal pain is broad and necessitates an imaging approach to evaluate many different organ systems. Although localizing pain prompts directed imaging/management, clinical presentations may vary and result in nonlocalized symptoms. This review focuses on imaging the adult population with nonlocalized abdominal pain, including patients with fever, recent abdominal surgery, or neutropenia. Imaging of the entire abdomen and pelvis to evaluate for infectious or inflammatory processes of the abdominal viscera and solid organs, abdominal and pelvic neoplasms, and screen for ischemic or vascular etiologies is essential for prompt diagnosis and treatment. Often the first-line modality, CT quickly evaluates the abdomen/pelvis, providing for accurate diagnoses and management of patients with abdominal pain. Ultrasound and tailored MRI protocols may be useful as first-line imaging studies, especially in pregnant patients. In the postoperative abdomen, fluoroscopy may help detect anastomotic leaks/abscesses. While often performed, abdominal radiographs may not alter management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- Minimally invasive surgical treatment using 'iliac pillar' screw for isolated iliac wing fractures in geriatric patients: a new challenge. [Journal Article]
- EJEur J Trauma Emerg Surg 2018 Nov 01
- CONCLUSIONS: Geriatric patients can have a form of IIWF caused by low-energy trauma that is a type of fragility fracture of the pelvis. Because subsequent deterioration of their walking status followed by a long period of non-weight bearing in geriatric patients could be as threatening as the fracture itself, the treatment paradigm for IIWF due to low-energy trauma in geriatric patients should differ from that due to high-energy trauma in most patients. In these types of fractures, minimally invasive surgical management that includes iliac pillar screw fixation can lead to good outcomes.
- Rare extraspinal cause of acute lumbar radiculopathy. [Journal Article]
- BCBMJ Case Rep 2018 Oct 28; 2018
- A 60-year-old man presented to an outpatient pain management clinic with antalgic gait and left lower extremity (LLE) radiculopathy from an unknown aetiology. A lumbar MRI revealed minimal disc protr...
A 60-year-old man presented to an outpatient pain management clinic with antalgic gait and left lower extremity (LLE) radiculopathy from an unknown aetiology. A lumbar MRI revealed minimal disc protrusion at L3 and a partially visualised left-sided kidney abnormality. Abdominal and pelvic CT demonstrated severe hydronephrosis of the left kidney compressing the left psoas major. The patient was immediately referred to an outside hospital for nephrology workup, and following nephrostomy tube, his radicular pain resolved. He remained asymptomatic at 4 weeks follow-up. We found two cases of postsurgical, retroperitoneal fluid collection that caused lumbar radiculopathy, but none associated with hydronephrosis. To our knowledge, this is the first case in the literature to report hydronephrosis as the potential aetiology of lumbar radiculopathy, which highlights an important clinical reminder: to consider extraspinal aetiologies in all patients who present with lumbar radiculopathy, when clinical symptoms, examination findings and diagnostic studies present with unusual characteristics.
- A 5-year retrospective cohort study of unplanned readmissions in an Australian tertiary paediatric hospital. [Journal Article]
- AHAust Health Rev 2018 Oct 29
- Objective The aim of this study was to examine the characteristics and prevalence of all-cause unplanned hospital readmissions at a tertiary paediatric hospital in Western Australia from 2010 to 2014...
Objective The aim of this study was to examine the characteristics and prevalence of all-cause unplanned hospital readmissions at a tertiary paediatric hospital in Western Australia from 2010 to 2014.Methods A retrospective cohort descriptive study was conducted. Unplanned hospital readmission was identified using both 28- and 30-day measurements from discharge date of an index hospital admission to the subsequent related unplanned admission date. This allowed international comparison.Results In all, 73 132 patients with 134 314 discharges were identified. During the 5-year period, 4070 discharges (3.03%) and 3330 patients (4.55%) were identified as 30-day unplanned hospital readmissions. There were minimal differences in the rate of readmissions on Days 28, 29 and 30 (0.2%). More than 50% of readmissions were identified as a 5-day readmission. Nearly all readmissions for croup and epiglottitis occurred by Day 5; those for acute bronchiolitis and obstructive sleep apnoea requiring tonsillectomy and/or adenoidectomy occurred by Day 15 and those for acute appendicitis and abdominal and pelvic pain occurred by Day 30.Conclusion This study highlights the variability in the distribution of time intervals from discharge to readmission among diagnoses, suggesting the commonly used 28- or 30-day readmission measurement requires review. It is crucial to establish an appropriate measurement for specific paediatric conditions related to readmissions for the accurate determination of the prevalence and actual costs associated with readmissions.What is known about this topic? Unplanned hospital readmissions result in inefficient use of health resources. Australia has used 28 days to measure unplanned readmissions. However, the 30-day measurement is commonly used in the literature. Only five Australian studies were identified with a focus on readmissions associated with specific paediatric health conditions.What does this paper add? This is the first known study examining paediatric all-cause unplanned same-hospital readmissions in Western Australia. The study used both 28- and 30-day measures from discharge to unplanned readmission to allow international comparison. More than half the unplanned hospital readmissions occurred between Day 0 and Day 5 following discharge from the index admission. Time intervals from discharge date to readmission date varied for diagnosis-specific readmissions of paediatric patients.What are the implications for practitioners? Targeting the top principal index admission diagnoses identified for paediatric readmissions is critical for improvement in the continuity of discharge care delivery, health resource utilisation and associated costs. Because 52% of unplanned readmissions occurred in the first 5 days, urgent investigation and implementation of prevention strategies are required, especially when the readmission occurs on the date of discharge.
- Imaging of the Pelvis and Lower Extremity: Demystifying Uncommon Sources of Pelvic Pain. [Review]
- RCRadiol Clin North Am 2018; 56(6):983-995
- Pelvic pain can result from gastrointestinal, gynecologic, urologic, neurologic, and musculoskeletal sources. This article focuses on the musculoskeletal lesions that contribute to acute and chronic ...
Pelvic pain can result from gastrointestinal, gynecologic, urologic, neurologic, and musculoskeletal sources. This article focuses on the musculoskeletal lesions that contribute to acute and chronic pain throughout the musculoskeletal core. Armed with an understanding of musculoskeletal core anatomy and biomechanics, imagers play an integral role in the accurate diagnosis and treatment planning for patients with pain and dysfunction from pelvic sources. MR imaging is the primary imaging modality used, but focused sonographic and radiographic techniques have a role. Ultimately, radiologists can help guide patients to the most appropriate subspecialty clinicians based on the underlying source of symptoms.
- Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn. [Journal Article]
- FRFertil Res Pract 2018; 4:6
- CONCLUSIONS: This case demonstrates the utility of magnetic resonance imaging and three-dimensional ultrasound in the assessment of myometrial integrity in a gravid patient with a heterotopic pregnancy and ruptured rudimentary uterine horn. This case demonstrates the importance of pre-pregnancy diagnosis and management of mullerian anomalies.
- Factors Affecting Sick Leave Duration for Non-Work-Related Temporary Disabilities in Brazilian University Public Servants. [Journal Article]
- IJInt J Environ Res Public Health 2018 Sep 27; 15(10)
- Sickness absenteeism in public institutions compromises the execution of services, and may also generate direct impacts on the population that receives coverage. To determine if sick leave duration f...
Sickness absenteeism in public institutions compromises the execution of services, and may also generate direct impacts on the population that receives coverage. To determine if sick leave duration for temporary disabilities is associated with non-work-related illnesses (NWRI), a historical cohort study was carried out of workers at a Brazilian University. The Charlson Comorbidity Index (CCI) was obtained from the most prevalent diagnoses in each expert examination and from the corresponding days of sick leave per episode, adjusting simple and multiple Cox regression models. As a result, 70% of the NWRI temporary disabilities were due to depressive disorders, convalescence, and dorsalgia with a sick leave duration between 4 and 320 days. The factors of protection for sick leave durations until the rehabilitation were non-insulin-dependent diabetes mellitus and hypertension. Long-term sick leaves were observed in the cases that required rehabilitation of those workers diagnosed with recurrent depressive disorders, conjunctivitis, acute sinusitis, skin disorders, calculus of kidney and ureter, abdominal and pelvic pain, and same-level fall accidents. It is also worth noting that even in a disease that can justify long-term sick leaves, such as breast cancer, the duration may be shorter according to the worker's capacity and self-efficacy.
- Ozone therapy ameliorates inflammation and endometrial injury in rats with pelvic inflammatory disease. [Journal Article]
- BPBiomed Pharmacother 2018; 107:1418-1425
- As a common cause of infertility, pelvic inflammatory disease (PID) is characterized by chronic pain, ectopic pregnancy as well as inflammation and infection of the female upper genital tract. Ozone ...
As a common cause of infertility, pelvic inflammatory disease (PID) is characterized by chronic pain, ectopic pregnancy as well as inflammation and infection of the female upper genital tract. Ozone water, also known as O3, has been previously reported to be a distinctly effective agent in treating inflammation. During the present study, we asserted the hypothesis that O3 could be applied by pelvic inflammation and works to regulate the expression of inflammatory factors including interleukin-6 (IL-6), IL-2 and tumor necrosis factor-α (TNF-α). In an attempt to evaluate the effect of O3 on PID, an acute PID rat model was subsequently established. O3 at concentrations of 45 μg/mL and 60 μg/mL in addition to levofloxacin (LVLX) was injected respectively into the PID rats in a bid to alter the contents of inflammatory factors and immunologic markers. Hematoxylin-eosin (HE) staining was applied to analyze endometrial inflammation. Reductions to the contents of IL-6 and TNF-α were recorded, while that of IL-2, IgA, IgG, IgM, C3 and C4, and E rosette formation rate and transformation rate of T lymphocytes exhibited notably elevated levels after the PID rats had been injected with 45 μg/mL O3, 60 μg/mL O3 or LVLX. The pathological condition of the endometrium in rats with PID was alleviated among the PID rats after injected with the 45 μg/mL O3, 60 μg/mL O3 or LVLX. Taken together, the key findings of the current study present evidence demonstrating that the administration of O3 to the pelvic cavity ameliorated the PID conditions among rat models via inhibition of the necrosis of the endometrial epithelial cells as well as alleviated the inflammatory reactions, highlighting a potential novel PID treatment target.
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- Incarceration of early gravid uterus with adenomyosis and myoma: report of two patients managed with uterine reduction. [Journal Article]
- OGObstet Gynecol Sci 2018; 61(5):621-625
- Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis p...
Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis presented at 7 + 2 weeks of gestation with increased urinary frequency and a sensation of incomplete bladder emptying. The uterine incarceration was successfully reduced by manual reduction and pessary insertion, and she delivered a normal infant at term. In the second case, a 31-year-old nulliparous woman with a large myoma complained of dysuria, acute urinary retention, and intense back pain at 6 weeks of gestation. Manual reduction was successful in the knee-chest position. Subsequent pessary insertion failed; however, a slight reduction in pain was achieved. After a week, the fetus spontaneously aborted. In summary, gravid uterine incarceration is a rare but potentially fatal condition for the fetus, and a suspicion of this condition in patients with urinary symptoms, especially urinary retention and pelvic pain, is important in the early gestation period.