Nascent myoma as a cause of urinary retention.

We present the case of a 47-year-old woman with a bulky, nascent necrotic myoma, which at first glance appeared to be a malignant process in the cervix. It caused significant retention of urine due to compression of the bladder and ureters, hydronephrosis and deterioration of renal function. A fully developed picture of the "bulge syndrome" dominated - lymphedema of the lower limbs and lower abdomen, pain in the lower abdomen, constipation, secondary secondary urinary infection, and paradoxical ischuria. During a gynecological examination in a specula, a strong-smelling, necrotic tumour was visualized reaching half of the vagina, which was causing a bloody discharge, which brought the patient to the examination. A biopsy was taken from the tumour. A permanent urinary catheter was inserted into the urinary bladder with gradual adjustment of renal functions. Due to the difficulties and the benign histological findings from the biopsy, a simple abdominal hysterectomy with bilateral salpingectomy from a lower midline incision was indicated. The operation was complicated by an extensive adhesive process and blood loss of 1,200 mL, with a decrease in hemoglobin in the blood count from 128 g/L to 79 g/L and the need for three blood transfusions. In the postoperative period, there is a prompt recovery of spontaneous micturition with normalization of bladder function, subsidence of lymphedema and subjective complaints of the patient.

Biomechanical analysis of INFINITY rehabilitation method for treatment of low back pain.

[Purpose] Low back pain is a pervasive problem in modern societies. Physical rehabilitation in treatment of low back pain should reduce pain, muscle tension and restore spine stability and balance. The INFINITY® rehabilitation method that is based on a figure of eight movement pattern was proved to be effective in low back pain treatment. The aim of the paper is to estimate the effect of a figure of eight motion on the L5/S1 load and lumbar spine muscle activation in comparison to other motion patterns. [Subjects and Methods] Three-dimensional model of lumbar spine musculoskeletal system is used to simulate effect of various load motion pattern induced by displacement of the center of gravity of the upper body. Four motion patterns were examined: lateral and oblique pendulum-like motion, elliptical motion and figure of eight motion. [Results] The simple pendulum-like and elliptical-like patterns induce harmonic muscle activation and harmonic spinal load. The figure of eight motion pattern creates high-frequency spinal loading that activates remodeling of bones and tendons. The figure of eight pattern also requires muscle activity that differs from harmonic frequency and is more demanding on muscle control and could also improve muscle coordination. [Conclusion] The results of the study indicate that complex motion pattern during INFINITY® rehabilitation might enhance the spine stability by influencing its passive, active and neural components.

Specific rehabilitation exercise for the treatment of patients with chronic low back pain.

[Purpose] To evaluate the efficacy of our special rehabilitation method for patients with low back pain (LBP). [Subjects and Methods] All participants (n=33) received at least five individual 30-minute therapy sessions per week using the INFINITY method(®) and six group therapy sessions per week in a gymnasium and swimming pool, each lasting 30 minutes and including the INFINITY method(®). The treatment lasted between four to seven weeks. Plantar function using a graphic method (computer plantography), graphical quantification of postural control during static standing (posturography), and pain were measured and evaluated before and after rehabilitation therapy. The INFINITY method(®) is a special rehabilitation method for patients with musculoskeletal problems. The method focuses on stabilization and strengthening of the trunk, dorsal and abdominal muscles, including the deep stabilization system which is closely linked with diaphragmatic breathing. It teaches the central nervous system to control muscles more precisely. [Results] Plantar functions, postural control in the upright stance and pain of LBP patients were significantly improved by 4-7 weeks of rehabilitation treatment with the INFINITY method(®). There were significant differences in all measured dependent variables of the patients between before and after treatment. [Conclusion] Rehabilitation therapy with the INFINITY method(®) positively influences body stabilization and pain in patients with problems of the lumbar spine. This method presents a new improved approach (with enhanced effect) to rehabilitation therapy for LBP patients.

Vacuum-assisted vaginal delivery and levator ani avulsion in primiparous women.

OBJECTIVE: We compared the incidence and type of levator ani avulsion diagnosed by translabial ultrasound evaluation in primiparous women six months after vacuum-assisted or spontaneous vaginal delivery. MATERIAL AND METHODS: This retrospective observational study was performed between January 2011 and December 2013. Primiparous women six months after vacuum-assisted vaginal delivery and after spontaneous vaginal delivery underwent translabial ultrasound evaluation. The distance between the urethra and fibers of the musculus levator ani puborectalis (levator-urethra gap) was measured. A levator-urethra gap >25 mm was considered a musculus levator ani avulsion. RESULTS: In total, 184 women participated in the study. Among them, 92 had vacuum extraction and 92 had uncomplicated spontaneous delivery. A longer levator-urethra gap on both sides of the pubic bone was found in women after vacuum-assisted vaginal delivery (p < 0.0001 for both sides). Musculus levator ani avulsion was identified in 20 women (unilateral in 16 cases and bilateral in four cases). No difference in an incidence of musculus levator ani avulsion was identified in women after vacuum-assisted vaginal delivery [11/92 (12%)] compared to spontaneous delivery [9/92 (10%); p = 0.81]. CONCLUSION: Vacuum-assisted vaginal delivery in primiparous women is associated with a longer levator-urethra gap but not with a higher frequency of avulsion of the musculus levator ani.