Search results for: groin

Authors: Ibrahim Mohamed Ibrahim Hassanin, Hany Hassan Mostafa, Mona Mohamed Shaban, Ahlam El Said Kamel

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Background: New so-called minimally invasive devices have been developed to limit groin pain after sling placement for treatment of stress urinary incontinence (SUI) to minimize the risk of postoperative pain and organ perforation. A new generation of suburethral slings was described that avoided skin incision to pull out and tension the sling. Evaluation of this device through prospective short-term series has shown controversial results compared with other tension-free techniques. The aim of this study is to compare success rates and complications for tension-free vaginal tape secur (TVT secur) and trans-obturator sub urethral tape inside-out technique (TVT-O) for treatment of stress urinary incontinence (SUI). Materials and Methods: Fifty patients with genuine SUI were divided into two groups: group S (n=25) were operated upon using (TVT secur) and group O (n=25) were operated upon using trans-obturator suburethral tape inside-out technique (TVT-O). Success rate, quality of life and postoperative complications such as groin pain, urgency, urine retention and vaginal tape erosion were reported in both groups at one, three, and six months after surgery. Results: As regards objective cure rate at one, three, six months intervals; there was a significant difference between group S (56%, 64%, and 60%), and group O (80%, 88%, and 88%) respectively (P <0.05). As regards subjective cure rate at one, three, six months intervals; there was a significant difference between group S (44%, 44%, and 48%), and group O (76%, 80%, and 80%) respectively (P <0.05). Quality of life (QoL) parameters improved significantly in cured patients with no difference between both groups. As regards complications, group O had a higher frequency of complications than group S; groin pain (12% vs 12% p= 0.05), urgency (4% (1 case) vs 0%), urine retention (8% (2 cases) vs 0%), vaginal tape erosion (4% (1 case) vs 0%). No cases were complicated with wound infection. Conclusion: Compared to TVT secur, TVT-O showed higher subjective and objective cure rates after six months but higher rate of complications. Both techniques were comparable as regards improvement of quality of life after surgery.

Keywords: stress urinary incontinence, trans-vaginal tape-obturator, TVT Secur, TVT-O

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Authors: Mir Ahmad Lashteh Neshaei, Hamed Afsoos Biria, Ata Ghabraei, Mir Abdolhamid Mehrdad

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Awareness of effective land using issues in coastal area including protection of natural ecosystems and coastal environment due to the increasing of human life along the coast is of great importance. There are numerous valuable structures and heritages which are located in defence sites and waterfront area. Marine structures such as groins, sea walls and detached breakwaters are constructed in coast to improve the coast stability against bed erosion due to changing wave and climate pattern. Marine mechanisms and interaction with the shore protection structures need to be intensively studied. Groins are one of the most prominent structures that are used in shore protection to create a safe environment for coastal area by maintaining the land against progressive coastal erosion. The main structural function of a groin is to control the long shore current and littoral sediment transport. This structure can be submerged and provide the necessary beach protection without negative environmental impact. However, for submerged structures adopted for beach protection, the shoreline response to these structures is not well understood at present. Nowadays, modelling and computer simulation are used to assess beach morphology in the vicinity of marine structures to reduce their environmental impact. The objective of this study is to predict the beach morphology in the vicinity of submerged groins and comparison with non-submerged groins with focus on a part of the coast located in Dahane sar Sefidrood, Guilan province, Iran where serious coast erosion has occurred recently. The simulations were obtained using a one-line model which can be used as a first approximation of shoreline prediction in the vicinity of groins. The results of the proposed model are compared with field measurements to determine the shape of the coast. Finally, the results of the present study show that using submerged groins can have a good efficiency to control the beach erosion without causing severe environmental impact to the coast. The important outcome from this study can be employed in optimum designing of defence sites in the coastal cities to improve their efficiency in terms of re-using the heritage lands.

Keywords: submerged structures, groin, shore protective structures, coastal cities

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Authors: Aniruddha Kulkarni

Abstract:

In very few cases of external hernias we require imaging modalities as on most occasions clinical examination tests are good enough. Ultrasound will help in chronic abdominal or groin pain, equivocal clinical results & complicated hernias. Ultrasound is useful in assessment of cause of raised intrabdominal pressure. In certain cases will comment about etiology, complications and chronicicty of lesion. Screening of rest of abdominal organs too is important advantage being real time modality. Cost effectiveness, no radiation allows modality be used repeatedly in indicated cases. Sonography is better accepted by patients too as it is cost effective. Best advanced tissue harmonic equipment and increasing expertise making it popular. Ultrasound can define surgical anatomy, rent size, contents, etiological /recurrence factors in great detail and with authority hence accidental findings in a planned surgical procedure can be easily avoided. Clinical dynamic valselva and reducibility test can better documented by real time ultrasound study. In case of recurrence, Sonography will help in assessing the hernia details better as being dynamic real time investigation. Ultrasound signs in case of internal hernias are well comparable with CT findings.

Keywords: laparoscopic repair, Hernia, CT findings, chronic pain

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Authors: Sonia Lachowska, Agnieszka Antonczyk, Joanna Tunikowska, Pawel Kucharski, Bartlomiej Liszka

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Isoflurane is one of the most commonly used anaesthetic gases in veterinary medicine. Due to its numerous side effects, intravenous anaesthesia is more often used. The combination of tiletamine with zolazepam has proved to be a safe and pharmacologically beneficial combination. Analgesic effect, fast induction time, effective myorelaxation, and smooth recovery are the main advantages of this combination of drugs. In the following study, the authors verified the necessity of isoflurane to maintain anaesthesia in dogs after the use of tiletamine-zolazepam for induction. 12 dogs were selected to the group with the inclusion criteria: ASA (American Society of Anaesthesiology) I or II. Each dog received premedication intramuscularly with medetomidine-butorfanol (10 μg/kg, 0,1 mg/kg respectively). 15 minutes from premedication, preoxygenation lasting 5 minutes was started. Anaesthesia was induced with tiletamine-zolazepam at the dose of 5 mg/kg. Then the dogs were intubated and anaesthesia was maintained with isoflurane. Initially, MAC (Minimum Alveolar Concentration) was set to 0.7 vol.%. After 15 minutes equilibration, MAC was determined using Dixon’s up-and-down method. Painful stimulation including compressions of paw pad, phalange, groin area, and clamping Backhaus on skin. Hemodynamic and ventilation parameters were measured and noted in 2 minutes intervals. In this method, the positive or negative response to the noxious stimulus is estimated and then used to determine the concentration of isoflurane for next patient. The response is only assessed once in each patient. The results show that isoflurane is not necessary to maintain anaesthesia after tiletamine-zolazepam induction. This is clinically important because the side effects resulting from using isoflurane are eliminated.

Keywords: anaesthesia, dog, Isoflurane, The Dixon's up-and-down method, Tiletamine, Zolazepam

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Authors: Y. Zhang, J. Perez, S. Marnier

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To date, no study on goaltending butterfly motion has been completed in real conditions, during an ice hockey game or training practice, to the author's best knowledge. This motion, performed to save score, is unnatural, intense, and repeated. The target of this research activity is to identify representative biomechanical criteria for this goaltender-specific movement pattern. Determining specific physical parameters may allow to will identify the risk of hip and groin injuries sustained by goaltenders. Four professional or academic goalies were instrumented during ice hockey training practices with five inertial measurement units. These devices were inserted in dedicated pockets located on each thigh and shank, and the fifth on the lumbar spine. A camera was also installed close to the ice to observe and record the goaltenders' activities, especially the butterfly motions, in order to synchronize the captured data and the behavior of the goaltender. Each data recorded began with a calibration of the inertial units and a calibration of the fully equipped goaltender on the ice. Three butterfly motions were recorded out of the training practice to define referential individual butterfly motions. Then, a data processing algorithm based on the Madgwick filter computed hip and knee joints joint range of motion as well as angular specific angular velocities. The developed algorithm software automatically identified and analyzed all the butterfly motions executed by the four different goaltenders. To date, it is still too early to show that the analyzed criteria are representative of the trauma generated by the butterfly motion as the research is only at its beginning. However, this descriptive research activity is promising in its ecological assessment, and once the criteria are found, the tools and protocols defined will allow the prevention of as many injuries as possible. It will thus be possible to build a specific training program for each goalie.

Keywords: biomechanics, butterfly motion, human motion analysis, ice hockey, inertial measurement unit

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Authors: Sena Park

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Background: The concurrent presentation with colorectal cancer in the inguinal hernia has been extremely rare. Due to its rarity, its presentation may lead to diagnostic and therapeutic dilemmas. We aim to review all the reported cases on colorectal cancer incarcerated in the inguinal hernia in the last 20 years, and discuss the operative approaches. Methods: We identified all case reports on colorectal cancer within inguinal hernia using PUBMED (2002-2022) and MEDLINE (2002-2022). The search strategy included the following keywords: colorectal cancer (title/abstract) AND inguinal hernia (title/abstract) OR incarceration (title/abstract). The search did not include letters, book chapters, systemic reviews, meta-analysis and editorials. Results: In the last 20 years, a total of 19 cases on colorectal cancer within the inguinal hernia were identified. The age of the patients ranged between 48 and 89. Majority of the patients were male (95%). Most commonly involved part of the large intestine was sigmoid colon (79%). Of all the cases, 79 percent of patients received open procedure and 21 percent had laparoscopic procedure. Discussion: Inguinal hernias are common with an incidence of approximately 1.7 percent. Colorectal cancer is the one of the leading causes of cancer-related mortality worldwide. However, their concurrent presentation has been extremely rare. In the last 20 years, 19 cases on concurrent presentation of colorectal cancer and inguinal hernia have been reported. Most patients who had open procedures had two incisions of groin incision and a midline laparotomy. There were 4 cases where the oncological resection was performed laparoscopically. The advantages of laparoscopic resection include reduced blood lost, reduced post-operative pain, reduced length of hospital stay and similar number of lymph nodes taken. From the review of the cases in the last 20 years, both open and laparoscopic approaches seemed to be safe and achieve adequate oncological resections. Conclusion: This is a brief overview of reported cases of colorectal cancer presenting with inguinal hernia concurrently. Due to its rarity, there are no current guidelines on operative approach in clinical practice. The experience in the last 20 years supports both open and laparoscopic approach.

Keywords: colorectal cancer, inguinal hernia, incarceration, operative approach

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Authors: Hansraj Bookun, Angela Tan, Rachel Xuan, Linheng Zhao, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos

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Introduction: Incisional wound complications in vascular surgery patients represent a significant clinical and econometric burden of morbidity and mortality. The objective of this study was to trial the feasibility of applying the Prevena negative pressure incision management system as a routine dressing in patients who had undergone arterial surgery. Conventionally, Prevena has been applied to groin incisions, but this study features applications on multiple wound sites such as the thigh or major amputation stumps. Method: This was a cross-sectional observational, single-centre case series of 12 patients who had undergone major vascular surgery. Their wounds were managed with the Prevena system being applied either intra-operatively or on the first post-operative day. Demographic and operative details were collated as well as the length of stay and complication rates. Results: There were 9 males (75%) with mean age of 66 years and the comorbid burden was as follows: ischaemic heart disease (92%), diabetes (42%), hypertension (100%), stage 4 or greater kidney impairment (17%) and current or ex-smoking (83%). The main indications were acute ischaemia (33%), claudication (25%), and gangrene (17%). There were single instances of an occluded popliteal artery aneurysm, diabetic foot infection, and rest pain. The majority of patients (50%) had hybrid operations with iliofemoral endarterectomies, patch arterioplasties, and further peripheral endovascular treatment. There were 4 complex arterial bypass operations and 2 major amputations. The mean length of stay was 17 ± 10 days, with a range of 4 to 35 days. A single complication, in the form of a lymphocoele, was encountered in the context of an iliofemoral endarterectomy and patch arterioplasty. This was managed conservatively. There were no deaths. Discussion: The Prevena wound management system shows that in conjunction with safe vascular surgery, absolute wound complication rates remain low and that it remains a valuable adjunct in the treatment of vasculopaths.

Keywords: wound care, negative pressure, vascular surgery, closed incision

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Authors: Nuruddin Mohammod Zahangir, Syed Tanvir Ahmady, Firoz Ahmed, Mainul Kabir, Tamjid Mohammad Najmus Sakib Khan, Nazmul Hossain, Niaz Ahmed, Madhava Janardhan Naik

Abstract:

The management of combined Coronary Artery Disease and Peripheral Vascular Disease is a challenge and brings with it numerous clinical dilemmas.The 56 year old gentleman presented to our department with significant triple vessel disease with occluded lower end of aorta just before bifurcation and bilateral superficial femoral arteries. Operation was done on 11.03.14. The The Left Internal Mammary Artery (LIMA) and the Right Internal Mammary Artery (RIMA) were harvested in skeletonized manner. The free RIMA was then anastomosed with LIMA to make LIMA-RIMA Y. Cardio Pulmonary Bypass was then established and coronary artery bypass grafts performed. LIMA was anastomosed to the Left Anterior Descending artery. RIMA was anastomosed to Posterior Descending Artery, 1st and 2nd Obtuse Marginal arteries in a sequential manner. Abdomen was opened by midline incision. The infrarenal aorta exposed and was found to be severely diseased. A Vascular Clamp was applied infrarenally, aortotomy done and limited endarterectomy performed. An end-to-side anastomosis was done with upper end of PTFE synthetic Y-graft (14/7 mm) to the infarenal Aorta and the Clamp released. Good flow noted in both limbs of the graft. Patient was then slowly weaned off from Cardio Pulmonary Bypass without difficulty. The distal two limbs of the Y graft were passed to the groin through retroperitoneal tunnels and anastomosed end-to-side with the common femoral arteries. Saphenous vein was interposed between common femoral and popliteal arteries bilaterally through subfascial tunnels in both thigh. On 12th postoperative day he was discharged from hospital in good general condition. Follow up after 3 months of operation the patient is doing good and free of chest pain and claudication pain.

Keywords: total arterial, coronary revascularization, aorto-bifemoral bypass, bifemoro-bipopliteal bypass

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Authors: C. Brandt, R. Christopher, N. Damons

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Background: Soccer is one of the most common sports in the world. It is associated with a significant chance of injury either during training or during the course of an actual match. Studies on the epidemiology of soccer injuries have been widely conducted, but methodological appraisal is lacking to make evidence-based decisions. Objectives: The purpose of this study was to conduct a systematic review of common injuries in soccer and their risk factors. Methods: A systematic review was performed based on the Joanna Briggs Institute procedure for conducting systematic reviews. Databases such as SPORT Discus, Cinahl, Medline, Science Direct, PubMed, and grey literature were searched. The quality of selected studies was rated, and data extracted and tabulated. Plot data analysis was done, and incidence rates and odds ratios were calculated, with their respective 95% confidence intervals. I² statistic was used to determine the proportion of variation across studies. Results: The search yielded 62 studies, of which 21 were screened for inclusion. A total of 16 studies were included for the analysis, ten for qualitative and six for quantitative analysis. The included studies had, on average, a low risk of bias and good methodological quality. The heterogeneity amongst the pooled studies was, however, statistically significant (χ²-p value < 0.001). The pooled results indicated a high incidence of soccer injuries at an incidence rate of 6.83 per 1000 hours of play. The pooled results also showed significant evidence of risk factors and the likelihood of injury occurrence in relation to these risk factors (OR=1.12 95% CI 1.07; 1.17). Conclusion: Although multiple studies are available on the epidemiology of soccer injuries and risk factors, only a limited number of studies were of sound methodology to be included in a review. There was also significant heterogeneity amongst the studies. The incidence rate of common soccer injuries was found to be 6.83 per 1000 hours of play. This incidence rate is lower than the values reported by the majority of previous studies on the occurrence of common soccer injuries. The types of common soccer injuries found by this review support the soccer injuries pattern reported in existing literature as muscle strain and ligament sprain of varying severity, especially in the lower limbs. The risk factors that emerged from this systematic review are predominantly intrinsic risk factors. The risk factors increase the risk of traumatic and overuse injuries of the lower extremities such as hamstrings and groin strains, knee and ankle sprains, and contusion.

Keywords: incidence, prevalence, risk factors, soccer injuries

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