A randomized controlled trial to compare the interface pressures of alternating pressure overlay with gel pad versus gel pad alone during prolonged surgery.

INTRODUCTION: Prolonged surgery is a known risk of pressure ulcer formation. Pressure ulcers affect the quality of life, are a significant cause of morbidity and mortality, and pose a burden on the healthcare system. This study aimed to compare the effectiveness of an alternating pressure (AP) overlay with Gel pad against the Gel pad in reducing interface pressure (IP) during prolonged surgery. METHODS: A total of 180 participants from a tertiary hospital were randomized to AP overlay with Gel pad group (n = 90) and Gel pad group (n = 90). Patients were placed supine on the pressure redistributing surfaces, and IP data under the sacrum and ischial tuberosities were collected at an interval of 30 min from 0 min up to a maximum of 570 min. RESULTS: Based on data from 133 participants, the average IPs during all the deflation cycles of the AP overlay (with Gel pad) were significantly lower than the average continuous IP recorded for Gel pad throughout the measuring period (p < 0.001). Only three patients (2.26% of study participants) - Gel pad group (n = 2; 2.99%) and AP overlay with Gel pad group (n = 1; 1.52%) developed post-operative pressure ulcer (p = 0.5687). CONCLUSIONS: The lower IP during deflation cycles of the AP overlay (with Gel pad) suggests its potential effectiveness in preventing pressure ulcer formation in patients undergoing prolonged surgery. The prevention and reduction of pressure ulcers will have a considerable impact on the improved quality of life and cost savings for the patient. The study findings may facilitate the formulation of policies for preventing pressure ulcer development in the perioperative setting.

The Benefit of Perineural Injection Treatment with Dextrose for Treatment of Chondromalacia Patella in Participants Receiving Home Physical Therapy: A Pilot Randomized Clinical Trial.

Introduction: Chondromalacia patella is the degeneration of articular cartilage on the posterior facet of the patella and may indicate the onset of osteoarthritis. Conservative management is the main treatment option, and surgical intervention is considered the last option in a small percentage of patients. Perineural Injection Treatment (PIT) is a recently developed treatment option that is directed adjacent to the peripheral nerves that are the source of pathology causing neurogenic inflammation and pain. Objective: The objective of this study was to evaluate the efficacy of PIT combined with a home physical therapy program in patients with a diagnosis of chondromalacia patella compared with a control group receiving physical therapy only. Methods: Two patient groups were involved in this randomized clinical trial. The first received PIT combined with physical therapy (PIT + PT group) and the second was managed with physical therapy alone (PT group). Both groups were indicated to follow a 6-week home therapy plan afterward. The Western Ontario and McMaster Osteoarthritis Index was used to assess the patients at baseline and 6 months after therapy interventions. Results: Fifty patients (38 women and 12 men, median age 54.7 ± 14.8 years) were included; sex distribution and age did not differ between groups. Both groups had chondromalacia grade II or III, but the degree of gonarthrosis did not differ significantly between groups. The PIT + PT group outperformed PT group for pain (7.3 ± 3.5 vs. 3.2 ± 2.9 points; p < 0.010), stiffness (3 ± 1.69 vs. 1.6 ± 1.5 points; p < 0.010), and functional capacity (23.2 ± 10.7 vs. 11.1 ± 8.9 points; p < 0.010). Conclusions: Compared with physical therapy alone, PIT plus physical therapy reduced pain and stiffness and restored functional capacity. ClinicalTrials.gov Register Number #NCT03515720.

An Investigation of Pressure Ulcer Risk, Comfort, and Pain in Medical Imaging.

INTRODUCTION: Pressure ulcers present significant trauma to patients and are expensive to manage. In medical imaging (MI), no study has been conducted to rigorously investigate interface pressure (IP) risk on MI table surfaces. IP is defined as the pressure between human body and a supporting surface. The aims of this research were to investigate whether IP risks exist on MI table surfaces and to assess pain and comfort when lying on MI table surfaces. METHODS: A calibrated XSENSOR mat was used to measure IP for three jeopardy areas (head, sacrum, and heels) in healthy volunteers on an x-ray table surface with no mattress, an x-ray table surface with a thin radiolucent mattress, and a computed tomography table surface, after which they completed a pain and comfort questionnaire. RESULTS: The sample consisted of 26 females and 23 males aged 18-59 years (mean = 34.6; standard deviation [SD] = 10.5). Analysis of variance identified statistically significant differences in the mean IP for the jeopardy areas across the three MI table surfaces (P ≤ .001). Results also indicated high mean IP value for the head (75.9 mmHg; SD = 6.9) on the x-ray table with no mattress. Seventy percent of the volunteers found lying on the x-ray table with no mattress to be very uncomfortable. Sixty-seven percent experienced most pain whilst lying on the x-ray table with no mattress and over 81% of the pain occurred at the head. CONCLUSION: IP risk exists on x-ray tables with no mattress. This could increase the risk of developing pressure ulcers in patients accessing prolonged radiography/radiology procedures.

Sensory neuron development in mouse coccygeal vertebrae and its relationship to tail biopsies for genotyping.

A common method of genotyping mice is via tissue obtained from tail biopsies. However, there is no available information on the temporal development of sensory neurons in the tail and how their presence or absence might affect the age for performing tail biopsies. The goals of this study were to determine if afferent sensory neurons, and in particular nociceptive neurons, are present in the coccygeal vertebrae at or near the time of birth and if not, when they first can be visualized on or in those vertebrae. Using toluidine blue neuronal staining, transmission electron microscopy, and calcitonin-related gene peptide immunostaining, we found proximal to distal maturation of coccygeal nerve growth in the C57BL/6J mouse. Single nerve bundles were first seen on postpartum day (PPD) 0. On PPD 3 presumptive nociceptive sensory nerve fibers were seen entering the vertebral perichondrium. Neural development continued through the last time point (PPD 7) but at no time were neural fibers seen entering the body of the vertebrae. The effect of age on the development of pain perception in the neonatal mouse is discussed.

Sacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome.

Various pelvic floor conditions, including overactive bladder syndrome and chronic pelvic pain, have been successfully managed with the neuromodulation of sacral nerves. Sacral neuromodulation is a minimally invasive procedure involving the implantation of a programmable pulse generator that delivers low-amplitude electrical current via quadripolar tined leads through the S3 foramen. Durable efficacy has been demonstrated in retrospective studies, but questions regarding ideal patient candidacy and optimal technical considerations remain unanswered.

Participation of estradiol and progesterone in the retrograde labeling of pubococcygeus motoneurons of the female rat.

Retrograde labeling with horseradish peroxidase conjugated to wheat germ agglutinin showed that the pubococcygeus muscles of the female rat are innervated by a population of motoneurons located in a column approximately 2 mm in length in the central region of lamina IX of the sixth lumbar-first sacral spinal cord segments. These neurons have a dendritic distribution that projects to the lateral, medial and ventral regions of the gray matter. Values for soma size, primary dendrite length and arborization area obtained from intact animals that were in diestrous-2, were significantly reduced following ovariectomy. After hormone priming of the ovariectomized animals with estradiol benzoate and progesterone, an additional injection of estradiol benzoate alone or followed by progesterone increased the labeled length of the primary dendrites distributed to the lateral, but not to the medial or ventral regions of the gray matter in the spinal cord. However, dendritic labeling was not significantly increased when only progesterone was additionally injected. It therefore seems that pubococcygeus muscle motoneurons of the female rat are sensitive to the effects of gonadal hormones.

Sacral nervous function, hormonal levels and sexuality in premenopausal women before and after hysterectomy.

OBJECTIVE: To investigate the predictive value of sacral nervous function, result of pelvic examination and hormonal status on sexuality before and after subtotal hysterectomy. MATERIAL AND METHOD: One hundred and four women were examined and interviewed one month before and one year after hysterectomy for non-malignant diseases. Genital examination, sacral nervous function testing including vibrotactility were performed, and sex hormone levels were estimated at each occasion. The results were evaluated and compared using multivariate analyses. RESULTS: Postoperative experience of multiple orgasm was negatively correlated to three out of five measured factors for pelvic sacral function: i.e. vibrotactility of the clitoris, the external anal reflex and the levator muscle strength. No correlations were found between tests for sacral nervous function and a latent factor for sexuality before and after the operation. Preoperative uterine size did not show correlation to either preoperative or postoperative sexual parameters nor did uterine pain during vaginal examination. The preoperative sex hormone levels, and the result of histopathological examination showed no correlation to sexual variables. CONCLUSION: Preoperative somatic findings including sacral nervous function and pelvic muscular strength cannot be used as predictors for sexuality after subtotal hysterectomy.

Abordaje anterior transperitoneal para lesiones de columna lumbo-sacra / Anterior transperitoneal access for lesions of the lunbo-sacral spine

Se relata un caso de dolor lumbar con irradiacion tipo radicular bilateral por Espondilolisis bilateral con Espondilolistesis L5-S1, sin mejoria con el tratamiento conservador, por lo que se decidio el abordaje posterior con decomprension radicular e instrumentacion metalica con marco de Hartshill mas artrodesis Lumbo-Sacra y en una segunda etapa el Abordaje anterior transperitoneal con el objetivo de hacerle discectomia y fusion con injerto oseo L5-S1.