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Sample records for incontinence retraining diaphragmatic

  1. Stress Incontinence

    Science.gov (United States)

    Stress incontinence Overview Urinary incontinence is the unintentional loss of urine. Stress incontinence happens when physical movement or activity — such ... coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress incontinence is not related ...

  2. RETRAINING BY PRIVATE INDUSTRY.

    Science.gov (United States)

    HOOS, IDA R.

    SEVERAL SAN FRANCISCO BAY AREA COMPANIES WERE EXAMINED FOR SPECIFIC PROGRAMS FOR DISPLACED EMPLOYEES. ARMOUR AND COMPANY SOUGHT TO GUIDE DISPLACED EMPLOYEES TO CLASSES OR COURSES OF ACTION OUTSIDE ITS OWN SPHERE OF OPERATION. LOCKHEED HAS PROVIDED UNUSUALLY WELL FOR UPGRADING AND RETRAINING, MAINLY BECAUSE OF INDUSTRY FLUCTUATIONS AND RAPID…

  3. Experiments with Retraining.

    Science.gov (United States)

    Shultz, George P.; Weber, Arnold R.

    When Armour and Company faced a shutdown of six plants, it joined in a cooperative program of vocational retraining with two labor unions; an Automation Fund Committee was formed, with representation from management, the unions, and "public" (college professors); and an experimental program in Oklahoma City provided experience which was…

  4. Diaphragmatic crural eventration

    Directory of Open Access Journals (Sweden)

    Sivakumar K

    2008-01-01

    Full Text Available Aim: We evaluated patients with gastric volvulus secondary to diaphragmatic pathology. Materials and Methods: Eight patients (5 males and 3 females presented to the author in a tertiary care center during 1997-2006 were analyzed in terms of age, sex, symptomatology, diagnosis and predisposing factors. Observations: Six had an acute presentation and rest had chronic symptomatology. The two patients who had total gangrene stomach died postoperatively and one patient died preoperatively due to aspiration. All the cases presented with acute symptoms had diaphragmatic pathology, and out of these, three cases had the specific entity, which is named as diaphragmatic crural eventration. Conclusions: Diaphragmatic crural eventration is characterized by the defective development of the right crus of diaphragm, and this is embryologically significant as the right crus and ligaments of the stomach develop from dorsal mesoesophagus and mesogastrium. The author recommends a closer look for this defect of diaphragm while operating a case of gastric volvulus.

  5. Urinary Incontinence

    Science.gov (United States)

    ... Why does urinary incontinence affect more women than men? Women have unique health events, such as pregnancy, ... urge incontinence, urine leakage usually happens after a strong, sudden urge to urinate and before you can ...

  6. Urinary Incontinence

    Science.gov (United States)

    ... with nerve signals involved in bladder control, causing urinary incontinence. Risk factors Factors that increase your risk of developing urinary incontinence include: Gender. Women are more likely to have ...

  7. Urinary incontinence

    Science.gov (United States)

    Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary ... and take out yourself. Bladder nerve stimulation. Urge incontinence and urinary frequency can sometimes be treated by electrical nerve ...

  8. Tinnitus retraining therapy.

    Science.gov (United States)

    Jastreboff, P J

    2007-01-01

    Tinnitus retraining therapy (TRT) is a specific clinical method based on the neurophysiological model of tinnitus described by Jastreboff (Jastreboff, P.J. (1990). Neurosci. Res., 8: 221-254). The method is aimed at habituation of reactions evoked by tinnitus, and subsequently habituation of the tinnitus perception. Several other methods have been suggested for habituation of tinnitus, but in TRT two components that strictly follow the principles of the neurophysiological model of tinnitus are implemented and necessary: (1) counseling, aimed at reclassification of tinnitus to a category of a neutral signals and (2) sound therapy, aimed at weakening tinnitus-related neuronal activity as suggested by Jastreboff and Hazell (Jastreboff, P.J. and Hazell, J.W.P. (2004). Cambridge University Press, Cambridge). This chapter outlines the theoretical basis of TRT as well as comments on the clinical outcome of the use of TRT for different kinds of tinnitus.

  9. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  10. Body composition variation following diaphragmatic breathing ...

    African Journals Online (AJOL)

    Body composition variation following diaphragmatic breathing. ... effect of commonly prescribed diaphragmatic breathing training on the body composition ... a non-exercising control (NE) group (n = 22) or diaphragmatic breathing (DB) group.

  11. [Male urinary incontinence

    NARCIS (Netherlands)

    Boer, T.A. de; Heesakkers, J.P.F.A.

    2008-01-01

    *Urinary incontinence in males is gaining increasingly more attention. *Male urinary incontinence can be classified as storage incontinence due to overactive bladder syndrome or stress incontinence due to urethral sphincter dysfunction. *Most patients benefit from the currently available treatment

  12. Retrain Who to Do What?

    Science.gov (United States)

    Geber, Beverly

    1993-01-01

    There are inherent problems when unskilled or semiskilled workers are retrained for high skilled jobs that do not and will not exist. Although the consensus is that smarter workers will make the nation more competitive in the world market, the occupation that will add the most jobs by the year 2005 is retail clerk. (JOW)

  13. MR diagnosis of diaphragmatic endometriosis

    International Nuclear Information System (INIS)

    Rousset, Pascal; Gregory, Jules; Coste, Joel; Rousset-Jablonski, Christine; Hugon-Rodin, Justine; Regnard, Jean-Francois; Chapron, Charles; Golfier, Francois; Revel, Marie-Pierre

    2016-01-01

    To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. (orig.)

  14. MR diagnosis of diaphragmatic endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Rousset, Pascal [Lyon 1 Claude Bernard University, Villeurbanne (France); Centre Hospitalier Lyon Sud, Radiology Department, Pierre Benite (France); Gregory, Jules; Coste, Joel [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Biostatistics and Epidemiology department, Paris (France); Rousset-Jablonski, Christine [Centre Hospitalier Lyon Sud, Obstetric and Gynecologic Department, Pierre Benite (France); Hugon-Rodin, Justine [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Gynecology Endocrinology Department, Paris (France); Regnard, Jean-Francois [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Thoracic Surgery Department, Paris (France); Chapron, Charles [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Obstetric and Gynecologic Department, Paris (France); Golfier, Francois [Lyon 1 Claude Bernard University, Villeurbanne (France); Centre Hospitalier Lyon Sud, Obstetric and Gynecologic Department, Pierre Benite (France); Revel, Marie-Pierre [Paris Descartes University, Sorbonne Paris Cite, Paris (France); Groupe Hospitalier Cochin Hotel-Dieu, Radiology Department, Paris (France)

    2016-11-15

    To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis. Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics. Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes. MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement. (orig.)

  15. Skin care and incontinence

    Science.gov (United States)

    ... skin care; Incontinence - pressure sore; Incontinence - pressure ulcer Patient Instructions Preventing pressure ulcers Images Male urinary system References Holroyd S. Incontinence-associated dermatitis: identification, prevention and care. Br J Nurs . 2015;24( ...

  16. Urinary incontinence - injectable implant

    Science.gov (United States)

    ... repair; ISD repair; Injectable bulking agents for stress urinary incontinence ... and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Lobo ...

  17. Elevation of the diaphragmatic cupola

    International Nuclear Information System (INIS)

    Semenov, V.M.; Talesnik, M.R.

    1988-01-01

    Altogether 45 patients with elevation of the diaphragmatic cupola were examined. A high frequency of erroneous initial interpretation of examination results was noted in inflammatory and tumorous lesions and congenital conditions. Routine and contrast methods (pneumoperitoneum, bronchography, pleurography and fistulography) were used. Disease-related methods of X-ray investigation were proposed. A variety of causes of diaphragm elevation was indicated

  18. Imaging of congenital diaphragmatic hernias

    International Nuclear Information System (INIS)

    Taylor, George A.; Estroff, Judy A.; Atalabi, Omolola M.

    2009-01-01

    Congenital diaphragmatic hernias are complex and life-threatening lesions that are not just anatomic defects of the diaphragm, but represent a complex set of physiologic derangements of the lung, the pulmonary vasculature, and related structures. Imaging plays an increasingly important role in the care of these infants. Prenatal sonography and MRI have allowed early and accurate identification of the defect and associated anomalies. These tools have also been the key to defining the degree of pulmonary hypoplasia and to predicting neonatal survival and need for aggressive respiratory rescue strategies. In the postnatal period, conventional radiography supplemented by cross-sectional imaging in selected cases can be very useful in sorting out the differential diagnosis of intrathoracic masses, in the detection of associated anomalies, and in the management of complications. Understanding the pathogenesis of diaphragmatic defects, the underlying physiologic disturbances, and the strengths and limitations of current imaging protocols is essential to the effective and accurate management of these complex patients. (orig.)

  19. Imaging of congenital diaphragmatic hernias

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, George A.; Estroff, Judy A. [Harvard Medical School, Department of Radiology, Children' s Hospital Boston, Boston, MA (United States); Atalabi, Omolola M. [Harvard Medical School, Department of Radiology, Children' s Hospital Boston, Boston, MA (United States); The College of Medicine/University College Hospital, Ibadan (Nigeria)

    2009-01-15

    Congenital diaphragmatic hernias are complex and life-threatening lesions that are not just anatomic defects of the diaphragm, but represent a complex set of physiologic derangements of the lung, the pulmonary vasculature, and related structures. Imaging plays an increasingly important role in the care of these infants. Prenatal sonography and MRI have allowed early and accurate identification of the defect and associated anomalies. These tools have also been the key to defining the degree of pulmonary hypoplasia and to predicting neonatal survival and need for aggressive respiratory rescue strategies. In the postnatal period, conventional radiography supplemented by cross-sectional imaging in selected cases can be very useful in sorting out the differential diagnosis of intrathoracic masses, in the detection of associated anomalies, and in the management of complications. Understanding the pathogenesis of diaphragmatic defects, the underlying physiologic disturbances, and the strengths and limitations of current imaging protocols is essential to the effective and accurate management of these complex patients. (orig.)

  20. Urinary incontinence products

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003973.htm Urinary incontinence products To use the sharing features on this ... There are many products to help you manage urinary incontinence . You can decide which product to choose based ...

  1. Urinary incontinence during pregnancy

    OpenAIRE

    Wesnes, Stian Langeland; Rørtveit, Guri; Bø, Kari; Hunskår, Steinar

    2007-01-01

    Objectives: To investigate incidence and prevalence of urinary incontinence during pregnancy, and associated risk factors.Method: The data collection was conducted as part of the Norwegian Mother and Child Cohort Study at the Norwegian Institute of Public Health. We present questionnaire data about urinary incontinence obtained from 43,279 women (response rate 45%) by week 30. We report data on any incontinence in addition to type, frequency and amount of incontinence. Po...

  2. Diaphragmatic Hernia Masquerading as Pleural Effusion

    African Journals Online (AJOL)

    As many as 30% of diaphragmatic hernias present late.[1] We present an unusual case report of a late presentation of isolated diaphragmatic injury, after apparently minor blunt trauma, which was initially misdiagnosed as pleural effusion. CASE REPORT. A 40-year-old man slipped and fell against the edge of his bath tub.

  3. [An assessment of tinnitus retraining therapy].

    Science.gov (United States)

    von Wedel, H; von Wedel, U C

    2000-12-01

    Based on the neurophysiological model of tinnitus developed by Jastreboff and Hazell [39] there have been some important developments in understanding and therapy of tinnitus over the last decade. The clinical applications of this model are known as "tinnitus retraining therapy", which has the objective of reducing both the distress associated with tinnitus and the tinnitus perception itself. As a form of systematic, repeated and skilled counselling over a long period of up to 2 years supported by sound therapy (hearing aid or noise generator) the evidence for their high degree of effectiveness is overwhelming. On the basis of a "German concept" of tinnitus retraining therapy developed and proposed by the ADANO (Arbeitsgemeinschaft deutschsprachiger Audiologen und Neurootologen) the current status of this treatment will be briefly reviewed including some actual studies of Goebel et al. [14] that confirm the world wide critical comments on the recent developments in the management of tinnitus especially with regard to tinnitus retraining therapy [79].

  4. Evaluation of diaphragmatic motion in normal and diaphragmatic paralyzed dogs using M-mode ultrasonography.

    Science.gov (United States)

    Choi, Mihyun; Lee, Namsoon; Kim, Ahyoung; Keh, Seoyeon; Lee, Jinsoo; Kim, Hyunwook; Choi, Mincheol

    2014-01-01

    Diagnosis of unilateral diaphragmatic paralysis in dogs is currently based on fluoroscopic detection of unequal movement between the crura. Bilateral paralysis may be more difficult to confirm with fluoroscopy because diaphragmatic movement is sometimes produced by compensatory abdominal muscle contractions. The purpose of this study was to develop a new method to evaluate diaphragmatic movement using M-mode ultrasonography and to describe findings for normal and diaphragmatic paralyzed dogs. Fifty-five clinically normal dogs and two dogs with diaphragmatic paralysis were recruited. Thoracic radiographs were acquired for all dogs and fluoroscopy studies were also acquired for clinically affected dogs. Two observers independently measured diaphragmatic direction of motion and amplitude of excursion using M-mode ultrasonography for dogs meeting study inclusion criteria. Eight of the clinically normal dogs were excluded due to abnormal thoracic radiographic findings. For the remaining normal dogs, the lower limit values of diaphragmatic excursion were 2.85-2.98 mm during normal breathing. One dog with bilateral diaphragmatic paralysis showed paradoxical movement of both crura at the end of inspiration. One dog with unilateral diaphragmatic paralysis had diaphragmatic excursion values of 2.00 ± 0.42 mm on the left side and 4.05 ± 1.48 mm on the right side. The difference between left and right diaphragmatic excursion values was 55%. Findings indicated that M-mode ultrasonography is a relatively simple and objective method for measuring diaphragmatic movement in dogs. Future studies are needed in a larger number of dogs with diaphragmatic paralysis to determine the diagnostic sensitivity of this promising new technique. © 2013 American College of Veterinary Radiology.

  5. The Transferability and Retraining of Defense Engineers.

    Science.gov (United States)

    Rittenhouse, Carl H.

    This study was undertaken to describe any special barriers to the transfer of engineers from defense to commercial work, and to evaluate retraining and reorientation techniques that might help ease the transfer. Interviews and questionnaires were used to obtain data from about 2,100 engineers and 100 managers in 14 industries. Characteristics,…

  6. Workplace High Tech Spurs Retraining Efforts.

    Science.gov (United States)

    Davis, Dwight B.

    1984-01-01

    Discusses who should provide training for displaced workers who need new skills. Areas examined include: (1) the need for retraining; (2) current corporate efforts; (3) agreements in the automotive industry; (4) job quality; (5) the federal government's role; and (6) federal legislation related to the problem. (JN)

  7. Bochdalek Hernia with Adult Diaphragmatic Agenesis

    Directory of Open Access Journals (Sweden)

    Erkan Akar

    2013-10-01

    Full Text Available    Diaphragmatic hernia arises from pleuro-peritoneal membranes inability to close pericardioperitoneal membranes. Diaphragmatic defect may be located in esophageal hiatus (hiatal hernia, nearby the hiatus (paraesophageal, retrosternal (Morgagni or posterolateral (Bochdalek. Congenital diaphragmatic hernias (CDH diagnosed after neonatal period are defined as late presenting CDH. This group of patients consist 5-31% of CDHs and lead to diagnostic difficulties. A case of adult type Bochdalek hernia who was admitted to our clinic with respiratory problems and recognized late with the absence of left diaphragm was discussed in the light of clinical and surgical methods.

  8. Urinary Incontinence in Elderly

    Directory of Open Access Journals (Sweden)

    N. S. Neki

    2016-01-01

    Full Text Available Urinary Incontinence (UI is dened any involuntary leakage of urine. It is twice as common in women as in men and affects at least 1 in 3 older women. It is not a normal result of aging. Rather it is a medical problem that is often curable and should be treated. Urine is stored in the bladder and emptied via the urethra. During urination, muscles of the bladder wall contract, forcing urine from the bladder into the urethra. Sphincter muscles surrounding the urethra relax thus releasing urine from the body. Incontinence occurs if bladder muscles suddenly contract or sphincter muscles are not strong enough to contain urine. The diagnosis of geriatric urinary incontinence includes evaluation for overow incontinence, functional incontinence and stress incontinence. The treatment goal should be realistic and aim to improve the patient's functional status and quality of life. Best treatment outcomes can only be achieved by a holistic treatment approach.

  9. Difficult weaning in delayed onset diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Ahmed Syed

    2009-01-01

    Full Text Available Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support.

  10. Endometriosis-related spontaneous diaphragmatic rupture.

    Science.gov (United States)

    Triponez, Frédéric; Alifano, Marco; Bobbio, Antonio; Regnard, Jean-François

    2010-10-01

    Non-traumatic, spontaneous diaphragmatic rupture is a rare event whose pathophysiology is not known. We report the case of endometriosis-related spontaneous rupture of the right diaphragm with intrathoracic herniation of the liver, gallbladder and colon. We hypothesize that the invasiveness of endometriotic tissue caused diaphragm fragility, which finally lead to its complete rupture without traumatic event. The treatment consisted of a classical management of diaphragmatic rupture, with excision of the endometriotic nodule followed by medical ovarian suppression for six months.

  11. Congenital diaphragmatic hernia with gastric volvulus

    OpenAIRE

    Jain, Prashant; Sanghavi, Beejal; Sanghani, Hemanshi; Parelkar, S. V.; Borwankar, S. S.

    2007-01-01

    Gastric volvulus is a surgical emergency presenting in various forms. Association with diaphragmatic defect is well known. Here we describe three cases of gastric volvulus associated with diaphragmatic defect having varied presentations and their management. A rare case of gastric volvulus with complete gangrene of the stomach is also reported. Three types of gastric volvulus have been described depending on the rotation axis: organoaxial, mesentericoaxial and combination of both types. Opera...

  12. Occult diaphragmatic injuries caused by stab wounds.

    Science.gov (United States)

    Leppäniemi, Ari; Haapiainen, Reijo

    2003-10-01

    Missed diaphragmatic perforation caused by penetrating trauma can lead to subsequent strangulation of a hollow viscus, which has prompted the use of invasive diagnostic procedures to exclude occult diaphragmatic injuries in asymptomatic, high-risk patients. The objective of this study was to determine the incidence of occult diaphragmatic injuries caused by stab wounds of the lower chest and upper abdomen, and to examine the natural history and consequences of missed diaphragmatic injuries. On the basis of patient data from two previous randomized studies from our institution, a retrospective analysis was performed on 97 patients treated for anterior stab wounds located between the nipple line, the umbilical level, and the posterior axillary lines not having indications for immediate surgical exploration. The patients were divided into two groups on the basis of their initial randomized management (open or laparoscopic exploration vs. expectant observation). In the exploration group (n = 47), four diaphragmatic injuries (9%) were detected (three left-sided and one right-sided). Excluding patients with associated injuries requiring surgical repair, the incidence of occult diaphragmatic injuries was 3 of 43 (7%). In the observation group (n = 50), there were two patients (4%) with delayed presentation of missed left-sided diaphragmatic injury 2 and 23 months later, respectively. Both injuries resulted from stab wounds of the left flank and presented with herniation of the stomach or small bowel and colon. The overall incidence of occult diaphragmatic injuries in left-sided thoracoabdominal stab wounds was 4 of 24 (17%), and was much lower after stab wounds of left epigastrium (0%), right lower chest (0%), and right epigastrium (4%). In asymptomatic patients with anterior or flank stab wounds of the lower chest or upper abdominal area, the risk of an occult diaphragmatic injury is approximately 7% which, if undetected, is associated with a high risk of subsequent

  13. Urinary incontinence during pregnancy.

    Science.gov (United States)

    Wesnes, Stian Langeland; Rortveit, Guri; Bø, Kari; Hunskaar, Steinar

    2007-04-01

    To investigate incidence and prevalence of urinary incontinence during pregnancy and associated risk factors. The data collection was conducted as part of the Norwegian Mother and Child Cohort Study at the Norwegian Institute of Public Health. We present questionnaire data about urinary incontinence obtained from 43,279 women (response rate 45%) by week 30. We report data on any incontinence, in addition to type, frequency, and amount of incontinence. Potential risk factors were investigated by logistic regression analyses. The prevalence of incontinence increased from 26% before pregnancy to 58% in week 30. The corresponding figures for nulliparous women were 15% and 48%, and for parous women 35% and 67%. The cumulative incidence was 46%. Stress urinary incontinence was the most common type of incontinence in week 30 of pregnancy, experienced by 31% of nulliparous and 42% of parous women. The majority of pregnant women had leakage less than once per week and droplets only, both before and during pregnancy. Parity was a strong and significant risk factor for incontinence in adjusted analyses both before pregnancy (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.4-2.7 for primiparous and OR 3.3, 95% CI 3.1-3.5 for multiparous women) and during pregnancy (ORs 2.0, 95% CI 1.9-2.1 and 2.1, 95% CI 2.0-2.2, respectively). Age and body mass index were weaker, but still statistically significant, risk factors. The prevalence of urinary incontinence increases substantially during pregnancy. Incontinence both before and during pregnancy seems to be associated with parity, age, and body mass index. II.

  14. Lung MRI and impairment of diaphragmatic function in Pompe disease

    DEFF Research Database (Denmark)

    Wens, Stephan C A; Ciet, Pierluigi; Perez-Rovira, Adria

    2015-01-01

    Background: Pompe disease is a progressive metabolic myopathy. Involvement of respiratory muscles leads to progressive pulmonary dysfunction, particularly in supine position. Diaphragmatic weakness is considered to be the most important component. Standard spirometry is to some extent indicative ...... tool to visualize diaphragmatic dynamics in Pompe patients and to study chest-walland diaphragmatic movements in more detail. Our data indicate that diaphragmatic displacement may be severely disturbed in patients with Pompe disease....

  15. Urinary incontinence in women

    Science.gov (United States)

    Aoki, Yoshitaka; Brown, Heidi W.; Brubaker, Linda; Cornu, Jean Nicolas; Daly, J. Oliver; Cartwright, Rufus

    2018-01-01

    Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence. PMID:28681849

  16. [Urinary incontinence and pregnancy].

    Science.gov (United States)

    Deffieux, X

    2009-12-01

    The goal of the current study was to systematically review the literature concerning urinary incontinence and pregnancy, in order to develop recommendations for clinical practice. The prevalence of urinary stress incontinence and overactive bladder symptoms increase with gestational age during pregnancy (from the first to the third trimester), and decrease during the third months following delivery. Obstetrics factors (position during delivery, length of the second part of the labour, forceps, episiotomy, epidural or pudendal anaesthesia) do not modify the risk of post-partum or long term urinary incontinence. At short term follow-up, caesarean delivery is associated with a lower rate of post-partum urinary incontinence. At long term follow-up, data are lacking. Non elective caesarean section is not associated with a decrease in the rate of post-partum or long-term urinary incontinence. Elective caesarean section and systematic episiotomy are not recommended methods for the prevention of post-partum urinary incontinence (grade B), even in "high risk" women. Pelvic floor muscle therapy is the first line treatment for prenatal or post-partum urinary incontinence (grade A). Copyright © 2009 Elsevier Masson SAS. All rights reserved.

  17. Imaging of diaphragmatic rupture after trauma

    International Nuclear Information System (INIS)

    Eren, S.; Kantarci, M.; Okur, A.

    2006-01-01

    Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented

  18. What is Urinary Incontinence?

    Science.gov (United States)

    ... Causes of urinary incontinence For women, thinning and drying of the skin in the vagina or urethra, ... make some changes in your diet. Alcohol, caffeine, foods high in acid (such as tomato or grapefruit) ...

  19. Prognostic factors of congenital diaphragmatic hernia accompanied by cardiovascular malformation.

    Science.gov (United States)

    Takahashi, Shigehiro; Sago, Haruhiko; Kanamori, Yutaka; Hayakawa, Masahiro; Okuyama, Hiroomi; Inamura, Noboru; Fujino, Yuji; Usui, Noriaki; Taguchi, Tomoaki

    2013-08-01

    Congenital diaphragmatic hernia is associated with cardiovascular malformation. Many prognostic factors have been identified for isolated congenital diaphragmatic hernia; however, reports of concurrent congenital diaphragmatic hernia and cardiovascular malformation in infants are limited. This study evaluated congenital diaphragmatic hernia associated with cardiovascular malformation in infants. Factors associated with prognosis for patients were also identified. This retrospective cohort study was based on a Japanese survey of congenital diaphragmatic hernia patients between 2006 and 2010. Frequency and outcome of cardiovascular malformation among infants with congenital diaphragmatic hernia were examined. Severity of congenital diaphragmatic hernia and cardiovascular malformation were compared as predictors of mortality and morbidity. Cardiovascular malformation was identified in 76 (12.3%) of 614 infants with congenital diaphragmatic hernia. Mild cardiovascular malformation was detected in 19 (33.9%) and severe cardiovascular malformation in 37 (66.1%). Their overall survival rate at discharge was 46.4%, and the survival rate without morbidity was 23.2%. Mortality and morbidity at discharge were more strongly associated with severity of cardiovascular malformation (adjusted OR 7.69, 95%CI 1.96-30.27; adjusted OR 7.93, 95%CI 1.76-35.79, respectively) than with severity of congenital diaphragmatic hernia. The prognosis for infants with both congenital diaphragmatic hernia and cardiovascular malformation remains poor. Severity of cardiovascular malformation is a more important predictive factor for mortality and morbidity than severity of congenital diaphragmatic hernia. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  20. Imaging diagnosis--positive contrast peritoneographic features of true diaphragmatic hernia.

    Science.gov (United States)

    Choi, Jihye; Kim, Hyunwook; Kim, Mieun; Yoon, Junghee

    2009-01-01

    A true diaphragmatic hernia is a congenital diaphragmatic malformation that can appear identical to a peritoneopericardial diaphragmatic hernia (PPDH). True diaphragmatic hernias are rare in dogs. Herein we describe the use of positive contrast peritoneography for diagnosis of a true diaphragmatic hernia in two dogs.

  1. Female urinary incontinence and sexuality

    Directory of Open Access Journals (Sweden)

    Renato Lains Mota

    Full Text Available ABSTRACT Urinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females. This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence. Female urinary incontinence management involves conservative (pelvic floor muscle training, surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence.

  2. Female urinary incontinence and sexuality

    Science.gov (United States)

    Mota, Renato Lains

    2017-01-01

    ABSTRACT Urinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females. This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence. Female urinary incontinence management involves conservative (pelvic floor muscle training), surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence. PMID:28124522

  3. Case Report - Diaphragmatic eventration complicated by gastric ...

    African Journals Online (AJOL)

    Eventration of the diaphragm with gastric volvulus is uncommon. Gastric perforation in these cases is rare and usually associated with acute gastric volvulus with strangulation. We describe a case of diaphragmatic eventration with chronic gastric volvulus with gastric perforation without strangulation in an elderly man.

  4. Radiographic observation of congenital diaphragmatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    Rhee, Chung Sik [Ewha Women' s University College of Medicine, Seoul (Korea, Republic of)

    1973-12-15

    Five cases of congenital diaphragmatic hernia. Case 1: A female infant, birth weight 2.25 kg, Apgar score 10, normal delivery at 11:33 P.M. on Feb.8, 1972. Lt side congenital diaphragmatic hernia. Case 2: A female infant, birth weight 1.48 kg, Apgar score 5, normal delivery at 11:20 A.M. on Oct.14, 1972. Lt. side congenital diaphragmatic hernia. This infant was twin. this infant's mother was toxemia. Case 3; A 33 years old women was admitted to the our hospital because of Lt.hip joint pain without other symptoms. Date of admission: Jan. 8, 1973. Rt side congenital diaphragmentic hernia. Case 4: A 4 month infant male was admitted to the our hospital because of vomiting, dyspnea and abdominal pain. He had cyanosis intermittently after one month ago. This infant was normal delivered. The family history was not contributory. Date of admission: This infant was normal delivered. The family history was not contributory. Date of admission: Aug. 30, 1971. Rt side congenital diaphragmatic hernia. Case 5: A 13 years old girl was admitted to our hospital because of general weakness without other symptoms. This patient was normal delivered. The family history was not contributory. Date of admission: March. 15, 1973. Lt. side congenital diaphragmentic hernia.

  5. Radiographic observation of congenital diaphragmatic hernia

    International Nuclear Information System (INIS)

    Rhee, Chung Sik

    1973-01-01

    Five cases of congenital diaphragmatic hernia. Case 1: A female infant, birth weight 2.25 kg, Apgar score 10, normal delivery at 11:33 P.M. on Feb.8, 1972. Lt side congenital diaphragmatic hernia. Case 2: A female infant, birth weight 1.48 kg, Apgar score 5, normal delivery at 11:20 A.M. on Oct.14, 1972. Lt. side congenital diaphragmatic hernia. This infant was twin. this infant's mother was toxemia. Case 3; A 33 years old women was admitted to the our hospital because of Lt.hip joint pain without other symptoms. Date of admission: Jan. 8, 1973. Rt side congenital diaphragmentic hernia. Case 4: A 4 month infant male was admitted to the our hospital because of vomiting, dyspnea and abdominal pain. He had cyanosis intermittently after one month ago. This infant was normal delivered. The family history was not contributory. Date of admission: This infant was normal delivered. The family history was not contributory. Date of admission: Aug. 30, 1971. Rt side congenital diaphragmatic hernia. Case 5: A 13 years old girl was admitted to our hospital because of general weakness without other symptoms. This patient was normal delivered. The family history was not contributory. Date of admission: March. 15, 1973. Lt. side congenital diaphragmentic hernia

  6. Diaphragmatic Hernia Masquerading as Pleural Effusion | Nalladaru ...

    African Journals Online (AJOL)

    Rupture of the diaphragm is almost always due to major trauma. We present here an unusual and rare case of late presentation of diaphragmatic hernia after an innocuous injury. The patient was initially misdiagnosed as a left pleural effusion on the basis of chest X.ray and ultrasound findings. Finally, the diagnosis was ...

  7. Imaging findings in fetal diaphragmatic abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Alamo, Leonor; Gudinchet, Francois [University Hospital Center of Lausanne, Unit of Radiopediatrics, Department of Radiology, Lausanne (Switzerland); Meuli, Reto [University Hospital Center of Lausanne, Department of Radiology, Lausanne (Switzerland)

    2015-12-15

    Imaging plays a key role in the detection of a diaphragmatic pathology in utero. US is the screening method, but MRI is increasingly performed. Congenital diaphragmatic hernia is by far the most often diagnosed diaphragmatic pathology, but unilateral or bilateral eventration or paralysis can also be identified. Extralobar pulmonary sequestration can be located in the diaphragm and, exceptionally, diaphragmatic tumors or secondary infiltration of the diaphragm from tumors originating from an adjacent organ have been observed in utero. Congenital abnormalities of the diaphragm impair normal lung development. Prenatal imaging provides a detailed anatomical evaluation of the fetus and allows volumetric lung measurements. The comparison of these data with those from normal fetuses at the same gestational age provides information about the severity of pulmonary hypoplasia and improves predictions about the fetus's outcome. This information can help doctors and families to make decisions about management during pregnancy and after birth. We describe a wide spectrum of congenital pathologies of the diaphragm and analyze their embryological basis. Moreover, we describe their prenatal imaging findings with emphasis on MR studies, discuss their differential diagnosis and evaluate the limits of imaging methods in predicting postnatal outcome. (orig.)

  8. Genetics Home Reference: congenital diaphragmatic hernia

    Science.gov (United States)

    ... of cells in the embryo. Environmental factors that influence development before birth may also increase the risk of ... occur? How can gene mutations affect health and development? More about Mutations and ... is only one affected individual in a family. When congenital diaphragmatic hernia occurs as a feature ...

  9. 25 years of tinnitus retraining therapy.

    Science.gov (United States)

    Jastreboff, P J

    2015-04-01

    This year marks 25 years of tinnitus retraining therapy (TRT), the approach that aims to eliminate tinnitus as a problem by extinguishing functional connections between the auditory and the limbic and autonomic nervous systems to achieve habituation of tinnitus-evoked reactions and subsequently habituation of perception. TRT addresses directly decreased sound tolerance (DST) as well as tinnitus. TRT consists of counseling and sound therapy, both based on the neurophysiological model of tinnitus. The main goal of retraining counseling is to reclassify tinnitus into the category of a neutral stimulus, while the main goal of sound therapy is to decrease the strength of tinnitus-related neuronal activity. A unique aspect of TRT is that because treatment is aimed to work above the tinnitus source, and at connections linking the auditory and other systems in the brain, the etiology of tinnitus is irrelevant. Any type of tinnitus, as well as somatosounds, can be successfully treated by TRT. Over 100 publications can be found on Medline when using "tinnitus retraining therapy" as a search term. The majority of these publications indicate TRT offers significant help for about 80 % of patients. A randomized clinical trial showing the effectiveness of TRT has been published and another large study is in progress. The principles of the neurophysiological model of tinnitus, and consequently TRT, have not changed in over 25 years of use, but a number of changes have been introduced in TRT implementation. These changes include the recognition of the importance of conditioned reflexes and the dominant role of the subconscious pathways; the introduction of the concept of misophonia (i.e., negative reactions to specific patterns of sound) and the implementation of specific protocols for its treatment; greater emphasis on the concurrent treatment of tinnitus, hyperacusis, misophonia, and hearing loss; extensive modification of counseling; and refinements in sound therapy. The

  10. Surgery for Stress Urinary Incontinence

    Science.gov (United States)

    ... Stress Urinary Incontinence Special Procedures What is stress urinary incontinence (SUI)? What causes SUI? What nonsurgical treatment options may help with SUI? What are the surgical treatment options for SUI? What factors are considered when deciding which SUI surgery is ...

  11. Urinary incontinence - vaginal sling procedures

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007376.htm Urinary incontinence - vaginal sling procedures To use the sharing features ... are types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ...

  12. A retraining program for inactive physicians.

    Science.gov (United States)

    Brown, M; Sakai, F J; Selzer, A

    1969-11-01

    During the past two years a pilot project was conducted in which 19 inactive physicians were retrained in preparation for resumption of active practice. The initial program consisted of a flexible training program of six months to one year patterned after conventional internship-residency concepts. During the second year the program was modified by providing an initial condensed indoctrination period of two months' duration especially designed for this purpose, followed by a preceptorship type of training. The project was considered successful in permitting trainees to enter some form of active medical work, or to enroll in formal specialty training. The observations made by the faculty of the program and its accomplishments are discussed in the light of the effort expended and the cost of the project.

  13. Incontinence: The Potential Budget Buster

    Science.gov (United States)

    Gardner, Sharon

    2009-01-01

    Someone who lives with incontinence, whether bowel, bladder, or both, knows the social stigma and personal toll on his life. Incontinence is the ever-present shadowy silhouette lurking over almost every decision, sometimes requiring complex preplanning. In this article, the author describes the challenges of incontinence and discusses how she…

  14. Reoperation for urinary incontinence

    DEFF Research Database (Denmark)

    Foss Hansen, Margrethe; Lose, Gunnar; Kesmodel, Ulrik Schiøler

    2016-01-01

    for urinary incontinence (retropubic midurethral tape, transobturator tape, urethral injection therapy, Burch colposuspension, pubovaginal slings, and miscellaneous operations). Cox proportional hazard models were used to estimate the hazard ratio (HR) with 95% confidence intervals (CIs), adjusted for factors......BACKGROUND: The synthetic midurethral slings were introduced in the 1990s and were rapidly replaced the Burch colposuspension as the gold standard treatment for urinary incontinence. It has been reported that the retropubic midurethral tape has an objective and subjective cure rate of 85% at 5...... years of follow-up, but the rate of reoperation after retropubic midurethral tape at the long-term follow-up is less well described. The existing literature specifies an overall lifetime rate of reoperation of about 8-9% after an initial operation for urinary incontinence. There are, however...

  15. Management of diaphragmatic rupture from blunt trauma.

    Science.gov (United States)

    Tan, K K; Yan, Z Y; Vijayan, A; Chiu, M T

    2009-12-01

    Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. We reviewed our institution's management of patients with diaphragmatic rupture after blunt trauma. All patients in this study were treated at Tan Tock Seng Hospital, Singapore, from March 2002 to October 2008. Patients with penetrating injuries were excluded. The parameters included age, mechanism of injury, haemodynamic status at admission, Glasgow coma scale (GCS) score, injury severity score (ISS), imaging studies, location of diaphragmatic injuries, associated injuries and outcome. 14 patients with a median age of 38 years formed the study group. Vehicular-related incidents accounted for 71.4 percent of the injuries. The median GCS score on admission was 14 (range 3-15), while the median systolic blood pressure and heart rate were 94 (range 50-164) mmHg and 110 (range 76-140) beats per minute, respectively. The median ISS was 41 (range 14-66). All had chest radiographs performed in the emergency department, six (42.9 percent) had computed tomography performed before surgery, while the remaining eight (57.1 percent) were sent straight to the operating theatre from the emergency department. There were five (35.7 percent) right-sided and nine (64.3 percent) left-sided diaphragmatic ruptures. The mortality rate was 35.7 percent. Some of the associated injuries included eight (57.1 percent) splenic lacerations, five (35.7 percent) haemothorax and lung injuries, four (28.6 percent) bone fractures and three (21.4 percent) liver lacerations. 12 (85.7 percent) patients underwent repair of the diaphragmatic rupture using interrupted polypropylene suture, while the remaining two (14.3 percent) were too haemodynamically unstable to undergo definitive treatment. Advanced age, haemodynamic instability and raised ISS were associated with mortality. An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult, and a thorough examination of both the

  16. Traumatic diaphragmatic hernias: Retrospective analysis

    Directory of Open Access Journals (Sweden)

    J.P.A. Sousa

    2006-05-01

    Full Text Available Aims: This study classifies cases of traumatic diaphragmatic hernias (TDH in patients admitted to the Intensive Care Unit (ICU of the Coimbra University Hospitals (HUC from 1990 to 2004. Methods: Retrospective analysis of 34 cases of TDH, studying anatomical location, place and time of diagnosis, complementary tests aiding diagnosis, herniated organs, associated traumatism, morbidity and mortality. Results: Twenty-eight male and six female patients with an average age of 40.5 years ± 20.5, average SAPS score 38.8. Average lenght of stay was 19.1 ± 13.6 days, all suffered from closed traumatism and were put on artificial ventilation. The left-side diaphragm was more frequently affected (94.1% then the right. Diagnosis in 19 cases was made up in the first six hours following the diagnosis of traumatism, in four cases within 12 hours and in the remaining cases between 48 hours and 16 years after traumatism. In 13 patients the diagnosis was established intra-operatively. The stomach was typically one of the herniated organs. The most frequently associated lesions at the thoracic level were pulmonary contusion, haemothorax and pneumothorax, and at the abdominal level, haemoperitoneum and splenic lesion. The rates for complications and mortality were 55.8% and 11.7% respectively. Conclusions: TDH mainly occurs on the left side through closed thoraco-abdominal trauma following road traffic accidents. This group of patients, on average younger than others admitted to ICU, presents a longer average hospitalisation period, but has lower rates of mortality and lower SAPS severity scores. The most commonly herniated organ was the stomach and the most frequently encountered lesions were cranial-encephalic, splenic and pleural traumatisms. Pre-operative diagnosis of diaphragmatic injuries is difficult and a high index of clinical suspicion is needed after thoracoabdominal trauma. This diagnosis should always be considered a possibility in

  17. Congenital diaphragmatic hernia-associated pulmonary hypertension.

    Science.gov (United States)

    Harting, Matthew T

    2017-06-01

    Congenital diaphragmatic hernia (CDH) is a complex entity wherein a diaphragmatic defect allows intrathoracic herniation of intra-abdominal contents and both pulmonary parenchymal and vascular development are stifled. Pulmonary pathology and pathophysiology, including pulmonary hypoplasia and pulmonary hypertension, are hallmarks of CDH and are associated with disease severity. Pulmonary hypertension (PH) is sustained, supranormal pulmonary arterial pressure, and among patients with CDH (CDH-PH), is driven by hypoplastic pulmonary vasculature, including alterations at the molecular, cellular, and tissue levels, along with pathophysiologic pulmonary vasoreactivity. This review addresses the basic mechanisms, altered anatomy, definition, diagnosis, and management of CDH-PH. Further, emerging therapies targeting CDH-PH and PH are explored. Published by Elsevier Inc.

  18. Congenital posterolateral diaphragmatic hernia : pathophysiological studies and clinical picture

    NARCIS (Netherlands)

    A.P. Bos (Albert)

    1993-01-01

    textabstractCongenital diaphragmatic hernias are classified according to the location of the defect: posterolateral hernia with or without a sac (Bochdalek-type), parasternal hernia through the foramen of Morgagni, central hernia, and diaphragmatic eventration. The so-called hiatal hernia has a

  19. Posterolateral diaphragmatic hernia with small-bowel incarceration ...

    African Journals Online (AJOL)

    Bochdalek hernia (BH), a closing defect of the peripheral posterior aspect of the diaphragm, is the most common of the congenital diaphragmatic hernias and is usually diagnosed in neonates. Symptomatic presentation of a right-sided diaphragmatic hernia in an adult is unusual. Owing to their rarity and varied presentation, ...

  20. Changes in incontinence after hysterectomy

    DEFF Research Database (Denmark)

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis

    2017-01-01

    . Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle......Purpose: Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy. Methods: 108...

  1. Preventing urinary incontinence in women.

    Science.gov (United States)

    Newman, Diane K; Cardozo, Linda; Sievert, Karl-Dietrich

    2013-10-01

    This review examines the evidence to date, analyzes specific risk factors and assesses the ability to prevent urinary incontinence in women, while providing clinical recommendations. More extraordinary risk factors such as ethnicity and race, mixed and fecal incontinence, iatrogenic and neurogenic factors should be discussed in a follow-up report. Studies have revealed that certain factors place women at risk for developing urinary incontinence, including age, obesity, diabetes, pregnancy and delivery, high-impact physical exercise factors and estrogen deficiency. Healthcare providers should screen women who are at risk for developing urinary incontinence and institute specific interventions, specifically behavioral and even rehabilitative techniques, to prevent this prevalent and distressing condition.

  2. Congenital diaphragmatic hernia with gastrointestinal symptomatology

    International Nuclear Information System (INIS)

    Siroka, M.; Bilicky, J.; Hernesniemi, B.

    2014-01-01

    The authors report a case of 6-week-old baby boy with congenital diaphragmatic hernia(CDH). He presented with nonspecific gastrointestinal symptoms. CDH is commonly manifested by nonspecific respiratory problems. The symptoms of CDH in older infants are atypical and misleading. Children may have only gastrointestinal problems even the acute abdomen. In our case, the ultrasound examination of abdomen did not detect the exact cause of vomiting and intolerance of oral intake, but the explanation has brought classic chest X-ray. (author)

  3. Epidemiology of congenital diaphragmatic hernia in Europe

    DEFF Research Database (Denmark)

    McGivern, Mark R.; Best, Kate E.; Rankin, Judith

    2015-01-01

    INTRODUCTION: Published prevalence rates of congenital diaphragmatic hernia (CDH) vary. This study aims to describe the epidemiology of CDH using data from high-quality, population-based registers belonging to the European Surveillance of Congenital Anomalies (EUROCAT). METHODS: Cases of CDH...... for isolated cases (ie, CDH cases that did not occur with any other congenital anomaly). There was significant variation in total and isolated CDH prevalence between registers. The proportion of cases that survived to 1 week was 69.3% (1392 cases) for total CDH cases and 72.7% (1107) for isolated cases...

  4. Transferability of Skills: Convergent, Postdictive, Criterion-Related, and Construct Validation of Cross-Job Retraining Time Estimates

    National Research Council Canada - National Science Library

    Kavanagh, Michael

    1997-01-01

    ... (job learning difficulty and cross-AFS differences in aptitude requirements), (b) XJRThs exhibited some postdictive validity when evaluated against Airman Retraining Program Survey retraining ease criteria, (c...

  5. Drug-induced urinary incontinence

    NARCIS (Netherlands)

    Tsakiris, Peter; Oelke, Matthias; Michel, Martin C.

    2008-01-01

    Physiological urinary continence depends on many factors that are potentially vulnerable to adverse drug effects, which may lead to incontinence. In principle, drugs could cause incontinence by lowering bladder outlet resistance and/or by increasing intravesical pressure, which disrupts the normal

  6. Faecal incontinence in myotonic dystrophy

    OpenAIRE

    Abercrombie, J; Rogers, J; Swash, M

    1998-01-01

    Two siblings with myotonic dystrophy presented for treatment of faecal incontinence. The pathophysiology of this functional disorder is described with the results of anorectal manometry, EMG, and biopsy of smooth and striated muscle of the anorectal sphincters. Both medical and surgical management of the incontinence was unsatisfactory in the long term. Involvement of gastrointestinal musculature is a characteristic feature the disease.



  7. Laparoscopic diaphragmatic hernia repair using expanded polytetrafluoroethylene (ePTFE) for delayed traumatic diaphragmatic hernia.

    Science.gov (United States)

    Jee, Yeseob

    2017-06-01

    Traumatic diaphragmatic hernia (TDH) is an uncommon surgical problem, and diagnosis is often delayed. However, the mortality from bowel necrosis can reach 80%. Therefore, suspicion is needed and surgery is required to prevent complications. A 50-year-old man was transferred due to abdominal pain and vomiting. Chest X-ray and computed tomography (CT) scan showed herniation of the stomach through the left diaphragm. The patient had fallen down 15 months ago and CT scan at that time revealed a small defect of the diaphragm without herniation. We diagnosed delayed herniation of TDH and the patient underwent laparoscopic repair using an expanded polytetrafluoroethylene (ePTFE) mesh. Recovery was uneventful and the CT scan at 3 months after the operation showed no recurrence. We reported a delayed presenting TDH and considered a laparoscopic approach to be safe and feasible during elective surgery. Moreover, use of an ePTFE mesh for repair of large diaphragmatic hernia was also feasible.

  8. Drug calculations for urinary incontinence in women

    OpenAIRE

    Nuttall, Dilyse

    2015-01-01

    An estimated 3–6 million people are affected by urinary incontinence in the UK, and women are most commonly affected (NHS Choices, 2015). Causes of urinary incontinence vary but urge incontinence is usually caused by over-activity of the bladder's detrusor muscles, and stress incontinence is caused by muscle damage or weakness (NHS Choices, 2015). The management of urinary incontinence may require pharmacological treatment in conjunction with pelvic floor and bladder training exercises (Joint...

  9. Internet based retraining as a treatment for gambling disorders

    NARCIS (Netherlands)

    Boffo, M.; Ronny, W.; Pronk, T.; Wiers, R.W.; Dom, G.

    2015-01-01

    Cognitive Bias Modification (CBM) has opened up new ways to treat addiction by retraining relatively automatic, maladaptive processes implied in the onset and maintenance of addiction disorders (Wiers et al., 2013). Many CBM interventions can, in principle, be administered online, thus showing

  10. Managing Multilinguality: Israel's Retraining Course for New Immigrant Librarians.

    Science.gov (United States)

    Lazinger, Susan S.; Peritz, Bluma C.

    1993-01-01

    Describes a six-month retraining program developed for Israel's Russian-speaking immigrant librarians and information specialists that includes Hebrew language, Jewish and Israeli history, English, and library automation. Differences from the Soviet library system are discussed, including censorship and public libraries, and characteristics of the…

  11. Changes in incontinence after hysterectomy.

    Science.gov (United States)

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis; Kallfa, Ervin; Madsen, Mogens Rørbæk

    2017-10-01

    Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy. 108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p effect on incontinence and de-novo cure.

  12. A late presenting congenital diaphragmatic hernia misdiagnosed as spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Chitra Sanjeev Juwarkar

    2010-01-01

    Full Text Available Congenital diaphragmatic hernia (CDH is described as (1 failure of diaphragmatic closure at development, (2 presence of herniated abdominal contents into chest and (3 pulmonary hypoplasia. Usually, pleural space is drained urgently when there is respiratory distress and radiological appearance of mediastinal shift. We present a case of a 5-month-old baby, diagnosed as tension pneumothorax and treated with chest drain insertion. CDH was the intraoperative diagnosis.

  13. Paper-thinned diaphragm: CT sign of diaphragmatic eventration

    International Nuclear Information System (INIS)

    Im, Jung Gi; Han, Man Chung; Kim, Chu Wan; Shim, Young Soo

    1990-01-01

    CT findings of total left hemidiaphragmatic eventration in two adult patients are described. Chest radiograph showed elevated left hemidiaphragm and left hilum. Paper-thinned muscular portion of the diseased diaphragm was clearly demonstrated with CT scan. With demonstration of paper-thinned diaphragm by CT scan, differentiation of the diaphragmatic eventration from recent onset phrenic nerve paralysis by tumor invasion or from post-traumatic diaphragmatic hernia can be made

  14. Paper-thinned diaphragm: CT sign of diaphragmatic eventration

    Energy Technology Data Exchange (ETDEWEB)

    Im, Jung Gi; Han, Man Chung; Kim, Chu Wan; Shim, Young Soo [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1990-10-15

    CT findings of total left hemidiaphragmatic eventration in two adult patients are described. Chest radiograph showed elevated left hemidiaphragm and left hilum. Paper-thinned muscular portion of the diseased diaphragm was clearly demonstrated with CT scan. With demonstration of paper-thinned diaphragm by CT scan, differentiation of the diaphragmatic eventration from recent onset phrenic nerve paralysis by tumor invasion or from post-traumatic diaphragmatic hernia can be made.

  15. Late-presenting congenital diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Raashid Hamid

    2014-01-01

    Full Text Available Background: This study was undertaken to highlight the clinical profile, misdiagnosis, surgical treatment,and prognosis of late-presenting congenital diaphragmatic hernia (CDH cases in a tertiary level hospital. Patients and Methods: This retrospective study included all the babies and children >1 month of age with CDH who were admitted in our Hospital (Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India during the period between January 2008 and December 2013. Babies with age <1 month were excluded from the study. Data regarding clinical profile, operative records, and follow-up was reviewed and analysed statistically. Results: A total of 20 patients were included in this study. The clinical picture ranged from respiratory distress (13 patients to non-specific gastrointestinal complaints (5 patients. In two patients, CDH was misdiagnosed as pneumothorax and had got chest tube inserted in other hospitals before referral to this tertiary care centre. In 14 patients chest, X-ray revealed the diagnosis of CDH and in remaining five patients (including the two patients with misdiagnosis further investigations were undertaken to establish the diagnosis. Age ranged from 45 days to 17 years with an average age of 58.9 months. There were 12 male and 8 female patients. In all the 20 patients, surgical procedures were undertaken with the retrieval of herniated contents from the thoracic cavity and repair of the diaphragmatic defect. There was no mortality in our series. All the 20 patients were followed-up for a period ranging from 6 months to 5 years (median 3.1 years. Conclusions: Late-presenting CDH can have diverse clinical presentation. Late diagnosis and misdiagnosis can result in significant morbidity and potential mortality if these cases are not managed properly at an appropriate stage. Outcome is favourable if these patients are expeditiously identified and surgically repaired.

  16. Urinary incontinence surgery - female - discharge

    Science.gov (United States)

    ... activities, such as golfing, playing tennis, bowling, running, biking, weight lifting, gardening or mowing, and vacuuming for ... A.D.A.M. Editorial team. Related MedlinePlus Health Topics Urinary Incontinence Browse the Encyclopedia A.D. ...

  17. Bowel Control Problems (Fecal Incontinence)

    Science.gov (United States)

    ... Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Hemorrhoids Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & ... Control Problems in Women (Urinary Incontinence) Constipation Diarrhea Hemorrhoids Related Diagnostic Tests Colonoscopy Flexible Sigmoidoscopy Lower GI ...

  18. The value of fetal ultrasonography and magnetic resonance imaging in the assessment of diaphragmatic hernias

    International Nuclear Information System (INIS)

    Amim, Bruno; Guerra, Fernando; Marchiori, Edson; Gasparetto, Emerson Leandro

    2008-01-01

    To demonstrate the relevance of ultrasonography and magnetic resonance imaging findings in the prenatal characterization and prognostic evaluation in cases of congenital diaphragmatic hernia. Materials And Methods: Fourteen pregnant women (mean gestational age = 28.7 weeks) who had undergone ultrasonography for suspicion of fetuses with congenital diaphragmatic hernia were assessed by means of magnetic resonance imaging on a 1.5 tesla equipment, following the standard protocol. Two radiologists evaluated the images and the findings were defined by consensus. Results: Twelve fetuses had left diaphragmatic hernia and two, right diaphragmatic hernia. Ultrasonography showed the fetal liver inside the thorax of five fetuses (three with left diaphragmatic hernia, and two with right diaphragmatic hernia) and magnetic resonance imaging in eight fetuses (six with left diaphragmatic hernia, and two with right diaphragmatic hernia). Stomach and small bowel loop herniation was observed in all of the fetuses with left diaphragmatic hernia (n = 12) at both magnetic resonance imaging and ultrasonography. Eight fetuses (seven with left diaphragmatic hernia and one with right diaphragmatic hernia) survived after surgical treatment. Conclusion: Ultrasonography and magnetic resonance imaging are complementary imaging methods in the evaluation of congenital diaphragmatic hernia. Magnetic resonance imaging is a helpful diagnostic method complementary to ultrasonography for evaluation of the fetal liver positioning, considering its relevance as a prognostic factor in cases of congenital diaphragmatic hernia. (author)

  19. Intensive Sleep Re-Training: From Bench to Bedside

    Directory of Open Access Journals (Sweden)

    Leon Lack

    2017-03-01

    Full Text Available Intensive sleep re-training is a promising new therapy for chronic insomnia. Therapy is completed over a 24-h period during a state of sleep deprivation. Improvements of sleep and daytime impairments are comparable to the use of stimulus control therapy but with the advantage of a rapid reversal of the insomnia. The initial studies have been laboratory based and not readily accessible to the patient population. However, new smart phone technology, using a behavioral response to external stimuli as a measure of sleep/wake state instead of EEG determination of sleep, has made this new therapy readily available. Technological improvements are still being made allowing the therapy to provide further improvements in the effectiveness of Intensive Sleep Re-training.

  20. Sustained effects of attentional re-training on chocolate consumption.

    Science.gov (United States)

    Kemps, Eva; Tiggemann, Marika; Elford, Joanna

    2015-12-01

    Accumulating evidence shows that cognitive bias modification produces immediate changes in attentional bias for, and consumption of, rewarding substances including food. This study examined the longevity of these attentional bias modification effects. A modified dot probe paradigm was used to determine whether alterations in biased attentional processing of food cues, and subsequent effects on consumption, were maintained at 24-h and one-week follow-up. One hundred and forty-nine undergraduate women were trained to direct their attention toward ('attend') or away from ('avoid') food cues (i.e., pictures of chocolate). Within each group, half received a single training session, the other half completed 5 weekly training sessions. Attentional bias for chocolate cues increased in the 'attend' group, and decreased in the 'avoid' group immediately post training. Participants in the 'avoid' group also ate disproportionately less of a chocolate food product in a so-called taste test than did those in the 'attend' group. Importantly, the observed re-training effects were maintained 24 h later and also one week later, but only following multiple training sessions. There are a number of limitations that could be addressed in future research: (a) the inclusion of a no-training control group, (b) the inclusion of a suspicion probe to detect awareness of the purpose of the taste test, and (c) the use of different tasks to assess and re-train attentional bias. The results showed sustained effects of attentional re-training on attentional bias and consumption. They further demonstrate the importance of administering multiple re-training sessions in attentional bias modification protocols. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Biased attention retraining in dysphoria: a failure to replicate.

    Science.gov (United States)

    Mastikhina, Liza; Dobson, Keith

    2017-04-01

    The present study replicated Wells and Beevers [(2010). Biased attention and dysphoria: Manipulating selective attention reduces subsequent depressive symptoms. Cognition & Emotion, 24, 719-728] and examined the longitudinal effects of attentional retraining on symptoms of depression. Dysphoric undergraduate psychology students were randomly assigned into either a neutral or control training condition. Training was administered using a dot-probe task that presented participants with pairs of pictures (of sad and neutral content) that were followed by a probe that participants had to respond to. Training took place over four sessions during a two-week period, followed by a final follow-up session two weeks later. Mood was measured at baseline, post-training, and at follow-up. All participants showed a significant reduction in depressive symptoms throughout the study, F(1.7, 73.55) = 21.19, p attentional retraining did not demonstrate any advantage over the control condition. Results were inconsistent with those of Wells and Beevers [(2010). Biased attention and dysphoria: Manipulating selective attention reduces subsequent depressive symptoms. Cognition & Emotion, 24, 719-728]. Implications of the findings on research on attentional retraining in the context of depression are discussed.

  2. Pediatric urinary incontinence: Classification, evaluation, and ...

    African Journals Online (AJOL)

    A.J. Schaeffer

    tinuous incontinence refers to constant leakage of urine and can occur even in .... evaluation of pediatric urinary incontinence and guide which tests, if any, should ..... ments taken during bladder filling and storage include the maximal bladder ...

  3. Fractured Ribs and the CT Funky Fat Sign of Diaphragmatic Rupture

    Directory of Open Access Journals (Sweden)

    Iclal Ocak

    2016-01-01

    Full Text Available Traumatic diaphragmatic rupture remains a diagnostic challenge for both radiologists and surgeons. In recent years, multidetector CT has markedly improved the diagnosis of diaphragmatic injury in polytrauma patients. Herein, we describe two cases of subacute presentation of traumatic diaphragmatic rupture from a penetrating rib fracture and subsequent intrathoracic herniation of omental fat, representing the CT “funky fat” sign.

  4. 21 CFR 882.5830 - Implanted diaphragmatic/phrenic nerve stimulator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implanted diaphragmatic/phrenic nerve stimulator... Implanted diaphragmatic/phrenic nerve stimulator. (a) Identification. An implanted diaphragmatic/phrenic nerve stimulator is a device that provides electrical stimulation of a patient's phrenic nerve to...

  5. The "costs" of urinary incontinence for women.

    Science.gov (United States)

    Subak, Leslee L; Brown, Jeanette S; Kraus, Stephen R; Brubaker, Linda; Lin, Feng; Richter, Holly E; Bradley, Catherine S; Grady, Deborah

    2006-04-01

    To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. Mean age was 56 +/- 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from 0.37 dollars (0, 4 dollars) for slight to 10.98 dollars (4, 21 dollars) for very severe incontinence. Costs increased with incontinence severity (P women (P women with urge compared with those having stress incontinence (P lower Health Utilities Index score (mean 0.90 +/- 0.11 for weekly and 0.81 +/- 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of 70 dollars +/- 64 dollars per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit. Women with severe urinary incontinence pay 900 dollars annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life. III.

  6. Does motivation predict outcome of pelvic floor muscle retraining?

    Science.gov (United States)

    Te West, Nevine I D; Parkin, Katrina; Hayes, Wendy; Costa, Daniel S J; Kasparian, Nadine A; Moore, Kate H

    2017-02-01

    Although pelvic floor muscle training (PFMT) is effective for stress urinary incontinence (SUI), patients need to be motivated to obtain cure. An instrument to assess motivation in such patients was published in 2009: the Incontinence Treatment Motivation Questionnaire (ITMQ). The ITMQ consists of five domains: (i) positive attitudes toward PFMT; (ii) reasons for not doing PFMT; (iii) difficulties living with incontinence; (iv) desire for treatment; and (v) incontinence severity influencing motivation. The aim of the present study was to examine the relationship between ITMQ scores and treatment success. After referral for PFMT, women with SUI completed the ITMQ. Pre- and post-treatment outcomes were the International Consultation on Incontinence Questionnaire (ICIQ) score and a 24-hr pad test. Correlations between ITMQ scores and baseline, as well as post-treatment change in ICIQ scores and pad test results were examined. Additionally, the demographics of non-participants, participants, and patients lost to follow-up were compared. Of 85 recruits, 18 did not complete the ITMQ, 14 were lost to follow-up, thus 53 completed the PFMT programme and undertook either one or both outcomes. Pre-treatment, severity on ICIQ correlated with total ITMQ (ρ = 0.33, P = 0.01). Post-treatment change in pad test was inversely correlated with Domain 2 (ρ = -0.33, P = 0.03). The pre-treatment severity of incontinence was significantly associated with motivation for treatment. Unfortunately, post-treatment change correlated with only one domain of the questionnaire. Further modification of the ITMQ is envisaged. Neurourol. Urodynam. 36:316-321, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  7. Renal artery entrapment by the diaphragmatic crus

    International Nuclear Information System (INIS)

    Thony, F.; Baguet, J.-P.; Rodiere, M.; Sessa, C.; Janbon, B; Ferretti, G.

    2005-01-01

    The aim of this study is to describe renal artery entrapment (RAE) by the diaphragmatic crus and to elucidate the diagnostic and therapeutic approach to this entity. From 1995 to 2002, 15 patients (mean age 65) were found to have a RAE. They were investigated by CT scan (n=14) and/or MRA (n=2) for hypertension (n=7), chronic renal insufficiency (n=4) or aneurysms (n=4). The right (n=11) or the left (n=4) renal artery (RA) was involved. The compression was ostial (n=8) or truncal (n=7), and was ≥50% in eight cases. The course of the RA along the aorta on angiographic views (n=8) or a concentric ostial stenosis in a patient free of atheromatous lesions (n=7) were two findings suggestive of an RAE. Seven RAEs were indicated for treatment but only three were treated, by mean of stenting. Among the latter, two stents were patent at 6-month follow-up and one evolved to restenosis because of a stent fracture. RAEs may be suspected on angiographic views and proved by cross-sectional imaging because of specific imaging features. It is of importance to detect this etiology of RA stenosis because angioplasty with stenting is probably not always advisable. (orig.)

  8. [Congenital diaphragmatic hernia: respiratory and vascular outcomes].

    Science.gov (United States)

    Pennaforte, T; Rakza, T; Sfeir, R; Aubry, E; Bonnevalle, M; Fayoux, P; Deschildre, A; Thumerelle, C; de Lagausie, P; Benachi, A; Storme, L

    2012-02-01

    Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly associated with a variable degree of pulmonary hypoplasia (PH) and persistent pulmonary hypertension (PPH). Despite remarkable advances in neonatal resuscitation and intensive care, and new postnatal treatment strategies, the rates of mortality and morbidity in the newborn with CDH remain high as the result of severe respiratory failure secondary to PH and PPH. Later, lung function assessments show obstructive and restrictive impairments due to altered lung structure and lung damage due to prolonged ventilatory support. The long-term consequences of pulmonary hypertension are unknown. Other problems include chronic pulmonary aspiration caused by gastro-oesophageal reflux and respiratory manifestations of allergy such as asthma or rhinitis. Finally, failure to thrive may be caused by increased caloric requirements due to pulmonary morbidity. Follow-up studies that systematically assess long-term sequelae are needed. Based on such studies, a more focused approach for routine multidisciplinary follow-up programs could be established. It is the goal of the French Collaborative Network to promote exchange of knowledge, future research and development of treatment protocols. Copyright © 2012. Published by Elsevier Masson SAS.

  9. Undertreatment of urinary incontinence in general practice.

    NARCIS (Netherlands)

    Penning-van Beest, F.J.A.; Sturkenboom, M.C.; Bemelmans, B.L.H.; Herings, R.M.C.

    2005-01-01

    BACKGROUND: In the urinary incontinence guidelines that are issued by the Dutch College of General Practitioners, treatment guidelines are related to the type of incontinence. It is unknown whether treatment of urinary incontinence in general practice complies with these guidelines. OBJECTIVE: To

  10. Urinary Incontinence: Management and Treatment Options

    Science.gov (United States)

    Griebling, Tomas L.

    2009-01-01

    Urinary incontinence, defined as the involuntary leakage of urine, is a common health problem in both women and men. Children may also suffer from this condition. Management and treatment of urinary incontinence depends primarily on the specific type of incontinence and the underlying problem causing the leakage for a given patient. Because…

  11. Recurrent Congenital Diaphragmatic Hernia in Ehlers-Danlos Syndrome

    International Nuclear Information System (INIS)

    Lin, I.C.; Ko, S.F.; Shieh, C.S.; Huang, C.F.; Chien, S.J.; Liang, C.D.

    2006-01-01

    Ehlers-Danlos syndrome (EDS) includes a group of connective tissue disorders with abnormal collagen metabolism and a diverse clinical spectrum. We report two siblings with EDS who both presented with congenital diaphragmatic hernia (CDH). The elder sister suffered from recurrent diaphragmatic hernia twice and EDS was overlooked initially. Echocardiography as well as contrast-enhanced magnetic resonance angiography (MRA) showed dilatation of the pulmonary artery, and marked elongation and tortuosity of the aorta and its branches. A diagnosis of EDS was eventually established when these findings were coupled with the clinical features of hyperelastic skin. Her younger brother also had similar features. This report emphasizes that EDS may present as CDH in a small child which could easily be overlooked. Without appropriate surgery, diaphragmatic hernia might occur. Echocardiographic screening is recommended in patients with CDH. Contrast-enhanced MRA can be helpful in delineation of abnormally tortuous aortic great vessels that are an important clue to the early diagnosis of EDS

  12. Thoracoscopic approach in management of congenital diaphragmatic hernia.

    Science.gov (United States)

    Liem, Nguyen Thanh

    2013-10-01

    Thoracoscopic repair is feasible and safe for congenital diaphragmatic hernia (CDH). The operation can be performed with three trocars using carbon dioxide insufflations at a pressure of 4-6 mmHG. From January 2001 to July 2012, we performed thoracoscopic repair for 311 children with CDH including 152 newborns and 159 infants and toddlers. Mean operative time was 75 ± 27 min. HFOV was used in 24 patients. Direct closure of two rims of diaphragmatic hernia was carried out in 175 patients. Closure of two rims of diaphragmatic hernia with the thoracic wall was performed in 136 patients. Prosthetic patches were required in 54 patients. Conversion to open surgery was required in 38 patients (12.2%). There were no intraoperative deaths. 38 patients died postoperatively (13.5%).

  13. Formed Due to Traumatic Diaphragmatic Injury, A Case of Gastric Perforation

    Directory of Open Access Journals (Sweden)

    Ceren Sen Tanrikulu

    2014-03-01

    Full Text Available Diaphragmatic hernia may be congenital or traumatic in origin. Diaphragmatic hernias are more common in adult and occur as a result of penetrating injuries are more common than from blunt injuries. Traumatic diaphragmatic hernia may manifest immediately or without any findings that several months/years after the incident. Early diagnosis is difficult, and it is usually made intraoperatively. Frequently during the early phase of traumatic diaphragmatic hernias, abdominal organ injury can be seen, such as stomach, colon and liver. In this study, we presented a case with acute gastric strangulation and perforation in the diaphragmatic injury occurred as a result of penetrating thoracic trauma.

  14. Traumatic diaphragmatic injuries: epidemiological, diagnostic and therapeutic aspects.

    Science.gov (United States)

    Thiam, Ousmane; Konate, Ibrahima; Gueye, Mohamadou Lamine; Toure, Alpha Omar; Seck, Mamadou; Cisse, Mamadou; Diop, Balla; Dirie, Elias Said; Ka, Ousmane; Thiam, Mbaye; Dieng, Madieng; Dia, Abdarahmane; Toure, Cheikh Tidiane

    2016-01-01

    Diaphragmatic injuries include wounds and diaphragm ruptures, due to a thoracoabdominal blunt or penetrating traumas. Their incidence ranges between 0.8 and 15 %. The diagnosis is often delayed, despite several medical imaging techniques. The surgical management remains controversal, particularly for the choice of the surgical approach and technique. The mortality is mainly related to associated injuries. The aim of our study was to evaluate the incidence of diaphragmatic injuries occuring in thoraco-abdominal traumas, and to discuss their epidemiology, diagnosis and treatment. We performed a retrospective study over a period of 21 years, between January 1994 and June 2015 at the Department of General Surgery of the Aristide Le Dantec hospital in Dakar, Senegal. All patients diagnosed with diaphragmatic injuries were included in the study. Over the study period, 1535 patients had a thoraco-abdominal trauma. There were 859 cases of blunt trauma, and 676 penetrating chest or abdominal trauma. Our study involved 20 cases of diaphragmatic injuries (1.3 %). The sex-ratio was 4. The mean age was 33 years. Brawls represented 83.3 % (17 cases). Stab attacks represented 60 % (12 cases). The incidence of diaphragmatic injury was 2.6 %. The wound was in the thorax in 60 % (seven cases). Chest radiography was contributory in 45 % (nine cases). The diagnosis of wounds or ruptures of the diaphragm was done preoperatively in 45 % (nine cases). The diaphragmatic wound was on the left side in 90 % (18 cases) and its mean size was 4.3 cm. The surgical procedure involved a reduction of herniated viscera and a suture of the diaphragm by "X" non absorbable points in 85 % (17 cases). A thoracic aspiration was performed in all patients. Morbidity rate was 10 % and mortality rate 5 %. The diagnosis of diaphragmatic rupture and wounds remains difficult and often delayed. They should be kept in mind in any blunt or penetrating thoraco-abdominal trauma. Diaphragmatic lesions

  15. Diaphragmatic hernia in the Coffin-Siris syndrome.

    Science.gov (United States)

    Delvaux, V; Moerman, P; Fryns, J P

    1998-01-01

    At 32 weeks of gestation, delivery of a female fetus was induced because of severe malformations seen on ultrasonogram: congenital diaphragmatic hernia and cerebellar hypoplasia. The diagnosis of Coffin-Siris syndrome was based on the physical examination: coarse face with low-set ears, low nuchal hairline, scalp hypotrichosis and hypoplasia of the nails of fingers and toes with absence of the right fifth fingernail. Autopsy confirmed the prenatally diagnosed major associated abnormalities: hypoplasia of the cerebellum and congenital diaphragmatic hernia. Various clinical entities are included in the differential diagnosis.

  16. Neuralgic Amyotrophy: A Rare Cause of Bilateral Diaphragmatic Paralysis

    Directory of Open Access Journals (Sweden)

    Neil Shinder

    1998-01-01

    Full Text Available Neuralgic amyotrophy, also known as brachial neuritis, is a well described clinical entity. Diaphragmatic dysfunction, as a result of phrenic nerve root involvement (cervical roots 3 to 5, is an uncommon, but increasingly recognized association. The case of a previously healthy 61-year-old woman who, after a prodrome of neck and shoulder discomfort, presented with severe orthopnea is described. Pulmonary function and electrophysiological studies led to a diagnosis of bilateral diaphragmatic paralysis. The patient's clinical course and the exclusion of other nerve entrapment syndromes and neurological disorders strongly favoured the diagnosis of neuralgic amyotrophy.

  17. Warfarin-Associated Diaphragmatic Hernia: An Unusual Diagnosis

    Directory of Open Access Journals (Sweden)

    Cristina Vilhena

    2015-01-01

    Full Text Available Fetal warfarin syndrome is a consequence of maternal intake of warfarin during pregnancy and comprises a wide range of manifestations, including some typical facial dysmorphologic features. The authors report a case of prenatal ultrasonographic diagnosis of warfarin embryopathy in an obese woman on unsupervised warfarin prophylaxis at the 16th week of gestation. The fetus presented with facial dysmorphism, pectus excavatum, diaphragmatic hernia, and pulmonary hypoplasia. To the best of our knowledge, this is the second reported case of warfarin-associated diaphragmatic hernia.

  18. Moderating Effects of Perceived Organizational Support on the Relationship between Job Satisfaction and Turnover Intentions for Recently Retrained USAF Enlisted Members

    National Research Council Canada - National Science Library

    Phelps, Jennifer A

    2006-01-01

    .... This study assessed the attitudinal variables of job satisfaction, perceived organizational support, and intent to stay in voluntarily retrained, involuntarily retrained, and non-retrained NCOs (n=1,093...

  19. [Male Urinary Incontinence--a Taboo Issue].

    Science.gov (United States)

    Kozomara-Hocke, Marko; Hermanns, Thomas; Poyet, Cédric

    2016-03-02

    Male urinary incontinence is an underestimated and frequently not broached issue. The urinary incontinence is divided into stress-, urge incontinence and hybrid forms as well as overflow incontinence. The fact that there are increasingly more men over 60 means that the prevalence of the urinary incontinence is up to 40%, and urinary incontinence will increasingly gain importance in daily routine practice. Many investigations and therapies can be realized by the general practitioner. Already simple therapy approaches can lead to a considerable clinical improvement of male urinary incontinence. If the initial therapy fails or pathological results (i. e. microhaematuria, recurrent urinary tract infections, raised residual urine and so on) are found, the patient should be referred to a urologist.

  20. Congenital diaphragmatic hernia: a modern day approach.

    Science.gov (United States)

    Waag, Karl-Ludwig; Loff, Steffan; Zahn, Katrin; Ali, Mansour; Hien, Steffen; Kratz, Markus; Neff, Wolfgang; Schaffelder, Regine; Schaible, Thomas

    2008-11-01

    Centralization of all complicated congenital diaphragmatic hernias (CDH) was organized in Germany from 1998, collecting 325 consecutive patients with striking increasing survival rates. This series report 244 patients from 2002 to 2007. Today, large defects are detected early in pregnancy by ultrasound and magnetic resonance imaging (MRI). In extracorporeal membrane oxygenation (ECMO) patients, prenatal lung head ratio (LHR) was 1.2 (median) at the 34th week of gestation or less than 25 ml lung tissue in MRI. This means that all patients below LHR of 1.4 should be transferred prenatally in a tertiary center. High risk group for survival was defined as LHR below 0.9, ie, 10 ml in MRI planimetry. Inborn patients show better results than outborns. In algorithm therapy, gentle ventilation plays an important role in preventing damage to the lung tissue and avoiding long term ventilation. When PaCO(2) was more than 75 mmHg, ventilation was changed to high frequency oscillatory ventilation (HFOV). Indication for ECMO was seen in preductal PaO(2) less than 50 mmHg over 2-4 h or less than 40 mmHg over 2 h. ECMO related risks included intracerebral bleeding (9%), intrapulmonary bleeding (14%), and convulsions (16%). Surgically, a longitudinal midline incision for exposure of the defect, the duodenal kinking, and probably for abdominal patching was perfect. A cone formed goretex patch provided more abdominal space and reduced abundant intrathoracical cavity. No drain was used. Postoperative complications were described. Overall survival in 244 consecutive patients was 86.5% for all patients born alive. All those who needed ECMO survived in 71%, underlining ECMO as a treatment of last choice. Follow-up for quality of life after CDH is described.

  1. Enhancing facial aesthetics with muscle retraining exercises-a review.

    Science.gov (United States)

    D'souza, Raina; Kini, Ashwini; D'souza, Henston; Shetty, Nitin; Shetty, Omkar

    2014-08-01

    Facial attractiveness plays a key role in social interaction. 'Smile' is not only a single category of facial behaviour, but also the emotion of frank joy which is expressed on the face by the combined contraction of the muscles involved. When a patient visits the dental clinic for aesthetic reasons, the dentist considers not only the chief complaint but also the overall harmony of the face. This article describes muscle retraining exercises to achieve control over facial movements and improve facial appearance which may be considered following any type of dental rehabilitation. Muscle conditioning, training and strengthening through daily exercises will help to counter balance the aging effects.

  2. Assessment of patients for treatment with tinnitus retraining therapy.

    Science.gov (United States)

    Henry, James A; Jastreboff, Margaret M; Jastreboff, Pawel J; Schechter, Martin A; Fausti, Stephen A

    2002-01-01

    Clinical management for patients complaining of severe tinnitus has improved dramatically in the last 25 years. During that period of time, various methods of treatment have been introduced and are being used with varying degrees of success. One method that has received considerable attention is tinnitus retraining therapy (TRT). This method is being practiced by hundreds of clinicians worldwide, and retrospective clinical data indicate that TRT has been effective for the majority of patients. This article provides a guide for clinicians to evaluate their patients for treatment with TRT. Included in this guide is the expanded version of the TRT initial interview and specific instructions for the clinician administering the interview.

  3. Pathophysiology of pediatric fecal incontinence

    NARCIS (Netherlands)

    Di Lorenzo, Carlo; Benninga, Marc A.

    2004-01-01

    This article addresses the diagnosis and treatment of pediatric fecal incontinence in 4 main categories: (1) Functional fecal retention, the withholding of feces because of fear of painful defecation, results in constipation and overflow soiling. Treatment includes dietary changes, use of laxatives,

  4. Congenital Diaphragmatic Hernia and Occupational Therapy: A Case Report

    Science.gov (United States)

    Bates, Angela C.

    2011-01-01

    This case report describes occupational therapy (OT) intervention in an outpatient setting and outcomes for a child diagnosed with congenital diaphragmatic hernia (CDH) from 4 to 28 months of age. There is little information on therapy intervention and outcomes of children who have survived. The patient is a white male, born at 35 weeks gestation…

  5. Laparoscopic repair of Morgagni diaphragmatic hernia in children ...

    African Journals Online (AJOL)

    Minimal invasive surgery allows for excellent visualisation of the diaphragm, and is increasingly used for the repair of diaphragmatic hernias in children. This report describes laparoscopic repairs between 2001 and 2007 of four Morgagni hernias in children. All defects were treated successfully using the laparoscopic ...

  6. Emergency traumatic Diaphragmatic injuries in Benin city | Iribhogbe ...

    African Journals Online (AJOL)

    Diaphragmatic injuries (DI) frequently accompany thoracoabdominal trauma. The diagnosis remains a challenge to surgeons and radiologists worldwide but missed injuries to the diaphragm is associated with great morbidity and mortality. We aimed to determine the prevalence of this injury in acute trauma and in general ...

  7. Congenital diaphragmatic hernia: A 4-year experience in a single ...

    African Journals Online (AJOL)

    Abstract. Background: This study aimed to evaluate congenital diaphragmatic hernia (CDH) patients in our department during a 4-year period. Patients and Methods: A retrospective study of 10 cases of CDH patients managed in the Neonatology and Pediatric Surgery Units of Goztepe Teaching Hospital from 2000 to 2004.

  8. Diaphragmatic excursion: does it predict successful weaning from mechanical ventilation?

    International Nuclear Information System (INIS)

    Hayat, A.; Khalil, A.

    2017-01-01

    To measure the diaphragmatic excursion and its outcome on weani ng from mechanical ventilation. Study Design: Cross-sectional comparative study. Place and Duration of Study: Medical Intensive Care Unit (ICU), Military Hospital (MH), Rawalpindi, Pakistan, from January to December 2014. Methodology: Diaphragmatic excursion (DE) in cm was measured through ultrasound by marking liver and spleen displacement in patients who fulfilled the criteria of removal from ventilatory support. The patients were followed up for 48 hours and classified according to the outcome as successful weaning and weaning failure. Results: Out of 100 cases, 76 patients had a successful weaning while 24 had a failed weaning outcome. At a diaphragmatic excursion of 1.2 cm and more, out of 67 cases, 60 had a successful weaning (89.55%) while 7 cases (10.45%) had a weaning failure. At an excursion of less than 1. 2 cm, 17 out of 33 cases (51.5%) had successful weaning while 16 (48.48%) had weaning failure. At this cut off point (1.2 cm), the sensitivity and specificity for successful weaning were 78.95% and 70.83%, respectively. The positive and negative likelihood ratio (LR) for these values being 2.70 and 0.29, respectively. The positive predictive value was 82.35% and negative predictive value 60.00%. Conclusion: Ultrasonographic measurement of diaphragmatic excursion is a good method for predicting weaning outcome from mechanical ventilation. (author)

  9. Congenital diaphragmatic hernia candidate genes derived from embryonic transcriptomes

    DEFF Research Database (Denmark)

    Russell, Meaghan K; Longoni, Mauro; Wells, Julie

    2012-01-01

    Congenital diaphragmatic hernia (CDH) is a common (1 in 3,000 live births) major congenital malformation that results in significant morbidity and mortality. The discovery of CDH loci using standard genetic approaches has been hindered by its genetic heterogeneity. We hypothesized that gene...

  10. Diaphragmatic eventration complicated by gastric volvulus with perforation

    OpenAIRE

    Gupta, V; Chandra, A; Gupta, P

    2012-01-01

    Eventration of the diaphragm with gastric volvulus is uncommon. Gastric perforation in these cases is rare and usually associated with acute gastric volvulus with strangulation. We describe a case of diaphragmatic eventration with chronic gastric volvulus with gastric perforation without strangulation in an elderly man.

  11. Control of impact loading during distracted running before and after gait retraining in runners.

    Science.gov (United States)

    Cheung, Roy T H; An, Winko W; Au, Ivan P H; Zhang, Janet H; Chan, Zoe Y S; MacPhail, Aislinn J

    2018-07-01

    Gait retraining using visual biofeedback has been reported to reduce impact loading in runners. However, most of the previous studies did not adequately examine the level of motor learning after training, as the modified gait pattern was not tested in a dual-task condition. Hence, this study sought to compare the landing peak positive acceleration (PPA) and vertical loading rates during distracted running before and after gait retraining. Sixteen recreational runners underwent a two-week visual biofeedback gait retraining program for impact loading reduction, with feedback on the PPA measured at heel. In the evaluation of PPA and vertical loading rates before and after the retraining, the participants performed a cognitive and verbal counting task while running. Repeated measures ANOVA indicated a significant interaction between feedback and training on PPA (F = 4.642; P = 0.048) but not vertical loading rates (F > 1.953; P > 0.067). Pairwise comparisons indicated a significantly lower PPA and vertical loading rates after gait retraining (P  0.68). Visual feedback after gait retraining reduced PPA and vertical loading rates during distracted running (P  0.36). Gait retraining is effective in lowering impact loading even when the runners are distracted. In dual-task situation, visual biofeedback provided beneficial influence on kinetics control after gait retraining.

  12. Diaphragmatic hernia: diagnostic approaches with review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Eren, Suat [Department of Radiology, Faculty of Medicine, Atatuerk University, 25240 Erzurum (Turkey)]. E-mail: suateren@atauni.edu.tr; Ciris, Fahri [Department of Radiology, Faculty of Medicine, Atatuerk University, 25240 Erzurum (Turkey)

    2005-06-01

    Because surgical repair is indicated for the treatment of diaphragmatic hernia (DH), preoperative imaging of the diaphragmatic defect, hernia content, and associated complications with other organ's pathologies is important. While various techniques can be used on imaging of DHs, selection of the most effective but the least invasive technique will present the most accurate findings about DH, and will facilitate the management of DH. We reviewed the diaphragmatic hernia types associated with our cases, and we discussed the preferred imaging modalities for different DHs with review of the literature. We evaluated the imaging findings of 21 DH cases. They were Morgagni's hernia (n = 4), Bochdalek hernia (n = 2), iatrogenic DH (n = 4), traumatic DH (n = 6), and hiatal hernia (n = 5). Although its limited findings on DH and indirect findings about the diaphragmatic rupture, plain radiography is firstly preferred technique on DH. We found that ultrasound (US) is a useful tool on DH, on traumatic DH cases especially. Not only it shows diaphragmatic continuity and herniated organs, but also it reveals associated abdominal organ's pathologies. Computed tomography (CT) scan is most effective in many DH cases. It shows the herniated abdominal organs together with complications, such as intestinal strangulation, haemothorax, and rib fractures. We stressed that Multislice CT scan with coronal and sagittal reformatted images is the most effective and useful imaging technique on DH. With high sensitivity for soft tissue, MR imaging may be performed in the selected patients, on the late presenting DH cases or on the cases of the diagnosis still in doubt especially.

  13. Congenital asymptomatic diaphragmatic hernias in adults: a case series.

    Science.gov (United States)

    Bianchi, Enrica; Mancini, Paola; De Vito, Stefania; Pompili, Elena; Taurone, Samanta; Guerrisi, Isabella; Guerrisi, Antonino; D'Andrea, Vito; Cantisani, Vito; Artico, Marco

    2013-05-13

    Congenital diaphragmatic hernia is a major malformation occasionally found in newborns and babies. Congenital diaphragmatic hernia is defined by the presence of an orifice in the diaphragm, more often to the left and posterolateral, that permits the herniation of abdominal contents into the thorax. The aim of this case series is to provide information on the presentation, diagnosis and outcome of three patients with late-presenting congenital diaphragmatic hernias. The diagnosis of congenital diaphragmatic hernia is based on clinical investigation and is confirmed by plain X-ray films and computed tomography scans. In the present report three cases of asymptomatic abdominal viscera herniation within the thorax are described. The first case concerns herniation of some loops of the large intestine into the left hemi-thorax in a 75-year-old Caucasian Italian woman. The second case concerns a rare type of herniation in the right side of the thorax of the right kidney with a part of the liver parenchyma in a 57-year-old Caucasian Italian woman. The third case concerns herniation of the stomach and bowel into the left side of the chest with compression of the left lung in a 32-year-old Caucasian Italian man. This type of hernia may appear later in life, because of concomitant respiratory or gastrointestinal disease, or it may be an incidental finding in asymptomatic adults, such as in the three cases featured here. Patients who present with late diaphragmatic hernias complain of a wide variety of symptoms, and diagnosis may be difficult. Additional investigation and research appear necessary to better explain the development and progression of this type of disease.

  14. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials.

    Science.gov (United States)

    Berghmans, L C; Hendriks, H J; De Bie, R A; van Waalwijk van Doorn, E S; Bø, K; van Kerrebroeck, P E

    2000-02-01

    To assess the efficacy of physical therapies for first-line use in the treatment of urge urinary incontinence (UUI) in women, using a systematic review of randomized clinical trials (RCTs). A computer-aided and manual search was carried out for RCTs published between 1980 and 1999 investigating the treatment of UUI defined by the keywords 'physical therapies', e.g. bladder (re)training (including 'behavioural' treatment), pelvic floor muscle (PFM) exercises, with or without biofeedback and/or electrical stimulation. The methodological quality of the included trials was assessed using methodological criteria, based on generally accepted principles of interventional research. Fifteen RCTs were identified; the methodological quality of the studies was moderate, with a median (range) score of 6 (3-8.5) (maximum possible 10). Eight RCTs were considered of sufficient quality, i.e. an internal validity score of >/= 5.5 points on a scale of 0-10, and were included in a further analysis. Based on levels-of-evidence criteria, there is weak evidence to suggest that bladder (re)training is more effective than no treatment (controls), and that bladder (re)training is better than drug therapy. Stimulation types and parameters in the studies of electrical stimulation were heterogeneous. There is insufficient evidence that electrical stimulation is more effective than sham electrical simulation. To date there are too few studies to evaluate effects of PFM exercise with or without biofeedback, and of toilet training for women with UUI. Although almost all studies included reported positive results in favour of physical therapies for the treatment of UUI, more research of high methodological quality is required to evaluate the effects of each method in the range of physical therapies.

  15. Urinary Incontinence Surgery: When Other Treatments Aren't Enough

    Science.gov (United States)

    ... Development of overactive bladder, which could include urge incontinence Urinary tract infection Difficult or painful intercourse Talk with ... article: http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/urinary-incontinence-surgery/ART-20046858 . Mayo Clinic Footer Legal ...

  16. The menopause and urinary incontinence

    DEFF Research Database (Denmark)

    Foldspang, Anders; Mommsen, Søren

    1994-01-01

    The objective was to study the possible role of the menopause in adult female urinary incontinence (UI) etiology, using a cross-sectional population study comprising a random sample of adult females and self-reported data based on postal questionnaires. The study group comprised 915 women who...... prevalence in 1987 of episodes of stress and urge urinary incontinence; prevalence of menopause and exposure to childbirth, gynecologic surgery, cystitis and obesity as indicated by body mass index more than 29; prevalence relative risks, as indicated by odds ratio of UI conditional on menopause and other...... the year of final menstruation. The findings suggest perimenopausal processes rather than the menopause in general to be responsible for an increased risk of developing UI. The elevation of UI prevalence in the perimenopause may reflect the adjustment of the female continence mechanism to function...

  17. [Caesarean section and anal incontinence].

    Science.gov (United States)

    Kalis, V; Stipán, J; Chaloupka, P; Karbanová, J; Rokyta, Z

    2008-04-01

    Summary of the impact of Caesarean section on anal incontinence. Review. Department of Gynaecology and Obstetrics, Charles University and University Hospital Plzen. Review of the current international literature. Currently, Caesarean section is not considered to reduce symptoms of anal incontinence. If there is any reduction of symptoms, that remains only for a short term (40% in 3 months after the delivery in the largest trial). In a long term, virtually in no trial has been observed any difference, and others, non-obstetrical factors (particularly aging) prevail. Current knowledge does not allow to assess sufficiently pros and cons of Caesarean compared to vaginal delivery. High risk groups, that would profit from elective Ceasarean, have not been clearly identified yet.

  18. Treatment of stress urinary incontinence

    DEFF Research Database (Denmark)

    Fischer-Rasmussen, W

    1990-01-01

    This review presents reported cure and improvement rates of stress urinary incontinence in women obtained by different treatment modalities. Apart from the urodynamic findings, histological and histochemical changes of the pelvic floor may be clinically relevant to treatment in the future. Long......-term cure and improvement rates achieved by non-surgical treatment (physiotherapy, biofeedback, bladder training, electrostimulation) are commented on. These rates range from 40-60% for physiotherapy and electrostimulation but are considerably less after biofeedback and bladder training. Pharmacotherapy...

  19. [Urinary incontinence in degenerative spinal disease].

    Science.gov (United States)

    De Riggo, J; Benčo, M; Kolarovszki, B; Lupták, J; Svihra, J

    2011-01-01

    The aim of the study was to evaluate the presence of urinary incontinence in patients with chronic degenerative spinal disease and to identify factors affecting the occurrence and changes in urinary incontinence after surgery. The group evaluated comprised 214 patients undergoing surgery for degenerative spinal disease at our department between January 1 and December 31, 2008. The patients were categorised according to the type of their degenerative disease (cervical disc herniation, lumbar disc herniation, spinal stenosis, spinal instability or olisthesis) and the spine level involved (cervical or lumbar spine). The symptoms of urinary incontinence included leakage of urine and non-obstructive chronic urinary retention developing in association with the manifestation of vertebrogenic disorder. Patients with diseases known to increase the risk of incontinence were not included in the study. Based on a retrospective analysis of the patients' clinical notes, the occurrence of urinary incontinence in each type of degenerative spinal disease was assessed. The effect of gender, age, body mass index (BMI), neurological status and spinal disease type on the development of incontinence was statistically evaluated. The efficacy of surgical treatment was assessed on the basis of the patients' subjective complaints at the first follow-up one month after surgery. The data were evaluated by the statistical programme InSTAT (analysis of variance ANOVA, t-test). All tests were two-sided; a 0.05 level of statistical significance was used. Of the 214 patients with degenerative spinal disease, 27 (12.6%) had urinary incontinence. A higher risk of developing incontinence was found in women (p = 0.008) and in patients with radicular weakness (p = 0.023). The patients with urinary incontinence had their BMI significantly lower than patients without this disorder (p = 0.019). Age had no effect. The differences in the occurrence of urinary incontinence amongst the different types of

  20. Early hemi-diaphragmatic plication following intraoperative phrenic nerve transection during complete AV canal repair

    Directory of Open Access Journals (Sweden)

    Hamad Alowayshiq

    2018-04-01

    Full Text Available Unilateral diaphragmatic palsy reduces pulmonary function by about 25% in older children and usually it is well tolerated; however, it causes severe respiratory distress in infants and young children. Diaphragmatic plication performed later than 10 days after cardiac surgery for patients under 1 year of age was associated with higher incidence of pneumonia and mortality. The management of the diaphragmatic paralysis due to phrenic nerve injury aiming mainly to preserve the respiratory function. Until now, the optimal management of diaphragmatic palsy in children who have undergone cardiac surgery remains controversial and consists of prolonged ventilation or diaphragmatic plication. In our case, many factors supported early diaphragmatic plication, the age of the patient, post-operative AV canal repair with severe pulmonary hypertension, and clear transection of the left phrenic nerve diagnosed intraoperatively.

  1. Design of microstrip patch antennas using knowledge insertion through retraining

    Science.gov (United States)

    Divakar, T. V. S.; Sudhakar, A.

    2018-04-01

    The traditional way of analyzing/designing neural network is to collect experimental data and train neural network. Then, the trained neural network acts as global approximate function. The network is then used to calculate parameters for unknown configurations. The main drawback of this method is one does not have enough experimental data, cost of prototypes being a major factor [1-4]. Therefore, in this method the author collected training data from available approximate formulas with in full design range and trained the network with it. After successful training, the network is retrained with available measured results. This simple way inserts experimental knowledge into the network [5]. This method is tested for rectangular microstrip antenna and circular microstrip antenna.

  2. Tinnitus retraining therapy--the experiences in Slovakia.

    Science.gov (United States)

    Suchova, L

    2005-01-01

    Since Mai 1999 Tinnitus Retraining Therapy (TRT) according to Jastreboff has been used in the management of 55 patients with tinnitus of various origin. Tinnitus isn't a disease, it is only a symptom. Therefore we needed to do an exact examination of the patient. We needed to apply causal therapy whenever it was possible. After six months of continuous therapy more than 50% patients reported improvement of tinnitus or it has disappeared. Concomitantly, we found hyperacusis, hypersensitivity to loud sounds. We could not assert that it was the cause or the consequence of the tinnitus. Considering these findings, it would appear TRT can be useful for extending the possibilities of tinnitus treatment. (Tab. 5, Fig. 1, Ref. 13.)

  3. The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus.

    Science.gov (United States)

    Esen, K; Tok, S; Balci, Yuksel; Apaydin, F D; Kara, E; Uzmansel, D

    2018-01-01

    The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p renal artery origin and renal artery- -diaphragmatic crus contact at the left (p renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

  4. Incontinence in persons with Down Syndrome.

    Science.gov (United States)

    Niemczyk, Justine; von Gontard, Alexander; Equit, Monika; Medoff, David; Wagner, Catharina; Curfs, Leopold

    2017-08-01

    To assess the rates of incontinence and associated psychological problems in children, adolescents and adults with Down Syndrome, a genetic syndrome caused by partial or complete triplication (trisomy) of chromosome 21 and characterized by typical facial features, a physical growth delay and mild or moderate intellectual disability. Three hundred and seventeen persons with Down Syndrome (4-51 years) were recruited through a German parent support group (59.6% male, mean age 19.2 years). The Parental Questionnaire: Enuresis/Urinary Incontinence, the Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms, as well as the Developmental Behavior Checklist (DBC) for parents or for adults were filled out by parents or care-givers. 17.2% of the sample had nocturnal enuresis, 15.9% had daytime urinary incontinence, and 14.2% had fecal incontinence. Incontinence was present in 64.0% of young children (4-12 years), 10.3% of teens (13-17 years), 12.8% of young adults (18-30 years) and in 22.4% of older adults (>30 years). 13.6% of children and 8.4% of adults had a DBC score in the clinical range. 19.5% of children and 27.8% of adults with incontinence had behavioral problems. There was a significant association between nocturnal enuresis, daytime urinary incontinence and clinical DBC scores in adults. Incontinence in Down Syndrome is mainly present in young children and increases in older adults. Behavioral comorbidity is associated with incontinence only in adults with Down Syndrome. Screening and treatment of incontinence in individuals with Down Syndrome is recommended. © 2016 Wiley Periodicals, Inc.

  5. Diaphragmatic lymphatic vessel behavior during local skeletal muscle contraction.

    Science.gov (United States)

    Moriondo, Andrea; Solari, Eleonora; Marcozzi, Cristiana; Negrini, Daniela

    2015-02-01

    The mechanism through which the stresses developed in the diaphragmatic tissue during skeletal muscle contraction sustain local lymphatic function was studied in 10 deeply anesthetized, tracheotomized adult Wistar rats whose diaphragm was exposed after thoracotomy. To evaluate the direct effect of skeletal muscle contraction on the hydraulic intraluminal lymphatic pressures (Plymph) and lymphatic vessel geometry, the maximal contraction of diaphragmatic fibers adjacent to a lymphatic vessel was elicited by injection of 9.2 nl of 1 M KCl solution among diaphragmatic fibers while Plymph was recorded through micropuncture and vessel geometry via stereomicroscopy video recording. In lymphatics oriented perpendicularly to the longitudinal axis of muscle fibers and located at skeletal muscle contraction (Dmc) decreased to 61.3 ± 1.4% of the precontraction value [resting diameter (Drest)]; however, if injection was at >900 μm from the vessel, Dmc enlarged to 131.1 ± 2.3% of Drest. In vessels parallel to muscle fibers, Dmc increased to 122.8 ± 2.9% of Drest. During contraction, Plymph decreased as much as 22.5 ± 2.6 cmH2O in all submesothelial superficial vessels, whereas it increased by 10.7 ± 5.1 cmH2O in deeper vessels running perpendicular to contracting muscle fibers. Hence, the three-dimensional arrangement of the diaphragmatic lymphatic network seems to be finalized to efficiently exploit the stresses exerted by muscle fibers during the contracting inspiratory phase to promote lymph formation in superficial submesothelial lymphatics and its further propulsion in deeper intramuscular vessels. Copyright © 2015 the American Physiological Society.

  6. Laparoscopic management of diaphragmatic endometriosis by three different approaches.

    Science.gov (United States)

    Roman, Horace; Darwish, Basma; Provost, Delphine; Baste, Jean-Marc

    2016-08-01

    To report our three surgical approaches in the management of diaphragmatic endometriosis. Video article presenting laparoscopic surgical techniques, with and without robotic assistance. University hospital. Nulliparas with deep endometriosis associated with multiple endometriosis lesions of the diaphragm. Laparoscopic approach in women who present with small black-pigmented diaphragmatic lesions, with or without infiltration of the diaphragm, which are ablated using plasma energy. Robotic-assisted laparoscopic route in larger deep infiltrating implants, which are resected. To avoid phrenic nerve injury, robotic-assisted thoracoscopy is preferred in large lesions involving the central tendon of the diaphragm. The steps of each technique are emphasized. Surgical technique reports in anonymous patients are exempted from ethical approval by the Institutional Review Board. Seven patients have been managed by these procedures from July 2015 to March 2016. Patients' functional outcomes were uneventful, with no phrenic nerve palsy or residual chest and right shoulder pain. By combining resection and ablation techniques, the laparoscopy and thoracoscopy route, conventional and robotic-assisted minimally invasive approach, we offer a surgical strategy that is as conservative as possible, with an aim to limit postoperative adhesions between the liver and the diaphragm, and avoid diaphragmatic paralysis. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Chronic diaphragmatic hernia in 34 dogs and 16 cats.

    Science.gov (United States)

    Minihan, Anne C; Berg, John; Evans, Krista L

    2004-01-01

    Medical records of 34 dogs and 16 cats undergoing surgical repair of diaphragmatic hernia of >2 weeks' duration were reviewed, and long-term follow-up information was obtained. The most common clinical signs were dyspnea and vomiting; however, many of the animals were presented for nonspecific signs such as anorexia, lethargy, and weight loss. Thoracic radiographs revealed evidence of diaphragmatic hernia in only 66% of the animals, and additional imaging tests were often needed to confirm the diagnosis. Thirty-six hernias were repaired through a midline laparotomy; 14 required a median sternotomy combined with a laparotomy. In 14 animals, division of mature adhesions of the lungs or diaphragm to the herniated organs was necessary to permit reduction of the hernia. Fourteen animals required resection of portions of the lungs, liver, or intestine. All hernias were sutured primarily without the use of tissue flaps or mesh implants. Twenty-one of the animals developed transient complications in the postoperative period; the most common of these was pneumothorax. The mortality rate was 14%. Thirty-four (79%) of the animals that were discharged from the hospital had complete resolution of clinical signs, and none developed evidence of recurrent diaphragmatic hernia during the follow-up period. Nine were lost to follow-up.

  8. Urinary incontinence in patients with cystic fibrosis.

    Science.gov (United States)

    Reichman, Gina; De Boe, Veerle; Braeckman, Johan; Michielsen, Dirk

    2016-01-01

    Owing to evolution in treatment, the average life expectancy of patients with cystic fibrosis (CF) has increased. This has been followed by an increase in urological complications such as urinary incontinence. As stress incontinence occurs during exercise, it may have a negative effect on the implementation of respiratory physiotherapy. The purpose of this study is to determine the prevalence of urinary incontinence and its effect on the quality of life and physiotherapy in a population with CF. Questionnaires were used to determine the prevalence of incontinence in patients of the Cystic Fibrosis Clinic of the University Hospital in Brussels. Two different surveys were used, depending on the age of the patients (incontinence were emphasized. Questionnaires were completed by 122 participants aged 6-59 years, showing an overall prevalence of 27% for urinary incontinence. Mainly adults reported urinary incontinence, with a prevalence of 11% in men and 68% in women aged 12 and above. The amount of urinary leakage was usually only a few drops and it was mainly triggered by coughing. Many of the participants had never mentioned this symptom to anyone. Doctors' and physical therapists' attention should be drawn to the fact that urinary incontinence is part of the complication spectrum of CF. A quarter of the study population refrained from coughing up phlegm and from physiotherapy. It is important to actively question and inform about this problem, to enable its detection and treatment.

  9. Urinary incontinence: the role of menopause.

    Science.gov (United States)

    Trutnovsky, Gerda; Rojas, Rodrigo Guzman; Mann, Kristy Pamela; Dietz, Hans P

    2014-04-01

    This study aims to explore the effects of menopause and hormone therapy on the symptoms and signs of stress urinary incontinence and urge urinary incontinence. Records of women who attended a tertiary urogynecological unit were reviewed retrospectively. A standardized interview included evaluations of symptoms, menopause age (ie, time since last menstrual period or onset of menopausal symptoms), current or previous hormone use, and visual analogue scales for bother. Multichannel urodynamics, including urethral pressure profilometry and determination of abdominal leak point pressure, was performed. Of 382 women seen during the inclusion period, 62% were postmenopausal. Current systemic or local hormone use was reported by 7% and 6%, respectively. Two hundred eighty-eight women (76%) reported symptoms of stress urinary incontinence, with a mean bother of 5.7, and 273 women (72%) reported symptoms of urge urinary incontinence, with a mean bother of 6.4. On univariate analysis, symptoms and bother of urge incontinence were significantly related to menopause age, whereas this relationship was not found for stress incontinence. After calendar age was controlled for, length of menopause showed no significant relationship with any symptom or sign of urinary incontinence. Hormone deficiency after menopause is unlikely to play a major role in urinary incontinence.

  10. Urinary Incontinence: Causes and Methods of Evaluation

    Science.gov (United States)

    Griebling, Tomas L.

    2008-01-01

    This article presents the third of a multi-part series offering the most timely educational information, innovative approaches, products and technology solutions as well as coping and stigma-fighting approaches available on the subject of incontinence. Here, the author introduces the types and physiology of urinary incontinence. The author also…

  11. Exercise performance, core temperature, and metabolism after prolonged restricted activity and retraining in dogs

    Science.gov (United States)

    Nazar, K.; Greenleaf, J. E.; Pohoska, E.; Turlejska, E.; Kaciuba-Uscilko, H.; Kozlowski, S.

    1992-01-01

    Physiological effects of restricted activity (RA) and subsequent retraining have been studied. Ten male mongrel dogs performed a submaximal exercise endurance test on a treadmill during kennel control, after 8 weeks of cage confinement and after eight weeks of retraining using the same treadmill protocol 1 h/d for 6 d/week. Data obtained show that RA reduces exercise endurance, the effectiveness of exercise thermoregulation, muscle glycogen stores, and the lipolytic response to exercise and to noradrenaline stimulation.

  12. Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results

    Directory of Open Access Journals (Sweden)

    Darcy Ribeiro Pinto Filho

    2015-02-01

    Full Text Available We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia.

  13. Gait Retraining From Rearfoot Strike to Forefoot Strike does not change Running Economy.

    Science.gov (United States)

    Roper, Jenevieve Lynn; Doerfler, Deborah; Kravitz, Len; Dufek, Janet S; Mermier, Christine

    2017-12-01

    Gait retraining is a method for management of patellofemoral pain, which is a common ailment among recreational runners. The present study investigated the effects of gait retraining from rearfoot strike to forefoot strike on running economy, heart rate, and respiratory exchange ratio immediately post-retraining and one-month post-retraining in recreational runners with patellofemoral pain. Knee pain was also measured. Sixteen participants (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. A 10-minute treadmill RE test was performed by all subjects. The experimental group performed eight gait retraining running sessions where foot strike pattern was switched from rearfoot strike to forefoot strike, while the control group received no intervention. There were no significant differences for running economy (p=0.26), respiratory exchange ratio (p=0.258), or heart rate (p=0.248) between the groups. Knee pain reported on a visual analog scale was also significantly reduced (pstrike to forefoot strike did not affect running economy up to one-month post-retraining while reducing running-related patellofemoral pain. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report

    Directory of Open Access Journals (Sweden)

    Muroni Mirko

    2010-08-01

    Full Text Available Abstract Introduction Traumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries. Case presentation We report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired. Conclusions This was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.

  15. Traumatic diaphragmatic hernia in a 5-month-old boxer dog.

    Science.gov (United States)

    Hoddinott, Katie

    2013-05-01

    A 5-month-old intact male boxer dog was presented to the Metro Animal Emergency Clinic, Dartmouth, Nova Scotia after being hit by a car. Radiography identified a diaphragmatic hernia with the stomach herniated into the thoracic cavity. Diaphragmatic herniorrhaphy and splenectomy were performed without complication. The patient returned to his regular active lifestyle.

  16. A fatal case of complicated congenital peritoneopericardial diaphragmatic hernia in a Holstein calf

    Science.gov (United States)

    Hicks, Keltie A.; Britton, Ann P.

    2013-01-01

    Congenital peritoneopericardial diaphragmatic hernia is a rare condition most commonly reported in cats and dogs. A 6-week-old Holstein heifer calf with a congenital peritoneopericardial diaphragmatic hernia complicated by a perforated abomasal ulcer is described. The clinical signs and pathological findings are compared with those reported in other species. PMID:24155464

  17. A fatal case of complicated congenital peritoneopericardial diaphragmatic hernia in a Holstein calf

    OpenAIRE

    Hicks, Keltie A.; Britton, Ann P.

    2013-01-01

    Congenital peritoneopericardial diaphragmatic hernia is a rare condition most commonly reported in cats and dogs. A 6-week-old Holstein heifer calf with a congenital peritoneopericardial diaphragmatic hernia complicated by a perforated abomasal ulcer is described. The clinical signs and pathological findings are compared with those reported in other species.

  18. Isolated Crural Hematoma Mimicking Retroperitoneal Lymphadenopathy, A Unique Sign of Traumatic Diaphragmatic Rupture: A Case Report

    Directory of Open Access Journals (Sweden)

    Abhishek Jha

    2014-09-01

    Full Text Available Diaphragmatic injury following blunt thoracoabdominal trauma is rare and is usually associated with key radiological features like dependent viscera sign, collar sign, diaphragmatic thickening and defects. It may also be associated with secondary signs like intrathoracic herniation of abdominal viscera. Diaphragmatic crura, which are attached to the upper lumbar vertebra represent prominently thickened folds along the posterior diaphragm, are usually inconspicuous on routine Computed Tomography (CT scans. We present a case of a young patient who sustained a motor vehicle accident and developed difficulty in breathing. CT scan of the patient revealed bilateral crural hematomas, with splenic and renal lacerations and no other sign of diaphragmatic injury. The patient was operated and blunt diaphragmatic rupture was confirmed at surgery.

  19. Comparison of Radiography and Ultrasonography for Diagnosis of Diaphragmatic Hernia in Bovines

    Directory of Open Access Journals (Sweden)

    Hakim Athar

    2010-01-01

    Full Text Available The present study was conducted on 101 animals suffering from thoracoabdominal disorders; out of which twenty seven animals (twenty six buffaloes and one cow were diagnosed with diaphragmatic hernia based on clinical signs, radiography, ultrasonography, and left flank laparorumenotomy. Radiography alone confirmed diaphragmatic hernia in 18 cases (66.67% with a sac-like structure cranial to the diaphragm. In 15 animals the sac contained metallic densities while in three cases a sac-like structure with no metallic densities was present. Ultrasonography was helpful in confirming diaphragmatic hernia in 23 cases (85.18% and ultrasonographically reticular motility was evident at the level of 4th/5th intercostal space in all the animals. B+M mode ultrasonography was used for the first time for diagnosis of diaphragmatic hernia in bovines and the results suggested that ultrasonography was a reliable diagnostic modality for diaphragmatic hernia in bovines.

  20. Somatic tinnitus prevalence and treatment with tinnitus retraining therapy.

    Science.gov (United States)

    Ostermann, K; Lurquin, P; Horoi, M; Cotton, P; Hervé, V; Thill, M P

    2016-01-01

    Somatic tinnitus originates from increased activity of the dorsal cochlear nucleus, a cross-point between the somatic and auditory systems. Its activity can be modified by auditory stimulation or somatic system manipulation. Thus, sound enrichment and white noise stimulation might decrease tinnitus and associated somatic symptoms. The present uncontrolled study sought to determine somatic tinnitus prevalence among tinnitus sufferers, and to investigate whether sound therapy with counselling (tinnitus retraining therapy; TRT) may decrease tinnitus-associated somatic symptoms. To determine somatic tinnitus prevalence, 70 patients following the TRT protocol completed the Jastreboff Structured Interview (JSI) with additional questions regarding the presence and type of somatic symptoms. Among 21 somatic tinnitus patients, we further investigated the effects of TRT on tinnitus-associated facial dysesthesia. Before and after three months of TRT, tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI), and facial dysesthesia was assessed with an extended JSI-based questionnaire. Among the evaluated tinnitus patients, 56% presented somatic tinnitus-including 51% with facial dysesthesia, 36% who could modulate tinnitus by head and neck movements, and 13% with both conditions. Self-evaluation indicated that TRT significantly improved tinnitus and facial dysesthesia in 76% of patients. Three months of TRT led to a 50% decrease in mean THI and JSI scores regarding facial dysesthesia. Somatic tinnitus is a frequent and underestimated condition. We suggest an extension of the JSI, including specific questions regarding somatic tinnitus. TRT significantly improved tinnitus and accompanying facial dysesthesia, and could be a useful somatic tinnitus treatment.

  1. Outcomes of clinical trial: tinnitus masking versus tinnitus retraining therapy.

    Science.gov (United States)

    Henry, James A; Schechter, Martin A; Zaugg, Tara L; Griest, Susan; Jastreboff, Pawel J; Vernon, Jack A; Kaelin, Christine; Meikle, Mary B; Lyons, Karen S; Stewart, Barbara J

    2006-02-01

    A controlled clinical study was conducted to evaluate prospectively the clinical efficacy of tinnitus masking (TM) and tinnitus retraining therapy (TRT) in military veterans having clinically significant tinnitus. Qualifying patients were placed into the two groups in an alternating manner (to avoid selection bias), and treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index) and the verbally administered TRT interview forms. Findings are presented from the three written questionnaires, and from two of the interview questions (percentage time aware of, and annoyed by, tinnitus). Outcomes were analyzed on an intent-to-treat basis, using a multilevel modeling approach. Of the 123 patients enrolled, 118 were included in the analysis. Both groups showed significant declines (improvements) on these measures, with the TRT decline being significantly greater than for TM. The greater declines in TRT compared to TM occurred most strongly in patients who began treatment with a "very big" tinnitus problem. When patients began treatment with a "moderate" tinnitus problem, the benefits of TRT compared to TM were more modest.

  2. Tinnitus retraining therapy: a different view on tinnitus.

    Science.gov (United States)

    Jastreboff, Pawel J; Jastreboff, Margaret M

    2006-01-01

    Tinnitus retraining therapy (TRT) is a method for treating tinnitus and decreased sound tolerance, based on the neurophysiological model of tinnitus. This model postulates involvement of the limbic and autonomic nervous systems in all cases of clinically significant tinnitus and points out the importance of both conscious and subconscious connections, which are governed by principles of conditioned reflexes. The treatments for tinnitus and misophonia are based on the concept of extinction of these reflexes, labeled as habituation. TRT aims at inducing changes in the mechanisms responsible for transferring signal (i.e., tinnitus, or external sound in the case of misophonia) from the auditory system to the limbic and autonomic nervous systems, and through this, remove signal-induced reactions without attempting to directly attenuate the tinnitus source or tinnitus/misophonia-evoked reactions. As such, TRT is effective for any type of tinnitus regardless of its etiology. TRT consists of: (1) counseling based on the neurophysiological model of tinnitus, and (2) sound therapy (with or without instrumentation). The main role of counseling is to reclassify tinnitus into the category of neutral stimuli. The role of sound therapy is to decrease the strength of the tinnitus signal. It is crucial to assess and treat tinnitus, decreased sound tolerance, and hearing loss simultaneously. Results from various groups have shown that TRT can be an effective method of treatment. Copyright (c) 2006 S. Karger AG, Basel.

  3. Inventing urine incontinence devices for women.

    Science.gov (United States)

    Pieper, B; Cleland, V; Johnson, D E; O'Reilly, J L

    1989-01-01

    Nurses have long been aware of the devastating effects of urinary incontinence on women. Although women may find diapers, pads and protective clothing valuable protection, there are few options for a continuous wear, external urine incontinence device (EUID). Inventors have attempted to develop an EUID since ancient times; the first United States patent for an EUID was awarded in 1949. The purpose of this paper is to review technological considerations for development of an external urinary incontinence device for women. Patents and products illustrate the considerations.

  4. Adult female urinary incontinence and childhood bedwetting

    DEFF Research Database (Denmark)

    Foldspang, Anders; Mommsen, S.

    1994-01-01

    A cross-sectional random population sample of women 30 to 59 years old was sent a questionnaire on urinary incontinence and, among other things, childhood bedwetting. Among 2,613 responders 17.0% reported prevalent urinary incontinence (14.7% stress provoked, 8.3% associated with urge, 6.8% stress...... and urge overlap, 2.2% occurring especially during sleep and 3.9% occurring especially when anxious), and 6.5% reported childhood bedwetting after age 5 years and 3.3% after age 10 years. Childhood bedwetting was associated with prevalent urge urinary incontinence (p ... during sleep (p anxiety (p

  5. Assessment and reduction of diaphragmatic tension during hiatal hernia repair.

    Science.gov (United States)

    Bradley, Daniel Davila; Louie, Brian E; Farivar, Alexander S; Wilshire, Candice L; Baik, Peter U; Aye, Ralph W

    2015-04-01

    During hiatal hernia repair there are two vectors of tension: axial and radial. An optimal repair minimizes the tension along these vectors. Radial tension is not easily recognized. There are no simple maneuvers like measuring length that facilitate assessment of radial tension. The aims of this project were to: (1) establish a simple intraoperative method to evaluate baseline tension of the diaphragmatic hiatal muscle closure; and, (2) assess if tension is reduced by relaxing maneuvers and if so, to what degree. Diaphragmatic characteristics and tension were assessed during hiatal hernia repair with a tension gage. We compared tension measured after hiatal dissection and after relaxing maneuvers were performed. Sixty-four patients (29 M:35F) underwent laparoscopic hiatal hernia repair. Baseline hiatal width was 2.84 cm and tension 13.6 dag. There was a positive correlation between hiatal width and tension (r = 0.55) but the strength of association was low (r (2) = 0.31). Four different hiatal shapes (slit, teardrop, "D", and oval) were identified and appear to influence tension and the need for relaxing incision. Tension was reduced by 35.8 % after a left pleurotomy (12 patients); by 46.2 % after a right crural relaxing incision (15 patients); and by 56.1 % if both maneuvers were performed (6 patients). Tension on the diaphragmatic hiatus can be measured with a novel device. There was a limited correlation with width of the hiatal opening. Relaxing maneuvers such as a left pleurotomy or a right crural relaxing incision reduced tension. Longer term follow-up will determine whether outcomes are improved by quantifying and reducing radial tension.

  6. Surgical repair of a congenital pericardial diaphragmatic hernia

    International Nuclear Information System (INIS)

    Wright, R.P.; Wright, R.; Scott, R.

    1987-01-01

    Objective: To describe the surgical repair and pre- and postoperative management of a peritoneopericardial diaphragmatic hernia (PPDH) in a pregnant dog. Case summary: A pregnant dog was presented for vomiting, lethargy, and pale mucous membranes. Pulsus paradoxus was noted on physical examination. The dog was diagnosed with a PPDH via thoracic radiographs, abdominal ultrasound, and a n echocardiogram. The hernia was surgically repaired and the dog received supportive medical care until the puppies were old enough to be delivered via cesarean section. The mother and all puppies survived. New or unique information provided: This is the first report that describes the surgical repair and postoperative management of a PPDH in a pregnant dog

  7. Hiatal hernia and diaphragmatic eventration in a leopard (Panthera pardus).

    Science.gov (United States)

    Kearns, K S; Jones, M P; Bright, R M; Toal, R; DeNovo, R; Orosz, S

    2000-09-01

    A 1-yr-old male leopard (Panthera pardus) presented for intermittent anorexia, emaciation, and generalized muscle wasting. Plain radiographs, ultrasonography, and esophageal endoscopy led to a diagnosis of diaphragmatic eventration with probable concurrent hiatal hernia. An exploratory laparotomy confirmed both diagnoses, and surgical repair and stabilization were performed. After surgery, the leopard was maintained on small liquid meals for 4 days, with a gradual return to normal diet over 2 wk. By 4 wk after surgery, the leopard was eating well and gaining weight, and it showed no recurrence of clinical signs for 2 yr subsequently, becoming mildly obese.

  8. Unusual cause of brachial palsy with diaphragmatic palsy.

    Science.gov (United States)

    Gupta, Vishal; Pandita, Aakash; Panghal, Astha; Hassan, Neha

    2018-05-12

    We report a preterm neonate born with respiratory distress. The neonate was found to have diaphragmatic palsy and brachial palsy. The neonate was born by caesarean section and there was no history of birth trauma. On examination, there was bilateral congenital talipes equinovarus and a scar was present on the forearm. The mother had a history of chickenpox during the 16 weeks of pregnancy for which no treatment was sought. On investigation, PCR for varicella was found to be positive in the neonate. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. [Postnatal diagnosis of gastric volvulus revealing congenital diaphragmatic hernia].

    Science.gov (United States)

    Aprahamian, A; Nouyrigat, V; Grévent, D; Hervieux, E; Chéron, G

    2017-05-01

    Postnatally diagnosed congenital diaphragmatic hernias (CDH) are rare and have a better prognosis than those diagnosed prenatally. Postnatal symptoms can be respiratory, digestive, or mixed. Gastric volvulus can reveal CDH. Symptoms are pain, abdominal distension, and/or vomiting. Upper gastrointestinal barium X-ray radiography provides the diagnosis. Prognosis is related to early surgical management in complicated forms with intestinal occlusion or sub-occlusion. We report on an infant who presented with vomiting, which revealed gastric volvulus associated with a CDH. Progression was favorable after surgical treatment. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Radiological features of 80 cases of diaphragmatic rupture

    International Nuclear Information System (INIS)

    Sullivan, M.; Lee, R.

    1989-01-01

    The films from 80 cases of diaphragmatic rupture in the dog and cat over a 10 year period were examined. The most common findings were loss of the cupola and masking of the cardiac shadow. Identification of the stomach or intestine in the thorax made the diagnosis straightforward. However, in some animals these organs were not visible and there was considerable accumulation of free pleural fluid. The use of barium contrast studies and post drainage films were unable to confirm the presence of a rupture in all cases with inconclusive plain film findings. The identification of a rupture was only made by exploratory surgery in these animals

  11. Urinary incontinence - tension-free vaginal tape

    Science.gov (United States)

    ... ency/article/007377.htm Urinary incontinence - tension-free vaginal tape To use the sharing features on this page, please enable JavaScript. Placement of tension-free vaginal tape is surgery to help control stress urinary ...

  12. Urinary Incontinence: MedlinePlus Health Topic

    Science.gov (United States)

    ... your doctor, or surgery. NIH: National Institute of Diabetes and Digestive and Kidney Diseases Start Here Urinary Incontinence (Mayo Foundation for Medical Education and Research) Urinary Tract Health (National Institute of Child Health and Human Development) ...

  13. Clinical trial to compare tinnitus masking and tinnitus retraining therapy.

    Science.gov (United States)

    Henry, J A; Schechter, M A; Zaugg, T L; Griest, S; Jastreboff, P J; Vernon, J A; Kaelin, C; Meikle, M B; Lyons, K S; Stewart, B J

    2006-12-01

    Both tinnitus masking (TM) and tinnitus retraining therapy (TRT) can be effective therapies for amelioration of tinnitus. TM may be more effective for patients in the short term, but with continued treatment TRT may produce the greatest effects. Although TM and TRT have been used for many years, research has not documented definitively the efficacy of these methods. The present study was a controlled clinical trial to prospectively evaluate the clinical efficacy of these two methods for US military veterans with severe tinnitus. Over 800 veterans were screened to ensure that enrolled patients had tinnitus of sufficient severity to justify 18 months of individualized treatment. Qualifying patients (n=123) were placed quasi-randomly (alternating placement) into treatment with either TM or TRT. Treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated primarily using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index). Findings are presented from the three written questionnaires with respect to three categories of patients: describing tinnitus as a 'moderate,' 'big,' and 'very big' problem at baseline. Based on effect sizes, both groups showed considerable improvement overall. In general, TM effects remained fairly constant over time while TRT effects improved incrementally. For the patients with a 'moderate' and 'big' problem, TM provided the greatest benefit at 3 and 6 months; benefit to these TRT patients was slightly greater at 12 months, and much greater at 18 months. For patients with a 'very big' problem, TM provided the greatest benefit at 3 months. For these latter patients, results were about the same between groups at 6 months, and improvement for TRT was much greater at 12 months, with further gains at 18 months.

  14. Diaphragmatic thickness ratio (inspiratory/expiratory) as a diagnostic method of diaphragmatic palsy associated with interescalene block.

    Science.gov (United States)

    López Escárraga, V M; Dubos España, K; Castillo Bustos, R H; Peidró, L; Sastre, S; Sala-Blanch, X

    2018-02-01

    Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block. We designed an observational study in 22 patients scheduled for shoulder arthroscopy. Spirometry was performed (criteria of phrenic paresis was a decrease in FVC and FEV1 ≥20%). Ultrasound apposition zone was assessed in anterior axillary line and diaphragmatic displacement was evaluated on inspiration and expiration (number of intercostal spaces; phrenic paresis considered a reduction ≥25%) and thickness of the diaphragm muscle (a phrenic paresis was considered an index block at C5-C6 with 20ml of 0.5% ropivacaine. Twenty-one patients (95%) presented phrenic nerve block according to one or more of the methods used. One patient did not show any symptoms or signs suggestive of phrenic paralysis and was excluded. All the patients presented phrenic paresis based on the diaphragmatic thickness index, with the pre-block index being 1.8±0.5 and post-block of 1.05±0.06 (Pblock (from 1.9±0.5 intercostal spaces to 0.5±0.3; Pblock. This index does not require a baseline pre-assessment. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. [A prophylactic program for strain urinary incontinence].

    Science.gov (United States)

    Stadnicka, Grazyna; Iwanowicz-Palus, Grazyna J; Bień, Agnieszka M

    2002-01-01

    The aim of the study was to work out a prophylactic program for strain urinary incontinence. Analysis of literature on the subject and results of own investigations presented in the first part of the paper indicate that the program of prophylaxis of strain urinary incontinence should primarily include: (1) Preparation of the medical staff (nurses, midwives) for propagating health education among women on prevention of strain urinary incontinence. (2) Preparation of adequate educational materials in the form of brochures, leaflets, information posters about symptoms, causes and prophylaxis of urinary incontinence indicating health care institutions available to all women when the disease is suspected or already present. (3) Propagation of problems connected with strain urinary incontinence in the mass media providing information to a wide audience in order to make people realize the significance of this social problem and break stereotypes associated with this disease of "shame". (4) Preparation of sets of exercises for the muscles of the base of the pelvis to be performed during pregnancy, confinement and menopause to maintain their proper function. (5) Indicating factors predisposing to strain urinary incontinence with focus on possibilities of their reduction or elimination.

  16. Drainage of pleural effusion improves diaphragmatic function in mechanically ventilated patients.

    Science.gov (United States)

    Umbrello, Michele; Mistraletti, Giovanni; Galimberti, Andrea; Piva, Ilaria R; Cozzi, Ottavia; Formenti, Paolo

    2017-03-01

    Pleural effusion adversely affects the pressuregenerating capacity of the diaphragm. It uncouples the lung and chest wall, which may result in diaphragmatic dysfunction. Information on the effects of effusion drainage on diaphragmatic function is limited, but several studies report relief of dyspnoea after drainage, which was attributed to improved diaphragmatic mechanics, even if this issue was never formally addressed. To investigate the effect of drainage of unilateral pleural effusion on diaphragmatic function. In a prospective twostep protocol (at baseline and after drainage of effusion), we conducted a spontaneous breathing trial in fourteen critically ill, mechanically ventilated patients undergoing pressure support ventilation. We used ultrasonography of the ipsilateral hemidiaphragm to evaluate and record respiratory displacement and thickening during tidal and maximal breathing efforts. We recorded and analysed airway pressures, respiratory system compliance, vital capacity, indices of respiratory effort and arterial blood gases. After drainage of the effusion, the respiratory rate decreased and tidal volume increased, but haemodynamic parameters were unaffected and oxygenation levels showed a non-significant increase. Drainage was associated with significant decreases in indices of respiratory drive and the maximal pressure generated by the respiratory muscles, as well as an increased compliance of the respiratory system. Diaphragmatic displacement and thickening significantly increased after drainage. We found there was a significant correlation between the volume of the effusion drained and the increase in tidal diaphragmatic thickening. Drainage of a unilateral pleural effusion during weaning from mechanical ventilation improves diaphragmatic contractile activity and respiratory system performance.

  17. [Does Return to Work after Vocational Retraining Depend on Labour Market?

    Science.gov (United States)

    Hetzel, C; Streibelt, M

    2016-10-01

    Background: Studies about the impact of the labour market on return to work (RTW) after vocational retraining are contradictory. We examined if (1) RTW after vocational retraining depends on regional labour markets and if (2) the regional labour markets variance affects the influence of personal characteristics on RTW. Methods: The data consisted of the scientific use file (completed rehabilitation in the course of health insurance 2002-2009) of the German Federal Pension Insurance (51 626 persons of 7 year cohorts) and regional economic data (412 districts). Multilevel logistic regression models were used. Results: At the context level the logarithmic unemployment rate was the most relevant predictor. The RTW rate decreased with increasing unemployment rate, saturating at an unemployment rate of around 15%. Significant differences between the intervention types (integration, 1-year and 2-year vocational retraining programs) were observed. The effects of individual predictors were clearer with higher unemployment, e. g. education, individual unemployment, income and further vocational interventions prior to vocational retraining. Conclusion: We demonstrate that the success of vocational retraining depends on the regional labour market. Furthermore individual predictors show stronger effects on success with the context of "poor" labour markets. In addition to the existing evidence the regional unemployment rate should be taken into consideration in effectiveness research studies and benchmarking processes in quality assurance. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Effects of resistance training, detraining, and retraining on strength and functional capacity in elderly.

    Science.gov (United States)

    Sakugawa, Raphael Luiz; Moura, Bruno Monteiro; Orssatto, Lucas Bet da Rosa; Bezerra, Ewertton de Souza; Cadore, Eduardo Lusa; Diefenthaeler, Fernando

    2018-05-17

    The interruption of training (detraining) results in loss of the gains acquired. Partial retention could occur after detraining, and variation in training stimuli may optimize retraining adaptations. To evaluate the effect of a resistance-retraining program on strength and functional capacity performance after a detraining period. Ten elderly men and women (63-68 years) completed 12 weeks of training, 16 weeks of detraining, and 8 weeks of retraining. One-repetition maximum (1-RM) at 45° leg press, maximum isometric knee extension torque, rate of torque development (RTD), 30-s sit-to-stand, timed up and go, and stair ascent and descent tests were assessed. The 1-RM increased after training (p training (p training period (p > 0.05). For RTD and 30-s sit-to-stand, there was an increase after retraining when compared to pre-training values (p training and post-training periods (p functional capacity at the same level obtained after a detraining period. The inclusion of an explosive strength session in retraining period improves RTD and 30-s sit-to-stand performance and can accelerate the recovery of strength after a detraining period.

  19. Traumatic diaphragmatic ruptures: clinical presentation, diagnosis and surgical approach in adults

    Directory of Open Access Journals (Sweden)

    Hofmann, Sabine

    2012-01-01

    Full Text Available Objective: Traumatic diaphragmatic injuries are rare, but potentially life-threatening due to herniation of abdominal organs into the pleural cavities. They can be easily overlooked on initial diagnostics and a high index of suspicion is required. The aim of this retrospective study was to analyze the clinical presentation, diagnostic methods and surgical management of patients with diaphragmatic rupture at our institution. Methods: A retrospective study was performed to analyze our experience with patients suffering from traumatic diaphragmatic rupture. Charts were reviewed for sex, age, side-location, concomitant injuries, time-to-diagnosis, diagnostic methods, surgical approach and outcome. Results: Fourteen patients (median age: 46 yrs, range 18–71, 9 male, 5 female with diaphragmatic injuries (left side: 10, right side: 4 were treated between July 2003 and September 2011. Mechanism of injury was a penetrating trauma (14%, blunt trauma (50% and others (36%. Associated abdominal injuries included spleen rupture (n=3, liver laceration (n=2, abdominal wall laceration (n=2 and gastric perforation (n=1. Computed tomography was the most sensitive diagnostic method. All patients underwent trans-abdominal repair of the diaphragmatic defect (direct suture: 10, prosthetic mesh insertion: 4. Associated abdominal procedures included splenectomy (n=3, liver packing (n=2, abdominal wall reconstruction (n=2 and partial gastric resection (n=1. Morbidity and hospital mortality rate were 36% and 0%, respectively. Median postoperative hospital stay was 17 days (range: 7–40 days. Conclusion: Morbidity and mortality of diaphragmatic ruptures are mainly determined by associated injuries or complications of diaphragmatic herniation like incarceration of viscera or lung failure. Early diagnosis helps to prevent severe complications. Spiral CT-scan is the most reliable tool for acute diagnosis of diaphragmatic rupture and associated visceral lacerations

  20. Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm?

    Science.gov (United States)

    Crausman, Robert S; Summerhill, Eleanor M; McCool, F Dennis

    2009-01-01

    Idiopathic diaphragm paralysis is probably more common and responsible for more morbidity than generally appreciated. Bell's palsy, or idiopathic paralysis of the seventh cranial nerve, may be seen as an analogous condition. The roles of zoster sine herpete and herpes simplex have increasingly been recognized in Bell's palsy, and there are some data to suggest that antiviral therapy is a useful adjunct to steroid therapy. Thus, we postulated that antiviral therapy might have a positive impact on the course of acute idiopathic diaphragm paralysis which is likely related to viral infection. Three consecutive patients with subacute onset of symptomatic idiopathic hemidiaphragm paralysis were empirically treated with valacyclovir, 1,000 mg twice daily for 1 week. Prior to therapy, diaphragmatic function was assessed via pulmonary function testing and two-dimensional B-mode ultrasound, with testing repeated 1 month later. Diaphragmatic function pre- and post-treatment was compared to that of a historical control group of 16 untreated patients. All three subjects demonstrated ultrasound recovery of diaphragm function 4-6 weeks following treatment with valacyclovir. This recovery was accompanied by improvements in maximum inspiratory pressure (PI(max)) and vital capacity (VC). In contrast, in the untreated cohort, diaphragm recovery occurred in only 11 subjects, taking an average of 14.9 +/- 6.1 months (mean +/- SD). The results of this small, preliminary study suggest that antiviral therapy with valacyclovir may be helpful in the treatment of idiopathic diaphragm paralysis induced by a viral infection.

  1. Delayed diaphragmatic herniation masquerading as a complicated parapneumonic effusion.

    Science.gov (United States)

    Tsang, J; Ryan, F

    1999-01-01

    Injury to the diaphragm following blunt or penetrating thoracoabdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.

  2. Delayed Diaphragmatic Herniation Masquerading as a Complicated Parapneumonic Effusion

    Directory of Open Access Journals (Sweden)

    John Tsang

    1999-01-01

    Full Text Available Injury to the diaphragm following blunt or penetrating thoraco-abdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.

  3. Comorbidity between Klinefelter syndrome and diaphragmatic hernia. A case report

    Directory of Open Access Journals (Sweden)

    Carolina Melendez Valdez

    Full Text Available CONTEXT: Intrathoracic cystic lesions have been diagnosed in a wide variety of age groups, and the increasing use of prenatal imaging studies has allowed detection of these defects even in utero.CASE REPORT: A 17-year-old pregnant woman in her second gestation, at 23 weeks of pregnancy, presented an ultrasound with evidence of a cystic anechoic image in the fet al left hemithorax. A morphological ultrasound examination performed at the hospital found that this cystic image measured 3.7 cm x 2.1 cm x 1.6 cm. Polyhydramnios was also present. At this time, the hypothesis of cystic adenomatoid malformation was raised. Fet al echocardiography showed only a dextroposed heart. Fet al magnetic resonance imaging produced an image compatible with a left diaphragmatic hernia containing the stomach and at least the first and second portions of the duodenum, left lobe of the liver, spleen, small intestine segments and portions of the colon. The stomach was greatly distended and the heart was shifted to the right. There was severe volume reduction of the left lung. Fet al karyotyping showed the chromosomal constitution of 47,XXY, compatible with Klinefelter syndrome. In our review of the literature, we found only one case of association between Klinefelter syndrome and diaphragmatic hernia.CONCLUSIONS: We believe that the association observed in this case was merely coincidental, since both conditions are relatively common. The chance of both events occurring simultaneously is estimated to be 1 in 1.5 million births.

  4. Extracorporeal Membrane Oxygenation in Premature Infants With Congenital Diaphragmatic Hernia.

    Science.gov (United States)

    Cuevas Guamán, Milenka; Akinkuotu, Adesola C; Cruz, Stephanie M; Griffiths, Pamela A; Welty, Stephen E; Lee, Timothy C; Olutoye, Oluyinka O

    2017-11-14

    Prematurity and low birth weight have been exclusion criteria for extracorporeal membrane oxygenation (ECMO); however, these criteria are not evidence based. With advances in anticoagulation, improved technology, and surgical expertise, it is difficult to deny a potential therapy based on these criteria alone. We report the outcome of three neonates who were ineligible based on traditional criteria but were offered ECMO as a life-saving measure. We highlight the interdisciplinary nature of modern decision-making. All three neonates had severe congenital diaphragmatic hernia diagnosed prenatally, had normal fetal karyotypes, were born prematurely, and weighed less than 2 kg. All three neonates underwent cervical venoarterial cannulation, stabilization on ECMO, and repair of their congenital diaphragmatic hernia early in their ECMO courses. All three infants had long courses of respiratory support attributable to lung hypoplasia, but there were no short- or long-term complications attributable to ECMO support directly. All three are alive at 2 years of age and were making progress developmentally. In conclusion, with interdisciplinary collaboration and clinical guidelines uniformly implemented, low birth weight infants may benefit from ECMO and should not be denied the therapy arbitrarily based on gestational age or size alone. Further research is essential to determine appropriate patient selection in premature infants.

  5. Behavior profiles in children with functional urinary incontinence before and after incontinence treatment

    NARCIS (Netherlands)

    A. Bael (An); P. Winkler (Pauline); H. Lax (Hildegard); H. Hirche (Herbert); E. Gäbel (Elisabeth); M. Vijverberg (Marianne); R. van Zon (Roelie); E. van Hoecke (Eline); J.D. van Gool (Jan)

    2008-01-01

    textabstractOBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. METHODS. A total of 202 children with

  6. Behavior profiles in children with functional urinary incontinence before and after incontinence treatment

    NARCIS (Netherlands)

    Bael, An; Winkler, Pauline; Lax, Hildegard; Hirche, Herbert; Gaebel, Elisabeth; Vijverberg, Marianne; van Zon, Roelie; Van Hoecke, Eline; van Gool, Jan D.

    OBJECTIVE. The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. METHODS. A total of 202 children with nonneuropathic

  7. Effect of weight loss on urinary incontinence in women

    Directory of Open Access Journals (Sweden)

    Whitcomb EL

    2011-08-01

    Full Text Available Emily L Whitcomb1, Leslee L Subak21Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA; 2University of California San Francisco, UCSF Departments of Obstetrics, Gynecology and Reproductive Sciences, and Urology, and Epidemiology and Biostatistics, SF Veterans Affairs Medical Center, San Francisco, CA, USABackground: The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence.Methods: A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized.Results: Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%–70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4–5. The odds of incident urinary incontinence over 5–10 years increase by approximately 30%–60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence.Conclusion: Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative

  8. Urinary incontinence in pregnant women and their quality of life.

    Science.gov (United States)

    Kocaöz, Semra; Talas, Melek S; Atabekoğlu, Cem S

    2010-12-01

    The aim was to investigate the prevalence of urinary incontinence during pregnancy and the related risk factors as well as to assess its influence on the quality of life. Although urinary incontinence is common during pregnancy and can have a substantial impact on quality of life, women rarely seek help for this symptom. This study was designed as a cross-sectional and descriptive survey. A total of 393 pregnant women participated in the study between March and June 2007. The data was collected using the International Consultation on Incontinence Questionnaire Short Form and Wagner's quality of life scale. Potential risk factors were investigated through logistic regression analysis. The prevalence of urinary incontinence was 27% (106/393). Factors significantly associated with urinary incontinence included age group, parity, previous urinary incontinence, constipation, urinary incontinence in mother and sister, previous urinary incontinence during pregnancy and postpartum. According to the results of our study, urinary incontinence is common in women during pregnancy. The quality of life of pregnant women was found to be either unaffected or affected very little by urinary incontinence. This study reveals that the prevalence of urinary incontinence during pregnancy is very high. The findings will help increase the awareness of health care workers involved in the care of pregnant women about urinary incontinence and aid the design of more intensive education programmes directed towards the prevention of urinary incontinence during pregnancy. © 2010 Blackwell Publishing Ltd.

  9. Retraining Attitudes and Stereotypes to Affect Motivation and Cognitive Capacity under Stereotype Threat

    Science.gov (United States)

    Forbes, Chad E.; Schmader, Toni

    2010-01-01

    A series of experiments used a retraining paradigm to test the effects of attitudes and stereotypes on individuals’ motivation and processing capacity in stereotype threatening contexts. Women trained to have a more positive math attitude exhibited increased math motivation (Study 1). This effect was not observed for men but was magnified among women when negative stereotypes were either primed subtly (Study 2) or indirectly reinforced (Study 3). Although attitudes had no effect on working memory capacity, women retrained to associate their gender with being good at math exhibited increased working memory capacity (Studies 3 and 4) that in turn mediated increased math performance (Study 4) in a stereotype threatening context. Results suggest that although positive attitudes can motivate stigmatized individuals to engage with threatening domains, stereotypes need to be retrained to give them the cognitive capacity critical for success. Implications for interventions to reduce stereotype threat are discussed. PMID:20822288

  10. Retraining attitudes and stereotypes to affect motivation and cognitive capacity under stereotype threat.

    Science.gov (United States)

    Forbes, Chad E; Schmader, Toni

    2010-11-01

    In a series of experiments, a retraining paradigm was used to test the effects of attitudes and stereotypes on individuals' motivation and cognitive capacity in stereotype-threatening contexts. Women trained to have a more positive math attitude exhibited increased math motivation (Study 1). This effect was not observed for men but was magnified among women when negative stereotypes were either primed subtly (Study 2) or indirectly reinforced (Study 3). Although attitudes had no effect on working memory capacity, women retrained to associate their gender with being good at math exhibited increased working memory capacity (Studies 3 and 4), which in turn mediated increased math performance (Study 4) in a stereotype-threatening context. Results suggest that although positive attitudes can motivate stigmatized individuals to engage with threatening domains, stereotypes need to be retrained to give them the cognitive capacity critical for success. Implications for interventions to reduce stereotype threat are discussed.

  11. AMP kinase expression and activity in human skeletal muscle: effects of immobilization, retraining, and creatine supplementation

    DEFF Research Database (Denmark)

    Eijnde, Bert O.; Derave, Wim; Wojtaszewski, Jørgen

    2005-01-01

    The effects of leg immobilization and retraining in combination with oral creatine intake on muscle AMP-activated protein kinase (AMPK) protein expression and phosphorylation status were investigated. A double-blind trial was performed in young healthy volunteers (n = 22). A cast immobilized...... the right leg for 2 wk, whereafter the knee-extensor muscles of that leg were retrained for 6 wk. Half of the subjects received creatine monohydrate throughout the study (Cr; from 15 g down to 2.5 g daily), and the others ingested placebo (P; maltodextrin). Before and after immobilization and retraining...... that immobilization-induced muscle inactivity for 2 wk does not alter AMPK a1-, a2-, and ß2-subunit expression or a-AMPK phosphorylation status. Furthermore, the present observations indicate that AMPK probably is not implicated in the previously reported beneficial effects of oral creatine supplementation on muscle...

  12. [Urinary incontinence 6 months after childbirth].

    Science.gov (United States)

    Ruiz de Viñaspre Hernández, Regina; Rubio Aranda, Encarnación; Tomás Aznar, Concepción

    2013-08-17

    Urinary incontinence initiated before and right after delivery and persisting 3 months after delivery tends to become chronic. We intended to estimate the persistence of urinary incontinence 6 months postpartum and to analyse the different factors associated with it. Follow-up study 6 months after delivery of women presenting urinary incontinence symptoms in gestation or in the first 2 months of postpartum. The dependent variable was the persistence and the independent variables were grouped in obstetric and non-obstetric. Odds ratio (OR) were calculated with their confidence interval at 95% (IC 95%) in the bivariate analysis. The variables that showed an important risk of persistence of incontinence were used to perform a multivariate model of logistic regression. The persistence of incontinence 6 months after delivery was 21.4% (CI 95% 16-26.7). The risk of persistence increased with the Kristeller maneuver (OR 7.89, CI 95% 3.04-20.49), not weight recovery (OR 3.64, CI 95% 1.10-12.02), not practising pelvic floor muscle exercises in postpartum (OR 9.36, CI 95% 2.71-32.33), appearance of incontinence after delivery (OR 6.66, CI 95% 2.37-18.68) and the weight of the newborn>3.5 kg (OR 6.76, CI 95% 2.54-18.03), all of them explaining 58% of the variability of persistence. 21.4% of women with urinary incontinence caused by pregnancy/delivery will continue to have it 6 months postpartum. An important part of this persistence is associated with some factors easy to modify. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  13. Faecal soiling: pathophysiology of postdefaecatory incontinence.

    Science.gov (United States)

    Pucciani, F

    2013-08-01

    Passive postdefaecatory incontinence is poorly understood and yet is an important clinical problem. The aim of this study was to characterize the pathophysiology of postdefaecatory incontinence in patients affected by faecal soiling. Seventy-two patients (30 women, age range 49-79 years; 42 men, age range, 53-75 years) affected by faecal passive incontinence with faecal soiling were included in the study. Two patient groups were identified: Group 1 comprised 42 patients with postdefaecatory incontinence and Group 2 had 30 patients without incontinence after bowel movements. After a preliminary clinical evaluation, including the Faecal Incontinence Severity Index (FISI) score and the obstructed defaecation syndrome (ODS) score, all patients of Groups 1 and 2 were studied by means of endoanal ultrasound and anorectal manometry. The results were compared with those from 20 healthy control subjects. A significantly higher ODS score was found in Group 1 (P IAS) in Group 2 (P IAS atrophy and the FISI score (ρs 0.78; P < 0.03). Anal resting pressure (Pmax and Pm ) was significantly lower in Group 2 (P < 0.04). The straining test was considered positive in 30 (71.4%) patients in Group 1, significantly greater than in Group 2 (P < 0.01). A significantly higher conscious rectal sensitivity threshold (CRST) was found in Group 1 patients (P < 0.01). The ODS score, a positive straining test and high CRST values suggest that postdefaecatory incontinence is secondary to impaired defaecation. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  14. 30 CFR 75.1713-5 - First-aid training program; retraining of supervisory employees; availability to all miners.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false First-aid training program; retraining of...-UNDERGROUND COAL MINES Miscellaneous § 75.1713-5 First-aid training program; retraining of supervisory... shall conduct refresher first-aid training courses each calendar year for all selected supervisory...

  15. Re-training High School Teachers of English in Brazil: The Experience of the Instituto de Idiomas Yazigi.

    Science.gov (United States)

    Gomes de Matos, Francisco

    The Yazigi Project for the Teaching of English in Brazilian High Schools, a 2-year, nationwide program for the retraining of high school teachers of English as a foreign language, involved 2,210 teachers and a team of 60 teacher trainers and retrainers. Each training session lasted 6 days and totalled a minimum of 30 hours, with a maximum of 50…

  16. Influence of Retraining Programme on Self-Esteem of Primary School Teachers in Ebonyi State of Nigeria

    Science.gov (United States)

    Igbo, Janet N.; Eze, Justina U.; Eskay, M.; Onu, V. C.; Omeje, J.

    2012-01-01

    This study investigated the influence of retraining programme on self-esteem of primary school teachers in Ebonyi State of Nigeria. The study was guided by one research question and a null hypothesis. A purposively selected sample of 775 primary school teachers who attended capacity building retraining programme provided the data collected using…

  17. [Urinary incontinence and other pelvic floor damages: ethilogy and prevention strategies].

    Science.gov (United States)

    Amóstegui Azcúe, J M; Ferri Morales, A; Lillo De La Quintana, C; Serra Llosa, M L

    2004-01-01

    Urinary incontinence, as well as additional pelvic floor damage, such as third and fourth degree muscular lacerations, as well as fecal incontinence, genital prolapse or dyspareunia, result from obstetric trauma, and are generally linked to the first delivery. The purpose of this study is to analyze, from a physiotherapeutic point of view, and therefore from the perspective of muscular physiology and biomechanics, why this damage occurs, while studying the birth process and the way it is currently performed in most hospitals in our country. Analysis of the birth process and, in short, of the different types of positions used for the first and second stage of labor, as well as of the care provided for women in the puerperium, leads us to propose a global prevention strategy to be carried out in three stages: --Ante-natal prevention: specific preparation of the pelvic floor and abdominal musculature during pregnancy, using massage techniques and manual stretching of the perineum. In addition, the pregnant woman learns these positions and methods of pushing, which makes the first and second stage of labour easier. An osteopathic treatment of the pelvis joints is performed in order to facilitate their mobility or to liberate blockades, if they exist. --Prevention during labour: During this stage, physiology is respected and manual, position-based and breathing techniques are implemented in order to enhance the protection of the baby and of the pelvic floor. --Postpartum prevention: The action is focused on the pelvic floor, through diaphragmatic and abdominal exercises or postures and, if necessary, osteopathic treatment in the early puerperium, in order to facilitate the correct involution of all soft tissues and the pelvic joints involved in labor. Early specific physiotherapeutic treatment will be proposed for women with functional pathology six weeks after delivery.

  18. Bladder Control Problems: Medications for Treating Urinary Incontinence

    Science.gov (United States)

    ... control problems, including how they work to treat urinary incontinence and possible side effects. By Mayo Clinic Staff ... a look at medications commonly prescribed to treat urinary incontinence and their possible side effects. Keep in mind ...

  19. Diaphragmatic hernia repair using a rectus abdominis muscle pedicle flap in three dogs.

    Science.gov (United States)

    Chantawong, P; Komin, K; Banlunara, W; Kalpravidh, M

    2013-01-01

    To report the clinical use of a pedicle flap from the rectus abdominis muscle to repair extensive diaphragmatic tears in dogs with diaphragmatic hernia. Three dogs with a combination of radial and circumferential diaphragmatic tears were studied. The circumferential tear was repaired by suturing the wound edge with the edge at the abdominal wall. A pedicle flap of the rectus abdominis muscle was used for repairing the radial tear. The dogs were examined radiographically for lung and diaphragm appearance and evidence of reherniation at 10 days, and at one, two, and four months after surgery, and fluoroscopically for paradoxical motion of the diaphragm at one and four months. The rectus abdominis muscle pedicle flap was successfully used in all three dogs. The animals recovered uneventfully without evidence of reherniation during the four follow-up months. Fluoroscopic examination revealed no paradoxical motion of the diaphragm. A rectus abdominis muscle pedicle flap can be used for repairing large diaphragmatic defects in dogs.

  20. Factors Associated with Urinary Stress Incontinence in Primiparas

    OpenAIRE

    Pei-Ling Chou; Fang-Ping Chen; Li-Fen Teng

    2005-01-01

    Objective: To evaluate obstetric and maternal risk factors for stress urinary incontinence in primiparas. Materials and Methods: From January 2001 to August 2002, 378 primiparas were interviewed about stress urinary incontinence 1 year after delivery. The association between symptoms of urinary stress incontinence and obstetric factors was assessed. Results: Twenty-four (6%) primiparas had urinary stress incontinence after delivery. Maternal age was positively associated with urinary st...

  1. Effect of weight loss on urinary incontinence in women

    Science.gov (United States)

    Whitcomb, Emily L; Subak, Leslee L

    2011-01-01

    Background The purpose of this research was review the epidemiology of the association of obesity and urinary incontinence, and to summarize the published data on the effect of weight loss on urinary incontinence. Methods A literature review of the association between urinary incontinence and overweight/obesity in women was performed. Case series and clinical trials reporting the effect of surgical, behavioral, and/or pharmacological weight loss on urinary incontinence are summarized. Results Epidemiological studies demonstrate that obesity is a strong and independent risk factor for prevalent and incident urinary incontinence. There is a clear dose-response effect of weight on urinary incontinence, with each 5-unit increase in body mass index associated with a 20%–70% increase in risk of urinary incontinence. The maximum effect of weight on urinary incontinence has an odds ratio of 4–5. The odds of incident urinary incontinence over 5–10 years increase by approximately 30%–60% for each 5-unit increase in body mass index. There appears to be a stronger association between increasing weight and prevalent and incident stress incontinence (including mixed incontinence) than for urge incontinence. Weight loss studies indicate that both surgical and nonsurgical weight loss leads to significant improvements in prevalence, frequency, and/or symptoms of urinary incontinence. Conclusion Epidemiological studies document overweight and obesity as important risk factors for urinary incontinence. Weight loss by both surgical and more conservative approaches is effective in reducing urinary incontinence symptoms and should be strongly considered as a first line treatment for overweight and obese women with urinary incontinence. PMID:24198645

  2. Factors Associated with Urinary Stress Incontinence in Primiparas

    Directory of Open Access Journals (Sweden)

    Pei-Ling Chou

    2005-03-01

    Conclusion: For primiparas who underwent vaginal delivery, an increase in age was associated with increased risk of development of stress incontinence. Increased vulnerability of the pelvic floor with age might explain this finding. Pelvic floor exercise had a protective effect against postpartum stress incontinence in primiparas who underwent cesarean section. This reflects the fact that pregnancy per se carries a risk of stress incontinence. We recommend that primiparas perform pelvic floor exercises to prevent the development of postpartum stress incontinence.

  3. In need of a patch UP: Recurrent congenital diaphragmatic hernia presenting with a large pleural effusion

    Directory of Open Access Journals (Sweden)

    Farhana Shariff

    2014-10-01

    Full Text Available We report a case of recurrent congenital diaphragmatic hernia (CDH presenting with a large unilateral pleural effusion. A 12-year old boy who had a left sided CDH repaired in the neonatal period, presented with fever, lethargy, and non-productive cough. Chest radiograph demonstrated a loculated pleural effusion. Computed tomography scan revealed recurrent herniation of abdominal contents. To our knowledge, this is the first reported case of a recurrent congenital diaphragmatic hernia presenting with large pleural effusion.

  4. An unusual cause of orthopnoea-hashimoto's thyroiditis presenting as bilateral diaphragmatic palsy

    Directory of Open Access Journals (Sweden)

    N.K. Thulaseedharan, MBBS, MD(General Medicine

    2017-01-01

    Full Text Available We report a case of 36 yr old male without any comorbidities, who presented with a history of gradually progressive dyspnoea and orthopnoea for 6 months. Physical examination revealed bradycardia, paradoxical respiration suggestive of bilateral diaphragmatic palsy. Fluoroscopy demonstrated the presence of bilateral diaphragmatic paralysis. Etiological work up showed evidence of autoimmune hypothyroidism due to hashimoto's thyroiditis. Other possibilities were ruled out with appropriate tests. He was started on thyroxine and showed symptomatic improvement.

  5. Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging

    Science.gov (United States)

    Santana, Pauliane Vieira; Prina, Elena; Albuquerque, André Luis Pereira; Carvalho, Carlos Roberto Ribeiro; Caruso, Pedro

    2016-01-01

    Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound. PMID:27167428

  6. Urinary incontinence after surgery for pelvic organ prolapse

    NARCIS (Netherlands)

    Lensen, E.J.M.; Withagen, M.I.J.; Kluivers, K.B.; Milani, A.L.; Vierhout, M.E.

    2013-01-01

    AIMS: This study focused on the changes in urinary incontinence (UI) rates pre- and postoperatively and identified risk factors which predict the presence of symptoms of urgency urinary incontinence (UUI) or stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP) without

  7. Prevalence of Urinary Incontinence During Pregnancy and Associated Risk Factors.

    Science.gov (United States)

    Dinç, Ayten

    2017-07-04

    To investigate the prevalence of urinary incontinence during pregnancy and associated risk factors. The study is a cross-sectional and descriptive study. A questionnaire was conducted with a total of 750 pregnant women about their urinary incontinence complaints between April and December 2013. The prevalence of urinary incontinence during pregnancy was 300 in 750 (40%). Stress urinary incontinence was the most common type of incontinence during pregnancy. 41.7% of nulliparous women, 38% of primipara women, and 20.3% of multipara women experienced urinary incontinence. Among women reporting UI, 29.3% experienced leakage a few times a day and the amount of leakage was generally (59.7%) moderate. Factors significantly associated with urinary incontinence included age group, gestational age, parity, previous urinary incontinence, constipation, mode of delivery at last childbirth, previous urinary tract infection, body mass index during pregnancy. But on multivariable analysis, the risk factors for urinary incontinence during pregnancy were previous urinary tract infection (OR = 3.8, 95%CI 1.5-9.3), constipation (OR 3.1, 95%CI 1.7-5.6) and gestational age (OR 0.5, 95%CI 0.3-0.9). As a result of this study, urinary incontinence is a common condition during pregnancy. Results would help the design of more intensive training programs to prevent incontinence during pregnancy by increasing the awareness about urinary incontinence of healthcare staff engaging in the care of pregnant women. © 2017 John Wiley & Sons Australia, Ltd.

  8. Rectus Fascia Sling for the Treatment of Total Urethral Incontinence ...

    African Journals Online (AJOL)

    Objectives: Urinary incontinence in patients with neurological disease is a major health problem. A modified rectus fascial sling has been assessed in incontinent male patients. Patients and Methods: Fourteen adult male patients with total incontinence due to neurogenic or post-traumatic and etiology were included in this ...

  9. Preoperative cardiorespiratory trends in infants with congenital diaphragmatic hernia.

    Science.gov (United States)

    Moffitt, S T; Schulze, K F; Sahni, R; Wung, J T; Myers, M M; Stolar, C J

    1995-04-01

    The objective of this study was to determine the cardiovascular and pulmonary adaptations of infants with congenital diaphragmatic hernia (CDH) from birth until delayed surgery through the use of continuous monitoring. Continuous cardiovascular (HR, heart rate variability [HR-SD], BP, blood pressure variability [BP-SD], and oxygen saturation) and ventilatory (minute volume, airway pressure, and effective compliance) measurements were made on-line, using a computerized whole-body plethysmograph-incubator (Vital-trends, VT1000), in nine ventilated infants with CDH. Data collection commenced at birth and continued until surgery. Minute mean values for each variable were recorded. Hourly means were computed from the minute means, averaged across infants each hour over the first 50 hours of life, and regressed against postnatal age. Results showed a significant increase in BP (P newborn infants. Deviation from these idealized patterns may identify an infant who is not responding satisfactorily to the given therapy and who may require alternative treatment modalities.

  10. Congenital peritoneopericardial diaphragmatic hernia in a terrier dog

    Directory of Open Access Journals (Sweden)

    Reza Kheirandish

    2014-06-01

    Full Text Available A one-month-old male terrier dog was referred in shock status with a history of anorexia, tachypnea, abdominal distention and progressive weight loss. Auscultation of right side of the lungs found enhanced respiratory noises. The thorough auscultation of the opposite side of the chest revealed the presence of typical intestinal sounds. Cardiac auscultation revealed muffled heart sounds and a diminished palpable precordial cardiac impulse was evident. The radiograph showed the presence of gas within the bowel in abrupt contrast to the adjacent structures of soft tissue opacity. Conservative treatment was failed and the animal died. At necropsy, cranial displacement of abdominal viscera into the pericardial sac was seen. A definitive diagnosis of peritoneopericardial diaphragmatic hernia was made. Although congenital pericardial diseases are rare in dogs, awareness of the clinical manifestation of these kinds of defects combined with early use of available imaging modalities can yield a preoperative diagnosis.

  11. Bilateral Diaphragmatic Paralysis in a Patient With Critical Illness Polyneuropathy

    Science.gov (United States)

    Chen, Hsuan-Yu; Chen, Hung-Chen; Lin, Meng-Chih; Liaw, Mei-Yun

    2015-01-01

    Abstract Bilateral diaphragmatic paralysis (BDP) manifests as respiratory muscle weakness, and its association with critical illness polyneuropathy (CIP) was rarely reported. Here, we present a patient with BDP related to CIP, who successfully avoided tracheostomy after diagnosis and management. A 71-year-old male presented with acute respiratory failure after sepsis adequately treated. Repeated intubation occurred because of carbon dioxide retention after each extubation. After eliminating possible factors, septic shock-induced respiratory muscle weakness was suspected. Physical examination, a nerve conduction study, and chest ultrasound confirmed our impression. Pulmonary rehabilitation and reconditioning exercises were arranged, and the patient was discharged with a diagnosis of BDP. The diagnosis of BDP is usually delayed, and there are only sporadic reports on its association with polyneuropathy, especially in patients with preserved limb muscle function. Therefore, when physicians encounter patients that are difficult to wean from mechanical ventilation, CIP associated with BDP should be considered in the differential diagnosis. PMID:26252301

  12. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history.

    Science.gov (United States)

    Komesu, Yuko M; Schrader, Ronald M; Ketai, Loren H; Rogers, Rebecca G; Dunivan, Gena C

    2016-05-01

    Urinary incontinence (UI) is common and the relationship among its subtypes complex. Our objective was to describe the natural history and predictors of the incontinence subtypes stress, urgency, and mixed, in middle-aged and older US women. We tested our hypothesis that UI subtype history predicted future occurrence, evaluating subtype incidence/remission over multiple time points in a stable cohort of women. We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women aged ≥50 in the 2004-2010 Health and Retirement Study. Mixed, stress, and urgency incontinence prevalence (2004, 2006, 2008, 2010) and 2-year cumulative incidence and remissions (2004-2006, 2006-2008, 2008-2010) were estimated. Patient characteristics and incontinence subtype status 2004-2008 were entered into a multivariable, transition model to determine predictors for incontinence subtype occurrence in 2010. The prevalence of each subtype in this population (median age 63-66) was 2.6-8.9 %. Subtype incidence equaled 2.1-3.5 % and remissions for each varied between 22.3 and 48.7 %. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, and functional limitations. Compared with white women, black women had decreased odds of incident stress incontinence and Hispanic women had increased odds of stress incontinence remission. The age range 80-90 and severe obesity predicted incident mixed incontinence. Functional limitations predicted mixed and urgency incontinence. The strongest predictor of incontinence subtype was subtype history. The presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence (odds ratio [OR] stress incontinence = 30.7, urgency OR = 47.4, mixed OR = 42.1). Although the number of remissions was high, a previous history of incontinence subtypes predicted recurrence. Incontinence status is dynamic, but tends to recur over the longer term.

  13. Female urinary incontinence, from pregnancy to menopause: a review of epidemiological and pathophysiological findings. : Female urinary incontinence, a review

    OpenAIRE

    Fritel , Xavier; Ringa , Virginie; Quiboeuf , Emeline; Fauconnier , Arnaud

    2012-01-01

    International audience; Hypotheses that might explain urinary incontinence during pregnancy and after childbirth have been examined. The prevalence of urinary incontinence reaches a maximum during pregnancy and decreases after childbirth. Cesarean delivery is associated with lower rates of stress incontinence than vaginal delivery. Women delivered by cesarean section differ from women who had a vaginal delivery through pre-existing characteristics associated with the incontinence risk, produc...

  14. Fetoscopic tracheal occlusion for severe congenital diaphragmatic hernia: retrospective study

    Directory of Open Access Journals (Sweden)

    Angélica de Fátima de Assunção Braga

    Full Text Available Abstract Background and objectives: The temporary fetal tracheal occlusion performed by fetoscopy accelerates lung development and reduces neonatal mortality. The aim of this paper is to present an anesthetic experience in pregnant women, whose fetuses have diaphragmatic hernia, undergoing fetoscopic tracheal occlusion (FETO. Method: Retrospective, descriptive study, approved by the Institutional Ethics Committee. Data were obtained from medical and anesthetic records. Results: FETO was performed in 28 pregnant women. Demographic characteristics: age 29.8 ± 6.5; weight 68.64 ± 12.26; ASA I and II. Obstetric: IG 26.1 ± 1.10 weeks (in FETO; 32.86 ± 1.58 (reversal of occlusion; 34.96 ± 2.78 (delivery. Delivery: cesarean section, vaginal delivery. Fetal data: Weight (g in the occlusion and delivery times, respectively (1045.82 ± 222.2 and 2294 ± 553; RPC in FETO and reversal of occlusion: 0.7 ± 0.15 and 1.32 ± 0.34, respectively. Preoperative maternal anesthesia included ranitidine and metoclopramide, nifedipine (VO and indomethacin (rectal. Preanesthetic medication with midazolam IV. Anesthetic techniques: combination of 0.5% hyperbaric bupivacaine (5-10 mg and sufentanil; continuous epidural predominantly with 0.5% bupivacaine associated with sufentanil, fentanyl, or morphine; general. In 8 cases, there was need to complement via catheter, with 5 submitted to PC and 3 to BC. Thirteen patients required intraoperative sedation; ephedrine was used in 15 patients. Fetal anesthesia: fentanyl 10-20 mg.kg-1 and pancuronium 0.1-0.2 mg.kg-1 (IM. Neonatal survival rate was 60.7%. Conclusion: FETO is a minimally invasive technique for severe congenital diaphragmatic hernia repair. Combined blockade associated with sedation and fetal anesthesia proved safe and effective for tracheal occlusion.

  15. Malformations associated with congenital diaphragmatic hernia: Impact on survival.

    Science.gov (United States)

    Bojanić, Katarina; Pritišanac, Ena; Luetić, Tomislav; Vuković, Jurica; Sprung, Juraj; Weingarten, Toby N; Schroeder, Darrell R; Grizelj, Ruža

    2015-11-01

    Congenital diaphragmatic hernia (CDH) is associated with high mortality. Survival is influenced by the extent of pulmonary hypoplasia and additional congenital defects. The purpose of this study was to assess the association of congenital anomalies and admission capillary carbon dioxide levels (PcCO2), as a measure of extent of pulmonary hypoplasia, on survival in neonates with CDH. This is a retrospective review of neonates with CDH admitted to a tertiary neonatal intensive care unit between 1990 and 2014. Logistic regression was used to assess whether hospital survival was associated with admission PcCO2 or associated anomalies (isolated CDH, CDH with cardiovascular anomalies, and CDH with noncardiac anomalies). The probabilities of survival (POS) score, based on birth weight and 5-min Apgar as defined by the Congenital Diaphragmatic Hernia Study Group were included as a covariate. Of 97 patients, 55 had additional malformations (cardiovascular n=12, noncardiac anomalies n=43). POS was lower in CDH with other anomalies compared to isolated CDH. Survival rate was 61.9%, 53.5% and 41.7% in isolated CDH, CDH with noncardiac anomalies and CDH with cardiovascular anomalies, respectively. After adjusting for POS score the likelihood of survival in CDH groups with additional anomalies was similar to isolated CDH (OR 0.95, 95% CI 0.22-4.15, and 1.10, 0.39-3.08, for CDH with and without cardiovascular anomalies, respectively). After adjusting for POS score, lower PcCO2 levels (OR=1.25 per 5mmHg decrease, P=0.003) were associated with better survival. Neonates with CDH have a high prevalence of congenital malformations. However, after adjusting for POS score the presence of additional anomalies was not associated with survival. The POS score and admission PcCO2 were important prognosticating factors for survival. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Electromyographic permutation entropy quantifies diaphragmatic denervation and reinnervation.

    Directory of Open Access Journals (Sweden)

    Christopher Kramer

    Full Text Available Spontaneous reinnervation after diaphragmatic paralysis due to trauma, surgery, tumors and spinal cord injuries is frequently observed. A possible explanation could be collateral reinnervation, since the diaphragm is commonly double-innervated by the (accessory phrenic nerve. Permutation entropy (PeEn, a complexity measure for time series, may reflect a functional state of neuromuscular transmission by quantifying the complexity of interactions across neural and muscular networks. In an established rat model, electromyographic signals of the diaphragm after phrenicotomy were analyzed using PeEn quantifying denervation and reinnervation. Thirty-three anesthetized rats were unilaterally phrenicotomized. After 1, 3, 9, 27 and 81 days, diaphragmatic electromyographic PeEn was analyzed in vivo from sternal, mid-costal and crural areas of both hemidiaphragms. After euthanasia of the animals, both hemidiaphragms were dissected for fiber type evaluation. The electromyographic incidence of an accessory phrenic nerve was 76%. At day 1 after phrenicotomy, PeEn (normalized values was significantly diminished in the sternal (median: 0.69; interquartile range: 0.66-0.75 and mid-costal area (0.68; 0.66-0.72 compared to the non-denervated side (0.84; 0.78-0.90 at threshold p<0.05. In the crural area, innervated by the accessory phrenic nerve, PeEn remained unchanged (0.79; 0.72-0.86. During reinnervation over 81 days, PeEn normalized in the mid-costal area (0.84; 0.77-0.86, whereas it remained reduced in the sternal area (0.77; 0.70-0.81. Fiber type grouping, a histological sign for reinnervation, was found in the mid-costal area in 20% after 27 days and in 80% after 81 days. Collateral reinnervation can restore diaphragm activity after phrenicotomy. Electromyographic PeEn represents a new, distinctive assessment characterizing intramuscular function following denervation and reinnervation.

  17. Clinical anatomy of fecal incontinence in women.

    Science.gov (United States)

    Kadam-Halani, Priyanka K; Arya, Lily A; Andy, Uduak U

    2017-10-01

    Fecal incontinence is a devastating condition that has a severe impact on quality of life. This condition disproportionately affects women and its incidence is increasing with the aging United States population. Fecal continence is maintained by coordination of a functioning anal sphincter complex, intact sensation of the anorectum, rectal compliance, and the ability to consciously control defecation. Particularly important are the puborectalis sling of the levator ani muscle complex and intact innervation of the central and peripheral nervous systems. An understanding of the intricate anatomy required to maintain continence and regulate defecation will help clinicians to provide appropriate medical and surgical management and diminish the negative impact of fecal incontinence. In this article, we describe the anatomic and neural basis of fecal continence and normal defecation as well as changes that occur with fecal incontinence in women. Clin. Anat. 30:901-911, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. Teflon injections in post-prostatectomy incontinence

    DEFF Research Database (Denmark)

    Osther, P J; Røhl, H F

    1988-01-01

    Twenty-five males with post-prostatectomy incontinence due to sphincter damage underwent transperineal or transurethral Teflon injections. The results were classified into three grades: good, moderate, and poor. Good or moderate results were obtained in 24%. No major immediate complications...... or longterm side-effects were observed. This intervention is associated with a minimum of discomfort for the patient and hospitalization can be limited to 48-72 hours. The results are not so good as those obtained in female incontinence, and the procedure cannot be recommended as first choice treatment...... in patients with post-prostatectomy incontinence, but because of the simplicity of the procedure, it is considered to be a valuable alternative in patients not suitable for prosthetic surgery....

  19. Association between tinnitus retraining therapy and a tinnitus control instrument.

    Science.gov (United States)

    Ito, Mari; Soma, Keiko; Ando, Reiko

    2009-10-01

    Tinnitus retraining therapy (TRT), which is an adaptation therapy for tinnitus based on the neurophysiological model proposed by Jastreboff in 1990,consists of directive counseling and acoustic therapy with a tinnitus control instrument (TCI) or other devices. For the past 5 years, our hospital has administered TRT characterized by the use of a TCI. In this study, we reviewed the clinical course of patients with tinnitus who presented to our outpatient clinic for tinnitus and hearing loss during the 3-year period from April 2004 to March 2007 and underwent TRT with a TCI. Among 188 patients with tinnitus (105 males and 83 females), 88 patients (51 males and 37 females, excluding dropouts) who purchased a TCI and continued therapy were included in the study. Significant improvement in Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. Among the noises generated by the TCI, the sound pressure output from the TCI was set at just below tinnitus loudness level both of the first adjustment and the second adjustment. Speech noise and white noise were frequently selected, whereas high-frequency noise and pink noise were infrequently selected. Speech noise was most frequently selected at the first adjustment, and the number of patients selecting white noise increased at the second adjustment. The results that we compared the two also revealed that the mean hearing level and tinnitus loudness levels were higher in the white noise group than in the speech noise group, which suggested that the inner ear disorder was more harder in the white noise group. Both the THI score and VAS grade improved after 1 month of treatment in the speech noise group, whereas improvement in these parameters was observed in the white noise group after 6 months of treatment. These results suggest that it took

  20. A clinical trial with combined transcranial direct current stimulation and alcohol approach bias retraining

    NARCIS (Netherlands)

    den Uyl, T.E.; Gladwin, T.E.; Rinck, M.; Lindenmeyer, J.; Wiers, R.W.

    2017-01-01

    Two studies showed an improvement in clinical outcomes after alcohol approach bias retraining, a form of Cognitive Bias Modification (CBM). We investigated whether transcranial direct current stimulation (tDCS) could enhance effects of CBM. TDCS is a neuromodulation technique that can increase

  1. Downsizing and the Impact of Job Counseling and Retraining on Effective Employee Responses

    Science.gov (United States)

    Tzafrir, Shay S.; Mano-Negrin, Rita; Harel, Gedalihau H.; Rom-Nagy, Daphna

    2006-01-01

    Purpose: Downsizing is a very pervasive organizational process. At these critical junctures many organizations do little to prepare their employees for a mass layoff. The main purpose of this study is to examine how the incorporation of job counseling and professional retraining programs during a period of downsizing affected the responses of both…

  2. Validity of the Microsoft Kinect for providing lateral trunk lean feedback during gait retraining.

    Science.gov (United States)

    Clark, Ross A; Pua, Yong-Hao; Bryant, Adam L; Hunt, Michael A

    2013-09-01

    Gait retraining programs are prescribed to assist in the rehabilitation process of many clinical conditions. Using lateral trunk lean modification as the model, the aim of this study was to assess the concurrent validity of kinematic data recorded using a marker-based 3D motion analysis (3DMA) system and a low-cost alternative, the Microsoft Kinect™ (Kinect), during a gait retraining session. Twenty healthy adults were trained to modify their gait to obtain a lateral trunk lean angle of 10°. Real-time biofeedback of the lateral trunk lean angle was provided on a computer screen in front of the subject using data extracted from the Kinect skeletal tracking algorithm. Marker coordinate data were concurrently recorded using the 3DMA system, and the similarity and equivalency of the trunk lean angle data from each system were compared. The lateral trunk lean angle data obtained from the Kinect system without any form of calibration resulted in errors of a high (>2°) magnitude (mean error=3.2±2.2°). Performing global and individualized calibration significantly (Psystem for gait retraining. Given that this system is low-cost, portable and does not require any sensors to be attached to the body, it could provide numerous advantages when compared to laboratory-based gait retraining systems. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Attributional Retraining, Self-Esteem, and the Job Interview: Benefits and Risks for College Student Employment

    Science.gov (United States)

    Hall, Nathan C.; Jackson Gradt, Shannan E.; Goetz, Thomas; Musu-Gillette, Lauren E.

    2011-01-01

    The present study evaluated the effectiveness of an attributional retraining program for helping upper-level undergraduates perform better in employment interviews as moderated by self-esteem levels. The sample consisted of 50 co-operative education students preparing for actual job interviews who were randomly assigned to an attributional…

  4. Re-training automatic action tendencies to approach cigarettes among adolescent smokers: a pilot study

    NARCIS (Netherlands)

    Kong, G.; Larsen, H.; Cavallo, D.A.; Becker, D.; Cousijn, J.; Salemink, E.; Collot D'Escury-Koenigs, A.L.; Morean, M.E.; Wiers, R.W.; Krishnan-Sarin, S.

    2015-01-01

    Background: This pilot study conducted a preliminary examination of whether Cognitive Bias Modification (CBM), a computerized task to retrain cognitive-approach biases towards smoking stimuli (a) changed approach bias for cigarettes, and (b) improved smoking cessation outcomes in adolescent smokers.

  5. Cognitive neuroscience of cognitive retraining for addiction medicine : From mediating mechanisms to questions of efficacy

    NARCIS (Netherlands)

    Gladwin, T.E.; Wiers, C.E.; Wiers, R.W.

    2016-01-01

    Cognitive retraining or cognitive bias modification (CBM) involves having subjects repeatedly perform a computerized task designed to reduce the impact of automatic processes that lead to harmful behavior. We first discuss the theory underlying CBM and provide a brief overview of important research

  6. Gait retraining as part of the treatment programme for soldiers with ...

    African Journals Online (AJOL)

    Background: Gait retraining as part of a treatment programme for exercise-related leg pain (ERLP) was introduced in the sports medicine department of the Royal ... Conclusion: Soldiers with exercise-related leg pain (ERLP), among them patients with Medial Tibial Stress Syndrome, respond well to a treatment programme ...

  7. Exploring the Contribution of Attribution Retraining to Student Perceptions and the Learning Process

    Science.gov (United States)

    Chodkiewicz, Alicia R.; Boyle, Christopher

    2014-01-01

    This paper looks at current research into how thinking influences learning. How people explain to themselves "why" they fail and succeed inevitably impacts on how well they learn new skills. Researchers have been developing attribution retraining programmes targeted at improving student academic achievement and learning experience…

  8. Gait retraining as part of the treatment programme for soldiers with ...

    African Journals Online (AJOL)

    Kathryn van Boom

    Gait retraining, as a treatment for overuse injuries of the lower extremities is ... pressure (N/cm2) on the heels at 317 days follow-up (average,. SD 108). ... The running style (type of strike) was .... findings on strike patterns among soldiers.

  9. The Effectiveness of Attribution Retraining on Anxiety of Students with Learning Disabilities

    Directory of Open Access Journals (Sweden)

    Marzieh Yahyaei

    2014-03-01

    Full Text Available Objective: The present study aimed to determine the effectiveness of attribution retraining group program on anxiety of students with learning disabilities. Materials & Methods: In this semi-experimental study pre-test and post-test design with control group was used. Two learning disorders centers were selected on purpose and conveniently in Tehran City in 2012-13 academic years. Thirty six students (9 girls and 27 boys who were educating in 2nd to 6th grade in elementary school with learning disabilities selected in convenience. One center was considered as experimental group and the other one as control group randomly (each group consisted of 18 individuals. Experimental group was divided into three subgroups (each consisted of 6 individuals, and were participated in 11 intervention sessions (each lasts for 45 minutes twice a week and received attribution retraining program, but control group received no training. Spence Children Anxiety Scale (SCAS was completed before and after the intervention by all subjects. Data were analyzed by independent t-test and analysis of covariance. Results: The results of analysis of covariance showed that attribution retraining intervention did not influence the anxiety. There is no significant difference between the anxiety of experimental and control group (P=0.34. Conclusion: It was concluded that attribution retraining group program can not probably reduce anxiety symptoms of students with learning disabilities.

  10. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients.

    Science.gov (United States)

    Jastreboff, P J; Jastreboff, M M

    2000-03-01

    The aim of this paper is to provide information about the neurophysiologic model of tinnitus and Tinnitus Retraining Therapy (TRT). With this overview of the model and therapy, professionals may discern with this basic foundation of knowledge whether they wish to pursue learning and subsequently implement TRT in their practice. This paper provides an overview only and is insufficient for the implementation of TRT.

  11. Retraining in Business German through the Goethe Institute in West Germany.

    Science.gov (United States)

    Clay, Gudrun; Schutte, Lilith

    A college language instructor recounts his experience in a retraining program in business German at the West Germany's Goethe Institute. Twenty-eight individuals from the United States and from five European countries participated in a program that offered (1) a 14-day immersion into business-related German, (2) establishment of German business…

  12. Incontinence and sexuality in later life.

    Science.gov (United States)

    Garrett, Dawne; Tomlin, Karen

    2015-07-01

    This article explores the interrelated aspects of incontinence and sexuality in older age. It describes the physiological changes that may have an effect on sexual function and the genitourinary system as people age. The enduring importance of sexual intimacy is discussed. Treatments for incontinence and to improve sexual function are explored. The authors conclude that nurses, particularly those involved in continence management, have a role in ensuring sensitive assessment and access to treatment, which can support many older people to maintain fulfilling sexual activity.

  13. [A systematic review of the predictors of return to work following vocational retraining].

    Science.gov (United States)

    Streibelt, M; Egner, U

    2013-04-01

    Vocational Rehabilitation (VR) is an essential element of interventions aimed at re-integrating people with work disability into work. In this context, vocational retraining is of special importance. However, the success of vocational retraining, represented by subsequent returning to work (RTW), is only to a limited extent attributable to intervention quality. Apart from methodical influences participant-related as well as context-related attributes are discussed as influencing factors. To know these RTW predictors is a necessary condition for a valid comparative evaluation of intervention quality. A structured literature search was conducted. All studies meeting the following criteria were included: publication between 2006 and 2011; context: German rehabilitation system and vocational retraining; multivariate analysis of RTW predictors. The evidence for or against the influence of a predictor was rated as strong if more than 75% of the models, and moderate if more than 50% of the models reported or excluded a significant relationship between predictor and RTW. All predictors included in more than 2 studies were considered in this review. 15 publications from 6 studies were included in the analysis. Due to differentiation of the models between different types of retraining the evidence was based on 9 prediction models. Strong evidence of an effect on RTW can be assumed for income before admission, subjective health rating and regular completion of retraining. There is moderate evidence for an effect of age and target job. Strong evidence against an effect on RTW is found for employment and occupational status before admission. There is moderate evidence against an RTW effect of sex, education and locus of control. Ambiguous evidence is obtained for the local job market, the type of retraining, social support and mobility. For the first time the review provides findings on the relevant influence factors of RTW following vocational retraining. These findings on the

  14. Prenatal imaging of a fetus with the rare combination of a right congenital diaphragmatic hernia and a giant omphalocele.

    Science.gov (United States)

    Nonaka, Ayasa; Hidaka, Nobuhiro; Kido, Saki; Fukushima, Kotaro; Kato, Kiyoko

    2014-11-01

    A co-existing right congenital diaphragmatic hernia and omphalocele is rare. We present images of a fetus diagnosed with this rare combination of anomalies. Early neonatal death occurred immediately after full-term birth due to severe respiratory insufficiency. In this case, disturbance of chest wall development due to the omphalocele rather than the diaphragmatic hernia was considered as the main cause of lung hypoplasia. Our experience suggests that caution should be exercised for severe respiratory insufficiency in a neonate with an omphalocele and diaphragmatic hernia, even in the absence of an intra-thoracic liver, one of the indicators of poor outcome for congenital diaphragmatic hernia. © 2014 Japanese Teratology Society.

  15. Optimal retraining time for regaining functional fitness using multicomponent training after long-term detraining in older adults.

    Science.gov (United States)

    Lee, Minyoung; Lim, Taehyun; Lee, Jaehyuk; Kim, Kimyeong; Yoon, BumChul

    2017-11-01

    Little is known about the optimal retraining time for regaining functional fitness through multicomponent training following long-term detraining in older adults. This study first investigated the time course of functional fitness changes during 12-month multicomponent training, 12-month detraining, and 9-month retraining in 18 older adults (68.33±3.46) and then determined the optimal retraining time for regaining the post-training functional fitness level after a 12-month detraining period. Functional fitness, including lower and upper limb strength, lower and upper limb flexibility, aerobic endurance, and dynamic balance, was assessed at baseline, 12 months post-training, 12 months post-detraining, and 3, 6, and 9 months post-retraining. There were significant increases in all of the functional fitness components except upper limb flexibility at post-training and no significant decreases at post-detraining. For lower and upper limb strength and lower limb flexibility, a 3-month period was required to regain the post-training condition. For aerobic endurance and dynamic balance, a retraining period ≥9months was necessary to regain the post-training functional fitness condition. To regain the post-training condition of all functional fitness components, a retraining period ≥9months was required. This information might be useful for health professionals to encourage older adults not to interrupt retraining until they regain their post-training functional fitness condition. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Urinary incontinence in primigravida: the neglected pregnancy predicament.

    Science.gov (United States)

    Abdullah, B; Ayub, S H; Mohd Zahid, A Z; Noorneza, A R; Isa, Mohamad Rodi; Ng, P Y

    2016-03-01

    To determine the prevalence of urinary incontinence among primigravida in the third trimester, its risk factors and its effect to quality of life. This is a cross sectional study involving primigravida in their third trimester of pregnancy, who attended the Patient Assessment Centre of a tertiary referral hospital in Klang Valley from July 2012 to June 2013. The participants were chosen randomly using convenience sampling. A face-to-face interview and a review of their antenatal record were done by trained interviewers. Data on sociodemographic and risk factors were obtained followed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The data was analysed using Statistical Package for Social Science version 20.0. A total of 306 women were involved. The prevalence of urinary incontinence during third trimester was 34.3% (95%CI: 29.0, 39.7). Stress incontinence (64.8%) is the commonest followed by mixed incontinence (24.8%) and urge incontinence (6.7%). Childhood enuresis (p=0.003) and previous history of urinary incontinence (purinary incontinence. More than 50 percent of women with urinary incontinence in the third trimester felt that it did not affect their daily activities at all. Only 10% of women felt greatly affected by this problem. Urinary incontinence is not uncommon among primigravida however many women did not feel that it affected their quality of life. Childhood enuresis and history of urinary incontinence were proven risk factors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Determining the optimal pelvic floor muscle training regimen for women with stress urinary incontinence.

    Science.gov (United States)

    Dumoulin, Chantale; Glazener, Cathryn; Jenkinson, David

    2011-06-01

    Pelvic floor muscle (PFM) training has received Level-A evidence rating in the treatment of stress urinary incontinence (SUI) in women, based on meta-analysis of numerous randomized control trials (RCTs) and is recommended in many published guidelines. However, the actual regimen of PFM training used varies widely in these RCTs. Hence, to date, the optimal PFM training regimen for achieving continence remains unknown and the following questions persist: how often should women attend PFM training sessions and how many contractions should they perform for maximal effect? Is a regimen of strengthening exercises better than a motor control strategy or functional retraining? Is it better to administer a PFM training regimen to an individual or are group sessions equally effective, or better? Which is better, PFM training by itself or in combination with biofeedback, neuromuscular electrical stimulation, and/or vaginal cones? Should we use improvement or cure as the ultimate outcome to determine which regimen is the best? The questions are endless. As a starting point in our endeavour to identify optimal PFM training regimens, the aim of this study is (a) to review the present evidence in terms of the effectiveness of different PFM training regimens in women with SUI and (b) to discuss the current literature on PFM dysfunction in SUI women, including the up-to-date evidence on skeletal muscle training theory and other factors known to impact on women's participation in and adherence to PFM training. Copyright © 2011 Wiley-Liss, Inc.

  18. Urinary incontinence after vaginal delivery or cesarean section.

    Science.gov (United States)

    Borges, João Bosco Ramos; Guarisi, Telma; Camargo, Ana Carolina Marchesini de; Gollop, Thomaz Rafael; Machado, Rogério Bonassi; Borges, Pítia Cárita de Godoy

    2010-06-01

    To assess the prevalence of stress urinary incontinence, urge incontinence and mixed urinary incontinence among women residing in the city of Jundiaí (São Paulo, Brazil), and the relation between the type of incontinence and the obstetric history of these women. A cross-sectional community-based study was conducted. A total of 332 women were interviewed; they were seen for whatever reason at the public primary healthcare units of the city of Jundiaí, from March 2005 to April 2006. A pre-tested questionnaire was administered and consisted of questions used in the EPINCONT Study (Epidemiology of Incontinence in the County of Nord-Trondelag). Statistical analysis was carried out using the χ2 test and odds ratio (95%CI). Urinary incontinence was a complaint for 23.5% of the women interviewed. Stress urinary incontinence prevailed (50%), followed by mixed urinary incontinence (35%) and urge incontinence (15%). Being in the age group of 35-64 years, having a body mass index of 30 or greater and having had only vaginal delivery or cesarean section, with uterine contraction, regardless of the number of pregnancies, were factors associated with stress urinary incontinence. However, being in the age group of 55 or older, having a body mass index of 30 or greater and having had three or more pregnancies, only with vaginal deliveries, were factors associated with mixed urinary incontinence. One third of the interviewees complained of some type of urinary incontinence, and half of them presented stress urinary incontinence. Cesarean section, only when not preceded by contractions, was not associated with stress urinary incontinence. The body mass index is only relevant when the stress factor is present.

  19. Pulmonary surfactant protein A, B, and C mRNA and protein expression in the nitrofen-induced congenital diaphragmatic hernia rat model

    NARCIS (Netherlands)

    van Tuyl, Minke; Blommaart, Piet jan E.; Keijzer, Richard; Wert, Susan E.; Ruijter, Jan M.; Lamers, Wouter H.; Tibboel, Dick

    2003-01-01

    Neonates with congenital diaphragmatic hernia (CDH) suffer from a diaphragmatic defect, lung hypoplasia, and pulmonary hypertension, with poor lung function forming the major clinical challenge. Despite prenatal diagnosis and advanced postnatal treatment strategies, the mortality rate of CDH is

  20. Pulmonary Vascular Defects in Congenital Diaphragmatic Hernia : the quest for early factors and intervention : Pulmonale vasculaire defecten in congenitale hernia diafragmatica : de zoektocht naar vroege factoren en interventie

    NARCIS (Netherlands)

    D.S. Mous (Daphne)

    2017-01-01

    markdownabstractCongenital diaphragmatic hernia (CDH) is a severe anomaly characterized by a diaphragmatic defect, lung hypoplasia and pulmonary hypertension. The associated pulmonary abnormalities are responsible for the high morbidity and mortality among patients with this disease. Vasodilator

  1. Surgical aspects of pediatric urinary incontinence

    NARCIS (Netherlands)

    Jong, Thomas Pius Vianney Maria de

    2001-01-01

    This thesis tries to bridge between functional and structural non-neuro- genic incontinence and to give insight in the surgical options. Children with anatomically based bladder neck and urethral insufficiency often present with the same symptoms as children with genuine non-neurogenic functional

  2. Surgery versus physiotherapy for stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.; Berghmans, B.L.; Fischer, K.; Milani, A.L.; Wijk, I. van; Smalbraak, D.J.; Vollebregt, A.; Schellart, R.P.; Graziosi, G.C.; Ploeg, J.M. van der; Brouns, J.F.; Tiersma, E.S.; Groenendijk, A.G.; Scholten, P.; Mol, B.W.; Blokhuis, E.E.; Adriaanse, A.H.; Schram, A.; Roovers, J.P.; Lagro-Janssen, A.L.M.; Vaart, C.H. van der

    2013-01-01

    BACKGROUND: Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial

  3. Surgery versus Physiotherapy for Stress Urinary Incontinence

    NARCIS (Netherlands)

    Labrie, Julien; Berghmans, Bary L. C. M.; Fischer, Kathelijn; Milani, Alfredo L.; van der Wijk, Ileana; Smalbraak, Dina J. C.; Vollebregt, Astrid; Schellart, Rene P.; Graziosi, Giuseppe C. M.; van der Ploeg, J. Marinus; Brouns, Joseph F. G. M.; Tiersma, E. Stella M.; Groenendijk, Annette G.; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E.; Adriaanse, Albert H.; Schram, Aaltje; Roovers, Jan-Paul W. R.; Lagro-Janssen, Antoine L. M.; van der Vaart, Carl H.

    2013-01-01

    BackgroundPhysiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial

  4. [Biofeedback effectiveness in patients with fecal incontinence].

    Science.gov (United States)

    Guerra-Mora, José Raúl; Buenrostro-Acebes, José María; Erciga-Vergara, Nancy; Zubieta-O'Farrill, Gregorio; Castillo-Calcáneo, Juan de Dios; Mosqueda, Maria Elena; Monroy-Argumedo, Montserrat; González-Alvarado, Carlos; Villanueva-Saenz, Eduardo

    2015-01-01

    Fecal incontinence is defined as an involuntary bowel movement through the anal canal in inadequate time and place. There are different types of therapies for the management of fecal incontinence, being biofeedback therapy one of the most effective techniques. The aim of this study was to evaluate the necessary number of sessions of biofeedback electromyographyc therapy to achieve the maximum sphincteric complex contraction. Descriptive, retrospective and longitudinal study. 65 patients with fecal incontinence were included. Weekly electromyographyc biofeedback therapies were applied, with a maximum of 6, in which the sphincteric complex contraction was measured. A two ways Friedman analysis was made to determine the significant differences between the sessions. A total of 65 patients were evaluated for fecal incontinence. The values for pelvic floor contraction were significantly higher in the third session, and did not show any significant difference in posterior sessions. The maximum contraction of the sphicnteric complex was achieved in the third weekly biofeedback session, without any significant differences in the posterior sessions.

  5. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults

    Directory of Open Access Journals (Sweden)

    Xiao Ma

    2017-06-01

    Full Text Available A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. However, the specific benefits of diaphragmatic breathing on mental health remain largely unknown. The present study aimed to investigate the effect of diaphragmatic breathing on cognition, affect, and cortisol responses to stress. Forty participants were randomly assigned to either a breathing intervention group (BIG or a control group (CG. The BIG received intensive training for 20 sessions, implemented over 8 weeks, employing a real-time feedback device, and an average respiratory rate of 4 breaths/min, while the CG did not receive this treatment. All participants completed pre- and post-tests of sustained attention and affect. Additionally, pre-test and post-test salivary cortisol concentrations were determined in both groups. The findings suggested that the BIG showed a significant decrease in negative affect after intervention, compared to baseline. In the diaphragmatic breathing condition, there was a significant interaction effect of group by time on sustained attention, whereby the BIG showed significantly increased sustained attention after training, compared to baseline. There was a significant interaction effect of group and time in the diaphragmatic breathing condition on cortisol levels, whereby the BIG had a significantly lower cortisol level after training, while the CG showed no significant change in cortisol levels. In conclusion, diaphragmatic breathing could improve sustained attention, affect, and cortisol levels. This study provided evidence demonstrating the effect of diaphragmatic breathing, a mind-body practice, on mental function, from a health psychology approach, which has important implications for health promotion in healthy individuals.

  6. The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults.

    Science.gov (United States)

    Ma, Xiao; Yue, Zi-Qi; Gong, Zhu-Qing; Zhang, Hong; Duan, Nai-Yue; Shi, Yu-Tong; Wei, Gao-Xia; Li, You-Fa

    2017-01-01

    A growing number of empirical studies have revealed that diaphragmatic breathing may trigger body relaxation responses and benefit both physical and mental health. However, the specific benefits of diaphragmatic breathing on mental health remain largely unknown. The present study aimed to investigate the effect of diaphragmatic breathing on cognition, affect, and cortisol responses to stress. Forty participants were randomly assigned to either a breathing intervention group (BIG) or a control group (CG). The BIG received intensive training for 20 sessions, implemented over 8 weeks, employing a real-time feedback device, and an average respiratory rate of 4 breaths/min, while the CG did not receive this treatment. All participants completed pre- and post-tests of sustained attention and affect. Additionally, pre-test and post-test salivary cortisol concentrations were determined in both groups. The findings suggested that the BIG showed a significant decrease in negative affect after intervention, compared to baseline. In the diaphragmatic breathing condition, there was a significant interaction effect of group by time on sustained attention, whereby the BIG showed significantly increased sustained attention after training, compared to baseline. There was a significant interaction effect of group and time in the diaphragmatic breathing condition on cortisol levels, whereby the BIG had a significantly lower cortisol level after training, while the CG showed no significant change in cortisol levels. In conclusion, diaphragmatic breathing could improve sustained attention, affect, and cortisol levels. This study provided evidence demonstrating the effect of diaphragmatic breathing, a mind-body practice, on mental function, from a health psychology approach, which has important implications for health promotion in healthy individuals.

  7. Introital ultrasonography in female urinary incontinence

    Energy Technology Data Exchange (ETDEWEB)

    Weon, Young Cheol; Cho, Kyoung Sik; Lee, Jin Seong; Choi, Sang Hee; Kim, Keon Seok; Choo, Myung Soo [Ulsan Univ. Asan Medical Center, Seoul (Korea, Republic of)

    1996-06-01

    To evaluate the usefulness of introital ultrasonography in the assessment of female urinary incontinence. Introital ultrasonography was performed in fifteen with stress urinary incontinence(mean age 50) and six patients without symptoms of incontinence(mean age 37). Using a sagittal section of the anterior pelvis in the plane of the symphysis pubis the posterior urethrovesical angle, the pubourethral distance and the pubo-yregrak abgle were measured at rest and during stress(Valsalva's maneuver state). The student T-test and the ANOVA test were used in statistical analysis. The posterior urethrovesical angles of the controls were 125.3 deg ({+-}10.9) at rest and 125.7 deg ({+-}7.6) during stress. In the patients, the corresponding angles were 135.3 deg ({+-}11.3) and 139.6 deg({+-}10.8). The posterior urethrovesical angles increased 0.3 deg ({+-}4.7) in the controls and 5.6 deg ({+-}4.0) in the patients(p=0.018). In the controls, the pubo-urethral distances were 21.8 mm({+-}5.8) at rest and 18.2 mm({+-}7.1) during stress, while in the patients these distances were 18.4 mm({+-}3.9) and 12.6 mm({+-}4.4). The pubo-urethral distance decreased 3.5 mm ({+-}1.5) in the controls and 5.8 mm ({+-}2.3) in the patients(p=0.039). In the patients with mild incontinence(Grade I), the posterior urethrovesical angles increased 3.4 deg ({+-}2.8) : 132.3 deg ({+-}12.5) at rest and 135.6 deg (12.8) during stress. In the patients with moderate incontinence(Grade II), the angles increased 8.1 deg({+-}3.8) : 136.0 deg({+-}6.5) at rest and 144.1 deg({+-}5.9) during stress. The change of the posterior urethrovesical angle was related to the grade of urinary incontinence in the patients(p<0.05). There was no statistical significancy in the pubo-urethral angle (p=0.315). Introital ultrasonography may be useful for assessment of stress urinary incontinence.

  8. Diaphragmatic height index: new diagnostic test for phrenic nerve dysfunction.

    Science.gov (United States)

    Pornrattanamaneewong, Chaturong; Limthongthang, Roongsak; Vathana, Torpon; Kaewpornsawan, Kamolporn; Songcharoen, Panupan; Wongtrakul, Saichol

    2012-11-01

    The diaphragmatic height index (DHI) was developed to measure the difference in diaphragm levels. The purpose of this study was to set definite DHI values and test the accuracy of these values for use as a new diagnostic test for phrenic nerve dysfunction. All data for this study were obtained from medical charts and retrospectively reviewed. One hundred sixty-five patients with brachial plexus injury who had undergone nerve transfers between 2005 and 2008 were divided into Groups A and B. Group A consisted of 40 patients (mean age 28.0 years) who had sustained concomitant injury of the brachial plexus and phrenic nerves. Patients in Group A1 had right phrenic nerve injury and those in Group A2 had left phrenic nerve injury. Intraoperative direct electrical stimulation of the phrenic nerve was considered the gold standard in assessing nerve function in all patients with brachial plexus injury. Group B consisted of 125 patients (mean age 28.7 years) with brachial plexus injury and normal phrenic nerve function. Group C, the control group, consisted of 80 patients with nonbrachial plexus injury (mean age 34.0 years) who had undergone other kinds of orthopedic operations between April and June 2009. Standard posteroanterior chest radiographs were blindly interpreted using the Siriraj inhouse picture archiving and communication system in all 245 patients in the study. First, a reference line (R line) was drawn along the inferior endplate of T-10. Then, 2 lines (lines A and B) were drawn through the highest point of each diaphragm and parallel to the R line. The difference between these 2 lines divided by the height of T-10 was defined as the DHI. The cutoff points of the DHI for diagnosing right and left phrenic nerve dysfunction were analyzed with a receiver operating characteristic curve. The accuracy of these DHI values was then evaluated. The DHI in Group C was 0.64 ± 0.44, slightly higher than the DHI in Group B, with no significant difference. Diaphragmatic

  9. Impact of urinary incontinence types on women's quality of life.

    Science.gov (United States)

    Saboia, Dayana Maia; Firmiano, Mariana Luisa Veras; Bezerra, Karine de Castro; Vasconcelos, José Ananias; Oriá, Mônica Oliveira Batista; Vasconcelos, Camila Teixeira Moreira

    2017-12-21

    To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires. Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28). All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.

  10. [Assessment of Urinary Incontinence in Pregnancy and Postpartum: Observational Study].

    Science.gov (United States)

    Rocha, Juliana; Brandão, Pedro; Melo, Anabela; Torres, Silvia; Mota, Lurdes; Costa, Fernanda

    2017-08-31

    The urinary incontinence can affect up to 50% of women at some stage of their lives, particularly during pregnancy and postpartum. This study was designed in order to identify and assess the prevalence and risk factors for urinary incontinence during the third trimester of pregnancy and three months postpartum. Observational and cross-sectional study. The population of the study was composed of 268 women who delivered and were admitted to the Centro Hospitalar Tâmega e Sousa in the years 2013 and 2014, and who agreed to participate in this study. Postpartum women were asked to fill out a questionnaire adapted from the International Consultation on Incontinence Questionnaire - Short Form, for urinary incontinence research in the third trimester of pregnancy. Three months after delivery, they were contacted by telephone and asked to answer the same questions about the urinary incontinence postpartum. Of the 268 women interviewed, 31 were excluded from the study, taking into account the defined inclusion and exclusion criteria. In total (n = 237), 51.89% of women included in the study, reported the occurrence of urinary incontinence during pregnancy. The prevalence of urinary incontinence in pregnancy by parity (primiparous versus multiparous) was statistically significant (p = 0.006). At postpartum (n = 237), 28.69% of women with urinary incontinence had vaginal delivery and 5.91% of women underwent cesarean delivery (p = 0.001). In these group of women with postpartum urinary incontinence (n = 82), 31.69% have had urinary incontinence only in the postpartum and 68.31% of women have had symptoms during pregnancy (p urinary incontinence in pregnancy and the respective decrease in postpartum. Multiparity and occurrence of urinary incontinence in pregnancy appear as potential risk factors in the emergence of the urinary incontinence.

  11. Phrenic Nerve Conduction Abnormalities Correlate with Diaphragmatic Descent in Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    El-Tantawi, Gihan A Younis; Imam, Mohamed H; Morsi, Tamer S

    2015-01-01

    Diaphragmatic weakness in chronic obstructive pulmonary disease (COPD) is ascribed to hyperinflation-induced diaphragm shortening as well as impairment in cellular and subcellular structures. Although phrenic neuropathy is known to cause diaphragmatic weakness, phrenic neuropathy is rarely considered in COPD. This work aimed at assessing phrenic nerve conduction in COPD and its relation to radiographic hyperinflation and pulmonary function. Forty COPD patients were evaluated. Radiographic parameters of lung hyperinflation were measured on postero-anterior and lateral chest x-ray films. Flow volume loop parameters were obtained from all patients. Motor conduction study of the phrenic nerves was performed and potentials were recorded over the xiphoid process and the ipsilateral 7th intercostal space. Twenty-seven healthy subjects were enrolled as controls. Parameters of phrenic nerve conduction differed significantly in patients compared to controls. Phrenic nerve abnormalities were detected in 17 patients (42.5%). Electrophysiological measures correlated with diaphragmatic angle of depression on lateral view films and with lung height on postero-anterior films. They did not correlate with the flow volume loop data or disease severity score. Phrenic nerve conduction abnormality is an appreciated finding in COPD. Nerve stretching associated with diaphragmatic descent can be a suggested mechanism for nerve lesion. The presence of phrenic neuropathy may be an additional contributing factor to diaphragmatic dysfunction in COPD patients.

  12. Functional restoration of diaphragmatic paralysis: an evaluation of phrenic nerve reconstruction.

    Science.gov (United States)

    Kaufman, Matthew R; Elkwood, Andrew I; Colicchio, Alan R; CeCe, John; Jarrahy, Reza; Willekes, Lourens J; Rose, Michael I; Brown, David

    2014-01-01

    Unilateral diaphragmatic paralysis causes respiratory deficits and can occur after iatrogenic or traumatic phrenic nerve injury in the neck or chest. Patients are evaluated using spirometry and imaging studies; however, phrenic nerve conduction studies and electromyography are not widely available or considered; thus, the degree of dysfunction is often unknown. Treatment has been limited to diaphragmatic plication. Phrenic nerve operations to restore diaphragmatic function may broaden therapeutic options. An interventional study of 92 patients with symptomatic diaphragmatic paralysis assigned 68 (based on their clinical condition) to phrenic nerve surgical intervention (PS), 24 to nonsurgical (NS) care, and evaluated a third group of 68 patients (derived from literature review) treated with diaphragmatic plication (DP). Variables for assessment included spirometry, the Short-Form 36-Item survey, electrodiagnostics, and complications. In the PS group, there was an average 13% improvement in forced expiratory volume in 1 second (p Phrenic nerve operations for functional restoration of the paralyzed diaphragm should be part of the standard treatment algorithm in the management of symptomatic patients with this condition. Assessment of neuromuscular dysfunction can aid in determining the most effective therapy. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Surgical management of the newborn with congenital diaphragmatic hernia.

    Science.gov (United States)

    Tsao, Kuojen; Lally, Kevin P

    2011-01-01

    Despite advances in the surgical treatment and medical management over the last 20 years, neonates with congenital diaphragmatic hernia (CDH) remain one of the most challenging patient groups for all clinicians. Treatment strategies have shifted from emergent surgical repair and maximum ventilatory support to delayed repair and preoperative hemodynamic stabilization with lung-sparing ventilation strategies and extracorporeal membrane oxygenation. Subsequently, overall survival has improved to as high as 80% in some centers. However, specific treatment criteria are vague and highly variable amongst centers. This lack of consensus of these treatment modalities remains elusive due to the heterogeneity in disease severity as well as heterogeneity in patient care amongst centers. As a result of the rare incidence of disease and limited experience of individual centers, the evidence for CDH is typically reported as a homogenous disease largely supported by case series and networked-based studies. To better evaluate the data and compare treatment strategies, a classification and stratification of disease and centers is needed. Copyright © 2010 S. Karger AG, Basel.

  14. Respiratory insufficiency with preserved diaphragmatic function in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Yamauchi, Rika; Imai, Tomihiro; Tsuda, Emiko; Hozuki, Takayoshi; Yamamoto, Daisuke; Shimohama, Shun

    2014-01-01

    We performed a longitudinal study to elucidate the correlation between respiratory insufficiency and respiratory biomarkers, including diaphragmatic compound muscle action potential (DCMAP), at the initiation of noninvasive ventilation (NIV) in patients with amyotrophic lateral sclerosis (ALS). The patients were assessed at least every six months. Additional assessments were performed at the start of respiratory therapy when the patients met the criteria for the initiation of NIV. Each assessment consisted of a full neurological examination, a phrenic nerve conduction study, respiratory function tests, and nocturnal pulsed oximetry. We enrolled 43 patients with either definite or probable ALS as defined by the revised El Escorial criteria. The patients were divided into two groups according to the timing of the initiation of respiratory therapy. Seventeen patients (group A) met the criteria for NIV initiation when their DCMAP remained normal. Twenty-six patients (group B) met the criteria when their DCMAP decreased below normal limits. Although respiratory function parameters were significantly worse in group B compared with group A at NIV initiation, more than 80% of the patients in both groups developed nocturnal desaturation during sleep. DCMAP is not always a reliable indicator for determining the optimal timing for NIV initiation during the progression of respiratory insufficiency in ALS. Physicians should be aware of the risk of respiratory insufficiency during sleep in patients with ALS.

  15. Traumatic diaphragmatic injuries in infants and children: imaging findings

    International Nuclear Information System (INIS)

    Koplewitz, B.Z.; Manson, D.E.; Babyn, P.S.; Ramos, C.; Ein, S.H.

    2000-01-01

    Objectives. Traumatic diaphragmatic injuries (DI) in infants and children are uncommon and are often associated with multiple severe injuries. Delayed presentation can be life threatening due to organ herniation and strangulation. We present the imaging findings in a relatively large population of children who experienced this rare injury. Methods. Medical records of all patients admitted to our Trauma Service from 1977 to 1998 with DI were retrospectively reviewed recording imaging, clinical and surgical or autopsy findings. Results. Of sixteen patients with DI (7 females, 9 males; age 3 weeks to 15 years), 14 suffered from blunt trauma secondary to high-energy impact, and 2 from penetrating injuries. Unilateral DI occurred equally on each side, with one bilateral injury. Associated injuries, present in 81%, included severe head injuries, visceral, mesenteric and vascular injuries and multiple fractures. Six patients died from multiple organ failure (3), head injury (2), and shock (1). Findings in the initial chest X-ray suggested the diagnosis in 13 (81%) of 16 injuries, and CT demonstrated irregularity and thickening of the diaphragm in 4 out of 7. Conclusions. Plain film findings suggested the diagnosis in most; CT and MR were useful adjuncts. High index of suspicion and awareness of the mechanism of injury can lead to prompt diagnosis, early repair, and decreased morbidity and mortality. (orig.)

  16. Imaging modalities used to confirm diaphragmatic hernia in small animals

    International Nuclear Information System (INIS)

    Williams, J.; Leveille, R.; Myer, C.W.

    1998-01-01

    When a patient is presented for treatment following a traumatic accident such as being hit by a car, thoracic radiographs are usually an integral part of the overall diagnostic evaluation. Diagnosis at diaphragmatic hernia (DH) is often challenging in small animals. The thorax may contain substantial fluid, thereby masking the presence of cranially displaced abdominal soft tissues (e.g., liver or spleen). The most common cause of decreased radiographic visualization of the diaphragm on survey radiographs is pleural fluid; however, the second most common cause is DH. Obviously, if a gas-filledviscus is identified within the thoracic cavity on survey radiographs, the diagnosis of DH is straightforward and relatively routine. If, however, there is substantial pleural effusion and the herniated structure is a soft tissue parenchymal organ (e.g., liver or spleen), the diagnosis is less clearly defined on survey radiographs. This review discusses the various imaging modalities (survey, positional, and contrast-enhanced radiographs and ultrasonography) that can be used in the diagnosis or confirmation of DH

  17. Behavioural interventions for urinary incontinence in community-dwelling seniors: an evidence-based analysis.

    Science.gov (United States)

    2008-01-01

    senior's caregiver to deliver an intervention such as prompted voiding, habit retraining, or timed voiding. The health care professional who trains the caregiver is commonly a nurse or a nurse with advanced training in the management of UI, such as a nurse continence advisor (NCA) or a clinical nurse specialist (CNS). The second category of behavioural interventions consists of patient-directed techniques targeted towards mobile, motivated seniors. Seniors in this population are cognitively able, free from any major physical deficits, and motivated to regain and/or improve their continence. A nurse or a nurse with advanced training in UI management, such as an NCA or CNS, delivers the patient-directed techniques. These are often provided as multicomponent interventions including a combination of bladder training techniques, pelvic floor muscle training (PFMT), education on bladder control strategies, and self-monitoring. Pelvic floor muscle training, defined as a program of repeated pelvic floor muscle contractions taught and supervised by a health care professional, may be employed as part of a multicomponent intervention or in isolation. Education is a large component of both caregiver-dependent and patient-directed behavioural interventions, and patient and/or caregiver involvement as well as continued practice strongly affect the success of treatment. Incontinence products, which include a large variety of pads and devices for effective containment of urine, may be used in conjunction with behavioural techniques at any point in the patient's management. A comprehensive search strategy was used to identify systematic reviews and randomized controlled trials that examined the effectiveness, safety, and cost-effectiveness of caregiver-dependent and patient-directed behavioural interventions for the treatment of UI in community-dwelling seniors (see Appendix 1). Are caregiver-dependent behavioural interventions effective in improving UI in medically complex, frail

  18. Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion.

    Science.gov (United States)

    Barton, C J; Bonanno, D R; Carr, J; Neal, B S; Malliaras, P; Franklyn-Miller, A; Menz, H B

    2016-05-01

    Running-related injuries are highly prevalent. Synthesise published evidence with international expert opinion on the use of running retraining when treating lower limb injuries. Mixed methods. A systematic review of clinical and biomechanical findings related to running retraining interventions were synthesised and combined with semistructured interviews with 16 international experts covering clinical reasoning related to the implementation of running retraining. Limited evidence supports the effectiveness of transition from rearfoot to forefoot or midfoot strike and increase step rate or altering proximal mechanics in individuals with anterior exertional lower leg pain; and visual and verbal feedback to reduce hip adduction in females with patellofemoral pain. Despite the paucity of clinical evidence, experts recommended running retraining for: iliotibial band syndrome; plantar fasciopathy (fasciitis); Achilles, patellar, proximal hamstring and gluteal tendinopathy; calf pain; and medial tibial stress syndrome. Tailoring approaches to each injury and individual was recommended to optimise outcomes. Substantial evidence exists for the immediate biomechanical effects of running retraining interventions (46 studies), including evaluation of step rate and strike pattern manipulation, strategies to alter proximal kinematics and cues to reduce impact loading variables. Our synthesis of published evidence related to clinical outcomes and biomechanical effects with expert opinion indicates running retraining warrants consideration in the treatment of lower limb injuries in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Kinetic changes during a six-week minimal footwear and gait-retraining intervention in runners.

    Science.gov (United States)

    Warne, Joe P; Smyth, Barry P; Fagan, John O'C; Hone, Michelle E; Richter, Chris; Nevill, Alan M; Moran, Kieran A; Warrington, Giles D

    2017-08-01

    An evaluation of a six-week Combined minimal footwear transition and gait-retraining combination vs. gait retraining only on impact characteristics and leg stiffness. Twenty-four trained male runners were randomly assigned to either (1) Minimalist footwear transition Combined with gait-retraining over a six-week period ("Combined" group; n = 12) examined in both footwear, or (2) a gait-retraining group only with no minimalist footwear exposure ("Control"; n = 12). Participants were assessed for loading rate, impact peak, vertical, knee and ankle stiffness, and foot-strike using 3D and kinetic analysis. Loading rate was significantly higher in the Combined group in minimal shoes in pre-tests compared to a Control (P ≤ 0.001), reduced significantly in the Combined group over time (P ≤ 0.001), and was not different to the Control group in post-tests (P = 0.16). The impact peak (P = 0.056) and ankle stiffness reduced in both groups (P = 0.006). Loading rate and vertical stiffness was higher in minimalist footwear than conventional running shoes both pre (P ≤ 0.001) and post (P = 0.046) the intervention. There has a higher tendency to non-rearfoot strike in both interventions, but more acute changes in the minimalist footwear. A Combined intervention can potentially reduce impact variables. However, higher loading rate initially in minimalist footwear may increase the risk of injury in this condition.

  20. Effectiveness of Attribution Retraining on Women's Depression and Anxiety After Miscarriage

    OpenAIRE

    Sharifi, Marzieh; Hajiheidari, Mahnaz; Khorvash, Fariborz; Mirabdollahi, Mansoureh Alsadat

    2013-01-01

    Background: Given miscarriage psychological consequences on the women health, the aim of the present study is the survey of effectiveness rate of attributive retraining interventions on women depression and anxiety reducing after miscarriage. Methods: The present study is semi-empiric and it′s made using control group, pre- and post-test execution and follow-up. Thirty-two women, who had recent experience of miscarriage, were selected among female referents to obstetricians and clinics in...

  1. Urinary incontinence nursing diagnoses in patients with stroke

    Directory of Open Access Journals (Sweden)

    Telma Alteniza Leandro

    2015-12-01

    Full Text Available Abstract OBJECTIVE Identifying the prevalence of Stress urinary incontinence (SUI, Urge urinary incontinence (UUI, Functional urinary incontinence (FUI, Overflow urinary incontinence (OUI and Reflex urinary incontinence (RUI nursing diagnoses and their defining characteristics in stroke patients. METHOD A cross-sectional study with 156 patients treated in a neurological clinic. Data were collected through interviews and forwarded to nurses for diagnostic inference. RESULTS 92.3% of the patients had at least one of the studied diagnoses; OUI showed the highest prevalence (72.4%, followed by FUI (53.2%, RUI (50.0%, UUI (41.0% and SUI (37.8%. Overdistended bladder and reports of inability to reach the toilet in time to avoid urine loss were the most prevalent defining characteristics. A statistically significant association of the defining characteristics with the studied diagnosis was verified. CONCLUSION The five incontinence diagnoses were identified in the evaluated patients, with different prevalence.

  2. Thoracic and diaphragmatic endometriosis: Single-institution experience using a novel broadened diagnostic criteria

    Science.gov (United States)

    Larraín, Demetrio; Suárez, Francisco; Braun, Hernán; Chapochnick, Javier; Diaz, Lidia; Rojas, Iván

    2018-06-05

    To describe our experience with the multidisciplinary management of both thoracic/diaphragmatic endometriosis (TED), applying a broadened definition of the “thoracic endometriosis syndrome (TES)” to define cases. We present a retrospective series of consecutive patients affected by pathology-proven TED, treated at our institution, during a period of 7 years. Five women were included. Two cases were referred due to catamenial chest/shoulder pain, one due to recurrent catamenial pneumothorax, one due to new-onset diaphragmatic hernia. One patient had not thoracic symptoms, and diaphragmatic endometriosis was found during gynecologic laparoscopy for pelvic endometriosis. Endometriosis was histologically confirmed in all cases. After follow-up all patients remain asymptomatic. Broadened TES criteria could increase the incidence of TED and determine better knowledge of this condition. Multidisciplinary, minimally invasive surgery is effective and safe, but should be reserved to tertiary referral centers.

  3. Acute Intrathoracic Gastric Volvulus due to Diaphragmatic Hernia: A Rare Emergency Easily Overlooked

    Directory of Open Access Journals (Sweden)

    Hyung Hun Kim

    2011-05-01

    Full Text Available Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.

  4. Sacral Nerve Stimulation For Urinary Urge Incontinence, Urgency-Frequency, Urinary Retention, and Fecal Incontinence

    Science.gov (United States)

    2005-01-01

    Executive Summary Objective The aim of this review was to assess the effectiveness, safety, and cost of sacral nerve stimulation (SNS) to treat urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence. Background: Condition and Target Population Urinary urge incontinence, urgency-frequency, urinary retention, and fecal incontinence are prevalent, yet rarely discussed, conditions. They are rarely discussed because patients may be uncomfortable disclosing their symptoms to a health professional or may be unaware that there are treatment options for these conditions. Briefly, urge incontinence is an involuntary loss of urine upon a sudden urge. Urgency-frequency is an uncontrollable urge to void, which results in frequent, small-volume voids. People with urgency-frequency may or may not also experience chronic pelvic pain. Urinary retention refers to the inability to void despite having the urge to void. It can be caused by a hypocontractile detrusor (weak or no bladder muscle contraction) or obstruction due to urethral overactivity. Fecal incontinence is a loss of voluntary bowel control. The prevalence of urge incontinence, urgency-frequency, and urinary retention in the general population is 3.3% to 8.2%, and the prevalence of fecal incontinence is 1.4% to 1.9%. About three-quarters of these people will be successfully treated by behaviour and/or drug therapy. For those who do not respond to these therapies, the options for treatment are management with diapers or pads, or surgery. The surgical procedures are generally quite invasive, permanent, and are associated with complications. Pads and/or diapers are used throughout the course of treatment as different therapies are tried. Patients who respond successfully to treatment may still require pads or diapers, but to a lesser extent. The Technology Being Reviewed: Sacral Nerve Stimulation Sacral nerve stimulation is a procedure where a small device attached to an electrode is

  5. The energetic cost of gait retraining: A pilot study of the acute effect.

    Science.gov (United States)

    Townshend, Andrew D; Franettovich Smith, Melinda M; Creaby, Mark W

    2017-01-01

    To investigate the acute effect of gait retraining aimed at reducing tibial peak positive acceleration (PPA) on energetic cost (VO 2 ). Intervention with a pre/post-test design. University biomechanics laboratory. 12 healthy male runners (23.4 ± 5.3 years, 179.7 ± 4.3 cm, 75.6 ± 9.2 kg). Tibial PPA and oxygen consumption (VO 2 ) were measured after a five minute baseline run and at the end of a gait retraining session aimed at minimizing tibial PPA. Tibial PPA significantly decreased between baseline and after gait retraining (32.6%, p = 0.007). VO 2 significantly increased between the two time periods (9.3%, p = 0.008). There was no correlation between change in tibial PPA and change in VO 2 (p = 0.956, r = 0.018). Practitioners who aim to reduce injury risk by minimizing tibial PPA in runners need to consider the possible acute effect on performance as a result of changes in VO 2 . Further investigation is warranted to understand the energetic cost of different kinematic strategies used by individuals. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Sensory retraining after orthognathic surgery: effect on patients' perception of altered sensation.

    Science.gov (United States)

    Phillips, Ceib; Essick, Greg; Preisser, John S; Turvey, Timothy A; Tucker, Myron; Lin, Dongming

    2007-06-01

    The primary research hypothesis was that the magnitude and duration of the perceived burden from altered sensation reported by patients after bilateral sagittal split osteotomy and trauma to the third division of the trigeminal nerve are decreased when facial sensory retraining exercises are performed in conjunction with standard opening exercises as compared with standard opening exercises alone. A total of 186 subjects were enrolled in a multicenter, double-blind, 2 parallel group-stratified block randomized clinical trial. Oral and facial pain, unusual sensations, numbness, and loss of sensitivity were scored from "no problem" to "serious problem" before surgery and 1 month, 3 months, and 6 months after surgery. A proportional odds model for the ordered multinomial response was used to compare the responses of the 2 exercise groups. The 2 exercise groups did not differ significantly at any postsurgical time in terms of perceived problem level from intraoral of facial pain. The difference between the 2 groups at each visit was not statistically significant for unusual sensations, although the trend was for the sensory retraining group to have a higher likelihood of reporting fewer problems. By 6 months, the likelihood of a subject reporting lower problem or interference level related to numbness or decreased lip sensitivity was significantly higher in the sensory-retraining group, approximately twice that of the opening exercise-only group. Our results support the premise that a simple noninvasive exercise program initiated shortly after orthognathic surgery can lessen the objectionable impression of negative altered sensations.

  7. Mastering algebra retrains the visual system to perceive hierarchical structure in equations.

    Science.gov (United States)

    Marghetis, Tyler; Landy, David; Goldstone, Robert L

    2016-01-01

    Formal mathematics is a paragon of abstractness. It thus seems natural to assume that the mathematical expert should rely more on symbolic or conceptual processes, and less on perception and action. We argue instead that mathematical proficiency relies on perceptual systems that have been retrained to implement mathematical skills. Specifically, we investigated whether the visual system-in particular, object-based attention-is retrained so that parsing algebraic expressions and evaluating algebraic validity are accomplished by visual processing. Object-based attention occurs when the visual system organizes the world into discrete objects, which then guide the deployment of attention. One classic signature of object-based attention is better perceptual discrimination within, rather than between, visual objects. The current study reports that object-based attention occurs not only for simple shapes but also for symbolic mathematical elements within algebraic expressions-but only among individuals who have mastered the hierarchical syntax of algebra. Moreover, among these individuals, increased object-based attention within algebraic expressions is associated with a better ability to evaluate algebraic validity. These results suggest that, in mastering the rules of algebra, people retrain their visual system to represent and evaluate abstract mathematical structure. We thus argue that algebraic expertise involves the regimentation and reuse of evolutionarily ancient perceptual processes. Our findings implicate the visual system as central to learning and reasoning in mathematics, leading us to favor educational approaches to mathematics and related STEM fields that encourage students to adapt, not abandon, their use of perception.

  8. Real-Time Knee Adduction Moment Feedback for Gait Retraining Through Visual and Tactile Displays

    KAUST Repository

    Wheeler, Jason W.; Shull, Pete B.; Besier, Thor F.

    2011-01-01

    The external knee adduction moment (KAM) measured during gait is an indicator of tibiofemoral joint osteoarthritis progression and various strategies have been proposed to lower it. Gait retraining has been shown to be an effective, noninvasive approach for lowering the KAM. We present a new gait retraining approach in which the KAM is fed back to subjects in real-time during ambulation. A study was conducted in which 16 healthy subjects learned to alter gait patterns to lower the KAM through visual or tactile (vibration) feedback. Participants converged on a comfortable gait in just a few minutes by using the feedback to iterate on various kinematic modifications. All subjects adopted altered gait patterns with lower KAM compared with normal ambulation (average reduction of 20.7%). Tactile and visual feedbacks were equally effective for real-time training, although subjects using tactile feedback took longer to converge on an acceptable gait. This study shows that real-time feedback of the KAM can greatly increase the effectiveness and efficiency of subject-specific gait retraining compared with conventional methods. © 2011 American Society of Mechanical Engineers.

  9. The effects of gait retraining in runners with patellofemoral pain: A randomized trial.

    Science.gov (United States)

    Roper, Jenevieve L; Harding, Elizabeth M; Doerfler, Deborah; Dexter, James G; Kravitz, Len; Dufek, Janet S; Mermier, Christine M

    2016-06-01

    Running popularity has increased resulting in a concomitant increase in running-related injuries with patellofemoral pain most commonly reported. The purpose of this study was to determine whether gait retraining by modifying footstrike patterns from rearfoot strike to forefoot strike reduces patellofemoral pain and improves associated biomechanical measures, and whether the modification influences risk of ankle injuries. Sixteen subjects (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. The experimental group performed eight gait retraining running sessions over two weeks where footstrike pattern was switched from rearfoot strike to forefoot strike, while the control group performed running sessions with no intervention. Variables were recorded pre-, post-, and one-month post-running trials. Knee pain was significantly reduced post-retraining (Pforefoot strike pattern leads to reduced knee pain, and should be considered a possible strategy for management of patellofemoral pain in recreational runners. This trial is registered at the US National Institutes of Health (clinicaltrials.gov) #NCT02567123. Published by Elsevier Ltd.

  10. [Women's strategies for coping with urinary incontinence].

    Science.gov (United States)

    Delarmelindo, Rita de Cássia Altino; Parada, Cristina Maria Garcia de Lima; Rodrigues, Rosalina Aparecida Partezani; Bocchi, Silvia Cristina Mangini

    2013-04-01

    This article is part of a more comprehensive qualitative study which used grounded theory and symbolic interactionism as theoretical and methodological frameworks, resulting in the theoretical model entitled, Between suffering and hope: rehabilitation of urinary incontinence as an intervenient component. In order to communicate all the knowledge produced, part of this model is presented, and it refers to the process of coping with urinary incontinence by women without perspectives of access to surgical treatment after failure of conservative procedures. When interrelating the components (categories and subcategories) of these women's experience in order to compare and analyze them to understand their interaction, moral and psychosocial vulnerability were noticed within the experience of the group, which makes them susceptible to health risks and to compromise of their quality of life, observed in the movement of the group's experience. Research is needed to further understand experiences in which there are barriers to surgical treatment due to physicians' disbelief in its effectiveness.

  11. Urinary stress incontinence in postpartum women. Bibliographic review

    OpenAIRE

    Jose Manuel Barranco Cuadros; Irene Herrera Vargas; Raquel Rodríguez-Blanque; Juan Carlos Sánchez-García

    2017-01-01

    Introduction: Both pregnancy and childbirth are important risk factors for urinary stress incontinence in women. For its prevention, exercies of the pelvic floor musculature have been shown to be effective. Guidelines for urinary stress incontinence management recommend offering pelvic floor muscle training to women during their first pregnancy as a preventive measure. Objective: To update the information provided in the scientific literature on urinary stress incontinence during postpartu...

  12. Neurological aspects of urinary incontinence in the elderly

    OpenAIRE

    Vladimir Anatolyevich Parfenov

    2013-01-01

    The paper gives data on the prevalence, pathogenesis, and treatment of urinary incontinence in the elderly. There is a high rate of urinary incontinence among the patients who have experienced stroke or suffer from dementia or other neurological diseases. The ideas on the pathogenesis and manifestations of overactive bladder, stress urinary incontinence are outlined. Currently available drugs (anticholinergics, antidepressants, botulinum toxin preparations), methods for behavioral therapy and...

  13. Risk factors for postpartum urinary incontinence

    OpenAIRE

    Lígia da Silva Leroy; Adélia Lúcio; Maria Helena Baena de Moraes Lopes

    2016-01-01

    Abstract OBJECTIVE: To investigate the risk factors for postpartum urinary incontinence (UI) and its characteristics. METHOD: This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. RESULTS: Stress UI was present in 45.5% of the women, incidents of urine...

  14. Transanal irrigation is effective in functional fecal incontinence

    DEFF Research Database (Denmark)

    Jørgensen, Cecilie Siggaard; Kamperis, Konstantinos; Modin, Line

    2017-01-01

    Functional fecal incontinence (FFI) is divided into cases related to functional constipation (FC) and cases without concomitant constipation termed functional non-retentive fecal incontinence (FNRFI). Transanal irrigation (TAI) is widely used in children with neurogenic fecal incontinence...... and 35% (n = 25) were titrated to daily sessions. Of the 63 children who fulfilled the Rome III criteria of constipation, 46 (73%) showed full response with complete remission of incontinence episodes. Eleven (17%) showed partial response (≥50% reduction). Of nine children with FNRFI, four (44%) showed...

  15. Neurological aspects of urinary incontinence in the elderly

    Directory of Open Access Journals (Sweden)

    Vladimir Anatolyevich Parfenov

    2013-01-01

    Full Text Available The paper gives data on the prevalence, pathogenesis, and treatment of urinary incontinence in the elderly. There is a high rate of urinary incontinence among the patients who have experienced stroke or suffer from dementia or other neurological diseases. The ideas on the pathogenesis and manifestations of overactive bladder, stress urinary incontinence are outlined. Currently available drugs (anticholinergics, antidepressants, botulinum toxin preparations, methods for behavioral therapy and physiotherapy, and skin care in urinary incontinence are discussed. The current treatment options can improve quality of life in the elderly and their milieu.

  16. Congenital diaphragmatic hernia as a part of Nance-Horan syndrome?

    Science.gov (United States)

    Kammoun, Molka; Brady, Paul; De Catte, Luc; Deprest, Jan; Devriendt, Koenraad; Vermeesch, Joris Robert

    2018-03-01

    Nance-Horan syndrome is a rare X-linked developmental disorder characterized by bilateral congenital cataract, dental anomalies, facial dysmorphism, and intellectual disability. Here, we identify a patient with Nance-Horan syndrome caused by a new nonsense NHS variant. In addition, the patient presented congenital diaphragmatic hernia. NHS gene expression in murine fetal diaphragm was demonstrated, suggesting a possible involvement of NHS in diaphragm development. Congenital diaphragmatic hernia could result from NHS loss of function in pleuroperitoneal fold or in somites-derived muscle progenitor cells leading to an impairment of their cells migration.

  17. Management of Postoperative Pulmonary Hypertension by Inhaled Nitric Oxide in a Newborn with Congenital Diaphragmatic Hernia

    International Nuclear Information System (INIS)

    Fettah, N. D.; Dilli, D.; Beken, S.; Zenciroglu, A.; Okumus, N.; Cavusoglu, H.; Ozgur, S.

    2014-01-01

    Postero-lateral congenital diaphragmatic hernia (CDH) is a life threatening anomaly characterized by diaphragmatic defect and intrathoracic herniation of abdominal viscera. In patients with CDH, the lungs are hypoplastic and persistent pulmonary hypertension develops in most cases. Although, inhaled nitric oxide (iNO) results in a reduction in pulmonary hypertension with improvement in oxygenation, its benefit in the patients with CDH remains controversial. In this report, the authors present successful management of postoperative pulmonary hypertension by iNO in a newborn with CDH. (author)

  18. Bilateral diaphragmatic paralysis after cardiac surgery: ventilatory assistance by nasal mask continuous positive airway pressure.

    Science.gov (United States)

    Hoch, B; Zschocke, A; Barth, H; Leonhardt, A

    2001-01-01

    The case of an 8-month-old boy with bilateral diaphragmatic paralysis after surgical reoperation for congenital heart disease is presented. In order to avoid repeated intubation and long-term mechanical ventilation or tracheotomy, we used nasal mask continuous positive airway pressure (CPAP) as an alternative method for assisted ventilation. Within 24 hours the boy accepted the nasal mask and symptoms such as dyspnea and sweating disappeared. Respiratory movements became regular and oxygen saturation increased. Nasal mask CPAP may serve as an alternative treatment of bilateral diaphragmatic paralysis in infants, thereby avoiding tracheotomy or long-term mechanical ventilation.

  19. Radiographic diagnosis of diaphragmatic hernia: review of 60 cases in dogs and cats.

    Science.gov (United States)

    Hyun, Changbaig

    2004-06-01

    Sixty cases of diaphragmatic hernia in dogs and cats were radiologically reviewed and categorized by their characteristic radiographic signs. Any particular predilection for age, sex, or breed was not observed. Liver, stomach and small intestine were more commonly herniated. At least two radiographs, at different angles, were required for a valid diagnosis, because some radiographic signs were not visible in a single radiographic view and more clearly detectable in two radiographic views. In addition to previously reported radiographic signs for diaphragmatic hernia, we found that the location of the stomach axis and the displacement of tracheal and bronchial segments were also useful radiographic signs.

  20. Diaphragmatic paralysis evaluated by phrenic nerve stimulation during fluoroscopy or real-time ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    McCauley, R.G.K.; Labib, K.B.

    1984-10-01

    Stimulation of the phrenic nerve by supplying an electrical impulse to the neck during fluoroscopy or real-time ultrasound (sonoscopy) of the diaphragm allows more precise functional evaluation than fluoroscopy and/or sonoscopy alone. This is especially true of patients who are unable to cooperate because the are on a ventilator, unconscious, or very young. The authors cite cases in which diaphragmatic paralysis was diagnosed by conventional methods but stimulation of the phrenic nerve demonstrated good diaphragmatic motion, leading to a change in prognosis in some cases and a change in therapy in others.

  1. Diaphragmatic paralysis evaluated by phrenic nerve stimulation during fluoroscopy or real-time ultrasound

    International Nuclear Information System (INIS)

    McCauley, R.G.K.; Labib, K.B.

    1984-01-01

    Stimulation of the phrenic nerve by supplying an electrical impulse to the neck during fluoroscopy or real-time ultrasound (sonoscopy) of the diaphragm allows more precise functional evaluation than fluoroscopy and/or sonoscopy alone. This is especially true of patients who are unable to cooperate because the are on a ventilator, unconscious, or very young. The authors cite cases in which diaphragmatic paralysis was diagnosed by conventional methods but stimulation of the phrenic nerve demonstrated good diaphragmatic motion, leading to a change in prognosis in some cases and a change in therapy in others

  2. Stress urinary incontinence in the female

    International Nuclear Information System (INIS)

    Baldelli, S.; Giovagnoni, A.; Bichi Secchi, E.; Argaglia, G.; Caraceni, E.; Muzzonigro, G.

    1988-01-01

    This work is aimed at demonstrating the validity of conventional radiological procedures, correlated with urodynamics, in the study of female urinary stress incontinence. In a study population of 110 patients with a clinical-urodynamic diagnosis of stress incontinence, radiological evaluation was performed by means of retrograde cystography, bead chain cystourethrography, and voiding cystourethrography. Radiographic findings were correlated with urodynamic data, and in particular with urethral pressure profile (fuctional lenght of the urethra, maximum closing pressure, maximum urethral pressure). In all patients the posterior urethro-vesical angle values were higher than 100 grade centigrades; moreover, a correlation was proven to exist between an increase in the angle of front urethral inclination, the lowering and mobility of the urethro-vesical junction, and the severeness of urodynamic findings. Furtheremore, in the different stages of urodynamic severeness, urethral funnelling was most frequent, and the flattening of the posterior vesical floor in voiding cystourethrography. The high reliability of the radiographic findings, although obtained by means of conventional techniques, and the variability of the morphodynamic results confirm the importance of a combined radiographic and urodynamic study in the evaluation of stress incontinence

  3. [Sport and urinary incontinence in women].

    Science.gov (United States)

    Lousquy, R; Jean-Baptiste, J; Barranger, E; Hermieux, J-F

    2014-09-01

    Women are more attentive to their physical appearance and a quarter of French women use to practice a regular physical activity. Benefits of sport on general health are recognized. However, sport may be the cause of various diseases when it is poorly chosen or improperly performed. In literature, intensive exercise is a risk factor for urinary incontinence, defined as "the complaint of any involuntary leakage of urine". It is essentially stress urinary incontinence, occurring because of the phenomenon of intrabdominal hyperpressure, inherent with certain activities, and excess capacity of sphincters. Some sports are more risky than others, and high-level sportswomen are the most exposed. Health professionals must invest in information, screening, prevention, counseling and treatment track athletes So, the general practitioner and the doctor of sports play a vital role in informing, screening, prevention, therapeutic and monitoring of sportswomen. Better information is needed because according to the severity of incontinence and its impact, there are simple, effective, more or less invasive treatment options. The aim of this study was to establish an inventory of scientific knowledge and to improve the management of these patients. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. [Surgical treatment of prolapse by abdominal route and effort-related urinary incontinence].

    Science.gov (United States)

    Wagner, L; Fatton, B; Delmas, V; Haab, F; Costa, P

    2009-12-01

    Stress urinary incontinence is often associated with prolapse. The suburethral tapes have modified the indication for a preventive treatment of incontinence. The tapes are necessary in case of patent or masked incontinence, discussed in case of potential incontinence. The diagnosis of incontinence is done on questions to the patient, clinical exam, more than in urodynamic study. There is no absolute sign allowing to predict postoperative incontinence after surgery for prolapse. A continent woman can be incontinent postoperatively. If a potential incontinence is treated in the same as the prolapse, the patient must be informed of risk of obstruction and/or urgency.

  5. Branched-chain aminoacids and retraining of patients with chronic obstructive lung disease.

    Science.gov (United States)

    Menier, R; Talmud, J; Laplaud, D; Bernard, M P

    2001-12-01

    The aim of this work was to improve the efficacy of rehabilitation by retraining, by oral supply in branched-chain aminoacids (BCAA). Patients with chronic respiratory insufficiency mainly suffer from obstructive bronchitis due to tobacco or asthma. Nutritional assessment is one of the components of respiratory rehabilitation, with retraining. Intense physical training for several days negativates the nitrogen balance, the beginning of a training programme for sedentary patients increases their need in proteins. An additional supply in branched-chain aminoacids increases proteic anabolism, by synthesis increase and catabolism slackening of proteins. Moreover it is known that exposure to high altitude reduces lean mass by inducing a muscular atrophy, which can be avoided by the BCAA provided. This leads to wonder if extra supply of BCAA could play similar role in muscular mass loss induced by pathological chronic hypoxia. The prospective and comparative survey carried out in Toki-Eder (private hospital in Cambo) consisted in supplying (during five weeks or more) 30 retrained patients suffering from chronic obstructive bronchitis, and in matching them with 30 witnesses (obstructive patients retrained without additional supply in BCAA). Their mean hypoxemia amounted to 7 torr for age. Each of them improved their reached maximal power, and their VO2 SL, very highly significantly. Each of them developed a moderate metabolic acidosis (whose possible mechanisms are discussed) and slightly increased their ventilation at rest. On the other hand only the supplied patients improved their PaO2 at rest highly significantly, a result which poses the question of the responsible mechanism, most likely a decrease of pulmonary shunt effect. The hypotheses concerning the acid load due to BCAA ingestion are discussed. Only the supplied patients developed hypocapnia expressing a gaseous alkalosis which might be due to a direct effect of BCAA on the respiratory centers. This observation

  6. Sepsis risk factors in infants with congenital diaphragmatic hernia.

    Science.gov (United States)

    Levy, Michaël; Le Sache, Nolwenn; Mokhtari, Mostafa; Fagherazzi, Guy; Cuzon, Gaelle; Bueno, Benjamin; Fouquet, Virginie; Benachi, Alexandra; Eleni Dit Trolli, Sergio; Tissieres, Pierre

    2017-12-01

    Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly and remains among the most challenging ICU-managed disease. Beside severe pulmonary hypertension, lung hypoplasia and major abdominal surgery, infective complications remain major determinants of outcome. However, the specific incidence of sepsis as well as associated risk factors is unknown. This prospective, 4-year observational study took place in the pediatric intensive care and neonatal medicine department of the Paris South University Hospitals (Le Kremlin-Bicêtre, France), CDH national referral center and involved 62 neonates with CDH. During their ICU stay, 28 patients (45%) developed 38 sepsis episodes. Ventilator-associated pneumonia (VAP: 23/38; 31.9 VAP per 1000 days of mechanical ventilation) and central line-associated blood stream infections (CLABSI: 5/38; 5.5 per 1000 line days) were the most frequently encountered infections. Multivariate analysis showed that gestational age at birth and intra-thoracic position of liver were significantly associated with the occurrence of sepsis. Infected patients had longer duration of mechanical and noninvasive ventilation (16.2 and 5.8 days, respectively), longer delay to first feeding (1.2 days) and a longer length of stay in ICU (23 days), but there was no difference in mortality. Healthcare-associated infections, and more specifically VAP, are the main infective threat in children with CDH. Sepsis has a significant impact on the duration of ventilator support and ICU length of stay but does not impact mortality. Low gestational age and intra-thoracic localization of the liver are two independent risk factors associated with sepsis.

  7. Collateral sources of costal and crural diaphragmatic blood flow

    International Nuclear Information System (INIS)

    Lockhat, D.; Magder, S.; Roussos, C.

    1985-01-01

    We measured the contribution of aortic, internal mammary, and intercostal arteries to the blood flow to the costal and crural segments of the diaphragm and other respiratory muscles in seven dogs breathing against a fixed inspiratory elastic load. We used radiolabeled microspheres to measure the blood flow with control circulation, occlusion of the aorta distal to the left subclavian artery, combined occlusion of the aorta and both internal mammary arteries, and occlusion of internal mammary arteries alone. With occlusion of the aorta distal to the left subclavian artery, blood flow to the crural diaphragm decreased from 40.3 to 23.5 ml . min-1 X 100 g-1, whereas costal flow did not change significantly (from 41.7 to 38.1 ml . min-1 . 100 g-1). Blood flows to the sternomastoid and scalene muscles (above the occlusion) increased by 200 and 340%, respectively, whereas flows to the other respiratory muscles did not change significantly. Blood flows to organs above the occlusion either remained unchanged or increased, whereas flows to those below the occlusion all decreased. When the internal mammary artery was also occluded, flows to the crural segment decreased further to 12.1 and costal flow decreased to 20.4 ml X min-1 X 100 g-1. Internal mammary arterial occlusion alone in two dogs had no effect on diaphragmatic flow. In conclusion, intercostal collateral vessels are capable of supplying a significant proportion of blood flow to both segments of the diaphragm but the costal segment is better served than the crural segment

  8. Diagnostic agreement of the 3 Incontinence Questionnaire to video-urodynamics findings in women with urinary incontinence

    Science.gov (United States)

    Omar, Mohammad Ali; Laniado, Marc

    2017-01-01

    Introduction There are limited studies evaluating the 3 Incontinence Questionnaire (3IQ) against urodynamics based diagnosis as a reference standard. The 3IQ has been proposed to be useful to evaluate women at the level of primary care. The aim of this study was to determine correlation between 3IQ and video-urodynamics (VUDS) in diagnosing types of urinary incontinence. Material and methods Prospective data was collected on 200 consecutive female patients referred by primary care physicians for urinary incontinence. The mean age was 55 years (range 15–83 years). The patients were evaluated using the 3IQ and video-urodynamics. The 3IQ-based diagnosis of type of female urinary incontinence was compared to VUDS-based results. Sensitivity, specificity, positive likelihood ratios and positive predictive values were calculated. Results On 3IQ based self-evaluation, 28% of patients were classified as having stress urinary incontinence, 20% with urge incontinence and 40% with mixed incontinence. On video-urodynamics, urodynamic stress urinary incontinence (UDSUI) was detected in 56% of patients, detrusor overactivity (DO) in 15% and mixed urinary incontinence (MUI) in 19%. The 3IQ had a sensitivity and specificity respectively of 43% and 92% for UDSUI, 57% and 86% for DO and 58% and 64% for MUI. The corresponding positive likelihood ratios (CI, 95%) were 5.4 (CI 2.6 to 11.3) for stress urinary incontinence, 4.0 (CI 2.5 to 6.5) for DO and 1.62 (1.2 to 2.3) for MUI. The respective positive predictive values were 87% (CI 75% to 95%), 42% (CI 26% to 58%) and 28% (18% to 39%). Conclusions In our study population, stress urinary incontinence was reasonably well predicted by the 3IQ, but the questionnaire under-performed in the diagnoses of detrusor overactivity and mixed urinaryincontinence. PMID:29732212

  9. Natural history of extensive diaphragmatic injury on the right side: experimental study in rats

    Directory of Open Access Journals (Sweden)

    Jorge Henrique Rivaben

    2014-08-01

    Full Text Available OBJECTIVE: To evaluate the natural healing of the rat diaphragm that suffered an extensive right penetrating injury.METHODS: Animals were submitted to an extensive penetrating injury in right diaphragm. The sample consisted of 40 animals. The variables studied were initial weight, weight 21 days after surgery; healing of the diaphragm, non-healing of the diaphragm, and herniated abdominal contents into the chest.RESULTS: Ten animals were used as controls for weight and 30 animals were operated. Two animals died during the experiment, so 28 animals formed the operated group; healing of the diaphragm occurred in 15 animals (54%, 11 other animals showed diaphragmatic hernia (39% and in two we observed only diaphragmatic injury without hernia (7%. Among the herniated organs, the liver was found in 100% of animals, followed by the omentum in 77%, small bowel in 62%, colon in 46%, stomach in 31% and spleen in 15%. The control group and the diaphragmatic healing subgroup showed increased weight since the beginning of the study and the 21 days after surgery (p <0.001. The unhealed group showed no change in weight (p = 0.228.CONCLUSION: there is a predominance of spontaneous healing in the right diaphragm; animals in which there was no healing of the diaphragm did not gain weight, and the liver was the organ present in 100% the diaphragmatic surface in all rats with healed diaphragm or not.

  10. Crura sign: differentiation between traumatic rupture of the diaphragm and nontraumatic diaphragmatic elevation on CT

    International Nuclear Information System (INIS)

    Kim, Sung Jin; Han, Hae Ja; Kim, Wang Jung; Youk, Yong Soo; Han, Gi Seok; Cha, Sang Hoon; Park, Kil Sun; Kim, Dae Young

    1997-01-01

    To evaluate whether in patients with diffuse evaluation of a hemidiaphragm on chest radiographs, the apparence of the crura on CT might be helpful in differentiating between traumatic rupture of the diaphragm (TRD) and nontraumatic causes such as diaphragmatic palsy or diffuse diaphragmatic eventration. Among patients with diffuse elevations of a hemidiaphragm on chest radiograph, 27 who had patients undergone CT scans were retrospectively reviewed. Twelve patients had surgically proven TRD, and 15 had nontraumatic elevation of a hemidiaphragm such as diaphragmatic palsy or diffuse diaphragmatic eventration. Under the hypothesis that the affected crus is markedly thinner than the normal side in nontraumatic elevation but is normal in TRD ('crura sign', we optically assessed without measurement the thickness of both crura. In all patients with TRD, the thickness of the affected crus was similar to that of the contralateral side. In all patients with nontraumatic causes, however, the crus of the elevated hemidiaphragm was markedly thinner than that of the normal side. The 'crura sign' may be useful additional CT finding of traumatic rupture the diaphragm

  11. Congenital Diaphragmatic Hernia: Long-term Risk of Gastroesophageal Reflux Disease

    NARCIS (Netherlands)

    Peetsold, Marieke G.; Kneepkens, C. M. F. Frank; Heij, Hugo A.; Ijsselstijn, Hanneke; Tibboel, Dick; Gemke, Reinoud J. B. J.

    2010-01-01

    Objectives: Gastroesophageal reflux disease (GERD) is a well-recognized consequence of congenital diaphragmatic hernia (CDH). Results of studies examining predictive factors for early and late GERD are inconclusive. The aim of this study was to assess the incidence of early ( <2 years) and late GERD

  12. Congenital Diaphragmatic Hernia: Long-term Risk of Gastroesophageal Reflux Disease

    NARCIS (Netherlands)

    Peetsold, M.G.; Kneepkens, C.M.F.; Heij, H.A.; IJsselstijn, H.; Tibboel, D.; Gemke, R.J.B.J.

    2010-01-01

    Objectives: Gastroesophageal reflux disease (GERD) is a well-recognized consequence of congenital diaphragmatic hernia (CDH). Results of studies examining predictive factors for early and lateGERDare inconclusive. The aim of this study was to assess the incidence of early (<2 years) and late GERD

  13. Blunt bilateral diaphragmatic rupture—A right side can be easily missed

    Directory of Open Access Journals (Sweden)

    Maria Michailidou

    2015-12-01

    Full Text Available Blunt diaphragmatic rupture (BDR is uncommon with a reported incidence range of 1%–2%. The true incidence is not known. Bilateral BDR is particularly rare. We presented a case of bilateral BDR and we think that the incidence is under-recognised thanks to an easily missed and difficult to diagnose right sided injury. Keywords: Blunt, Diaphragm, Bilateral, Injury

  14. Clinical, echocardiographic, and radiographic findings of peritoneopericardial diaphragmatic hernia in two dogs and a cat

    International Nuclear Information System (INIS)

    Hay, W.H.; Woodfield, J.A.; Moon, M.A.

    1989-01-01

    Peritoneopericardial diaphragmatic hernia was diagnosed in 2 dogs and a cat. One dog was referred because of clinical signs of cardiac tamponade and acute decompensation from liver entrapment within the hernia. Surgical correction of the hernia alleviated clinical signs in all 3 animals. Echocardiography was used in combination with radiography to provide a rapid and accurate diagnosis

  15. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Directory of Open Access Journals (Sweden)

    Miguel L. Tedde

    2012-11-01

    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  16. Hepatic fibrosarcoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat

    Directory of Open Access Journals (Sweden)

    Michael Linton

    2016-03-01

    Full Text Available Case summary A 14-year-old, female neutered domestic shorthair presented for dyspnoea. Thoracic ultrasonography and radiography showed that a heterogeneous mass was present within the pericardial sac, and the mass continued caudally with the mesenteric fat. On CT, the outline of the diaphragm was not continuous and there was an obvious defect with diaphragmatic thickening present at the mid-level of the liver. A pleural effusion and a small-volume pericardial effusion were also present. A ventral midline coeliotomy and median sternotomy revealed a 5 × 6 × 7 cm firm, irregular, tan-coloured soft tissue mass within the pericardial sac attached to both the diaphragmatic defect and liver. The mass was carefully dissected away from the heart and the diaphragmatic defect was repaired with primary closure. Postoperatively, the cat had a persistent pneumothorax that required continuous pleural suction for 41 h. The cat died 44 h postoperatively. Histopathology and immunohistochemistry confirmed the mass to be a hepatic fibrosarcoma incarcerated in a peritoneopericardial diaphragmatic hernia (PPDH. Relevance and novel information This is the first reported case of metaplastic transformation of liver into a sarcoma in a cat with PPDH. In addition, hepatic fibrosarcoma is a rarely reported location for fibrosarcoma in this species.

  17. Inhalation of nitric oxide as a treatment of pulmonary hypertension in congenital diaphragmatic hernia

    DEFF Research Database (Denmark)

    Henneberg, Steen Winther; Jepsen, S; Andersen, P K

    1995-01-01

    Congenital diaphragmatic hernia (CDH) still has a mortality risk of around 40%. The concomitant pulmonary hypoplasia and the persistent pulmonary hypertension are of major prognostic importance. The use of a selective pulmonary vasodilator may revert this vicious circle that is fatal to many...

  18. A rare case of diaphragmatic paralysis due to isolated phrenic nerve ...

    African Journals Online (AJOL)

    2008-11-04

    Nov 4, 2008 ... Isolated phrenic nerve palsy is a rare condition resulting from birth injury, with many possible complications such as diaphragmatic paralysis, pulmonary infection, chronic lung disease, growth failure and even death.1-3 I report a case of neonatal isolated phrenic nerve palsy in an infant delivered.

  19. Radionuclide scintigraphy in detection of gastroesophageal reflux in survivors of congenital diaphragmatic hernia

    International Nuclear Information System (INIS)

    Thomas, E.J.; Bharathi Dasan, J.; Patel, C.D.; Bal, C.S.; Malhotra, A.; Kumar, R.; Mitra, D.K.; Agarwala, S.; Padhy, A.K.

    2003-01-01

    Gastro-esophageal Reflux is a common cause of long-term morbidity in survivors of congenital diaphragmatic hernia. The present retrospective analysis was undertaken to find out the incidence of GER in survivors of congenital diaphragmatic hernia (CDH). A total of 26 survivors of congenital diaphragmatic hernia with a mean age of 19 months were studied. Of these, only 7 had clinical symptoms suggestive of GER such as recurrent respiratory tract infection, vomiting, regurgitation, and epigastric pain. The remaining 19 were asymptomatic and had radionuclide scintigraphy for detection of GER as a part of routine follow-up. All the 26 underwent radionuclide scintigraphy with 100-200 μCi (3.7 -7.4MBq) of Tc99m-Sulphur Colloid. GER was detected in 11 out of 26 patients (4 out of 7 symptomatic patients and 7 out of 19 asymptomatic patients). We concluded that there is high incidence of GER in survivors of congenital diaphragmatic hernia and these patients should be followed up for GER regularly. Scintiscanning being a simple, noninvasive test, may be used for initial evaluation and follow-up of survivors of CDH for GER. (author)

  20. Incontinence in Individuals with Rett Syndrome: A Comparative Study

    NARCIS (Netherlands)

    Giesbers, S.A.H.; Didden, H.C.M.; Radstaake, M.; Korzilius, H.P.L.M.; Gontard, A. von; Lang, R.; Smeets, E.E.J.; Curfs, L.M.G.

    2012-01-01

    Frequency and type of incontinence and its association with other variables were assessed in females with Rett Syndrome (RS) (n = 63), using an adapted Dutch version of the ‘Parental Questionnaire: Enuresis/Urinary Incontinence’ (Beetz et al. 1994). Also, incontinence in RS was compared to a control

  1. Combined stress urinary incontinence surgery at the time of ...

    African Journals Online (AJOL)

    2009-09-18

    Sep 18, 2009 ... Stanton SL, Hilton P, Norton C, Cardozo L. Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinence. Br J Obstet Gynaecol 1982; 89: 459-463. 2. Borstad E, Rud T. The risk of developing urinary stress-incontinence after vaginal repair in ...

  2. Effective Factors on Urinary Incontinence in Natural Menopausal Women

    OpenAIRE

    Shohani; V Carson; Sayehmiri; Shohani

    2015-01-01

    Background Urinary tract infections and urinary incontinence are common urogenital problems affecting 7 - 10% of menopausal women. Objectives The primary objective of this study was to quantify effective factors on urinary incontinence in a cohort of menopausal women. Patients and Methods A sample of 150 menopausal women (natural menopause for at least 12 months) were recruited fro...

  3. Towards patient centered care in female stress urinary incontinence

    NARCIS (Netherlands)

    Labrie, J.

    2015-01-01

    This thesis focussed on the treatment of stress urinary incontinence in women. It comprises the results of the PORTRET study (Physiotherapy OR Tvt Effectiveness Trial). Currently, pelvic floor muscle training is advised as initial treatment for all women with stress urinary incontinence. We

  4. High prevalence of urinary incontinence and poor knowledge of ...

    African Journals Online (AJOL)

    2010-12-02

    Dec 2, 2010 ... Demographic and Health Survey (SADHS) measured the prevalence of stress urinary incontinence (SUI) in South. Africa for the first time, but only among women who had had children.2. In 1998, the World Health Organization's first International. Consultation on Incontinence classified UI as a disease,.

  5. The Sexual Function and Influence of Urinary Incontinence ...

    African Journals Online (AJOL)

    Objective. To develop and psychometrically validate a questionnaire that assesses sexual function of urinary incontinent women in South Africa and the influence of incontinence on their sexual function. Design. A prospective descriptive study. Setting. Urogynaecology and gynaecology outpatient clinics at Tygerberg ...

  6. Sling surgery for stress urinary incontinence; the perfect solution?

    NARCIS (Netherlands)

    Hogewoning, C.R.C.

    2017-01-01

    Stress urinary incontinence (SUI) is the most observed type of urinary incontinence and is defined as the loss of urine following a rise in abdominal pressure. The TVT (Tension-free Vaginal Tape), a mid-urethral sling (MUS), was introduced in 1996 and soon became the gold standard in the surgical

  7. The Management of Urinary Incontinence by Community-Living Elderly.

    Science.gov (United States)

    Mitteness, Linda S.

    1987-01-01

    Explored ways elderly people (N=30) manage urinary incontinence. Subjects tended to dismiss their urinary incontinence as a normal part of aging and used various behavioral and psychological strategies to maintain their independence, usually without any assistance from the health professions. Management strategies commonly involved some degree of…

  8. Left-Sided Congenital Diaphragmatic Hernia with Multiple Congenital Cardiac Anomalies, Hernia Sac, and Microscopic Hepatic Heterotopia: A Case Report

    Directory of Open Access Journals (Sweden)

    Maria Arafah

    2011-01-01

    Full Text Available Congenital diaphragmatic hernia is a common congenital anomaly of uncertain etiology. Its association with multiple congenital anomalies in various organs is well recognized and antenatal radiological evidence of congenital diaphragmatic hernia warrants thorough evaluation to detect other anomalies, some of which can be life threatening. Rarely, heterotopic hepatic tissue is identified in the hernia, a rare pathological finding, exhibiting more than one macroscopic and microscopic characteristics, and always associated with cardiac congenital anomalies. Herein, we report a case of left-sided microscopic heterotopic hepatic tissue in a congenital diaphragmatic hernia in an infant with multiple cardiac congenital anomalies, but with preserved pericardium.

  9. Sphingolipids in Congenital Diaphragmatic Hernia; Results from an International Multicenter Study.

    Directory of Open Access Journals (Sweden)

    Kitty G Snoek

    Full Text Available Congenital diaphragmatic hernia is a severe congenital anomaly with significant mortality and morbidity, for instance chronic lung disease. Sphingolipids have shown to be involved in lung injury, but their role in the pathophysiology of chronic lung disease has not been explored. We hypothesized that sphingolipid profiles in tracheal aspirates could play a role in predicting the mortality/ development of chronic lung disease in congenital diaphragmatic hernia patients. Furthermore, we hypothesized that sphingolipid profiles differ between ventilation modes; conventional mechanical ventilation versus high-frequency oscillation.Sphingolipid levels in tracheal aspirates were determined at days 1, 3, 7 and 14 in 72 neonates with congenital diaphragmatic hernia, born after > 34 weeks gestation at four high-volume congenital diaphragmatic hernia centers. Data were collected within a multicenter trial of initial ventilation strategy (NTR 1310.36 patients (50.0% died or developed chronic lung disease, 34 patients (47.2% by stratification were initially ventilated by conventional mechanical ventilation and 38 patients (52.8% by high-frequency oscillation. Multivariable logistic regression analysis with correction for side of the defect, liver position and observed-to-expected lung-to-head ratio, showed that none of the changes in sphingolipid levels were significantly associated with mortality /development of chronic lung disease. At day 14, long-chain ceramides 18:1 and 24:0 were significantly elevated in patients initially ventilated by conventional mechanical ventilation compared to high-frequency oscillation.We could not detect significant differences in temporal sphingolipid levels in congenital diaphragmatic hernia infants with mortality/development of chronic lung disease versus survivors without development of CLD. Elevated levels of ceramides 18:1 and 24:0 in the conventional mechanical ventilation group when compared to high

  10. Sensory Retraining following Orthognathic Surgery: Effect on Patient Perception of Altered Sensation

    Science.gov (United States)

    Phillips, Ceib; Essick, Greg; Preisser, John S; Turvey, Timothy A; Tucker, Myron; Lin, Dongming

    2007-01-01

    Purpose The primary research hypothesis was that the magnitude and duration of the perceived burden from altered sensation reported by patients following bilateral sagittal split osteotomy (BSSO) and trauma to the third division of the trigeminal nerve is lessened when facial sensory retraining exercises are performed in conjunction with standard opening exercises as compared to standard opening exercises alone. Subjects and Methods 186 subjects were enrolled in a multi-center double-blind two parallel group stratified block randomized clinical trial. Oral and facial pain, unusual sensations, numbness and loss of sensitivity, were scored from “no problem” to “serious problem” before surgery, 1,3, and 6 months after surgery. Analysis A proportional odds model for the ordered multinomial response was used to compare the responses of the two exercise groups. Results The two exercise groups did not differ significantly at any postsurgical time in the perceived problem level from mouth or face pain. The difference between the two groups at each visit was not statistically significant for unusual sensations although the trend was for the sensory retraining group to have a higher likelihood of reporting fewer problems. By 6 months, the likelihood of a subject reporting lower problem or interference level related to numbness or less lip sensitivity was significantly higher in the sensory-retraining group, approximately twice that of the opening exercise only group. Conclusion The results from this clinical trial support the premise that a simple noninvasive exercise program initiated shortly after orthognathic surgery can lessen the objectionable impression of negative altered sensations. PMID:17517301

  11. Statistical Learning Framework with Adaptive Retraining for Condition-Based Maintenance

    International Nuclear Information System (INIS)

    An, Sang Ha; Chang, Soon Heung; Heo, Gyun Young; Seo, Ho Joon; Kim, Su Young

    2009-01-01

    As systems become more complex and more critical in our daily lives, the need for the maintenance based on the reliable monitoring and diagnosis has become more apparent. However, in reality, the general opinion has been that 'maintenance is a necessary evil' or 'nothing can be done to improve maintenance costs'. Perhaps these were true statements twenty years ago when many of the diagnostic technologies were not fully developed. The developments of microprocessor or computer based instrumentation that can be used to monitor the operating condition of plant equipment, machinery and systems have provided the means to manage the maintenance operation. They have provided the means to reduce or eliminate unnecessary repairs, prevent catastrophic machine failures and reduce the negative impact of the maintenance operation on the profitability of manufacturing and production plants. Condition-based maintenance (CBM) techniques help determine the condition of in-service equipment in order to predict when maintenance should be performed. Most of the statistical learning techniques are only valid as long as the physics of a system does not change. If any significant change such as the replacement of a component or equipment occurs in the system, the statistical learning model should be re-trained or re-developed to adapt the new system. In this research, authors will propose a statistical learning framework which can be applicable for various CBMs, and the concept of the adaptive retraining technique will be described to support the execution of the framework so that the monitoring system does not need to be re-developed or re-trained even though there are any significant changes in the system or component

  12. Parturition events and risk of urinary incontinence in later life.

    Science.gov (United States)

    Thom, David H; Brown, Jeanette S; Schembri, Michael; Ragins, Arona I; Creasman, Jennifer M; Van Den Eeden, Stephen K

    2011-11-01

    To examine the association between specific events during vaginal deliveries and urinary incontinence later in life. A retrospective cohort study of 1,521 middle-aged and older women with at least one vaginal delivery who were long-term members of an integrated health delivery system. Age, race/ethnicity, current incontinence status, medical, surgical history, pregnancy and parturition history, menopausal status, hormone replacement, health habits, and general health were obtained by questionnaire. Labor and delivery records, archived since 1948, were abstracted by professional medical record abstractors to obtain parturition events including induction, length of labor stages, type of anesthesia, episiotomy, instrumental delivery, and birth weight. The primary dependent variable was current weekly urinary incontinence (once per week or more often) versus urinary incontinence less than monthly (including no incontinence) in past 12 months. Associations of parturition events and later incontinence were assessed in multivariate analysis with logistic regression. The mean age of participants was 56 years. After adjustment for multiple risk factors, weekly urinary incontinence significantly associated with age at first birth (P = 0.036), greatest birth weight (P = 0.005), and ever having been induced for labor (OR = 1.51; 95%CI = 1.06-2.16, P = 0.02). Risk of incontinence increased from OR = 1.35 (95%CI = 0.92-1.97, P = 0.12) for women with one induction to OR = 2.67 (95%CI = 1.25-5.71, P = 0.01) for women with two or more inductions (P = 0.01 for trend). No other parturition factors were associated with incontinence. Younger age at first birth, greatest birth weight, and induction of labor were associated with an increased risk of incontinence in later life. Copyright © 2011 Wiley Periodicals, Inc.

  13. Quality of life in women with urinary incontinence

    Directory of Open Access Journals (Sweden)

    DraLjiljana Mladenović Segedi

    2011-08-01

    Full Text Available Aim To determine the characteristics of urinary incontinence and its impact on the quality of life in adult women with urinary incontinence who presented to a tertiary care clinic of Vojvodina from September 2008 to May 2009 for treatment Methods We used a prospective case-control study. Cases were defined as patients (47 with urinary incontinence symptoms. Controls(50 were defined as patients without urinary incontinence who presented to a tertiary care gynecology clinic for other reasons. Both, cases and controls, completed two questionnaires recommended for the evaluation of symptoms, The Urinary Distress Inventory, and quality of life impact The Urinary Impact Questionnaire. Results There was a significant correlation between aging(r=0.614; p<0.01, body mass index (r=0.357; p<0.01 and menopause(r= -0.572; p<0.01 and urinary incontinence. All patients had symptoms of stress incontinence, 61.7% had urge incontinence symptoms, 21.3% voiding difficulty and 85.1% dysuria. Ninety-four patients believed that urinary incontinence impaired their quality of life: 50% of patients reported an impaired ability to do household activities, 59.1% avoided social activities, 70.4% reported an impaired ability to travel more than 30 minutes by car or bus, 88.6% avoided leisure activities, 45.5% of patients had impaired emotional health and 34% felt frustrated. Conclusion The dominant type of urinary incontinence in more than half of the respondents was a mixed type, with moderate to very severe problems. Symptoms of urinary incontinence interfere with the performance of everyday household and social activities, causing the appearance of anxiety, depression and frustration, and in more than 50% of women leads to reduced quality of life.

  14. Effects of aging on human skeletal muscle after immobilization and retraining

    DEFF Research Database (Denmark)

    Suetta, C; Hvid, L G; Justesen, L

    2009-01-01

    Inactivity is a recognized compounding factor in sarcopenia and muscle weakness in old age. However, while the negative effects of unloading on skeletal muscle in young individuals are well elucidated, only little is known about the consequence of immobilization and the regenerative capacity...... in elderly individuals. Thus the aim of this study was to examine the effect of aging on changes in muscle contractile properties, specific force, and muscle mass characteristics in 9 old (61-74 yr) and 11 young men (21-27 yr) after 2 wk of immobilization and 4 wk of retraining. Both young and old...

  15. The Effectiveness of Attribution Retraining on Anxiety of Students with Learning Disabilities

    OpenAIRE

    Marzieh Yahyaei; Firouzeh Sajedi; Akbar Biglarian; Ma'soumeh Pourmohammadreza-Tajrishi

    2014-01-01

    Objective: The present study aimed to determine the effectiveness of attribution retraining group program on anxiety of students with learning disabilities. Materials & Methods: In this semi-experimental study pre-test and post-test design with control group was used. Two learning disorders centers were selected on purpose and conveniently in Tehran City in 2012-13 academic years. Thirty six students (9 girls and 27 boys who were educating in 2nd to 6th grade in elementary school) with le...

  16. Guideline related to training and re-training of research reactor personnel

    International Nuclear Information System (INIS)

    1983-01-01

    The guideline, which entered into force on 1 July 1983, lays down training and re-training requirements to be met by research reactor personnel in the framework of the Radiation Protection Ordinance of 26 November 1969, the Regulation related to the Licensing of Nuclear Facilities of 21 June 1979, and the Regulation related to Further Education in the Field of Radiation Protection 27 January 1975. It contains the scope of application; the principles and objectives; the minimum requirements relating to technical qualification of plant managers, shift personnel, and responsible radiation protection officers; appointment and certification; the preservation of the technical qualification; and exceptional and transitional regulations

  17. Urinary leakage during sexual intercourse among women with incontinence: Incidence and risk factors.

    Directory of Open Access Journals (Sweden)

    Hui-Hsuan Lau

    Full Text Available Coital incontinence is an under-reported disorder among women with urinary incontinence. Women seldom voluntarily report this condition, and as such, related data remains limited and is at times conflicting.To investigate the incidence and quality of life in women with coital incontinence and to determine associated predictors.This observational study involved 505 sexually active women attending the urogynecologic clinic for symptomatic urinary incontinence at a tertiary medical center. All of the patients were consulted about the experience of coital incontinence and completed evaluations including urodynamics, and valid questionnaires including the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, the Urogenital Distress Inventory and the Incontinence Impact Questionnaire.Of these women, 281 (56% had coital incontinence, while 224 (44% did not. Among women with coital incontinence, 181 (64% had urodynamic-proven stress incontinence, 29 (10% had mixed incontinence, and 15 (5% had detrusor overactivity. Only 25 (9% sought consultation for this disorder before direct questioning. Fifty percent (84/281 of the women rarely or sometimes had incontinence during coitus, while 33% (92/281 often had incontinence, and 17% (48/281 always had incontinence. The frequency of coital incontinence was not different regarding the types of incontinence (p = 0.153. Women with mixed incontinence had the worst sexual quality of life and incontinence-related symptom distress. Based on univariate analysis, higher body mass index (OR 2.47, p = 0.027, and lower maximal urethral closure pressure (≤ 30 cmH2O (OR 4.56, p = 0.007 were possible predictors for coital incontinence. Multivariate analysis showed lower MUCP was independently significant predictors (OR3.93, p = 0.042.The prevalence of coital intercourse in urinary incontinence women was high. Coital incontinence in these women was associated with abnormal urodynamic diagnosis and

  18. Role of antimuscarinics in the treatment of nonneurogenic daytime urinary incontinence in children

    NARCIS (Netherlands)

    Nijman, RJM

    Idiopathic or "functional" urinary incontinence in children-incontinence with no known neurologic or anatomic cause-may take the form of urge incontinence, the most common type of incontinence, which is characterized by detrusor overactivity during the filling phase, or dysfunctional voiding. The

  19. In-Hospital Basic Life Support: Major Differences in Duration, Retraining Intervals, and Training Methods - A Danish Nationwide Study

    DEFF Research Database (Denmark)

    Rasmussen, Ditte K; Glerup Lauridsen, Kasper; Staerk, Mathilde

    2017-01-01

    Introduction: High-quality chest compressions and early defibrillation is essential to improve survival following in-hospital cardiac arrest. Efficient training in basic life support (BLS) for clinical staff is therefore important. This study aimed to investigate duration, training methods...... and retraining intervals for BLS training of clinical staff in Danish hospitals.Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team. Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires inquired information on: A) Course duration...... and retraining interval, and B) Training methods and setting.Results: In total, 44 hospitals replied (response rate: 96%). BLS training for clinical staff was conducted in 41 hospitals (93%). Median (Q1;Q3) course duration was 1.5 (1;2.5) hours. Retraining was conducted every year (17%), every second year (56...

  20. Spatial and temporal expression of glucocorticoid, retinoid, and thyroid hormone receptors is not altered in lungs of congenital diaphragmatic hernia

    NARCIS (Netherlands)

    Rajatapiti, Prapapan; Keijzer, Richard; Blommaart, Pietjan E.; Lamers, Wouter H.; de Krijger, Ronald R.; Visser, Theo J.; Tibboel, Dick; Rottier, Robbert

    2006-01-01

    The degree of associated pulmonary hypoplasia and persistent pulmonary hypertension are major determination factors for survival in congenital diaphragmatic hernia (CDH) patients. Glucocorticoids, thyroid hormone, and vitamin A have been shown to be involved in human lung development. To determine

  1. [Urine incontinence referral criteria for primary care].

    Science.gov (United States)

    Brenes Bermúdez, F J; Cozar Olmo, J M; Esteban Fuertes, M; Fernández-Pro Ledesma, A; Molero García, J M

    2013-05-01

    Despite the high incidence of urinary incontinence (UI), health professional awareness of this disease is low, which in itself is not serious but significantly limits the lives of the patients. The Primary Care associations, Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Médicos Generales y de Familia [SEMG], Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) along with the Asociación Española de Urología (EAU) have developed this consensus with the proposal of making GPs aware, and to help them in the diagnosis, treatment and referral to Urologists. The first goal in primary care must be the detection of UI, thus an opportunistic screening at least once in the lifetime of asymptomatic women > 40 years old and asymptomatic men > 55 years old. The diagnosis, based on medical history and physical examination, must determine the type and severity of the UI in order to refer severe cases to the Urologist. Except for overactive bladder (OAB), non-pharmacological conservative treatment is the first approach to uncomplicated UI in females and males. Antimuscarinics are the only drugs that have demonstrated efficacy and safety in urge urinary incontinence (UUI) and OAB. In men with mixed symptoms, excluding severe obstruction cases, a combination therapy of alpha-blockers and antimuscarinics should be chosen. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  2. Surgical Management of Post-Prostatectomy Incontinence

    Directory of Open Access Journals (Sweden)

    Arthi Satyanarayan

    2016-04-01

    Full Text Available Post-prostatectomy incontinence (PPI is a common and significant issue that can affect the quality of life in men who are undergoing treatment for prostate cancer. While some patients opt for conservative management of their incontinence, many elect to undergo surgical treatment as a result of the significant impact to quality of life. The most commonly employed surgical techniques to address PPI are placement of a male sling or artificial urinary sphincter (AUS. Currently, the AUS continues to serve as the gold standard for management, with robust data concerning longitudinal outcomes available. However, in recent years, the various methods to place the male sling have emerged as viable, less complex alternatives that avoid the need for pump manipulation. In the present review, we discuss these main surgical treatment modalities for PPI, and focus on the selection criteria that may influence appropriate operative stratification of PPI patients. Indeed, an individualised, comprehensive assessment of baseline urinary function, age, radiation, prior surgeries, functional status, and other comorbidities must be considered in the context of shared decision-making between the treatment provider and the patient in determining the optimal approach to managing PPI.

  3. Promoting Positive Learning in Australian Students Aged 10- to 12-Years-Old Using Attribution Retraining and Cognitive Behavioral Therapy: A Pilot Study

    Science.gov (United States)

    Chodkiewicz, Alicia R; Boyle, Christopher

    2016-01-01

    This study piloted an intervention using attribution retraining and cognitive behavioral therapy techniques to promote positive learning experiences and outcomes for students. This research is an important step to revitalise the dwindling field of attribution retraining research by assessing whether these techniques effectively improve student…

  4. Reliability and validity of the Incontinence Quiz-Turkish version.

    Science.gov (United States)

    Kara, Kerime C; Çıtak Karakaya, İlkim; Tunalı, Nur; Karakaya, Mehmet G

    2018-01-01

    The aim of this study was to investigate the reliability and validity of the Turkish version of the Incontinence Quiz, which was developed by Branch et al. (1994), to assess women's knowledge of and attitudes toward urinary incontinence. Comprehensibility of the Turkish version of the 14-item Incontinence Quiz, which was prepared following translation-back translation procedures, was tested on a pilot group of eight women, and its internal reliability, test-retest reliability and construct validity were assessed in 150 women who attended the gynecology clinics of three hospitals in İçel, Turkey. Physical and sociodemographic characteristics and presence of incontinence complaints were also recorded. Data were analyzed at the 0.05 alpha level, using SPSS version 22. The scale had good reliability and validity. The internal reliability coefficient (Cronbach α) was 0.80, test-retest correlation coefficients were 0.83-0.94; and with regard to construct validity, Kaiser-Meyer-Olkin coefficient was 0.76 and Barlett sphericity test was 562.777 (P = 0.000). Turkish version of the Incontinence Quiz had a four-factor structure, with Eigenvalues ranging from 1.17 to 4.08. The Incontinence Quiz-Turkish version is a highly comprehensible, reliable and valid scale, which may be used to assess Turkish-speaking women's knowledge of and attitudes toward urinary incontinence. © 2017 Japan Society of Obstetrics and Gynecology.

  5. Effectiveness of a visual attention retraining program on the driving performance of clients with stroke.

    Science.gov (United States)

    Mazer, Barbara L; Sofer, Susan; Korner-Bitensky, Nicol; Gelinas, Isabelle; Hanley, James; Wood-Dauphinee, Sharon

    2003-04-01

    To compare the effectiveness of a visual attention retraining program using the Useful Field of View (UFOV) with a traditional visuoperception treatment program on the driving performance of clients with stroke. Randomized controlled trial. Rehabilitation hospital located in Quebec, Canada. Ninety-seven individuals referred for driving evaluation after a stroke. Participants were randomized to receive 20 sessions of either UFOV training of visual processing speed, divided attention, and selective attention or traditional computerized visuoperception retraining. Subjects were evaluated with an on-road driving evaluation, visuoperception tests, and the Test of Everyday Attention. An occupational therapist unaware of group assignment conducted all evaluations. Eighty-four participants completed the outcome evaluation. There were no significant differences between groups on any of the outcome measures. There was, however, almost a 2-fold increase (52.4% vs 28.6%) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions. Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation. However, results suggest a potential improvement for subjects with right-sided lesions, indicating that training must target specific skills.

  6. Skeletal muscle adaptation to immobilization and subsequent retraining in elderly men

    DEFF Research Database (Denmark)

    Dideriksen, K; Boesen, A P; Kristiansen, J F

    2016-01-01

    BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) may enhance resistance training induced gain in skeletal muscle mass and strength, but it is unknown if NSAIDs affects muscle loss during periods of inactivity in elderly individuals. Thus, we studied the influence of NSAID treatment on h...... weeks of retraining and whey protein supplementation. After 6weeks of retraining and whey protein supplementation, muscle mass and strength increased beyond baseline levels, and NSAID treatment did not significantly influence this in elderly.......BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) may enhance resistance training induced gain in skeletal muscle mass and strength, but it is unknown if NSAIDs affects muscle loss during periods of inactivity in elderly individuals. Thus, we studied the influence of NSAID treatment...... isolate was ingested (2×20g/d) throughout the whole study period. Plasma inflammatory markers, quadriceps muscle mass and strength, and muscle gene expression were investigated. RESULTS: Muscle mass and strength decreased after 2weeks of immobilization (P

  7. Impact of identifying factors which trigger bothersome tinnitus on the treatment outcome in tinnitus retraining therapy.

    Science.gov (United States)

    Molini, Egisto; Faralli, Mario; Calzolaro, Lucia; Ricci, Giampietro

    2014-01-01

    The aim of this work was to ascertain any differences in the effectiveness of rehabilitation therapy in relation to the presence or absence of a known negative reinforcement responsible for the tinnitus-related pathology. Between 1 January 2001 and 31 December 2008, we recruited 294 subjects suffering from incapacitating tinnitus and/or hyperacusis. The patients underwent tinnitus retraining therapy (TRT) according to the methods described by Jastreboff and Hazell [Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. Cambridge, Cambridge University Press, 2004, pp 121-133]. We clinically assessed the presence or absence of known phenomena of associative learning, regarding the presence of adverse events temporally correlated with tinnitus and the treatment outcome. The separate analysis of the 2 subgroups shows a statistically significant difference in the improvement rate between the group with a known triggering factor and the group without a triggering factor, with a preponderance of the former with a 91% improvement rate versus approximately 56% for the latter. In our study, the inability to identify factors triggering bothersome tinnitus negatively affected the treatment outcome in TRT. © 2014 S. Karger AG, Basel.

  8. Urodynamic study in women with pure stress urinary incontinence.

    Science.gov (United States)

    Valdevenito, J P; Águila, F; Naser, M; Manríquez, V; Wenzel, C; Díaz, J P

    2015-03-01

    To describe the results of urodynamic study in women with pure stress urinary incontinence symptoms, including the characteristics of the overactive detrusor. No other clinical assessments were taken into account. A retrospective study in women with urinary incontinence consecutively evaluated by urodynamic study. From a total of 710 women, only 108 (15%) with pure stress urinary incontinence symptoms were selected. Women with prior urinary incontinence surgery, pelvic organ prolapse (stage ≥iii), pelvic radiotherapy, using medication active on the lower urinary tract and neurological diseases were excluded. Infusion rate was 70 ml/min. Detrusor overactivity was induced only by cough. A standardized cough stress test with progressive cough intensity was carried out. Reference urodynamic values for stress incontinent women are described. Urodynamic stress incontinence was observed in 79 women (73.1%), detrusor overactivity in 4 (3.7%) and mixed urodynamic diagnosis in 15 (13.8%). Test was inconclusive in 10 patients (9.2%). Two women had detrusor overactivity incontinence (1.9%). One patient had detrusor overactivity induced by cough without urodynamic stress incontinence (0.9%). There was an association between detrusor overactivity and nocturia ≥2 (P=.002; odds ratio: 3.74; 95% confidence interval: 1.22-11.39). One woman had a bladder outlet obstruction (0.9%). In women with pure stress urinary incontinence, without knowing the outcome of other clinical assessments, urodynamic study can provide useful information to define the proper therapy. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Lower Urinary Tract Symptoms and Urinary Incontinence During Pregnancy.

    Science.gov (United States)

    Balik, Gülşah; Güven, Emine Seda G; Tekin, Yeşim B; Şentürk, Şenol; Kağitci, Mehmet; Üstüner, Işık; Mete Ural, Ülkü; Şahin, Figen K

    2016-05-01

    Lower urinary tract symptoms (LUTS) can frequently be seen in pregnant women. Pregnancy and delivery have been considered as risk factors in the occurrence of pelvic floor dysfunction and determinants of LUTS. The main associated risk factor is parity. In the present study, we aim to determine the frequency of LUTS and urinary incontinence (UI) during pregnancy and the associated risk factors. This prospective study was carried out in a total of 250 women during their 28- and 40-gestational week checks. The Urinary Distress Inventory-6, the Incontinence Impact Questionnaire-7, and International Consultation on Incontinence Questionnaire-Short Form were used to determine LUTS and its effect on quality of life. The mean age and gestational age of the participants were 29.41 ± 5.70 year (range 18-44) and 35.45 ± 2.98 weeks (range 28-40), respectively. The prevalence of LUTS was 81.6%. The prevalence of UI during pregnancy was 37.2%. Stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were diagnosed as 15.6, 4.8 and 16.8%, respectively. We found that advanced age, smoking and multiparity were risk factors associated with incontinence. Incontinence reduced pregnant women's quality of life. Lower urinary tract symptoms are commonly seen among pregnant women and these symptoms negatively affect the quality of life of pregnant women. Advanced age, smoking and multiparity were risk factors associated with urinary incontinence and LUTS. Obstetricians should be on the lookout for individual urological problems in pregnancy. Resolving any urological issues and cessation of smoking for the affected individuals will help alleviate the problem. © 2014 Wiley Publishing Asia Pty Ltd.

  10. Delayed Presentation of Traumatic Diaphragmatic Hernia: The Evaluation of Surgical Treatment Results

    Directory of Open Access Journals (Sweden)

    Ali Sadrizadeh

    2015-06-01

    Full Text Available Introduction: Diaphragmatic hernia could be caused by congenital disorders, blunt trauma or penetrating injuries. The diagnosis of traumatic diaphragmatic hernia is normally neglected during the first presentation leading to late complications and considerably increased mortality and morbidity among the patients. Materials and Methods: In this retrospective, descriptive study, we reviewed the medical records of patients presented with traumatic diaphragmatic hernia who had undergone surgical operations between 1982-2015 in Ghaem Hospital and Omid Hospital affiliated to Mashhad University of Medical Sciences, Iran. The studied variables included age, gender, clinical symptoms, location of hernia, involved organs, type of imaging modalities, surgical techniques, length of hospital stay, mortality rate and surgical complications. Results: In this study, 38 patients were diagnosed with traumatic diaphragmatic hernia consisting of 28 men and 10 women. In total, 79% and 21% of the patients suffered from penetrating trauma and blunt trauma, respectively. In addition, left-sided, right-sided and bilateral hernias were present in 33%, 4% and 1% of the patients, respectively. The most frequently herniated organ was the stomach, and the most common clinical symptoms were abdominal pain (84% and dyspnea (53%. Initially, chest radiographs were performed on all the patients, and thoracotomy was performed to repair diaphragmatic tears in all the cases (100%. In this study, 3 patients had previously undergone Hartmann’s operation for gangrenous herniated colon, and devolvulation of gastric volvulus had also been performed on 3 patients. The main post-operative complications were reported to be pneumonia and respiratory insufficiency (2 cases, and the mean length of hospital stay was 6 days (5-8 days which was longer (1-2 months in patients with gangrenous bowel (3 patients. Furthermore, no mortality was reported during the course of hospitalization in these

  11. Therapeutic effects of diaphragmatic plication for acquired unilateral non-malignant diaphragm paralysis in twenty patients

    Directory of Open Access Journals (Sweden)

    Reza Bagheri

    2013-12-01

    Full Text Available Background: Acquired paralysis of the diaphragm is a condition caused by trauma, surgical injuries, (lung cancer surgery, esophageal surgery, cardiac surgery, thoracic surgery, and is sometimes of an unknown etiology. It can lead to dyspnea and can affect ventilatory function and patients activity. Diaphragmatic plication is a treatment method which decreases inconsistent function of diaphragm. The aim of this study is to evaluate the outcome of diaphragmatic plication in patients with acquired unilateral non-malignant diaphragmatic paralysis. Methods: From 1991 to 2011, 20 patients with acquired unilateral diaphragmatic paralysis who underwent surgery enrolled in our study in Ghaem Hospital Mashhad University of Medical Science. Patients were evaluated in terms of age, sex, BMI, clinical symptoms, dyspnea score (DS, etiology of paralysis, diagnostic methods, respiratory function tests and complication of surgery. Some tests including dyspnea score were carried out again six months after surgery. We evaluated patients with SPSS version 11.5 and Paired t-test or nonparametric equivalent. Results: Twenty patients enrolled in our study. 14 were male and 6 were female. The mean age was 58 years and the average time interval between diagnosis to surgical treatment was 38.3 months. Acquired diaphragmatic paralysis was mostly caused by trauma (in 11 patients and almost occurred on the left side (in 15 patients. Diagnostic methods included chest x-ray, CT scan, ultrasonography and sniff. Test prior to surgery the average FVC was 41.4±7 percent and the average FEV1 was 52.4±6 percent and after surgery they were 80.1±8.6 percent and 74.4±1 percent respectively. The average increase in FEV1 and FVC 63.4±4, 61.1±7.8. Performing surgery also leads to a noticeable improvement in dyspnea score in our study. Conclusion: In patients with acquired unilateral non-malignant diaphragm paralysis diaphragmatic plication is highly recommended due to the

  12. Bowel retraining

    Science.gov (United States)

    ... exercises. BIOFEEDBACK Biofeedback gives you sound or visual feedback about a bodily function. In people with fecal ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

  13. Bladder Retraining

    Science.gov (United States)

    ... Gifts & Estate Planning Donor Stock Transfer Instructions IC Charity in Combined Federal Campaign ICA Resources for Donors ... floor dysfuction. How Long Does It Take to Work? If urinary urgency and frequency are your only ...

  14. Vascular incontinence: incontinence in the elderly due to ischemic white matter changes

    Directory of Open Access Journals (Sweden)

    Ryuji Sakakibara

    2012-09-01

    Full Text Available This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD. The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normalpressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.

  15. Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence.

    Science.gov (United States)

    Wagg, Adrian; Gibson, William; Ostaszkiewicz, Joan; Johnson, Theodore; Markland, Alayne; Palmer, Mary H; Kuchel, George; Szonyi, George; Kirschner-Hermanns, Ruth

    2015-06-01

    Evidence based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management. To update the recommendations of the 4th ICI. A series of systematic reviews and evidence updates were performed by members of the working group in order to update the 2009 recommendations. The resulting guidelines were presented at the 2012 meeting of the European Associatioon of Urology. Along with the revision of the treatment algorithm and accompanying text. There have been significant advances in several areas including pharmacological treatment of overactive bladder. The committee continue to notes the relative paucity of data concerning frail older persons and draw attention to knowledge gaps in this area. © 2014 Wiley Periodicals, Inc.

  16. Diagnosis and management of urinary incontinence and functional fecal incontinence (encopresis) in children.

    Science.gov (United States)

    Nijman, Rien J M

    2008-09-01

    The ability to maintain normal continence for urine and stools is not achievable in all children by a certain age. Gaining control of urinary and fecal continence is a complex process, and not all steps and factors involved are fully understood. While normal development of anatomy and physiology are prerequisites to becoming fully continent, anatomic abnormalities, such as bladder exstrophy, epispadias, ectopic ureters, and neurogenic disturbances that can usually be recognized at birth and cause incontinence, will require specialist treatment, not only to restore continence but also to preserve renal function. Most forms of urinary incontinence are not caused by an anatomic or physiologic abnormality and, hence, are more difficult to diagnose and their management requires a sound knowledge of bladder and bowel function.

  17. Urinary incontinence: hospital-based prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Marzieh Nojomi

    2008-02-01

    Full Text Available

    • BACKGROUND: This study was carried out to determine the prevalence and risk factors of urinary incontinence in women aged 30 to 70 years, who were attending to a gynecologic hospital.
    • METHODS: During 2006, married women (aged 30-70 years attending to a teaching gynecological hospital were assessed during their visits for any gynecologic diseases. We used a questionnaire with interview for collecting data. The potential risk factors were measured; i.e., the demographics, menopausal status, urinary symptoms (frequency, nocturia and urgency, urinary incontinence, (urgency, stress and mixed, body mass index, medical history (type of delivery, parity, gravidity, chronic illnesses, medication use, pelvic surgery and seeking medical care for their problem.
    • RESULTS: The mean age was 46.5 (± 8.4 years. The mean parity was 5.1 ± 1.5. 27% of the participants reported urinary incontinence. Out of 111 women with urinary incontinence, 77 (18.7%, CI: 14.7-22.7%, 17 (4.1%, CI: 2.2-5.8% and 17 (4.1%, CI: 2.2-5.8% were classified as having stress, urge and mixed urinary incontinence, respectively. The overall prevalence of urinary incontinence was 18.9% (34 subjects in women aged 30-44 years, 30.9% (46 subjects in those aged 45-54 years and 37.8% (31 subjects in those aged 55 years and older. Out of 117 menopause women, 39 (33.3% were incontinent. On average, women reported 4.4 (± 1.06 diurnal and 0.55 (± 0.66 nocturnal voidings in 24 hours. Diurnal and nocturnal frequencies were different between continent and incontinent women. The high parity, excessive birth weight, pelvic trauma, constipation, chronic illnesses (specially diabetes and gynecologic and other pelvic surgeries were known as risk factors for urinary incontinence.>
    • CONCLUSIONS: There was a significant association between urinary incontinence and high parity, excessive birth weight, pelvic

    • Obesity, overweight, and eating problems in children with incontinence.

      Science.gov (United States)

      Wagner, Catharina; Equit, Monika; Niemczyk, Justine; von Gontard, Alexander

      2015-08-01

      The aim was to analyze the prevalence of eating problems and specific associations between overweight, obesity, and eating behavior in children with incontinence. Forty-three consecutively presented children with incontinence, diagnosed to International Children's Continence Society standards, and 44 matched continent controls were examined prospectively. All children received a physical examination, sonography, and a one-dimensional intelligence test. Child psychopathology was measured with the Child Behavior Checklist (CBCL/4-18). Eating problems were assessed with the German version of the Dutch Eating Behaviour Questionnaire for Children (DEBQ-C) and a 40-item-parental questionnaire referring to atypical eating problems. Of the 43 children with incontinence, 23.3% had nocturnal enuresis (NE) only, 37.2% had any form of daytime urinary incontinence (DUI) (isolated or combined with NE) and 39.5% had fecal incontinence (FI) (isolated or combined with NE and/or DUI). Incontinent children showed significantly more CBCL externalizing symptoms (35.7% vs. 6.8%) and total problems (46.3% vs. 6.8%) in the clinical range (>90th percentile), as well as significantly lower mean IQ (105.5 vs. 120.6) than continent controls. Of the children with incontinence, 16.9% were affected by obesity (≥95th body mass index [BMI] percentile) compared with none of the continent controls. Especially in children with FI, the rate of obesity was significantly increased (23.5%). In addition, 46.5% of incontinent children, but none of the controls, had constipation. Again, children with FI (82.4%) had the highest rate of constipation (>DUI: 25% > NE only: 20%). "Food refusal" (FR) and "intense fear of gaining weight" (GW), but not other eating problems, were significantly more common among incontinent children (FR mean score 7.3; GW mean score 1.4) than in controls (FR mean score 5.6; GW mean score 0.7). After controlling for BMI percentiles, FR still was significantly higher in

    • Diagnosis and conservative management of female stress urinary incontinence

      Directory of Open Access Journals (Sweden)

      Anil Krishna Dass

      2013-05-01

      Full Text Available Urinary incontinence affects 17–45% of women worldwide and stress urinary incontinence is responsible for 48% of all cases. Detailed history, physical examination and investigations are crucial to identify the diagnosis underlying the incontinence symptoms to select effective therapy. Although mid-urethral sling procedures are considered to be ‘gold standard’ treatment of SUI, conservative treatment with pelvic floor muscle training and lifestyle modification is still the first line of management. This article discusses the diagnosis and conservative management of female SUI.

    • An Unusual Cause of Urinary Incontinence: Ewing's Sarcoma

      Directory of Open Access Journals (Sweden)

      Serhan Kupeli

      2015-03-01

      Full Text Available Urinary incontinence in children can be originated mostly from urinary tract infections, but constipation, neurologic disorders, obstruction and tumors can also be considered among other causes. Pelvic tumors may present with back pain, bladder or bowel dysfunction. Ewing's sarcoma is among the small round-cell tumors of the childhood and potentially can arise from any part of the body. Here, we report an 11-year-old male presented with urinary incontinence and diagnosed as Ewing's sarcoma after 6 weeks' delay. Clinicians should suspect from pelvic tumors in the presence of urinary incontinence especially associated with low back pain. [Cukurova Med J 2015; 40(Suppl 1: 94-96

  1. Surgery versus physiotherapy for stress urinary incontinence.

    Science.gov (United States)

    Labrie, Julien; Berghmans, Bary L C M; Fischer, Kathelijn; Milani, Alfredo L; van der Wijk, Ileana; Smalbraak, Dina J C; Vollebregt, Astrid; Schellart, René P; Graziosi, Giuseppe C M; van der Ploeg, J Marinus; Brouns, Joseph F G M; Tiersma, E Stella M; Groenendijk, Annette G; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E; Adriaanse, Albert H; Schram, Aaltje; Roovers, Jan-Paul W R; Lagro-Janssen, Antoine L M; van der Vaart, Carl H

    2013-09-19

    Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial therapy. We performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence. Crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months. We randomly assigned 230 women to the surgery group and 230 women to the physiotherapy group. A total of 49.0% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. In an intention-to-treat analysis, subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference, 26.4 percentage points; 95% confidence interval [CI], 18.1 to 34.5). The rates of subjective cure were 85.2% in the surgery group and 53.4% in the physiotherapy group (absolute difference, 31.8 percentage points; 95% CI, 22.6 to 40.3); rates of objective cure were 76.5% and 58.8%, respectively (absolute difference, 17.8 percentage points; 95% CI, 7.9 to 27.3). A post hoc per-protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery. For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).

  2. [The artificial sphincter: therapy for faecal incontinence].

    Science.gov (United States)

    Baumgartner, U

    2012-08-01

    Faecal incontinence (FI) challenges a patient's professional, social and sexual life. Often the patient becomes depressive and socially isolated. If able to break open for therapy the patient should receive as first line a conservative treatment (like dietary measures, pelvic re-education, biofeedback, bulking agents, irrigation). When is the time to implant an artificial anal sphincter? If conservative therapy fails as well as surgical options (like a sphincteroplasty - if indicated a reconstruction of the pelvic floor if insufficient, or a sacral nerve stimulation) an ultimo surgical procedure should be offered to appropriate and compliant patients: an artificial anal sphincter. Worldwide, there are two established devices on the market: the artificial bowel sphincter® (ABS) from A. M. S. (Minnetonka, MN, USA) and the soft anal band® from A. M. I. (Feldkirch, Austria). How to implant the artificial anal sphincter? Both devices consist of a silicon cuff which can be filled with fluid. Under absolute aseptic conditions this cuff is placed in the lithotomy position by perianal incisions around the anal canal below the pelvic floor. A silicon tube connects the anal cuff with a reservoir (containing fluid) which is placed either behind the pubis bone in front of the bladder (ABS) or below the costal arch (anal band). With a pump placed in the scrotum/labia (ABS) or by pressing the balloon (anal band) in both types operated by the patient the fluid is shifted forth and back between the anal cuff and the reservoir closing or opening the anal canal. Both systems are placed completely subcutaneously. Both devices improve significantly the anal continence. Both systems have a high rate of reoperations. However, the causes for the redos are different. The ABS is associated with high infection and anal penetration rates of the cuff leading to an explantation rate to up to 60 % of the implants. This kind of complication seems to be much lower with the anal band. The major

  3. Transient mega-esophagus in a neonate with congenital diaphragmatic hernia

    International Nuclear Information System (INIS)

    Makhoul, I.R.; Smolkin, T.; Sujov, P.; Shoshany, G.; Epelman, M.

    2001-01-01

    Esophageal dilatation (ED) in neonates is rare. In the present case, ED was detected in a chest radiograph following repair of congenital diaphragmatic hernia (CDH) in a term neonate. A roentgenographic swallow study on the seventh day of life demonstrated ED and a sub-diaphragmatic stomach. The infant thrived adequately on enteral feeding. A swallow study on the twentieth day of life showed a normal-width esophagus with gastroesophageal reflux and small hiatus hernia. The longstanding herniated stomach in the fetus apparently caused kinking, edema, and obstruction of the gastroesophageal junction. This led to a significant ED and concealment of gastroesophageal reflux. We aim to arouse awareness about the occurrence of ED with CDH, and about its benign course under conservative management. (orig.)

  4. [Phrenic nerve stimulation protects against mechanical ventilation-induced diaphragmatic dysfunction through myogenic regulatory factors].

    Science.gov (United States)

    An, G H; Chen, M; Zhan, W F; Hu, B; Zhang, H X

    2018-02-12

    Objective: To explore the protective effect of electrical stimulation of phrenic nerve on diaphragmatic function during mechanical ventilation. Methods: Forty healthy adult SD rats were randomly divided into 5 groups: blank control group (BC), spontaneous breathing group (SB), electrical stimulation group (ES), mechanical ventilation group (MV), and electrical stimulation and mechanical ventilation group (MS). The rats in each group were treated for 18 h except for the BC group. After treatment, the diaphragm muscle tissue was obtained and the diaphragm contractility including peak-to-peak value(Vpp) and maximum rate of contraction(+ dT/dt max) were measured. Expression of MyoD and myogenin were detected. Results: Except for the ES and the MS groups, there was a significant difference for peak-to-peak value (Vpp) between each 2 groups ( P mechanical ventilation induced diaphragmatic function damage, and therefore plays a protective effect on the diaphragm.

  5. Effect of upper costal and costo-diaphragmatic breathing types on electromyographic activity of respiratory muscles.

    Science.gov (United States)

    Celhay, Isabel; Cordova, Rosa; Miralles, Rodolfo; Meza, Francisco; Erices, Pia; Barrientos, Camilo; Valenzuela, Saúl

    2015-04-01

    To compare electromyographic (EMG) activity in young-adult subjects with different breathing types. This study included 50 healthy male subjects with complete natural dentition, and no history of orofacial pain or craniomandibular-cervical-spinal disorders. Subjects were classified into two groups: upper costal breathing type, and costo-diaphragmatic breathing. Bipolar surface electrodes were located on sternocleidomastoid, diaphragm, external intercostal, and latissimus dorsi muscles. Electromyographic activity was recorded during the following tasks: (1) normal quiet breathing; (2) speaking the word 'Mississippi'; (3) swallowing saliva; and (4) forced deep breathing. Sternocleidomastoid and latissimus dorsi EMG activity was not significantly different between breathing types, whereas diaphragm and external intercostal EMG activity was significantly higher in the upper costal than costo-diaphragmatic breathing type in all tasks (P<0·05; Wilcoxon signed rank-sum test). Diaphragm and external intercostal EMG activity suggests that there could be differences in motor unit recruitment strategies depending on the breathing type.

  6. Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature.

    Science.gov (United States)

    Aissa, Sana; Benzarti, Wafa; Alimi, Faouzi; Gargouri, Imen; Salem, Halima Ben; Aissa, Amène; Fathallah, Khadija; Abdelkade, Atef Ben; Alouini, Rafika; Garrouche, Abdelhamid; Hayoun, Abdelaziz; Abdelghani, Ahmed; Benzarti, Mohamed

    2017-01-01

    Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.

  7. Case report: Non-invasive neurally adjusted ventilatory assist in a newborn with unilateral diaphragmatic paralysis.

    Science.gov (United States)

    Roosens, Sander; Derriks, Frank; Cools, Filip

    2016-11-01

    Diaphragmatic paralysis is a rare cause of respiratory distress in the newborn. In this paper, a patient with unilateral phrenic nerve injury after traumatic delivery is presented. The child inadequately responded to standard respiratory supportive measures. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA®), providing an optimally synchronized respiratory support proportional to the effort of the patient, resulted in prompt clinical and biological improvement of the patient's respiratory condition. NAVA is a relatively new mode of ventilation in neonatal care. In this case of unilateral diaphragmatic paralysis, it provided an alternative strategy of non-invasive respiratory support avoiding prolonged mechanical ventilation. Pediatr Pulmonol. 2016;51:E37-E39. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. Fluorouracil implants caused a diaphragmatic tumor to be misdiagnosed as liver metastasis: a case report

    International Nuclear Information System (INIS)

    Shen, Yang-Yang; Qin, Hong-Wei; Zhang, Jian-Bo; Wang, Zhen-Dan; Li, Pang; Pang, Kai; Zhang, Bo; Li, Sheng; Cui, Kai

    2016-01-01

    Fluorouracil implants are widely used in peritoneal interstitial chemotherapy. Curative effects have been obtained, but implants have also caused some complications. We performed an analysis of a 66-year-old male patient’s case history, as well as conventional pathological analysis and Raman spectroscopic detection of the diaphragmatic tumor. We also analyzed the underlying causes of this condition to prevent complications and reduce misdiagnoses in future cases. The patient had a history of peritoneal fluorouracil implantation. Pathological analysis of the diaphragmatic mass revealed foreign particles, and Raman detection showed that the mass contained fluorouracil. Fluorouracil implants may persist due to the high concentrations of this drug used in peritoneal chemotherapy. This finding should provide guidance and improve the application of peritoneal implants. In clinical trials, and the diagnosis of liver metastasis should be based on pathological results

  9. Transient megaoesophagus and oesophagitis following diaphragmatic rupture repair in a cat.

    Science.gov (United States)

    Joseph, Rotem; Kuzi, Sharon; Lavy, Eran; Aroch, Itamar

    2008-07-01

    A 6-month-old domestic shorthair female cat was presented with suspected diaphragmatic hernia (DH) that was later confirmed by thoracic radiography. The cat underwent exploratory celiotomy with a diaphragmatic rupture (DR) repair and recovered. Six days later, it was represented with vomiting and anorexia. Megaoesophagus (MO) and gastric dilatation were diagnosed by contrast radiography. A second celiotomy revealed no abnormalities and gastropexy was performed. Endoscopy demonstrated MO, oesophagitis and gastro-oesophageal reflux. MO persisted for several weeks and was an unexpected complication as no association between DR (or DH) and MO has never been described in the veterinary literature. The cat was treated medically with aggressive prokinetic and antacid therapy along with prolonged temporary oesophageal diversion (percutaneous endoscopic gastrostomy tube) with an excellent outcome.

  10. Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma

    Directory of Open Access Journals (Sweden)

    H. Hoffmann

    2010-01-01

    Full Text Available Blunt traumatic diaphragmatic rupture (BTDR is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

  11. Transient mega-esophagus in a neonate with congenital diaphragmatic hernia

    Energy Technology Data Exchange (ETDEWEB)

    Makhoul, I.R.; Smolkin, T.; Sujov, P. [Dept. of Neonatology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa (Israel); Shoshany, G. [Dept. of Pediatric Surgery, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Bat-Galim, Haifa (Israel); Epelman, M. [Dept. of Radiology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Bat-Galim, Haifa (Israel)

    2001-05-01

    Esophageal dilatation (ED) in neonates is rare. In the present case, ED was detected in a chest radiograph following repair of congenital diaphragmatic hernia (CDH) in a term neonate. A roentgenographic swallow study on the seventh day of life demonstrated ED and a sub-diaphragmatic stomach. The infant thrived adequately on enteral feeding. A swallow study on the twentieth day of life showed a normal-width esophagus with gastroesophageal reflux and small hiatus hernia. The longstanding herniated stomach in the fetus apparently caused kinking, edema, and obstruction of the gastroesophageal junction. This led to a significant ED and concealment of gastroesophageal reflux. We aim to arouse awareness about the occurrence of ED with CDH, and about its benign course under conservative management. (orig.)

  12. Correlates of urinary incontinence in pregnancy

    DEFF Research Database (Denmark)

    Hvidman, Lone; Foldspang, Anders; Mommsen, S.

    2002-01-01

    for the nulliparous and the primiparous, respectively. The present data suggest pregnancy UI not to be provoked by the mere onset of pregnancy, but by increasing hormonal concentrations or local tissue changes caused by hormones, whereas there was no support for a theory based on increasing pressure on the bladder......In a population sample, the period prevalence of urinary incontinence (UI) during pregnancy was found to be 19.9% and 24.1% among 352 nulliparous and 290 primiparous women, respectively. The first UI episode ever was experienced by 16.7% and 7.0% during the two last trimesters of the first...... and second pregnancies, respectively. None of the pregnancy-specific risk factors, such as emesis and birthweight, was significantly associated with UI during pregnancy. Previous UI was a significant risk factor for period prevalent UI during pregnancy, explaining 34% and 83% of pregnancy UI...

  13. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature......, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed since the last consultation 4 years previously. Where...... possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition...

  14. Risk factors for postpartum urinary incontinence

    Directory of Open Access Journals (Sweden)

    Lígia da Silva Leroy

    2016-04-01

    Full Text Available Abstract OBJECTIVE: To investigate the risk factors for postpartum urinary incontinence (UI and its characteristics. METHOD: This was a case-control study with 344 puerperal women (77 cases and 267 controls with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. RESULTS: Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, p<0.0001, multiparity (OR 2.26, CI 95% 1.22 - 4.19, p=0.009, gestational age at birth greater or equal to 37 weeks (OR 2.52, CI 95% 1.16 - 5.46, p=0.02 and constipation (OR 1.94, CI 95% 1.05 - 5.46, p=0.035. CONCLUSION: Most often, UI first appeared during pregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent.

  15. Incarcerated Diaphragmatic Hernia with Bowel Perforation Presenting as a Tension Pneumothorax

    Directory of Open Access Journals (Sweden)

    Ryan P. Offman

    2014-03-01

    Full Text Available We present an interesting case of a patient with a previously known diaphragmatic hernia in which the colon became incarcerated, ischemic and finally perforated. She had no prior history of abdominal pain or vomiting, yet she present with cardiovascular collapse. To our knowledge, this is the only case report of a tension pneumothorax associated with perforated bowel that was not in the setting of trauma or colonoscopy. [West J Emerg Med. 2014;15(2:142-144.

  16. Diaphragmatic Breathing during Virtual Reality Exposure Therapy for Aviophobia: Functional Coping Strategy or Avoidance Behavior?

    OpenAIRE

    Mühlbauer, Andreas; Shiban, Youssef; Diemer, Julia Elisabeth; Müller, Jana; Brütting-Schick, Johanna; Pauli, Paul

    2017-01-01

    Background Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment. Method Twenty-nine patients with aviophobia were randomly a...

  17. The problem of sterility in men and women after wide area sub-diaphragmatic irradiation

    International Nuclear Information System (INIS)

    Dana, M.; Weisgerber, C.; Teillet, F.; Desprez-Curely, J.P.; Goguel, A.; Chotin, G.; Bernard, J.

    1976-01-01

    Sub-diaphragmatic irradiation in an upside down Y pattern for Hodgkin's disease results in sterility in the woman. Protection consists of irradiating the lumbar chain only when possible or by displacement of the ovary before irradiation, and laterally for preference. Although subsequent pregnancy is then possible, the genetic risk remains. In the male, Y irradiation results in prolonged virtually complete azoospermia. Associated chemotherapy also causes definitive sterility in the male. Collection for a sperm bank before treatment is advised [fr

  18. Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants.

    Science.gov (United States)

    Moyer, V; Moya, F; Tibboel, R; Losty, P; Nagaya, M; Lally, K P

    2002-01-01

    Congenital diaphragmatic hernia, although rare (1 per 2-4,000 births), is associated with high mortality and cost. Opinion regarding the timing of surgical repair has gradually shifted from emergent repair to a policy of stabilization using a variety of ventilatory strategies prior to operation. Whether delayed surgery is beneficial remains controversial. To summarize the available data regarding whether surgical repair in the first 24 hours after birth rather than later than 24 hours of age improves survival to hospital discharge in infants with congenital diaphragmatic hernia who are symptomatic at or immediately after birth. Search of MEDLINE (1966-2002), EMBASE (1978-2002) and the Cochrane databases using the terms "congenital diaphragmatic hernia" and "surg*"; citations search, and contact with experts in the field to locate other published and unpublished studies. Studies were eligible for inclusion if they were randomized or quasi-randomized trials that addressed infants with CDH who were symptomatic at or shortly after birth, comparing early (24 hours) surgical intervention, and evaluated mortality as the primary outcome. Data were collected regarding study methods and outcomes including mortality, need for ECMO and duration of ventilation, both from the study reports and from personal communication with investigators. Analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. Two trials met the pre-specified inclusion criteria for this review. Both were small trials (total n<90) and neither showed any significant difference between groups in mortality. Meta-analysis was not performed because of significant clinical heterogeneity between the trials. There is no clear evidence which favors delayed (when stabilized) as compared with immediate (within 24 hours of birth) timing of surgical repair of congenital diaphragmatic hernia, but a substantial advantage to either one cannot be ruled out. A large, multicenter randomized

  19. Prematurity and fetal lung response after tracheal occlusion in fetuses with severe congenital diaphragmatic hernia.

    Science.gov (United States)

    Sananes, Nicolas; Rodo, Carlota; Peiro, Jose Luis; Britto, Ingrid Schwach Werneck; Sangi-Haghpeykar, Haleh; Favre, Romain; Joal, Arnaud; Gaudineau, Adrien; Silva, Marcos Marques da; Tannuri, Uenis; Zugaib, Marcelo; Carreras, Elena; Ruano, Rodrigo

    2016-09-01

    To evaluate the independent association of fetal pulmonary response and prematurity to postnatal outcomes after fetal tracheal occlusion for congenital diaphragmatic hernia. Fetal pulmonary response, prematurity (prematurity (prematurity was not statistically associated with mortality after controlling for fetal pulmonary response (aOR 0.52, 95% CI 0.12-2.30, p=0.367). Fetal pulmonary response after FETO is the most important factor associated with survival, independently from the gestational age at delivery.

  20. Radiographic diagnosis of diaphragmatic hernia: review of 60 cases in dogs and cats

    International Nuclear Information System (INIS)

    Hyun, C.B.

    2004-01-01

    Sixty cases of diaphragmatic hernia in dogs and cats were radiologically reviewed and categorized by their characteristic radiographic signs. Any particular predilection for age, sex, or breed was not observed. Liver, stomach and small intestine were more commonly herniated. At least two radiographs, at different angles, were required for a valid diagnosis, because some radiographic signs were not visible in a single radiographic view and more clearly detectable in two radiographic views

  1. Acute gastric volvulus and congenital diaphragmatic hernia, case report and review

    Directory of Open Access Journals (Sweden)

    Laura Pérez-Egido

    2015-01-01

    Full Text Available Congenital diaphragmatic hernia (CDH is the result of the incomplete fusion and closure of the pleuroperitoneal canal during the fetal development. CDH is usually diagnosed prenatally but, if undiagnosed, the clinical presentation ranges from asymptomatic children to serious respiratory or gastrointestinal symptoms. Acute gastric volvulus associated with CDH is a rare surgical emergency in children. We report two cases of acute gastric volvulus associated with CDH and review the literature.

  2. Characteristics of Infants With Congenital Diaphragmatic Hernia Who Need Follow-Up of Pulmonary Hypertension.

    Science.gov (United States)

    Kraemer, Ulrike S; Leeuwen, Lisette; Krasemann, Thomas B; Wijnen, René M H; Tibboel, Dick; IJsselstijn, Hanneke

    2018-02-06

    Pulmonary hypertension is one of the main causes of mortality and morbidity in patients with congenital diaphragmatic hernia. Currently, it is unknown whether pulmonary hypertension persists or recurs during the first year of life. Prospective longitudinal follow-up study. Tertiary university hospital. Fifty-two congenital diaphragmatic hernia patients admitted between 2010 and 2014. None. Pulmonary hypertension was measured using echocardiography and electrocardiography at 6 and 12 months old. Characteristics of patients with persistent pulmonary hypertension were compared with those of patients without persistent pulmonary hypertension. At follow-up, pulmonary hypertension persisted in four patients: at 6 months old, in three patients (patients A-C), and at 12 months old, in two patients (patients C and D). Patients with persistent pulmonary hypertension had a longer duration of mechanical ventilation (median 77 d [interquartile range, 49-181 d] vs median 8 d [interquartile range, 5-15 d]; p = 0.002) and hospital stay (median 331 d [interquartile range, 198-407 d) vs median 33 d (interquartile range, 16-59 d]; p = 0.003) than patients without persistent pulmonary hypertension. The proportion of patients with persistent pulmonary hypertension (n = 4) treated with inhaled nitric oxide (100% vs 31%; p = 0.01), sildenafil (100% vs 15%; p = 0.001), and bosentan (100% vs 6%; p pulmonary hypertension (n = 48). At 6 months, all patients with persistent pulmonary hypertension were tube-fed and treated with supplemental oxygen and sildenafil. Less than 10% of congenital diaphragmatic hernia patients had persistent pulmonary hypertension at ages 6 and/or 12 months. Follow-up for pulmonary hypertension should be reserved for congenital diaphragmatic hernia patients with echocardiographic signs of persistent pulmonary hypertension at hospital discharge and/or those treated with medication for pulmonary hypertension at hospital discharge.

  3. Anterior vaginal wall repair (surgical treatment of urinary incontinence) - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100110.htm Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series— ... to slide 4 out of 4 Overview The vaginal opening lies just below the urethral opening, and ...

  4. Combined stress urinary incontinence surgery at the time of ...

    African Journals Online (AJOL)

    based approach to the problem of preventing stress urinary incontinence (SUI) following prolapse surgery. Design. We reviewed the current English language literature available on PubMed (Medline), as well as current relevant textbooks in print.

  5. Duloxetine in the treatment of stress urinary incontinence

    NARCIS (Netherlands)

    Michel, Martin C.; Oelke, Matthias

    2005-01-01

    This manuscript reviews the pharmacodynamics and pharmacokinetics of duloxetine and its efficacy and safety in women with stress urinary incontinence. Duloxetine is a selective inhibitor of neuronal serotonin and norepinephrine uptake which increases urethral striated muscle activity and bladder

  6. Electrophysiological and Behavioral Effects of Combined Transcranial Direct Current Stimulation and Alcohol Approach Bias Retraining in Hazardous Drinkers

    NARCIS (Netherlands)

    den Uyl, T.E.; Gladwin, T.E.; Wiers, R.W.

    2016-01-01

    BACKGROUND: Cognitive bias modification (CBM) can be used to retrain automatic approach tendencies for alcohol. We investigated whether changing cortical excitability with transcranial direct current stimulation (tDCS) could enhance CBM effects in hazardous drinkers. We also studied the underlying

  7. 30 CFR 77.1705 - First aid training program; retraining of supervisory employees; availability to all miners.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false First aid training program; retraining of..., SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Miscellaneous § 77.1705 First aid..., 1972, each operator of a surface coal mine shall conduct refresher first aid training programs each...

  8. Organizational aspects of recruiting, training, maintaining the level of professional skills and retraining of NPP operations personnel in Russia

    International Nuclear Information System (INIS)

    Veltchinsky, V.

    1993-01-01

    The organization of personnel work during WWER-1000 operation is presented as recommended by the Russian operating organization. The system is described of recruiting, training control of professional activities, maintaining of professional skills and retraining of the Russian nuclear power plant operation personnel (PKPO system). The basic documentation of the PKPO system is listed. (Z.S.) 1 fig

  9. A Randomized Controlled Trial of Intensive Sleep Retraining (ISR): A Brief Conditioning Treatment for Chronic Insomnia

    Science.gov (United States)

    Harris, Jodie; Lack, Leon; Kemp, Kristyn; Wright, Helen; Bootzin, Richard

    2012-01-01

    Study Objective: To investigate the effectiveness of intensive sleep retraining in comparison and combination with traditional behavioral intervention for chronic primary insomnia. Participants: Seventy-nine volunteers with chronic sleep-onset insomnia (with or without sleep maintenance difficulties) were randomly assigned either to intensive sleep retraining (ISR), stimulus control therapy (SCT), ISR plus SCT, or the control (sleep hygiene) treatment condition. Intervention: ISR treatment consisted of 50 sleep onset trials over a 25-h sleep deprivation period. Measurements and Results: Treatment response was assessed with sleep diary, activity monitoring, and questionnaire measures. The active treatment groups (ISR, SCT, ISR+SCT) all resulted in significant improvements in sleep onset latency and sleep efficiency, with moderate to large effect sizes from pre- to post-treatment. Wake time after sleep onset decreased significantly in the SCT and ISR+SCT groups. Total sleep time increased significantly in the ISR and ISR+SCT treatment groups. Participants receiving ISR (ISR, ISR+SCT) experienced rapidly improved SOL and TST during treatment, suggesting an advantage of rapid improvements in sleep in response to ISR. Although there were few statistically significant differences between groups on individual variables, ISR+SCT resulted in consistently larger effect sizes of change than other treatments, including questionnaire measures of sleep quality, sleep self-efficacy, and daytime functioning. The combination treatment group (ISR+SCT) showed trends to outperform other active treatment groups with fewer treatment dropouts, and a greater proportion of treatment responders with 61% reaching “good sleeper” status. Treatment gains achieved at post-treatment in the active treatment groups were largely maintained throughout follow-up periods to 6 months. Conclusion: This 25-hour intensive conditioning treatment for chronic insomnia can produce rapid improvements in

  10. [Effectiveness of partial and complete instrumental masking in chronic tinnitus. Studies with reference to retraining therapy].

    Science.gov (United States)

    von Wedel, H; von Wedel, U C; Streppel, M; Walger, M

    1997-09-01

    Jastreboff und Hazell [9] developed a neurophysiological approach to tinnitus perception, including the important role of the central nervous system in the maintenance and intrusiveness of tinnitus. They introduced tinnitus-retraining therapy, consisting of four different strategies: (1) directive and person-centered counseling; (2) hearing aids and/or noise generators and/or environmental sounds; (3) psychological therapy; (4) adjacent therapies. Tinnitus should not be masked as with a tinnitus-masker, but must be able to be heard in addition to the noise! A noise generator or hearing aid should be worn at least 6-8 h per day over a period of up to 18 months. In additions several clinical visits are required in order to reinforce the counseling. The actual results show complete tinnitus remission for about 20-30% and partial remission for 50-60% of the patients [6]. We report on a retrospective study in patients wearing hearing aids or tinnitus-maskers over a period of 3 years. We compared the results of patients using partial tinnitus masking to those using complete masking. The tinnitus-related and general psychological complaints were acquired by the 52-item tinnitus questionnaire developed by Hallam et al. [4] and modified by Goebel and Hiller [3]. To describe the dimensions of tinnitus-related distress the scales are labelled emotional distress, cognitive distress, emotional and cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbance and somatic complaints. Positive changes for the global tinnitus questionnaire score of more than 10 points are significant in the dimensions of tinnitus-related distress and are described as partial tinnitus-reduction. The group with partial masking effects can be compared to those performing retraining therapy to day because directive and personal centered counseling were integrated for all patients. Patients reporting partial masking effects through their aids (hearing aid or noise generator

  11. Experiences Related to Urinary Incontinence of Stroke Patients: A Qualitative Descriptive Study.

    Science.gov (United States)

    Arkan, Gulcihan; Beser, Ayse; Ozturk, Vesile

    2018-02-01

    Poststroke urinary incontinence is a common problem, with a prevalence ranging from 32% to 79%. Urinary incontinence after stroke has negative physiological, psychological, and economic effects, which lead to lifestyle changes for both patients and caregivers. Nurses play an important role in preventing and improving incontinence, understanding the experiences of individuals experiencing incontinence, providing healthcare for them, and implementing behavioral therapy methods. The aim of this study was to determine the experience related to urinary incontinence of stroke patients. In this qualitative descriptive study, using semistructured interviews, 15 participants with urinary incontinence after stroke selected through purposeful sampling were interviewed. Data were collected with a semistructured interview form prepared within the framework of the Health Belief Model. All data were analyzed using content analysis. Three main themes were identified: "perception of urinary incontinence," "effects of urinary incontinence," and "management of urinary incontinence." The respondents explained that urinary incontinence also adversely affected their caregivers. They experienced many daily life and psychological problems because of urinary incontinence. In addition, they made several changes to management urinary incontinence such as limiting fluid intake, changing underwear frequently, using waterproof mattress protectors, applying traditional practice, and taking medicine. This study revealed that stroke patients needed help and support for urinary incontinence management. Nurses should provide information about management and urinary incontinence after stroke.

  12. Urethro-cystography for female urinary stress incontinence

    International Nuclear Information System (INIS)

    Voigt, R.; Starker, K.; Friedrich-Schiller-Universitaet, Jena

    1985-01-01

    The normal parameters of urethro-cystography were evaluated in 324 examinations. There were definite differences between continent and pressure-incontinent women on the one hand, and stress-incontinent patients on the other, as regards the pubo-urethral angle, but not as regards the posterior vesico-urethral angle. Preoperative and post-operative urethro-cystograms showed statistically significant differences. (orig.) [de

  13. Quality-of-life assessment in children with fecal incontinence.

    Science.gov (United States)

    Filho, Humberto S; Mastroti, Roberto A; Klug, Wilmar A

    2015-04-01

    Fecal incontinence is a clinical condition that causes embarrassment and changes the perception of quality of life. The absence of a specific tool for assessing fecal incontinence in children led us to adapt an instrument originally developed for adults, which has already been validated into Portuguese. The purpose of this work was to evaluate the quality of life of children with fecal incontinence. This is a single-center, prospective study based on the application of survey. The Fecal Incontinence Quality of Life questionnaire was modified by eliminating 2 questions related to sexuality and by substituting the word "depressed" with "sad" in the statement, "I feel depressed." The study took place at a tertiary academic medical center. Forty-one children >5 years of age, with incontinence of organic etiology and preserved cognition but without stomy, were interviewed with the use of the Fecal Incontinence Quality of Life modified questionnaire. To evaluate the discrimination validity, 28 healthy children were interviewed as control subjects. As to reproducibility, a test/retest was performed, involving 25 children. For construct validation, the Fecal Incontinence Quality of Life modified was correlated with the generic instrument Autoquestionnaire Qualité de Vie Enfant Imagé with the continence index São Paulo Score of Continence. The average values by scale included lifestyle, 3.1; emotional, 2.8; behavior, 2.3; and embarrassment, 1.6. The average values for the control group included lifestyle, 3.7; emotional, 4.0; behavior, 3.6; and embarrassment, 3.6. The instrument showed a general reliability of 0.78, measured by the Cronbach α. Reproducibility was also >0.90 according to the Cronbach α. The intrinsic characteristics of children include their constant growth, and this presented a challenge in our search for an instrument that permitted us to identify and measure these variations. The experiment showed a reduction in all of the scale values, particularly

  14. Pathophysiology of pelvic organ prolapse and stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Payal D Patel

    2006-01-01

    Full Text Available Although they may present with significant morbidity, pelvic organ prolapse and stress urinary incontinence are mainly afflicitions that affect quality of life. To appropiately treat these entities, comprehension of the various theories of pathophysiology is paramount. Utilizing a Medline search, this article reviews recent data concerning intrinsic (i.e., genetics, postmenopausal status and extrinsic factors (i.e., previous hysterectomy, childbirth leading to organ prolapse or stress incontinence

  15. Incontinence in children, adolescents and adults with Williams syndrome.

    Science.gov (United States)

    von Gontard, Alexander; Niemczyk, Justine; Borggrefe-Moussavian, Sorina; Wagner, Catharina; Curfs, Leopold; Equit, Monika

    2016-11-01

    Williams Syndrome (WS) is a microdeletion syndrome (chromosome 7q11.23) characterized by typical facial features, cardiovascular disease, behavioural symptoms, and mild intellectual disability (ID). The aim of this study was to assess the rates of incontinence and psychological problems in persons with WS. 231 individuals with WS were recruited through the German parent support group (52.0% male, mean age 19.4 years). Faecal incontinence (FI) was diagnosed from the age of 4 years and nocturnal enuresis (NE) and daytime urinary incontinence (DUI) of 5 years onwards. The Parental Questionnaire: Enuresis/Urinary Incontinence, the International-Consultation-on-Incontinence-Questionnaire-Pediatric LUTS (ICIQ-CLUTS), as well as the Developmental Behavior Checklist for parents (DBC-P) or for adults (DBC-A) were filled out by parents or caregivers. 17.8% of the sample had NE, 5.9% DUI and 7.6% FI. NE was present in 44.9% of children (4-12 years), 13.5% of teens (13-17y), 3.3% of young adults (18-30y) and in 3.6% of adults (> 30y). DUI (and FI) decreased from 17.9% (21.4%) in children to 0% in adults. 3.5% of the sample had an ICIQ-CLUTS score in the clinical range. 30.5% of children and 22.1% of adults had a clinical DBC score. Children and teens with clinically relevant DBC-P-scores had significantly higher DUI rates. Children with WS have high rates of incontinence and LUTS, which decrease with age. Most adults are continent. NE is the most common subtype. Except for DUI in children, incontinence is not associated with behavioural problems. Screening, assessment and treatment of incontinence in individuals with WS is recommended. Neurourol. Urodynam. 35:1000-1005, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  16. Diabetes, glycemic control, and urinary incontinence in women

    Science.gov (United States)

    Wang, Rui; Lefevre, Roger; Hacker, Michele R.; Golen, Toni H.

    2015-01-01

    OBJECTIVES To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85. METHODS We included 7,270 women from the 2005–2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): i) those below the diagnostic threshold (HbA1c8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates. RESULTS The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% CI: 1.03–1.25) increase for any urinary incontinence and a 34% (95% CI 1.06–1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity. CONCLUSIONS Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes. PMID:26313496

  17. Patient reported outcome measures in male incontinence surgery.

    Science.gov (United States)

    Tran, M G B; Yip, J; Uveili, K; Biers, S M; Thiruchelvam, N

    2014-10-01

    Patient reported outcome measures (PROMs) were used to evaluate outcomes of the artificial urinary sphincter (AUS) and the AdVance™ (American Medical Systems, Minnetonka, MN, US) male sling system (AVMS) for the symptomatic management of male stress urinary incontinence. All male patients with stress urinary incontinence referred to our specialist clinic over a two-year period completed the ICIQ-UI SF (International Consultation on Incontinence Questionnaire on Urinary Incontinence Short Form) and the ICIQ-MLUTS LF (International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form) at consultation as well as at subsequent follow-up appointments. The Wilcoxon signed-rank test for non-parametric paired data was used for pre and postoperative comparisons. The chi-squared test was used for categorical variables. Thirty-seven patients (forty surgical cases) completed a preoperative and at least one follow-up questionnaire. There was a statistically significant improvement in PROMs postoperatively, regardless of mode of surgery (p25) had greater improvement with an AUS than with the AVMS (p<0.01). This prospective study shows that completion and collection of PROMs as part of routine clinical practice is achievable and useful in the assessment of male stress incontinence surgery. PROMs are important instruments to assess effectiveness of healthcare intervention and they are useful adjuncts in surgical studies.

  18. Quality of life in women with urinary incontinence.

    Science.gov (United States)

    Mladenović Segedi, Ljiljana; Segedi, Dimitrije; Parezanović Ilić, Katarina

    2011-08-01

    To determine the characteristics of urinary incontinence and its impact on the quality of life in adult women with urinary incontinence who presented to a tertiary care clinic of Vojvodina from September 2008 to May 2009 for treatment We used a prospective case-control study. Cases were defined as patients (47) with urinary incontinence symptoms. Controls (50) were defined as patients without urinary incontinence who presented to a tertiary care gynecology clinic for other reasons. Both, cases and controls, completed two questionnaires recommended for the evaluation of symptoms, The Urinary Distress Inventory, and quality of life impact The Urinary Impact Questionnaire. There was a significant correlation between aging (r=0.614; ptravel more than 30 minutes by car or bus, 88.6% avoided leisure activities, 45.5% of patients had impaired emotional health and 34% felt frustrated. The dominant type of urinary incontinence in more than half of the respondents was a mixed type, with moderate to very severe problems. Symptoms of urinary incontinence interfere with the performance of everyday household and social activities, causing the appearance of anxiety, depression and frustration, and in more than 50% of women leads to reduced quality of life.

  19. Incontinence and Erectile Dysfunction Following Radical Prostatectomy: A Review

    Directory of Open Access Journals (Sweden)

    Gerasimos Alivizatos

    2005-01-01

    Full Text Available Radical prostatectomy remains the treatment of choice for localized prostate cancer in age-appropriate and health-appropriate men. Although cancer control is the most important aspect of a radical prostatectomy, minimization of postoperative morbidity, especially urinary incontinence and erectile dysfunction, is becoming a greater concern. We reviewed recent data available on Medline regarding the incidence, pathophysiology, evaluation, and treatment of incontinence and sexual dysfunction after radical prostatectomy. Health-related quality of life issues have been specifically addressed. Although low incidences of incontinence and erectile dysfunction after radical prostatectomy have been reported in the hands of experienced surgeons, the literature review revealed a great variety, with incontinence rates ranging from 0.3–65.6% and potency rates ranging from 11–87%. Several factors contribute to this wide difference, the most important being the application of a meticulous surgical technique. General and cancer-specific health-related quality of life is not being affected after radical prostatectomy. The incidence of incontinence and erectile dysfunction is higher after radical prostatectomy when compared to the incidence observed when other therapies for localized prostate cancer are applied. However, the majority of the patients undergoing radical prostatectomy would vote for the operation again. Today, avoidance of major complications after radical prostatectomy depends mostly on a high-quality surgical technique. When incontinence or erectile dysfunction persists after radical prostatectomy, the majority of the treated patients can be managed effectively by various methods.

  20. Surgical Techniques for Diaphragmatic Resection During Cytoreduction in Advanced or Recurrent Ovarian Carcinoma: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Lorusso, Domenica; Chiappa, Valentina; Donfrancesco, Cristina; Di Donato, Violante; Indini, Alice; Aletti, Giovanni; Raspagliesi, Francesco

    2016-02-01

    Optimal cytoreduction is one the main factors improving survival outcomes in patients affected by ovarian cancer (OC). It is estimated that approximately 40% of OC patients have gross disease located on the diaphragm. However, no mature data evaluating outcomes of surgical techniques for the management of diaphragmatic carcinosis exist. In the present study, we aimed to estimate surgery-related morbidity of different surgical techniques for diaphragmatic cytoreduction in advanced or recurrent OC. PubMed (MEDLINE), Web of Science, and Clincaltrials.gov databases were searched for records estimating outcomes of diaphragmatic peritoneal stripping (DPS) or diaphragmatic full-thickness resection (DFTR) for OC. The meta-analysis was performed using the Cochrane Review software. For the final analysis, 5 articles were available, including 272 patients. Diaphragmatic peritoneal stripping and DFTR were performed in 197 patients (72%) and 75 patients (28%), respectively. Pooled analysis suggested that the estimated pleural effusion rate was 43% and 51% after DPS and DFTR, respectively. The need for pleural punctures or chest tube placement was 4% and 9% after DPS and DFTR, respectively. The rate of postoperative pneumothorax (4% vs 9%; odds ratio, 0.31; 95% confidence interval, 0.05-2.08) and subdiaphragmatic abscess (3% vs 3%; odds ratio, 0.45; 95% confidence interval, 0.09-2.31) were similar after the execution of DPS and DFTR. Diaphragmatic surgery is a crucial step during cytoreduction for advanced or recurrent OC. Obviously, the choice to perform DPS or DFTR depends on the infiltration of the diaphragmatic muscle or not. Both the procedures are associated with a low pulmonary complication and chest tube placement rates.

  1. Guide to conducting tinnitus retraining therapy initial and follow-up interviews.

    Science.gov (United States)

    Henry, James A; Jastreboff, Margaret M; Jastreboff, Pawel J; Schechter, Martin A; Fausti, Stephen A

    2003-01-01

    Tinnitus Retraining Therapy (TRT) is a structured method of tinnitus treatment that has been performed since 1990. The TRT Initial Interview form was developed to guide clinicians in obtaining essential information from patients that would specify treatment needs. The TRT Follow-up Interview form is similar to the initial interview form and is designed to evaluate outcomes of treatment. The clinician administers these forms verbally. The forms have been used in a highly abbreviated format with the potential for inconsistent interview administration between examiners. This project was to expand the forms to provide specific wording for each question. The expanded forms are presented in this article, and the intent of each question is explained. Standardized administration of these interview forms will facilitate greater uniformity in the initial evaluation and outcomes analyses of patients treated with TRT.

  2. The effect of urinary incontinence status during pregnancy and delivery mode on incontinence postpartum. A cohort study

    OpenAIRE

    Wesnes, Stian Langeland; Hunskår, Steinar; Bø, Kari; Rørtveit, Guri

    2009-01-01

    Objective: The objectives of this study were to investigate prevalence of urinary incontinence at 6 months postpartum and to study how continence status during pregnancy and mode of delivery influence urinary incontinence at 6 months postpartum in primiparous women.Design: Cohort study.Setting: Pregnant women attending routine ultrasound examination were recruited to the Norwegian Mother and Child Cohort Study (MoBa).Population A total of 12 679 primigravidas who were contin...

  3. Diaphragmatic patch: A useful adjunct in surgical treatment of recurrent catamenial hemothorax

    Directory of Open Access Journals (Sweden)

    J. Nwiloh

    2011-11-01

    Full Text Available Although catamenial hemothorax compared to pneumothorax is a rarer clinical presentation of thoracic endometriosis syndrome (TES, it is more commonly associated with diaphragmatic fenestrations. These openings may serve as entry portals for peritoneal fluid to access into the pleural space thereby perpetuating recurrent pleural effusion even after prior surgical pleurodesis. We report our experience with two patients with recurrent right catamenial hemothorax after previous interventions that were subsequently treated by talc pleurodesis and goretex diaphragmatic patch, and who have had no further recurrence at a mean follow up of 15 months.We therefore recommend that diaphragmatic patch should be considered as an adjunct to talc pleurodesis in patients with recurrent catamenial hemothorax when either multiple diaphragmatic fenestrations are seen at surgery or if there is concomitant bloody peritoneal fluid which could potentially lead to recurrence. The patch by sealing any occult pores and possible future fenestrations appear to decrease recurrent pleural effusion at an intermediate term follow up. Resumo: Embora o hemotórax catamenial comparado com o pneumotórax seja uma apresentação clínica mais rara de síndrome de endometriose torácica (TES, está mais associado a fenestrações diafragmáticas. Estas aberturas podem atuar como portais de entrada para o acesso ao fluido peritoneal na cavidade pleural, perpetuando assim o derrame pleural recorrente mesmo após uma pleurodese cirúrgica prévia. Registamos a nossa experiência em dois pacientes com hemotórax catamenial recorrente do lado direito após outras intervenções, que foram posteriormente tratados com pleurodese com talco e penso diafragmático em gore-tex, e que não apresentaram nenhuma outra recorrência durante um acompanhamento de 15 meses.Recomendamos, então, que o penso diafragmático seja considerado um auxiliar à pleurodese com talco em pacientes com hemot

  4. Risk factors for postpartum urinary incontinence.

    Science.gov (United States)

    Leroy, Lígia da Silva; Lúcio, Adélia; Lopes, Maria Helena Baena de Moraes

    2016-04-01

    To investigate the risk factors for postpartum urinary incontinence (UI) and its characteristics. This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, ppregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent. Investigar os fatores de risco para a incontinência urinária (IU) no puerpério e as suas características. Trata-se de estudo caso-controle com 344 puérperas (77 casos e 267 controles), com até 90 dias pós-parto. Foi aplicado, em um único momento, um questionário para os dados sociodemográficos e clínicos, e dois outros para avaliar a perda urinária, situações de perda e o tipo de IU. Apresentaram IU de esforço 45,5%, perda urinária diversas vezes ao dia 44,2%, sendo 71,4% em pequena quantidade e 57,1% ao tossir ou espirrar. Em 70,1% dos casos a IU iniciou-se na gestação e permaneceu no puerpério. Ao ajustar-se um modelo de regressão logística binária, apenas IU na gestação (OR 12,82, IC 95% 6,94 - 23,81, p<0,0001), multiparidade (OR 2,26, IC 95% 1,22 - 4,19, p=0,009), idade gestacional no parto maior ou igual a 37 semanas (OR 2,52, IC 95% 1,16 - 5,46, p=0,02) e constipação (OR 1,94, IC

  5. Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion

    International Nuclear Information System (INIS)

    Kaya, Seyda Ors; Karabulut, Nevzat; Yuncu, Gokhan; Sevinc, Serpil; Kiroglu, Yilmaz

    2006-01-01

    The objective of our study was to describe the 'sinus cut-off' sign at CT in the diagnosis of diaphragmatic rupture in patients with blunt abdominal trauma complicated with pleural effusion, and evaluate its utility in an experimental model. Between January 2004 and March 2005, we observed an unusual interruption of costophrenic sinus at CT in three patients with blunt abdominal trauma accompanied with pleural effusion. This observation prompted us to evaluate the utility of this sign in an experimental model. Laparotomically, we created 2 cm diapragmatic lacerations at each hemidiaphragm in two rabbits and pushed up the abdominal viscera with omentum through the defect. To simulate hemothorax, we also injected 5-10 mL of diluted contrast material into the pleural space. Using a dual-slice helical CT scanner, limited thoracoabdominal CT examination was performed before and after injection of intrapleural contrast material. The images were analyzed for the presence of CT signs for diaphragmatic injury. The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the 'sinus cut-off sign' was the sole finding in one patient. The sinus cut-off sign was observed on the CT scans of 100% of the rabbits with a left and right sided diaphragmatic rupture. The 'sinus cut-off sign' is useful and can increase the CT detection of acute diaphragmatic injury associated with pleural effusion

  6. Posterior diaphragmatic defect detected on chest CT: the incidence according to age and the lateral chest radiographic appearances

    International Nuclear Information System (INIS)

    Lee, Son Youl; Choi, Yo Won; Jeon, Seok Chol; Heo, Jeong Nam; Park, Choong Ki

    2007-01-01

    We wanted to investigate the incidence of posterior diaphragmatic defect on chest CT in various age groups and its lateral chest radiographic appearances. The chest CT scans of 78 patients of various ages with posterior diaphragmatic defect were selected among 1,991 patients, and they were analyzed for the incidence of defect in various age groups, the defect location and the herniated contents. Their lateral chest radiographs were analyzed for the shape of the posterior diaphragm and the posterior costophrenic sulcus. The patients' ages ranged from 34 to 87 with the tendency of a higher incidence in the older patients. The defect most frequently involved the medial two thirds (n = 49, 50.4%) and middle one third (n = 36, 37%) of the posterior diaphragm. The retroperitoneal fat was herniated into the thorax through the defect in all patients, and sometimes with the kidney (n = 8). Lateral chest radiography showed a normal diaphragmatic contour (n = 51, 49.5%), blunting of the posterior costophrenic sulcus (n = 41, 39.8%), focal humping of the posterior diaphragm (n = 7, 6.8%), or upward convexity (n = 4, 3.9%) of the posterior costophrenic sulcus on the affected side. The posterior diaphragmatic defect discovered in asymptomatic patients who are without a history of peridiaphragmatic disease is most likely acquired, and this malady increases in incidence according to age. An abnormal contour of the posterior diaphragm or the costophrenic sulcus on a lateral chest radiograph may be a finding of posterior diaphragmatic defect

  7. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women

    Directory of Open Access Journals (Sweden)

    Jundt K

    2010-06-01

    Full Text Available Abstract Objective To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries. Methods Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound. Results 112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12% to after childbirth (21 and 28% in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section. The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence. Conclusion Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women.

  8. Urinary incontinence, pelvic floor dysfunction, exercise and sport.

    Science.gov (United States)

    Bø, Kari

    2004-01-01

    Urinary incontinence is defined as "the complaint of any involuntary leakage of urine" and is a common problem in the female population with prevalence rates varying between 10% and 55% in 15- to 64-year-old women. The most frequent form of urinary incontinence in women is stress urinary incontinence, defined as "involuntary leakage on effort or exertion, or on sneezing or coughing". The aim of this article is to systematically review the literature on urinary incontinence and participation in sport and fitness activities with a special emphasis on prevalence and treatment in female elite athletes. Stress urinary incontinence is a barrier to women's participation in sport and fitness activities and, therefore, it may be a threat to women's health, self-esteem and well-being. The prevalence during sports among young, nulliparous elite athletes varies between 0% (golf) and 80% (trampolinists). The highest prevalence is found in sports involving high impact activities such as gymnastics, track and field, and some ball games. A 'stiff' and strong pelvic floor positioned at an optimal level inside the pelvis may be a crucial factor in counteracting the increases in abdominal pressure occurring during high-impact activities. There are no randomised controlled trials or reports on the effect of any treatment for stress urinary incontinence in female elite athletes. However, strength training of the pelvic floor muscles has been shown to be effective in treating stress urinary incontinence in parous females in the general population. In randomised controlled trials, reported cure rates, defined as athletes than in other women. There is a need for more basic research on pelvic floor muscle function during physical activity and the effect of pelvic floor muscle training in female elite athletes.

  9. Iatrogenic gastric perforation in a misdiagnosed case of late presenting congenital diaphragmatic hernia: Report of an avoidable complication

    Directory of Open Access Journals (Sweden)

    Pradeep Kajal

    Full Text Available Introduction: Congenital diaphragmatic hernia (CDH is a defect in diaphragm which usually presents with severe respiratory distress in neonatal period. Presentation of case: We present a case of congenital diaphragmatic hernia presenting at an age of 2.5 years in a male child. It was misdiagnosed as a case of pyothorax for which chest tube was attempted on left side resulting in iatrogenic gastric perforation. The patient was managed by early and prompt surgery. Discussion: Late presentation is usually rare with vast array of respiratory and gastrointestinal symptoms. It often leads to clinical and radiological misdiagnosis. Conclusion: Surgical intervention in misdiagnosed cases can lead to catastrophic iatrogenic complications. Keywords: Case report, Congenital diaphragmatic hernia, Pyothorax, Chest tube, Iatrogenic gastric perforation

  10. Fecal incontinence in operated cases for anorectal malformations

    International Nuclear Information System (INIS)

    Fondelli, P.; Taccone, A.; Martucciello, G.; Dodero, P.; Caffarena, P.

    1989-01-01

    In spite of great progress in surgical treatment of anorectal malformations, fecal incontinence is still, in variable degrees, a frequent and unpleasant postsurgical sequela. The most frequent causes of incontinence are: 1) the incorrect placement of the pulled-through colon in the levator ani and sphincteric muscular complex during abdomino-perineal surgical procedures; 2) the poor development of sphinteric musculature; 3) the associated sacral anomalies. Postoperative CT helps to evaluate all the above-mentioned conditions, in view of possible new surgical procedure for improving continence (besides postoperative CT can help in choosing the more suitable surgical technique). Nine patients, aged 3 to 13 years (2 with good continence and 7 with various degrees of incontinence), were studied with pelvic postoperative CT. In the cases (2) with good continence the CT picture was: good development of sphincteric musculature and neo-anorectum correctly placed into sphinteric musculature; in the cases (3) with low degree of continence: neoanorectum correctly placed, but hypoplasic puborectal muscle; in the case (4) with complete incontinence, neo-anorectum incorrectly placed and poor development of sphinteric musculature. A further Posterior Sagittal Anorectoplasty (according Pena) is only suitable in the incontinence cases with: 1) neo-anorectum seriously misplaced; 2) good development of sphinteric musculature; 3) absence of sacral anomalies. Postoperative CT is a valid mean for demostrating all the above-mentioned conditions and for chooosing the best surgical technique in each case

  11. Urinary stress incontinence in postpartum women. Bibliographic review

    Directory of Open Access Journals (Sweden)

    Jose Manuel Barranco Cuadros

    2017-11-01

    Full Text Available Introduction: Both pregnancy and childbirth are important risk factors for urinary stress incontinence in women. For its prevention, exercies of the pelvic floor musculature have been shown to be effective. Guidelines for urinary stress incontinence management recommend offering pelvic floor muscle training to women during their first pregnancy as a preventive measure. Objective: To update the information provided in the scientific literature on urinary stress incontinence during postpartum and possible forms of treat it. Methodology: A systematic bibliographic review was carried out in the following databases: PUBMED, COCHRANE, CINHAL, MEDLINE, SciELO and SCOPUS. The date was restricted to the last 5 years (2012-2017, in Spanish, English and Portuguese. Restrictions were made regarding the type of study, and Randomized Clinical Trials (RCTs were considered for this review. Results: After reviewing the literature consulted, it is concluded that the training of the pelvic floor musculature is beneficial to prevent the occurrence of urinary stress incontinence during pregnancy and the postpartum period. Conclusions: The results obtained in this review are consistent with previous studies and bibliographic reviews of the same topic. It follows that training of the pelvic floor muscles is beneficial in preventing the occurrence of urinary stress incontinence during pregnancy or postpartum.

  12. Urinary incontinence in women in relation to occupational status.

    Science.gov (United States)

    Kim, Yoonjung; Kwak, Yeunhee

    2017-01-01

    Through this cross-sectional study the authors explore urinary incontinence in women in relation to occupational status and environment. Data from the fourth Korea National Health and Nutrition Examination Survey (2008-2009) were used (n = 5,928) excluding those aged under 19 or over 65 years, male, with renal disease, and with missing data. Urinary incontinence was prevalent in working women. Compared to unemployed women, the adjusted odds ratio (95% confidence intervals) for women working in services/sales was 1.62 (1.21-2.19); for paid workers was 1.81 (1.20-2.73); and for self-employed workers was 1.46 (1.05-2.03). Compared to unemployed women, the adjusted odds ratio for working women with a daytime work schedule was 2.14 (1.18-3.87), while for those with evening work schedules, it was 1.35 (1.05-1.74). Urinary incontinence was significantly associated with various occupational environments: an unclean and uncomfortable workplace, dangerous job and probability of accidents, feeling pressed for time, awkward position for long periods, and carrying heavy weights. These findings suggest that urinary incontinence was prevalent in working women and was associated with occupational status and working environment. Therefore, improving occupational status and environment for working women-such as modifying the working schedule, posture, and workplace atmosphere-are needed to prevent urinary incontinence.

  13. MR imaging of pelvic floor in stress urinary incontinence=20

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Rae; Park, Heung Jae; Kook, Shin Ho; Chung, Eun Chul [Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul (Korea, Republic of)

    2000-04-01

    To demonstrate the anatomy of the female pelvic floor and to determine the anatomic differences between normal controls and women with stress urinary incontinence, using MRI. Five healthy, young, nulliparous women and 12 with stress urinary incontinence underwent MR imaging. We obtained FSE T2-weighted axial images, 3mm thick, of the region extending from the urethroversical junction to the perineal membrane. The following parameters were determined : angle, asymmetry and signal intensity of the levator ani muscles, the distance between the urethra and symphysis, and the presence, shape and angulation of urethropelvic ligament. In contrast to normal controls, frequent findings in women with stress incontinence were as follows : increased angle (43%), asymmetry (43%) and higher signal intensity (67%) of the levator ani muscles; increased distance between the urethra and symphysis; loss (43%), discontinuity (60%) and dorsal angulation (43%) of the urethropelvic ligament. In women with stress urinary incontinence, MRI clearly demonstrates the anatomy of the female pelvic floor, changes in the levator ani muscles, the distance between the urethra and symphysis, and the urethropelvic ligament. The modality can therefore be used to evaluate the anatomical changes occurring in cases of stress urinary incontinence. (author)

  14. Studies on risk factors for urinary incontinence in Swedish female twins

    OpenAIRE

    Tettamanti, Giorgio

    2013-01-01

    Approximately half of all women in industrialized countries will experience urinary incontinence during their lifetime. Even though urinary incontinence is not a life threatening disease, it often has severe implications for daily function, social interactions, sexuality and psychological well-being. Moreover, urinary incontinence has a major impact on health economy and is increasingly recognized as a global health burden. Hence, identifying risk factors for urinary incontinence is of import...

  15. Perioperative survival rates after surgery for diaphragmatic hernia in dogs and cats: 92 cases (1990-2002).

    Science.gov (United States)

    Gibson, Thomas W G; Brisson, Brigitte A; Sears, William

    2005-07-01

    To determine the survival rates of dogs and cats that underwent surgical treatment for traumatic diaphragmatic hernia within 24 hours of admission and determine whether timing of surgery affected perioperative survival rate. Retrospective study. 63 dogs and 29 cats treated surgically for traumatic diaphragmatic hernia. Medical records were reviewed to evaluate associations between perioperative survival rates and variables including timing of surgery in relation to admission and acute versus chronic diaphragmatic hernia. Among the 92 animals, 82 (89.1%) were discharged alive after surgery. Sixty-four (69.6%) patients received surgical intervention within 12 hours of admission, and 84 (91.3%) received surgical intervention within 24 hours of admission. Median time from admission to discharge was 4 days (2 to 33 days). Data for acute cases (68 dogs and cats) were analyzed separately. Sixty-three (92.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of admission to the hospital, and 59 (93.7%) of these patients were discharged alive. Twenty-nine (42.6%) patients with acute diaphragmatic hernia received surgical intervention within 24 hours of trauma, and 26 of 29 (89.7%) patients were discharged alive. An overall acute and chronic perioperative survival rate of 89.7% was observed in dogs and cats that received surgical intervention within 24 hours of admission. Results in 68 dogs and cats that underwent surgery within 24 hours of admission suggested that early surgical intervention for acute diaphragmatic hernia was associated with good perioperative survival rates.

  16. Patients' experiences of breathing retraining for asthma: a qualitative process analysis of participants in the intervention arms of the BREATHE trial.

    OpenAIRE

    Arden-Close, E; Yardley, L; Kirby, S; Thomas, M; Bruton, A

    2017-01-01

    Poor symptom control and impaired quality of life are common in adults with asthma, and breathing retraining exercises may be an effective method of self-management. This study aimed to explore the experiences of participants in the intervention arms of the BREATHE trial, which investigated the effectiveness of breathing retraining as a mode of asthma management. Sixteen people with asthma (11 women, 8 per group) who had taken part in the intervention arms of the BREATHE trial (breathing retr...

  17. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women

    NARCIS (Netherlands)

    Herderschee, Roselien; Hay-Smith, E. Jean C.; Herbison, G. Peter; Roovers, Jan Paul; Heineman, Maas Jan

    2011-01-01

    Pelvic floor muscle training (PFMT) is an effective treatment for stress urinary incontinence in women. Whilst most of the PFMT trials have been done in women with stress urinary incontinence, there is also some trial evidence that PFMT is effective for urgency urinary incontinence and mixed urinary

  18. Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence

    DEFF Research Database (Denmark)

    Bing, Mette Hornum; Gimbel, Helga; Greisen, Susanne

    2015-01-01

    incontinence, previous incontinence surgery, body mass index (BMI) ≥ 35, age ≥ 75, and presence of diabetes mellitus were significantly related to decreased outcome of incontinence surgery. Furthermore, noninvasive and invasive urodynamic parameters indicating detrusor overactivity, voiding difficulties, low...

  19. Prevalence of double incontinence, risk and influence on quality of life in a general female population

    NARCIS (Netherlands)

    Slieker- ten Hove, Marijke; Pool-Goudzwaard, A.L.; Eijkemans, MJ; Steegers-Theunissen, R. P M; Burger, CW; Vierhout, ME

    2010-01-01

    BACKGROUND: Urinary incontinence (UI) and anal incontinence (AI) are complaints with impact on quality of life (QOL). Few data are available on prevalence of double incontinence (DI) in the general female population. OBJECTIVE: To determine prevalence of UI, AI, and DI, their associations with age,

  20. [Prenatal diagnosis of a right thoracic congenital ectopic kidney with a diaphragmatic hernia: a combination with a good prognosis].

    Science.gov (United States)

    Cessans, C; Pharamin, J; Crouzet, K; Kessler, S; Puget, C; Bouali, O; Galinier, P; Marcoux, M-O

    2015-11-01

    Ectopic intrathoracic kidney is a rare congenital anomaly, usually asymptomatic. This anomaly is sometimes associated with a diaphragmatic hernia. Few cases of this combination have been described, often in the absence of a prenatal diagnosis. We report on the case of a female newborn infant who was diagnosed with an ectopic intrathoracic right kidney and a diaphragmatic hernia upon 33 weeks of gestation. The patient underwent surgery on the first day of life and the respiratory and renal outcomes were simple. We review the literature and discuss the seemingly good prognosis of this combination. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. [A case of Crow-Fukase syndrome with respiratory failure due to bilateral diaphragmatic paralysis].

    Science.gov (United States)

    Namekawa, Michito; Muramatsu, Shin-ichi; Hashimoto, Ritsuo; Kawakami, Tadataka; Fujimoto, Ken-ichi; Nakano, Imaharu

    2002-07-01

    A 62-year-old man with well-controlled diabetes mellitus developed numbness of the bilateral feet and hands, followed by subacutely progressive weakness and amyotrophy of extremities. He became bed-ridden state, and dyspnea also appeared, so he was referred to our hospital. Physical examination revealed a lean man, with dark-reddish skin pigmentation, crabbed fingers, bilateral pretibial pitting edema, and bristles in extremities. Thoracoabdominal paradoxical respiration was observed and pulmonary vesicular sounds was decreased markedly in the both lungs. Laboratory data revealed hypoproteinemia, abnormalities of endocrine system, but M-protein was not detected. Serum vascular endothelial growth factor level was quite high. Chest radiography revealed elevation of the bilateral diaphragm, the % vital capacity (%VC) was 24%, and arterial blood gas analysis showed marked hypoxia with hypercapnia. These findings suggested that his respiratory failure was induced by bilateral diaphragmatic paralysis caused by bilateral phrenic nerve palsy due to Crow-Fukase syndrome. He became somnolent because of hypercapnic narcosis, so non-invasive positive pressure ventilation (NIPPV) was started. We treated him with intravenous immunoglobulin and oral corticosteroids therapies, and after these therapies, his symptoms were remarkably recovered and NIPPV became unnecessary soon. The most frequent causes of respiratory failure in Crow-Fukase syndrome are pleural effusion and pulmonary hypertension, and only two cases of this syndrome with respiratory failure caused by bilateral diaphragmatic paralysis were reported until now. When the patients with Crow-Fukase syndrome complain of dyspnea, we should take the diaphragmatic paralysis into consideration, which may be improved by appropriate therapies.

  2. [Multicentric prospective randomized study evaluating the interest of intravaginal electro-stimulation at home for urinary incontinence after prior perineal reeducation. Interim analysis].

    Science.gov (United States)

    Lopès, P; Levy-Toledano, R; Chiarelli, P; Rimbault, F; Marès, P

    2014-03-01

    Perineal reeducation of stress urinary incontinence is beneficial in 80% of cases. However, patients have to perform self-retraining exercises of the perineal muscles at home, in order to maintain the benefit of the physiotherapy. The aim of this study is to assess the benefit of GYNEFFIK(®), a perineal electro-stimulator, during this home-care phase. Women with stress urinary incontinence (UI) or with mixed UI (composed predominantly of stress UI) that responded to physiotherapy were included in this study in two parallel groups. The groups followed a self-reeducation program, with or without GYNEFFIK(®) electro-stimulation sessions. The comparison of the two groups was based on the rate of women for whom the benefit of the initial perineal reeducation was maintained (defined as non-worsening ICIQ and Ditrovie scales' score). According to the protocol, an interim analysis was performed on 95 patients (i.e. almost half of the expected sample size) who had had at least one evaluation under treatment, among which 44 patients had finished the study. The therapeutic benefit of the initial perineal reeducation was maintained in 87.8% of the GYNEFFIK(®) patient group, while it was maintained in 52.2% (P=0.0001) in the usual care group (i.e. who did not use electro-stimulation). Likewise, patient had a more favorable subjective impression when using GYNEFFIK(®) (83.7% versus 60.0% in the usual care group) as they felt that they improved during the study. In the GYNEFFIK(®) group, no increase in symptoms was reported, whereas almost one out of five patients in the usual care group felt that their condition had worsened. Copyright © 2014. Published by Elsevier SAS.

  3. Effects of strength training, detraining and retraining in muscle strength, hypertrophy and functional tasks in older female adults.

    Science.gov (United States)

    Correa, Cleiton S; Cunha, Giovani; Marques, Nise; Oliveira-Reischak, Ãlvaro; Pinto, Ronei

    2016-07-01

    Previous studies presented different results regarding the maintenance time of muscular adaptations after strength training and the ability to resume the gains on muscular performance after resumption of the training programme. This study aimed to verify the effect of strength training on knee extensors and elbow flexor muscle strength, rectus femoris muscle volume and functional performance in older female adults after 12 weeks of strength training, 1 year of detraining and followed by 12 weeks of retraining. Twelve sedentary older women performed 12 weeks of strength training, 1 year of detraining and 12 weeks of retraining. The strength training was performed twice a week, and the assessment was made four times: at the baseline, after the strength training, after the detraining and after the retraining. The knee extensor and elbow flexor strength, rectus femoris muscle volume and functional task were assessed. Strength of knee extensor and elbow flexor muscles, rectus femoris muscle volume and 30-s sit-to-stand increased from baseline to post-training (respectively, 40%, 70%, 38% and 46%), decreased after detraining (respectively, -36%, -64%, -35% and -43%) and increased again these parameters after retraining (35%, 68%, 36% and 42%). Strength training induces gains on strength and hypertrophy, also increased the performance on functional tasks after the strength training. The stoppage of the strength caused strength loss and reduction of functional performance. The resumption of the strength training promoted the same gains of muscular performance in older female adults. © 2015 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  4. Percutaneous transhepatic drainage of lung abscess through a diaphragmatic fistula caused by a penetrating liver abscess.

    Science.gov (United States)

    Taniguchi, Masako; Morita, Satoru; Ueno, Eiko; Hayashi, Mitsutoshi; Ishikawa, Motonao; Mae, Masahiro

    2011-11-01

    Liver abscesses occurring just below the diaphragm can penetrate or perforate the thoracic cavity, resulting in lung abscess or pyothorax. Although surgical or percutaneous transpleural drainage is often required in such cases, the latter approach has some risks, including hemothorax and bronchopleural fistula formation when the cavity is surrounded by normal lung parenchyma. The present report describes a treatment technique of percutaneous transhepatic drainage through the diaphragmatic fistula to avoid the risks of a transpulmonary approach in a case of lung abscess caused by a penetrating liver abscess.

  5. Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia.

    Science.gov (United States)

    Thakur, Shruti; Jhobta, Anupam; Sharma, Brij; Chauhan, Arun; Thakur, Charu S

    2017-07-01

    Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus. Copyright © 2014. Published by Elsevier Taiwan.

  6. Neonatal diabetes mellitus and congenital diaphragmatic hernia: coincidence or concurrent etiology?

    Directory of Open Access Journals (Sweden)

    Topiol Emmanuelle S

    2012-07-01

    Full Text Available Abstract Neonatal diabetes mellitus (NDM is a rare metabolic disorder, affecting approximately 1 in 500,000 live births. The management of NDM is challenging, as the benefits of controlling hyperglycemia must be balanced with the risks of iatrogenic hypoglycemia. NDM occurs in both permanent and transient forms, which have been genetically and phenotypically well characterized. Herein, we present the previously unreported combination of transient NDM (TNDM and congenital diaphragmatic hernia (CDH. In addition to reviewing the management and genetics of NDM we discuss the potential for overlapping genetic or embryologic abnormalities to explain the concurrence of CDH and NDM.

  7. Chylothorax associated with a congenital peritoneopericardial diaphragmatic hernia in a dog.

    Science.gov (United States)

    Schmiedt, Chad Weber; Washabaugh, Kate F; Rao, Deepa B; Stepien, Rebecca L

    2009-01-01

    A 2-year-old dog was presented with a 3-month history of increasing respiratory effort and rate, inappetence, and lethargy. Chest radiographs demonstrated significant pleural effusion, which was consistent with chyle on biochemical and cytological evaluations. Further diagnostic evaluation, including a thoracic computed tomographic scan, revealed a peritoneopericardial diaphragmatic hernia (PPDH) resulting in a large, fat-attenuating mass within the pericardium. The dog was taken to surgery for repair of the PPDH, pericardectomy, and cisterna chyli ablation. Rapid and permanent resolution of the chylothorax occurred postoperatively. This is the first reported case of chylothorax secondary to PPDH.

  8. Unusual presentation of adult Marfan syndrome as a complex diaphragmatic hiatus hernia

    Directory of Open Access Journals (Sweden)

    Shruti Thakur

    2017-07-01

    Full Text Available Marfan syndrome is multisystem connective tissue disorder that primarily involves the skeletal, cardiovascular, and ocular systems. The gastrointestinal complications in Marfan syndrome are rare, with only a few case reports described in the literature. We present a 25-year-old woman who presented with acute abdominal pain for 1 day. The imaging features revealed complex diaphragmatic hiatus hernia with organoaxial gastric volvulus. This is a unique case report about an adult patient with Marfan syndrome who presented with symptomatic paraesophageal hernia and organoaxial gastric volvulus.

  9. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    Energy Technology Data Exchange (ETDEWEB)

    Nahum, E.; Ben-Ari, J.; Schonfeld, T. [Pediatric Intensive Care Unit, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Horev, G. [Dept. of Diagnostic Radiology, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2001-06-01

    A 3{sup 1}/{sub 2}-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  10. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    International Nuclear Information System (INIS)

    Nahum, E.; Ben-Ari, J.; Schonfeld, T.; Horev, G.

    2001-01-01

    A 3 1 / 2 -year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  11. PHYSICAL TREATMENT OF THE STRESS URINARY INCONTINENCE IN WOMEN

    Directory of Open Access Journals (Sweden)

    Jugoslav Stojiljković

    2003-01-01

    Full Text Available The paper presents various methods of the physical treatment used in healing women with the stress urinary incontinence. It is emphasized that the exercises for strengthening the pelvic floor are effective in curing the stress incontinence but the most efficient exercise program has not been determined yet. Likewise, it is pointed out that the biofeedback application, along with the exercise, is no more efficient than the application of the exercises only but, still, much better results are achieved by applying the biofeedback at the beginning of the treatment. In order to evaluate the effects of the vaginal coni, electric and magnetic simulations in treating women with the stress urinary incontinence further explorations are necessary.

  12. Effects of two retraining strategies on nursing students' acquisition and retention of BLS/AED skills: A cluster randomised trial.

    Science.gov (United States)

    Hernández-Padilla, José Manuel; Suthers, Fiona; Granero-Molina, José; Fernández-Sola, Cayetano

    2015-08-01

    To determine and compare the effects of two different retraining strategies on nursing students' acquisition and retention of BLS/AED skills. Nursing students (N = 177) from two European universities were randomly assigned to either an instructor-directed (IDG) or a student-directed (SDG) 4-h retraining session in BLS/AED. A multiple-choice questionnaire, the Cardiff Test, Laerdal SkillReporter(®) software and a self-efficacy scale were used to assess students' overall competency (knowledge, psychomotor skills and self-efficacy) in BLS/AED at pre-test, post-test and 3-month retention-test. GEE, chi-squared and McNemar tests were performed to examine statistical differences amongst groups across time. There was a significant increase in the proportion of students who achieved competency for all variables measuring knowledge, psychomotor skills and self-efficacy between pre-test and post-test in both groups (all p-valuesstudy demonstrated that using a student-directed strategy to retrain BLS/AED skills has resulted in a higher proportion of nursing students achieving and retaining competency in BLS/AED at three months when compared to an instructor-directed strategy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Sensory retraining: burden in daily life related to altered sensation after orthognathic surgery, a randomized clinical trial.

    Science.gov (United States)

    Phillips, C; Kim, S H; Tucker, M; Turvey, T A

    2010-08-01

    Assess the long-term effect of sensory retraining exercises, age, gender, type of surgery, and pre-surgical psychological distress on patients' perception of the interference related to altered sensation 2 years after orthognathic surgery. A total of 186 subjects with a developmental dentofacial disharmony were enrolled in a multicenter randomized clinical trial: one center was a community-based practice and the other a university-based center. Subjects were randomly allocated to two groups: standard of care mouth opening exercises after BSSO or a progressive series of sensory retraining facial exercises in addition to the opening exercises. At 1, 3, 6, 12, and 24 months after surgery, subjects scored unusual feelings on the face, numbness, and loss of lip sensitivity from 'no problem (1)' to 'serious problem (7)'. A marginal proportional odds model was fit for each of the ordinal outcomes. Up to 2 years after surgery, the opening exercise only group had a higher likelihood of reporting interference in daily activities related to numbness and loss of lip sensitivity than the sensory retraining exercise group. The difference between the two groups was relatively constant. Older subjects and those with elevated psychological distress before surgery reported higher burdens related to unusual facial feelings, numbness, and loss of lip sensitivity (p pre-surgical counseling regarding the impact on daily life of persistent altered sensation following a mandibular osteotomy.

  14. Rectal motility after sacral nerve stimulation for faecal incontinence

    DEFF Research Database (Denmark)

    Michelsen, H B; Worsøe, J; Krogh, K

    2010-01-01

    Sacral nerve stimulation (SNS) is effective against faecal incontinence, but the mode of action is obscure. The aim of this study was to describe the effects of SNS on fasting and postprandial rectal motility. Sixteen patients, 14 women age 33-73 (mean 58), with faecal incontinence of various...... contractions, total time with cyclic rectal contractions, the number of aborally and orally propagating contractions, the number of anal sampling reflexes or rectal wall tension during contractions. Postprandial changes in rectal tone were significantly reduced during SNS (P

  15. Faecal incontinence following radiotherapy for prostate cancer: A systematic review

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Høyer, Morten; Lundby, Lilli

    2011-01-01

    BACKGROUND: Faecal incontinence (FI) after radiotherapy is a known phenomenon, but has received little attention to date. This article aimed to review current knowledge on faecal incontinence related to radiotherapy for prostate cancer. METHODS: PubMed was searched for English-language articles......-volume parameters and incidence is equivocal, although some studies suggest parameters confined to the lower rectum and/or anal canal may be of value to predict the extent of the injury and could be used as constraints in the dose planning process. CONCLUSIONS: Interpretation of data is limited due to lack of large...

  16. Urinary incontinence monitoring system using laser-induced graphene sensors

    KAUST Repository

    Nag, Anindya

    2017-12-25

    This paper presents the design and development of a sensor patch to be used in a sensing system to deal with the urinary incontinence problem primarily faced by women and elderly people. The sensor patches were developed from laser-induced graphene from low-cost commercial polyimide (PI) polymers. The graphene was manually transferred to a commercial tape, which was used as sensor patch for experimentation. Salt solutions with different concentrations were tested to determine the most sensitive frequency region of the sensor. The results are encouraging to further develop this sensor in a platform for a fully functional urinary incontinence detection system.

  17. Electrophysiological Basis of Fecal Incontinence and Its Implications for Treatment

    Science.gov (United States)

    2017-01-01

    The majority of patients with neuropathic incontinence and other pelvic floor conditions associated with straining at stool have damage to the pudendal nerves distal to the ischial spine. Sacral nerve stimulation appears to be a promising innovation and has been widely adopted and currently considered the standard of care for adults with moderate to severe fecal incontinence and following failed sphincter repair. From a decision-to-treat perspective, the short-term efficacy is good (70%–80%), but the long-term efficacy of sacral nerve stimulation is around 50%. Newer electrophysiological tests and improved anal endosonography would more effectively guide clinical decision making. PMID:29159162

  18. Effects of attributional retraining on writing performance and perceived competence of Taiwanese university nursing students.

    Science.gov (United States)

    Tai, Hung-Cheng; Pan, Mei-Yu; Lee, Bih-O

    2016-09-01

    Attributional retraining (AR) has been applied in various professional fields. The application of AR in nursing education is rarely seen. This study explores the effects of AR on university nursing students' writing performance, perceived competence, and the relationship between writing performance and perceived competence using a blended platform of online and face-to-face approaches. A single-group experimental study was used. A total of 187 students participated in this study. The setting was the two-year vocational nursing course in a university. The Scale for Rating Composition Tasks and the Perceived Competence Scale were used before and after the AR intervention. The students' writing performance showed significant improvement after the intervention. AR had effectively influenced the students' perceived competence. The perceived competence of the students interacted with the writing performance improvements after the AR intervention. The AR intervention suggests an alternative teaching approach that can help enhance students' English writing performance as well as perceived competence. The AR programme may be applied in English language teaching and professional courses. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Supervised pelvic floor muscle training versus attention-control massage treatment in patients with faecal incontinence

    DEFF Research Database (Denmark)

    Ussing, Anja; Dahn, Inge; Due, Ulla

    2017-01-01

    supplements is recommended as first-line treatment for faecal incontinence. Despite this, the effect of pelvic floor muscle training for faecal incontinence is unclear. No previous trials have investigated the efficacy of supervised pelvic floor muscle training in combination with conservative treatment...... treatment and conservative treatment. The primary outcome is participants' rating of symptom changes after 16 weeks of treatment using the Patient Global Impression of Improvement Scale. Secondary outcomes are the Vaizey Incontinence Score, the Fecal Incontinence Severity Index, the Fecal Incontinence...

  20. Patients' experiences of breathing retraining for asthma: a qualitative process analysis of participants in the intervention arms of the BREATHE trial.

    Science.gov (United States)

    Arden-Close, Emily; Yardley, Lucy; Kirby, Sarah; Thomas, Mike; Bruton, Anne

    2017-10-05

    Poor symptom control and impaired quality of life are common in adults with asthma, and breathing retraining exercises may be an effective method of self-management. This study aimed to explore the experiences of participants in the intervention arms of the BREATHE trial, which investigated the effectiveness of breathing retraining as a mode of asthma management. Sixteen people with asthma (11 women, 8 per group) who had taken part in the intervention arms of the BREATHE trial (breathing retraining delivered by digital versatile disc (DVD) or face-to-face sessions with a respiratory physiotherapist) took part in semi-structured telephone interviews about their experiences. Interviews were analysed using thematic analysis. Breathing retraining was perceived positively as a method of asthma management. Motivations for taking part included being asked, to enhance progress in research, to feel better/reduce symptoms, and to reduce medication. Participants were positive about the physiotherapist, liked having the materials tailored, found meetings motivational, and liked the DVD and booklet. The impact of breathing retraining following regular practice included increased awareness of breathing and development of new habits. Benefits of breathing retraining included increased control over breathing, reduced need for medication, feeling more relaxed, and improved health and quality of life. Problems included finding time to practice the exercises, and difficulty mastering techniques. Breathing retraining was acceptable and valued by almost all participants, and many reported improved wellbeing. Face to face physiotherapy was well received. However, some participants in the DVD group mentioned being unable to master techniques. PATIENTS RECEPTIVE TO BREATHING RETRAINING: Patients with asthma taught how to change their unconscious breathing patterns generally like non-pharmacological interventions. Researchers in the UK, led by Mike Thomas from the University of Southampton

  1. Incontinência do choro e infarto protuberancial unilateral Incontinence of crying and unilateral pontine infarct

    Directory of Open Access Journals (Sweden)

    Ricardo de Oliveira-Souza

    1995-09-01

    Full Text Available O presente estudo trata do caso de um paciente que apresentou incontinência do choro e hemiplegia direita por infarto ventroprotuberancial paramediano detectado pela RNM. O caráter circunscrito da lesão foi endossado pela normalidade dos potenciais evocados sômato-sensitivos e auditivos de curta-latência. Os episódios de choro desapareceram poucos dias depois do início do tratamento com doses baixas de imipramina. Discutimos o choro e riso patológicos como forma de incontinência da mímica resultante de desconexão límbico-motora, enfatizando a impropriedade de incluí-los na síndrome pseudobulbar, uma vez que dependem de correlatos anatômicos e funcionais distintos.A 64-year-old man presented with pathologic crying and right hemiplegia due to a unilateral pontine infarct from probable branch disease of the basilar artery. The circumscribed nature of the lesion was supported by MRI and short-latency evoked potentials. The weeping spells ceased after a few days of imipramine in low doses. Pathologic laughing and crying can be viewed as a limbic-motor disconnection syndrome, in which the faciovocal motor system is released from forebrain afferents carrying information of emotional content. The inclusion of pathologic laughing and crying in the syndrome pseudobulbar palsy is inaccurate and misleading, since each is related to distinct functional and anatomic systems intrinsic to the human brainstem.

  2. Retrocrural Lymph Node Metastasis Disclosed by (18)F-FDG PET/CT: A Predictor of Supra-diaphragmatic Spread in Ovarian Cancer.

    Science.gov (United States)

    Im, Hyung-Jun; Kim, Yong-Il; Paeng, Jin Chul; Chung, June-Key; Kang, Soon-Beom; Lee, Dong Soo

    2012-03-01

    Retrocrural lymph nodes (RCLNs) communicate with retroperitoneal and posterior mediastinal LNs. It is possible that, when RCLNs are involved, supra-diaphragmatic extension will occur in abdomino-pelvic cancers. The authors investigated performance of (18)F-FDG PET/CT to diagnose RCLN metastasis and whether RCLN metastases were associated with supra-diaphragmatic lymphatic metastases of ovarian cancer. Sixty-seven patients with stage IV ovarian cancer who had undergone (18)F-FDG PET/CT were included in this retrospective study. Diagnostic performance of (18)F-FDG PET/CT for RCLN metastasis was evaluated. Patients were divided into two groups by presence or absence of supra-diaphragmatic LN metastasis. The prevalences of RCLN metastasis between the two groups were compared and the odds ratio was calculated. Sensitivity and specificity of (18)F-FDG PET/CT for RCLN metastasis were 96.3 and 100%, respectively. Of the 67 study subjects, 27 patients had RCLN metastases (40.3%). Fifty patients had supra-diaphragmatic LN metastases. (18)F-FDG PET/CT showed 26 RCLN metastases in patients with supra-diaphragmatic LN metastases (54.5%), and only 1 in patients without supra-diaphragmatic LN metastasis (5.9%), and the difference between two groups was statistically significant (P supra-diaphragmatic LN metastasis was 17.3 (95% confidence interval = 2.1 to 140.9, P = 0.008). Performance of (18)F-FDG PET/CT to diagnose RCLN metastasis was excellent. RCLN metastasis revealed by (18)F-FDG PET/CT was strongly associated with supra-diaphragmatic LN spread of ovarian cancer. Thus, RCLN metastasis could be used as a predictor of supra-diaphragmatic lymphatic metastasis of ovarian cancer.

  3. Urinary incontinence at orgasm: relation to detrusor overactivity and treatment efficacy.

    Science.gov (United States)

    Serati, Maurizio; Salvatore, Stefano; Uccella, Stefano; Cromi, Antonella; Khullar, Vik; Cardozo, Linda; Bolis, Pierfrancesco

    2008-10-01

    To understand the pathophysiological mechanism of incontinence during orgasm and to compare women affected by symptomatic detrusor overactivity (DO) with and without incontinence at orgasm in terms of efficacy of antimuscarinic treatment. All consecutive sexually active women with incontinence during intercourse were prospectively included and divided into two groups: women with coital incontinence at orgasm or at penetration. The two forms of coital incontinence were correlated to the urodynamic finding of DO. Women complaining of overactive bladder (OAB) symptoms, with urinary incontinence at orgasm and urodynamically proven DO (cases), were prescribed tolterodine 4 mg extended release for at least 12 wk. The cases were compared in terms of efficacy of treatment on OAB symptoms to consecutive patients with symptomatic DO without coital incontinence (control group). Among the 1133 women who underwent urodynamic testings during the study period, 132 patients were eligible for final analysis. A significant difference in DO was observed in women with incontinence at orgasm (34 of 49; 69.4%) compared with women with incontinence during penetration (24 of 83; 28.9%) (porgasm associated with DO were given antimuscarinics treatment and were compared with 53 controls. Fourteen of 34 (41.2%) and 9 of 53 (17%) women did not respond to antimuscarinics in the cases and in the control group, respectively (p=0.023). Incontinence at orgasm is associated with DO in the majority of cases. This is the first study showing an inferior efficacy of antimuscarinic treatment in women with DO complaining of incontinence at orgasm.

  4. Time to and predictors of dual incontinence in older nursing home admissions.

    Science.gov (United States)

    Bliss, Donna Z; Gurvich, Olga V; Eberly, Lynn E; Harms, Susan

    2018-01-01

    There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents. Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used. At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care. The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents. © 2017 Wiley Periodicals, Inc.

  5. Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication.

    Science.gov (United States)

    Ahn, Hyo Yeong; Kim, Yeong Dae; Hoseok, I; Cho, Jeong Su; Lee, Jonggeun; Son, Joohyung

    2016-12-01

    Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO 2 ) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO 2 gas and group without using CO 2 gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. The improvement of forced expiratory volume at 1 second in the group using CO 2 gas and the group not using CO 2 gas was 22.46±11.27 and 21.08±5.39 (p=0.84). The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO 2 ) and 15.6±0.89 (without CO 2 ) (p=0.03). During follow-up (17±17 months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Thoracoscopic plication under single lung ventilation using CO 2 insufflation could be an effective, safe option to flatten the diaphragm.

  6. Surgical Outcomes of Pneumatic Compression Using Carbon Dioxide Gas in Thoracoscopic Diaphragmatic Plication

    Directory of Open Access Journals (Sweden)

    Hyo Yeong Ahn

    2016-12-01

    Full Text Available Background: Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide (CO2 gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Methods: Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using CO2 gas and group without using CO2 gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. Results: The improvement of forced expiratory volume at 1 second in the group using CO2 gas and the group not using CO2 gas was 22.46±11.27 and 21.08±5.39 (p=0.84. The improvement of forced vital capacity 3 months after surgery was 16.74±10.18 (with CO2 and 15.6±0.89 (without CO2 (p=0.03. During follow-up (17±17 months, there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Conclusion: Thoracoscopic plication under single lung ventilation using CO2 insufflation could be an effective, safe option to flatten the diaphragm.

  7. Bilious emesis as presenting symptom of congenital diaphragmatic hernia in an 8-month-old

    Directory of Open Access Journals (Sweden)

    Daphney Clermont

    2017-12-01

    Full Text Available Although congenital diaphragmatic hernia (CDH primarily presents in either the prenatal or neonatal period, late presentation has a reported incidence of 2.5–25%. This case report describes an 8-month-old-male who presented to the emergency department with dehydration and a 24-h history of bilious emesis. Work-up led to the diagnosis of a left-sided Bochdalek CDH. He subsequently underwent laparoscopic diaphragmatic hernia repair with reduction of near-total length of incarcerated bowel. The patient had an uneventful recovery. Babies born with CDH are typically unstable at birth, and even with repair, the mortality rate remains high. However, in the case of delayed CDH diagnosis where there are no perinatal issues, surgical repair has very high success rates, provided that there are no complications regarding the delay. If there is not a high index of suspicion based on the patient's history and exam, delayed diagnosis and intervention with late CDH presentations can lead to complications which could otherwise be minimized. The purpose of this case report is to raise awareness and contribute to the growing knowledge about delayed CDH presentation among physicians and surgeons to facilitate early diagnosis and care of a morbid yet manageable condition.

  8. Visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy

    Directory of Open Access Journals (Sweden)

    Yasushi Mizukami

    2017-10-01

    Full Text Available Abstract Background Pulmonary visceral subpleural hematoma is rare. We report visceral subpleural hematoma of the left diaphragmatic surface following left upper division segmentectomy. This very rare case was difficult to distinguish from thoracic abscess. Case presentation A 68-year-old man with hypertension had undergone video-assisted thoracoscopic left upper division segmentectomy for suspected lung carcinoma. Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. Computed tomography-guided drainage was attempted, but proved unsuccessful. Fever continued and surgical investigation was therefore performed. Visceral subpleural hematoma was identified under the diaphragmatic surface of the left basal lung. We excised the pleura, then performed drainage and applied running sutures. The parenchyma and visceral pleura were covered with polyglycolic acid sheet and fibrin glue. Edoxaban was restarted on postoperative day 12 of video-assisted thoracoscopic surgery and no recurrence of hematoma has been revealed. Conclusions Visceral subpleural hematoma after thoracic surgery is extremely rare. Furthermore, correct diagnosis was difficult and surgery offered a good diagnostic and therapeutic procedure.

  9. Video-assisted thoracoscopy for diaphragmatic plication: experimental study in a canine model.

    Science.gov (United States)

    Gonzalez-Zamora, Jose F; Perez-Guille, Beatriz; Soriano-Rosales, Rosa E; Jimenez-Bravo-Luna, Miguel A; Gutierrez-Castrellon, Pedro; Ridaura-Sanz, Cecilia; Alvarez, Fernando Villegas

    2005-12-01

    Plication of a nonfunctional hemidiaphragm usually restores altered ventilatory mechanics. This study compared two techniques in performing diaphragmatic plication: video-assisted thoracoscopy (group A) and thoracotomy (group B). Twenty dogs with induced paralysis of the right hemidiaphragm were randomly assigned to one of the two groups. Evaluations were performed before and after plication of the respiratory frequency (f) and lung area (LA) of the affected side. Operative time, time to resumption of walking, ingestion of fluids and solid food, pain intensity, and postoperative complications were measured. Group A had less pain after the surgery (P fluid ingestion (P < 0.05), and earlier resumption of walking (P < 0.019). Four weeks after the procedure, LA was similar in both groups, while a significant decrease in f was recorded in group A (P < 0.02). The remaining evaluated variables showed no differences. Both approaches were effective. Pain recorded in the postoperative period was less and recovery was faster in group A. Complications and surgical times were similar. The video-assisted thoracoscopy is a safe and efficient option for performing diaphragmatic plication in dogs.

  10. Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax

    Directory of Open Access Journals (Sweden)

    Lingohr P

    2014-02-01

    Full Text Available Philipp Lingohr,1 Thomas Galetin,2 Boris Vestweber,2 Hanno Matthaei,1 Jörg C Kalff,1 Karl-Heinz Vestweber2 1Department of Surgery, University of Bonn, Bonn, Germany; 2Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany Purpose: Diaphragmatic hernias (DHs are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. Keywords: bilateral diaphragmatic hernia, enterothorax, conventional hernia repair, PERMACOL™, biological implant, diaphragm replacement, mesh repair

  11. Normal appearance and size of the diaphragmatic crura in children: CT evaluation

    International Nuclear Information System (INIS)

    Brengle, M.; Cohen, M.D.; Katz, B.

    1996-01-01

    Purpose. The objectives of the study were to document the normal CT appearance and size of the crura of the diaphragm in children. Materials and methods. The CT scans of 80 children (0-15 years) were reviewed. The children were divided into eight age groups. The maximal transverse diameters of the right and left crura were measured. They were normalized by comparison with the transverse and anterior-posterior diameters of the 12th thoracic vertebra (T12) and the transverse abdominal diameter at T12. The crura were also evaluated as to whether their contour was smooth or nodular. Results. The diaphragmatic crura of smaller children appear large, relative to body size and the diameters of the T12 vertebral body, compared with those in older children. Crural width does not increase significantly with age. Additionally, the crura were found to have a greater tendency to be nodular in appearance in children under the age of 5 years than in older children. Conclusion. Diaphragmatic crura are more nodular and larger relative to body size in younger children. (orig.). With 6 figs., 2 tabs

  12. Spontaneous prematurity in fetuses with congenital diaphragmatic hernia: a retrospective cohort study about prenatal predictive factors.

    Science.gov (United States)

    Barbosa, Bruna Maria Lopes; Rodrigues, Agatha S; Carvalho, Mario Henrique Burlacchini; Bittar, Roberto Eduardo; Francisco, Rossana Pulcineli Vieira; Bernardes, Lisandra Stein

    2018-01-12

    To evaluate possible predictive factors of spontaneous prematurity in fetuses with congenital diaphragmatic hernia (CDH). A retrospective cohort study was performed. Inclusion criteria were presence of CDH; absence of fetoscopy; absence of karyotype abnormality; maximum of one major malformation associated with diaphragmatic hernia; ultrasound monitoring at the Obstetrics Clinic of Clinicas Hospital at the University of São Paulo School of Medicine, from January 2001 to October 2014. The data were obtained through the electronic records and ultrasound system of our fetal medicine service. The following variables were analyzed: maternal age, primiparity, associated maternal diseases, smoking, previous spontaneous preterm birth, fetal malformation associated with hernia, polyhydramnios, fetal growth restriction, presence of intrathoracic liver, invasive procedures performed, side of hernia and observed-to- expected lung to head ratio (o/e LHR). On individual analysis, variables were assessed using the Chi-square test and the Mann-Whitney test. A multiple logistic regression model was applied to select variables independently influencing the prediction of preterm delivery. A ROC curve was constructed with the significant variable, identifying the values with best sensitivity and specificity to be suggested for use in clinical practice. Eighty fetuses were evaluated, of which, 21 (26.25%) were premature. O/e LHR was the only factor associated with prematurity (p = 0.020). The ROC curve showed 93% sensitivity with 48.4% specificity for the cutoff of 40%. O/e LHR was the only predictor of prematurity in this sample.

  13. Congenital diaphragmatic hernia with concurrent aplasia of the pericardium in a foal.

    Science.gov (United States)

    Tăbăran, Alexandru-Flaviu; Nagy, Andras Laszlo; Cătoi, Cornel; Morar, Iancu; Tăbăran, Alexandra; Mihaiu, Marian; Bolfa, Pompei

    2015-12-30

    In veterinary medicine congenital abnormalities of the diaphragm and pericardium are rare, idiopathic malformations, being reported mainly in dogs. This report documents an unusual case of developmental defects in a foal consisting of diaphragmatic hernia concurrent with pericardial aplasia. Following a normal delivery, a full term, female Friesian stillborn foal with the placenta was presented for necropsy. External morphological examination indicated a normally developed foal. At necropsy, a large oval defect (approximately 20 × 15 cm in size) was observed in the left-dorsal side of the diaphragm (left lumbocostal triangle). This defect allowed the intestinal loops, spleen and partially the liver to translocate into the thorax. The loops of the left ascending colon, including the pelvic flexure and partially the small intestine covered the cranial and dorsal posterior parts of the heart due to the complete absence of the left pericardium. The remaining pericardium presented as a white, semi-transparent strip, partially covering the right side of the heart. The left lung and the main bronchus were severely hypoplastic to approximately one-fifth the size of their right homologue. The intermediate part of the liver, containing mainly the enlarged quadrate lobe was translocated in the thorax, severely enlarged and showed marked fibrosis. Histologically in the herniated lobes we diagnosed hepatic chronic passive congestion, telangiectasia and medial hypertrophy of blood vessels. Concomitant malformation involving diaphragmatic hernia and pericardial aplasia in horses have not been previously reported. Moreover, this is the first case describing pericardial aplasia in horse.

  14. Congenital diaphragmatic hernia: neonatal outcomes following referral to a paediatric surgical centre.

    LENUS (Irish Health Repository)

    Chukwu, J

    2012-02-01

    Congenital diaphragmatic hernia (CDH) is a rare malformation observed in approximately 1 in 3000 live births. Estimates of postnatal survival range from 50 to 70% despite advances in neonatal care. Antenatal diagnosis is associated with termination of pregnancy in 25-50% pregnancy internationally which may not be reflective of the Irish population. We aimed to evaluate the mortality of infants with CDH who survived to admission in a tertiary referral paediatric hospital between 1996 and 2007. The Hospital In-Patient Enquiry system was used to determine the number of neonatal referrals for CDH to OLHSC between 1996 and 2007. Mortality, sex distribution, length of patient stay and the number of cases per year were examined. 141 neonates with CDH were over 12 years with approximately 12 referrals per annum of which 82 (58%) were male and 59 (42%) female. The average length of stay in the hospital was 33 (range 0-364) days. Overall 71% of the patients survived to discharge. In the first epoch (1996-2001) survival was 63% compared with 78% in the later epoch (2002-7). The overall survival for neonates with CDH presenting to OLCHC during the 12 year-period was 71% although this improved to 78% in recent epoch. Further study of associated congenital anomalies, number of terminations of pregnancy, complexity of the diaphragmatic defect and degree of pulmonary hypertension are required to compare this population with other international centres.

  15. Acute gastrointestinal compromise in neonates with congenital diaphragmatic hernia prior to repair.

    Science.gov (United States)

    Fox, Catherine; Stewart, Michael; King, Sebastian K; Patel, Neil

    2016-12-01

    Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise. A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012). A total of 126 CDH patients were managed during the 8-year period. Five neonates (male - 1; gestation 37+4-39+7; birth weight 2.9-3.7kg; left CDH - 5) required emergency operative intervention for presumed gastrointestinal compromise. All five neonates demonstrated systemic hypotension despite inotropic support, raised serum lactate (>2mmol/L), and abnormal radiographic findings. Operative intervention occurred within 3days of birth (1-3days). Findings included gastric volvulus, jejunal volvulus, and perforated caecum. All patients underwent primary diaphragmatic repair without a patch. Temporary ileostomy was required in 1 patient. All patients remain alive. Gastrointestinal compromise is a rare, but potentially catastrophic, complication of CDH. Emergency operative intervention may be required in a select cohort of patients. Early deterioration following birth should alert clinicians to the possibility of significant intestinal pathology. Level IV case series with no comparison group. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Radiological diagnosis of congenital diaphragmatic hernia in 17th century Korean mummy.

    Directory of Open Access Journals (Sweden)

    Yi-Suk Kim

    Full Text Available Congenital diaphragmatic hernia (CDH is a birth defect of the diaphragm resulting in pulmonary sequelae that threaten the lives of infants. In computed tomography (CT images of a 17th century middle-aged male mummy (the Andong mummy, we observed that the abdominal contents had protruded into the right thoracic cavity through the diaphragmatic defect, accompanied by a mediastinal shift to the left. On autopsy, the defect in the right posterolateral aspect of the diaphragm was reconfirmed, as was the herniation of the abdominal organs. The herniated contents included the right lobe of the liver, the pyloric part of the stomach, a part of the greater omentum, and the right colic flexure connecting the superior part of the ascending colon and the right part of the transverse colon. Taking our CT and autopsy results together, this case was diagnosed as the Bochdalek-type CDH. Herein we make the first ever report of a CT-assisted diagnosis of a pre-modern historical case of CDH. Our results show the promising utility of this modality in investigations of mummified human remains archaeologically obtained.

  17. Interval between injection of contrast material and positive contrast cheliography affects accurate diagnosis of diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Ismail A. Sen

    2015-01-01

    Full Text Available The aim of this study was to evaluate the clinical, surgical and diagnostic imaging findings in 11 cats and 3 dogs with suspected acute and chronic traumatic diaphragmatic hernia, and to compare the results of positive contrast cheliography (peritoneography taken immediately and 5 min after the injection of contrast material. Thoracic and abdominal radiography, ultrasonography, and positive contrast cheliography of all animals were performed. Eight cases were considered as acute and six cases were considered chronic. The contrast images taken immediately after the injection of contrast material revealed the contrast material in the thoracic cavity in 8/8 acute trauma patients, but in none of the chronic cases. In 5/6 of these cases contrast material was seen in the thoracal cavity only in additional images taken after 5 min. One patient was diagnosed with FIP and excluded from the study. Twelve cases had complete resolution and one animal died during the early postoperative period. Our results suggest that positive contrast cheliography performed immediately after the injection of contrast material may not reveal chronic cases of diaphragmatic hernia and a second imaging (or imaging after 5 min is indicated in order not to overlook chronic cases.

  18. Quantification of renal and diaphragmatic interfractional motion in pediatric image-guided radiation therapy: A multicenter study

    NARCIS (Netherlands)

    Huijskens, Sophie C.; van Dijk, Irma W. E. M.; de Jong, Rianne; Visser, Jorrit; Fajardo, Raquel Dávila; Ronckers, Cécile M.; Janssens, Geert O. R. J.; Maduro, John H.; Rasch, Coen R. N.; Alderliesten, Tanja; Bel, Arjan

    2015-01-01

    To quantify renal and diaphragmatic interfractional motion in order to estimate systematic and random errors, and to investigate the correlation between interfractional motion and patient-specific factors. We used 527 retrospective abdominal-thoracic cone beam CT scans of 39 childhood cancer

  19. Evaluation of lung function changes before and after surfactant application during artificial ventilation in newborn rats with congenital diaphragmatic hernia

    NARCIS (Netherlands)

    E.C. Scheffers; H. IJsselstijn (Hanneke); R. Tenbrinck (Robert); B.F. Lachmann (Burkhard); J.C. de Jongste (Johan); J.C. Molenaar; D. Tibboel (Dick)

    1994-01-01

    textabstractPatients with congenital diaphragmatic hernia (CDH) have unilateral or bilateral hypoplasia of the lungs including delayed maturation of the terminal air sacs. Because these lungs are highly susceptible to barotrauma and oxygen toxicity, even in full-term newborns, continued research

  20. Congenital diaphragmatic hernia interval on chromosome 8p23.1 characterized by genetics and protein interaction networks

    DEFF Research Database (Denmark)

    Longoni, Mauro; Hansen, Kasper Lage; Russell, Meaghan K.

    2012-01-01

    Chromosome 8p23.1 is a common hotspot associated with major congenital malformations, including congenital diaphragmatic hernia (CDH) and cardiac defects. We present findings from high‐resolution arrays in patients who carry a loss (n = 18) or a gain (n = 1) of sub‐band 8p23.1. We confirm a region...

  1. Quantification of renal and diaphragmatic interfractional motion in pediatric image-guided radiation therapy: A multicenter study

    NARCIS (Netherlands)

    Huijskens, S.C.; Dijk, I.W. van; Jong, R. de; Visser, J.; Fajardo, R.D.; Ronckers, C.M.; Janssens, G.O.R.J.; Maduro, J.H.; Rasch, C.R.; Alderliesten, T.; Bel, A.

    2015-01-01

    BACKGROUND AND PURPOSE: To quantify renal and diaphragmatic interfractional motion in order to estimate systematic and random errors, and to investigate the correlation between interfractional motion and patient-specific factors. MATERIAL AND METHODS: We used 527 retrospective abdominal-thoracic

  2. Effect of Age, Educational Status, Parity and BMI on Development of Urinary Incontinence - a Cross Sectional Study in Saudi Population

    OpenAIRE

    Saadia, Zaheera

    2015-01-01

    Background: The research article looks at the background of women with urinary incontinence and exposed to different demographic factors. Women who had urinary incontinence and women without urinary incontinence were compared with regards to their demographic features and risk of development of urinary problems. These risk factors can either cause short term or temporary urinary incontinence or they can cause long term or permanent urinary incontinence. This article explores the association o...

  3. Prevalence of Stress Urinary Incontinence in Elite Female Endurance Athletes

    Directory of Open Access Journals (Sweden)

    Poświata Anna

    2014-12-01

    Full Text Available The goal of the study was to assess the prevalence of stress urinary incontinence in a group of elite female endurance athletes, as professional sport is one of the risk factors for stress urinary incontinence. SUI rates in the groups of female cross-country skiers and runners were compared to determine whether the training weather conditions like temperature and humidity influenced the prevalence of urinary incontinence. An anonymous questionnaire was distributed among 112 elite female athletes ie., 57 cross-country skiers and 55 runners. We used a short form of the Urogenital Distress Inventory (UDI-6 to assess the presence of SUI symptoms and the level of urogenital distress. Only women who had been practicing sport professionally for at least 3 years, on an international and national level, were included in the research. The study group consisted of 76% nulliparous and 24% parous women. 45.54% of all participants reported leakage of urine associated with sneezing or coughing which indicates stress urinary incontinence. 29.46% were not bothered by the urogenital distress symptoms. 42.86% of the participants were slightly bothered by the symptoms, 18.75% were moderately bothered, 8.04% were significantly bothered and 0.89% were heavily bothered. The absence of statistically significant differences between both groups seems to indicate that training weather conditions did not influence the prevalence of SUI in elite female endurance athletes.

  4. Quality of life in women with urinary incontinence

    Directory of Open Access Journals (Sweden)

    Cláudia Senra

    2015-04-01

    Full Text Available Summary The aim of this study is to examine the relationship among psychological, clinical and sociodemographic variables, and quality of life in women with urinary incontinence. The sample consisted of 80 women diagnosed with urinary incontinence (UI followed in a Northern Central Hospital in Portugal. Participants answered the Incontinence Quality of Life (I-QOL; Satisfaction with Sexual Relationship Questionnaire (SSRQ; Hospital Anxiety and Depression Scales (HADS and the Brief Cope. The results revealed that women with higher quality of life considered their symptoms of urine loss as mild or moderated compared to those with severe urine loss. The less severe urine loss was associated with greater sexual satisfaction and less use of religion and self-blame as coping strategies. In terms of coping, women who considered the loss of urine as severe expressed more feelings regarding UI. Stress urinary incontinence, high sexual satisfaction, and less use of denial, distraction, and religion as coping strategies, predicted higher quality of life. According to the results, UI has an impact on women’s sexual satisfaction and quality of life. Therefore, intervention programs should target these women, including their partners, helping them to adjust to their condition and teaching effective coping strategies in order to improve their sexual satisfaction and quality of life.

  5. Urinary incontinence in persons with Prader-Willi Syndrome

    NARCIS (Netherlands)

    Gontard, A. von; Didden, H.C.M.; Sinnema, M.; Curfs, L.M.G.

    2010-01-01

    OBJECTIVE To assess and identify the frequency and type of urinary incontinence (UI), as well as associated symptoms in persons with Prader-Willi syndrome (PWS). PWS is characterized by mental retardation, short stature, obesity and hypogonadism. The behavioural phenotype includes eating problems,

  6. Stress urinary incontinence: effect of pelvic muscle exercise

    NARCIS (Netherlands)

    Ferguson, K. L.; McKey, P. L.; Bishop, K. R.; Kloen, P.; Verheul, J. B.; Dougherty, M. C.

    1990-01-01

    Twenty women with stress urinary incontinence diagnosed by urodynamic testing participated in a 6-week pelvic muscle exercise program. The aim of the study was to evaluate the effectiveness of the exercise program, with or without an intravaginal balloon, on urinary leakage as determined by a

  7. Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review

    NARCIS (Netherlands)

    Heesakkers, J.P.F.A.; Farag, F.; Bauer, R.M.M.J.; Sandhu, J.; Ridder, D. de; Stenzl, A.

    2017-01-01

    CONTEXT: The incidence and awareness of postprostatectomy incontinence (PPI) has increased during the past few years, probably because of an increase in prostate cancer surgery. Many theories have been postulated to explain the pathophysiology of PPI. OBJECTIVE: The current review scrutinizes

  8. Anal incontinence in women with recurrent obstetric anal sphincter rupture

    DEFF Research Database (Denmark)

    Bøgeskov, Reneé; Nickelsen, Carsten Nahne Amtoft; Secher, Niels Jørgen

    2015-01-01

    UNLABELLED: Abstract Objectives: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS...

  9. Yoga for treatment of urinary incontinence in women

    Science.gov (United States)

    Wieland, L. Susan; Shrestha, Nipun; Lassi, Zohra S; Panda, Sougata; Chiaramonte, Delia; Skoetz, Nicole

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of yoga for treatment of urinary incontinence in women, compared to no specific treatment, to another active treatment, or to an active treatment without adjuvant yoga, with a focus on patient symptoms and quality of life. PMID:29081716

  10. Assessment and management of urinary incontinence in women.

    Science.gov (United States)

    Stewart, Ellie

    2018-05-02

    Urinary incontinence is a common and usually hidden issue that can affect women of all ages. It is often ignored by the patient because of their misconception that incontinence is an inevitable consequence of ageing and their low expectations of successful treatment. There are various types of incontinence, with symptoms that can significantly affect patients' quality of life. This article aims to enhance nurses' understanding of the types of urinary incontinence affecting women, associated risk factors and continence assessment, as well as the initial investigations and conservative treatments that can be instigated by general nurses. It also discusses some of the advanced treatments offered by specialist services. The article emphasises the importance of undertaking a holistic continence assessment to ensure appropriate continence care is provided, and how tailoring this care to the individual can improve adherence to treatment plans. © 2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  11. Prospective assessment of interobserver agreement for defecography in fecal incontinence

    NARCIS (Netherlands)

    Dobben, Annette C.; Wiersma, Tjeerd G.; Janssen, Lucas W. M.; de Vos, Rien; Terra, Maaike P.; Baeten, Cor G.; Stoker, Jaap

    2005-01-01

    OBJECTIVE. The primary aim of our study was to determine the interobserver agreement of defecography in diagnosing enterocele, anterior rectocele, intussusception, and anismus in fecal-incontinent patients. The subsidiary aim was to evaluate the influence of level of experience on interpreting

  12. Ano-rectal tuberculous granulomapresenting with faecal incontinence

    African Journals Online (AJOL)

    ... present a case of a 68-year old man with a huge mass in the ano-rectum with faecal incontinence, which was clinically diagnosed as an advanced carcinoma of the ano-rectum for which the biopsy was reported as tuberculosis. He improved with anti-tuberculosis treatment. Keywords: Ano-rectum, tuberculosis, cancer.

  13. Evaluation of a behavioral treatment for female urinary incontinence

    Directory of Open Access Journals (Sweden)

    Santacreu M

    2011-06-01

    Full Text Available Marta Santacreu, Rocío Fernández-BallesterosBiological and Health Psychology, Autonomous University of Madrid, Madrid, SpainAbstract: Urinary incontinence is a medical, psychological, social, economic, and hygienic problem. Although it is difficult to state its prevalence, all authors agree that it is related to age and gender. This study aimed to carry out a urinary incontinence behavioral treatment in order to reduce urine leakages in 14 participants recruited from a senior center. The program consists of daily training of the pelvic floor muscles with a weekly control by a supervisor during a 2-month period and follow-up of results 2 months after the last control session. Urinary incontinence episodes were reduced by 75.67% after program completion. It appears that pelvic floor muscles training, carried out under controlled and constant supervision, significantly reduces urinary leakage. Moreover, maintaining this improvement after treatment depends on the continuation of the exercises as well as on the urinary leakage frequency baseline and the urinary leakage frequency during the last treatment session.Keywords: urinary incontinence, pelvic floor muscle training, quasi-experimental design

  14. [Increase in number of operations for stress urinary incontinence

    NARCIS (Netherlands)

    Vierhout, M.E.

    2005-01-01

    Since the introduction of the minimally invasive tension-free vaginal tape (TVT) the number of operations performed for treatment of stress urinary incontinence has increased dramatically from over 1600 in 1999 to more than 4200 in 2003. Both gynaecologists and urologists now perform more TVTs and

  15. High-resolution endovaginal MR imaging in stress urinary incontinence

    Energy Technology Data Exchange (ETDEWEB)

    Stoker, Jaap; Lameris, Johan S. [Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam (Netherlands); Rociu, Elena [Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam (Netherlands); Department of Radiology, Erasmus Medical Center, 3015 GD, Rotterdam (Netherlands); Bosch, J.L.H. Ruud [Department of Urology, Erasmus Medical Center, 3015 GD, Rotterdam (Netherlands); Messelink, Embert J. [Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam (Netherlands); Department of Urology, Onze Lieve Vrouwe Gasthuis, 1091 HA, Amsterdam (Netherlands); Hulst, Victor P.M. van der [Department of Radiology, Onze Lieve Vrouwe Gasthuis, 1091 HA, Amsterdam (Netherlands); Groenendijk, Annette G. [Department of Gynecology, Onze Lieve Vrouwe Gasthuis, 1091 HA, Amsterdam (Netherlands); Eijkemans, Marinus J.C. [Department of Public Health, Erasmus Medical Center, 3015 GD, Rotterdam (Netherlands)

    2003-08-01

    The causes of stress urinary incontinence are not completely known. Recent papers have stressed the importance of more anatomical information, which may help to elucidate the mechanism of stress urinary incontinence. The purpose of this study was to evaluate the prevalence of lesions of the urethral support mechanism and lesions (defects and scars, thinning) of levator ani muscle with endovaginal MRI in a case-control study. Forty women (median age 52 years, age range 40-65 years) - 20 patients with stress urinary incontinence (cases) and 20 age-matched healthy volunteers (controls) - underwent endovaginal MRI: axial, coronal, and sagittal T2-weighted turbo spin echo. The examinations were evaluated for the presence of lesions of urethral supporting structures and levator ani and scar tissue of the levator ani. The thickness of the levator ani muscle was measured. Lesions of the urethral support system and levator ani were significantly more prevalent in cases than in controls (p<0.01). Median levator ani thickness in patients was significantly lower than in healthy controls [2.5 mm (range 0.9-4.1 mm) vs 3.9 mm (range 1.4-7 mm)] (p<0.01). This study indicates a relationship between stress urine incontinence and the presence of lesions of the urethral support and levator ani and levator ani thinning. (orig.)

  16. Development of hydrogel implants for urinary incontinence treatment

    Czech Academy of Sciences Publication Activity Database

    Šefc, L.; Přádný, Martin; Vacík, Jiří; Michálek, Jiří; Povýšil, C.; Vítková, I.; Halaška, M.; Šimon, V.

    2002-01-01

    Roč. 23, č. 17 (2002), s. 3711-3715 ISSN 0142-9612 R&D Projects: GA AV ČR KSK4050111 Institutional research plan: CEZ:AV0Z4050913 Keywords : urinary incontinence * swelling materials * artificial obstruction Subject RIV: FJ - Surgery incl. Transplants Impact factor: 3.008, year: 2002

  17. Female ejaculation orgasm vs. coital incontinence: a systematic review.

    Science.gov (United States)

    Pastor, Zlatko

    2013-07-01

    Women may expel various kinds of fluids during sexual arousal and at orgasm. Their origins, quantity, compositions, and expulsion mechanisms depend on anatomical and pathophysiological dispositions and the degree of sexual arousal. These are natural sexual responses but may also represent symptoms of urinary incontinence. The study aims to clarify the etiology of fluid leakage at orgasm, distinguish between associated physiological sexual responses, and differentiate these phenomena from symptoms of illness. A systematic literature review was performed. EMBASE (OvidSP) and Web of Science databases were searched for the articles on various phenomena of fluid expulsions in women during sexual arousal and at orgasm. Articles included focused on female ejaculation and its variations, coital incontinence (CI), and vaginal lubrication. Female ejaculation orgasm manifests as either a female ejaculation (FE) of a smaller quantity of whitish secretions from the female prostate or a squirting of a larger amount of diluted and changed urine. Both phenomena may occur simultaneously. The prevalence of FE is 10-54%. CI is divided into penetration and orgasmic forms. The prevalence of CI is 0.2-66%. Penetration incontinence occurs more frequently and is usually caused by stress urinary incontinence (SUI). Urodynamic diagnoses of detrusor overactivity (DOA) and SUI are observed in orgasmic incontinence. Fluid expulsions are not typically a part of female orgasm. FE and squirting are two different physiological components of female sexuality. FE was objectively evidenced only in tens of cases but its reported high prevalence is based mostly on subjective questionnaire research. Pathophysiology of squirting is rarely documented. CI is a pathological sign caused by urethral disorder, DOA, or a combination of both, and requires treatment. An in-depth appreciation of these similar but pathophysiologically distinct phenomena is essential for distinguishing normal, physiological sexual

  18. [Analysis of risk factors about stress urinary incontinence in female].

    Science.gov (United States)

    Song, Yan-feng; Lin, Jian; Li, Ya-qin; He, Xiao-yu; Xu, Bo; Hao, Lan; Song, Jian

    2003-12-01

    The aim was to assess the prevalence of stress urinary incontinence (SUI) in community dwelling women and to assess the relationship between the various risk factors and this disease. Selecting the community of Gulou at random and sending questionnaires to 6,066 women who living there. The questionnaire was designed to investigate the lower urinary tract symptoms, especially urinary incontinence. The questionnaire included some questions such as: age, weight, occupation, the level of education, menopause pregnancy and delivery, delivery through vagina or by cesarean section, the maximum body weight of fetus, chronic disease (hypertension, diabetes mellitus, cough, constipation), operation in abdomen and pelvis, the behaviour of life (smoking, alcohol abuse, exercise), the prevalence and frequency of urinary incontinence, the quality of life and the recognition of this disease. The collecting rate was 92.1% (5,587/6,066). The prevalence of urinary incontinence was 18.1% and the prevalence of SUI was 8.8%. Age (OR: 1.010, 95% CI: 1.001 - 1.025), higher body mass index (OR: 1.092, 95% CI: 1.054 - 1.132), hypertension (OR: 2.342, 95% CI: 1.026 - 5.349), constipation (OR: 1.448, 95% CI: 1.216 - 1.725), multiple abortion (OR: 1.306, 95% CI: 1.113 - 1.533), multipara (OR: 1.205, 95% CI: 1.009 - 1.440), using abdominal pressure in laboring (OR: 1.684, 95% CI: 1.140 - 2.489), straight cutting of perineum (OR: 2.244, 95% CI: 1.162 - 4.334), perineum tear (OR: 2.576, 95% CI: 1.724 - 3.851), infection of perineal incision (OR: 5.988, 95% CI: 1.936 - 18.616) were risk factors of SUI in women. Many risk factors can cause urinary incontinence, among them age, pregnancy and childbirth are most important ones.

  19. [Established treatment options for male stress urinary incontinence].

    Science.gov (United States)

    Hampel, C; Gillitzer, R; Wiesner, C; Thüroff, J W

    2007-03-01

    Nowadays, male stress urinary incontinence is rare and almost always of iatrogenic origin (radiotherapy, pelvic surgery). However, the prognosis of urinary incontinence following surgery is good and can be improved by pelvic floor muscle exercises in combination with biofeedback systems. For the remaining patient cohort with persistent urinary incontinence, several established surgical treatment options are available. Suburothelial injections of bulking agents can easily be performed in an ambulatory setting. However, regardless of the material used, long-term results are disappointing. Moreover, the residual urethral function deteriorates due to cicatrization of the suburothelial plexus with consequent loss of urethral elasticity. The fascial sling procedure in males has to be performed in preoperated areas and is as technically demanding for the surgeon as it is burdening for the patient. Alloplastic material is not used, thus minimizing risks for arrosion or infection. Since the sling tension can neither be standardized nor postoperatively readjusted, the risk of overcorrection is considerable and the success of the procedure is heavily dependent on the surgeon's experience. Despite wear and high revision rates, the technically mature artificial sphincter produces excellent continence results and has become the gold standard in the therapy of male stress urinary incontinence. The circumferential and continuous urethral compression by the cuff is highly effective, but at the price of an almost inevitable urethral atrophy. To overcome this problem, various surgical techniques have been developed (tandem cuff, cuff downsizing, transcorporal cuff placement). However, the expensive artificial sphincter is not a nostrum for every incontinent man, since it requires certain minimal cognitive and manual capabilities. Therefore, the search for less demanding treatment alternatives seems to be necessary, even if one has to accept lower continence rates.

  20. Trans-obturator Tape in surgical treatment of urinary incontinence

    Directory of Open Access Journals (Sweden)

    Ashrafi M

    2008-06-01

    Full Text Available Background: The aim of this study was to assess the efficacy and safety of a new minimally-invasive surgical procedure using trans-obturator Tape (TOT to treat female stress urinary incontinence.Methods: This clinical trial study was performed from 2003 to 2004 in the Gynecology Department of Imam Hospital, Vali-e-Asr, Tehran, Iran. A total of 35 women with stress urinary incontinence underwent the TOT procedure. All patients underwent pre-operative clinical examination, cough-stress test (full bladder, uroflowmetry and post-voiding residual volume assessment. Results: The mean age of patients was 50 years, ranging from 26 to 74 years, with an average urinary stress incontinence duration of six years. The mean time of follow-up was 14 months (at 1, 6, 12 and 24 months and the average duration of surgery was about 20 minutes. The perioperative complication rate was 9% with no vascular, nerve or bowel injuries. The rate of hemorrhagic side effects (spontaneously-absorbed hematoma and blood loss not requiring blood transfusion was 2.9%. Post-operative urinary retention and vaginal erosion occurred in one case each; the former was treated by intermittent self-catheterization. In total, 91.4% of patients were completely cured and 8.6% were improved without failure of treatment. Conclusions: The present study confirms the results obtained by Delorme and coworkers, and allows us to consider TOT as a safe, minimally invasive and efficient short-term surgical technique for the treatment of female stress urinary incontinence, alone or in combination with prolapse repair. Following this study, a randomized control trial is recommended to compare TOT with the gold standard surgery for women with urinary incontinence.

  1. The female urinary microbiome in urgency urinary incontinence.

    Science.gov (United States)

    Pearce, Meghan M; Zilliox, Michael J; Rosenfeld, Amy B; Thomas-White, Krystal J; Richter, Holly E; Nager, Charles W; Visco, Anthony G; Nygaard, Ingrid E; Barber, Matthew D; Schaffer, Joseph; Moalli, Pamela; Sung, Vivian W; Smith, Ariana L; Rogers, Rebecca; Nolen, Tracy L; Wallace, Dennis; Meikle, Susan F; Gai, Xiaowu; Wolfe, Alan J; Brubaker, Linda

    2015-09-01

    The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes. Catheterized urine samples were collected from multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms. More than one-half (51.1%; 93/182) of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m(2); P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P urinary incontinence episodes, -4.4 vs -3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%). DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Retraining therapy for chronic tinnitus. A critical analysis of its status.

    Science.gov (United States)

    Kroener-Herwig, B; Biesinger, E; Gerhards, F; Goebel, G; Verena Greimel, K; Hiller, W

    2000-01-01

    Tinnitus retraining therapy (TRT), as conceived of mainly by PJ Jastreboff, has recently received increasing attention in the media, as well as in seminars and congresses on treatment methods for chronic tinnitus. It is often claimed, though not explicitly in scientific publications, that TRT is currently the most efficacious therapy for tinnitus, obtaining improvement rates exceeding 80%. This assertion is highly significant in light of the most likely increasing prevalence of chronic tinnitus and ensuing urgent demand for effective therapies. Before examining the evidence regarding the effectiveness of TRT, Jastreboff's theoretical idea of tinnitus as a neurophysiological disorder is examined and evaluated. This idea is plausible and is supported by some evidence. The interaction between neuroacoustic and emotional processes emphasized by Jastreboff is, however, neither new nor sufficiently elaborated with respect to the underlying psychological factors. The TRT intervention technique and its main components 'directive counselling' and use of 'noise generators' are found to be theoretically well grounded. The lack of detailed information concerning TRT implementation and the potential consequence that differing interventions may be labelled TRT are criticized. Jastreboff's obvious opposition to psychologists' participation in TRT, despite the increase in efficacy they could affect through utilization of cognitive restructuring techniques and behaviour modification interventions, is also criticized. Finally, studies regarding the efficacy of TRT are reviewed and severe methodological shortcomings (e.g. lack of controlled randomized group studies) in TRT research are noted. Taking the current state of evidence into account, we conclude that there is no convincing empirical support for the assumption that TRT is superior to other treatments, since no comparative studies have been conducted. It is contended that there is more substantial empirical support for the

  3. Effect of attentional retraining on cognition, craving, and smoking in African American smokers.

    Science.gov (United States)

    Robinson, Cendrine D; Muench, Christine; Brede, Emily; Endrighi, Romano; Szeto, Edwin H; Sells, Joanna R; Lammers, John P; Okuyemi, Kolawole S; Waters, Andrew J

    2017-08-01

    African American cigarette smokers have lower rates of cessation than Whites and live in communities with a higher number of tobacco advertisements. Exposure to smoking cues may promote smoking and undermine cessation. It may be possible to reduce attention to smoking cues ("attentional bias"). In this study, we investigated the effect of attentional retraining (AR) on attentional bias and smoking in African American smokers. Nontreatment- seeking African American smokers (N = 64) were randomly assigned to an AR or control condition. Participants were given a mobile device for 2 weeks and prompted to complete up to 3 AR (or control) trainings per day. Participants completed assessments of attentional bias, craving, and smoking both in the lab and in the field. Participants in the AR and control conditions completed an average of 29.07 AR (SD = 12.48) and 30.61 control training tasks (SD = 13.07), respectively. AR reduced attentional bias assessed in the laboratory, F(1, 126) = 9.20, p = .003, and field, F(1, 374) = 6.18, p = .01. This effect generalized to new stimuli, but not to new tasks. AR did not significantly reduce craving or biological measures of smoking. Smoking assessed on the mobile device declined over days in the AR group, F(1, 26) = 10.95, p = .003, but not in the control group, F(1, 27) = 0.02, p = .89. Two weeks of AR administered on a mobile device reduced attentional bias in African American smokers and had mixed effects on smoking. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  4. [Study on reductive surgery for pelvic organ prolapse concomitant with anti-incontinence sling for treatment of occult stress urinary incontinence].

    Science.gov (United States)

    Zhang, Xiaolong; Lu, Yongxian; Shen, Wenjie; Liu, Jingxia; Ge, Jing; Liu, Xin; Zhao, Ying; Niu, Ke; Zhang, Yinghui; Wang, Wenying; Qiu, Chengli

    2014-06-01

    To evaluate the clinical outcome of anti-incontinence sling in the treatment of occult stress urinary incontinence (OSUI) during reductive surgery for advanced pelvic organ prolapse (POP). From Jun. 2003 to Dec. 2012, 78 patients with OSUI underwent reductive surgery for advanced POP such as high uterosacral ligament suspension, sacrospinous ligament suspension and sacral colpopexy in the First Affiliated Hospital, General Hospital of People's Liberation Army. Among them, 41 patients received reductive surgery alone was enrolled in non-concomitant anti-incontinence group and the other 37 patients who underwent same surgery with tension-free vaginal tape (TVT) or tension-free vaginal tape-obturator technique (TVT-O) was in anti-incontinence group. The patient's demography, objective and subjective outcomes, as well as complications and injures were compared between the two groups. The pelvic organ prolapse quantitation (POP-Q) was used to evaluate the objective outcomes of POP. Urinary distress inventory (UDI-6) and incontinence impact questionnaire short form (IIQ-7) were used to evaluate the subjective outcomes of stress urinary incontinence (SUI). Compared with the non-concomitant anti-incontinence group, the objective outcomes of reductive surgery exhibited no significant differences (100%, 78/78), and only the operation time of anti-incontinence group slightly increased 16 minutes. The occurrence rate of postoperative SUI was 12% (5/41), 15% (6/41), 17% (7/41) respectively after the operation at 2-month, 6-month and 12-month follow up in the non-concomitant anti-incontinence group; and the occurrence rate of the anti-incontinence group was 3% (1/37), 3% (1/37), 3% (1/37); but none of patients in the two groups require further surgery for stress urinary incontinence. Mean score of UDI-6 and IIQ-7 in all the patients decreased significantly after operation at 2-month, 6-month and 12-month follow up (all P statistic difference between the two groups (P > 0.05). It

  5. Analysis of diaphragmatic movement before and after pulmonary rehabilitation using fluoroscopy imaging in patients with COPD

    Directory of Open Access Journals (Sweden)

    Chun EM

    2015-01-01

    Full Text Available Eun Mi Chun,1 Soo Jeong Han,2 Hitesh N Modi3 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul, Republic of Korea; 2Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea; 3Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Republic of Korea Background: The diaphragm is the principal inspiratory muscle. The purpose of this study was to assess improvements in diaphragmatic movement before and after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD, using a fluoroscopy-guided chest X-ray.Patients and methods: Among 117 patients with COPD receiving pulmonary rehabilitation who underwent the initial fluoroscopy-guided chest X-ray and pulmonary function test, 37 of those patients who underwent both initial and follow-up fluoroscopy and pulmonary function tests were enrolled in this study. After hospital education, participants received pulmonary rehabilitation through regular home-based training for at least 3 months by the same physiatrist. We assessed the changes in diaphragm area with fluoroscopy-guided posteroanterior chest X-rays between pre- and postpulmonary rehabilitation. To minimize radiation hazards for subjects, the exposure time for fluoroscopy to take chest X-rays was limited to less than 5 seconds.Results: There were significant improvements (2,022.8±1,548.3 mm² to 3,010.7±1,495.6 mm² and 2,382.4±1,475.9 mm² to 3,315.9±1,883.5 mm²; right side P=0.001 and left side P=0.019, respectively in diaphragmatic motion area during full inspiration and expiration in both lungs after pulmonary rehabilitation. Pulmonary function tests showed no statistically significant difference between pre- and postpulmonary rehabilitation.Conclusion: The study suggests that the strategy to assess diaphragm movement using fluoroscopy is a relatively effective tool for the evaluation of pulmonary

  6. Urinary and anal incontinence during pregnancy and postpartum: incidence, severity, and risk factors.

    Science.gov (United States)

    Solans-Domènech, Maite; Sánchez, Emília; Espuña-Pons, Montserrat

    2010-03-01

    To estimate frequency and severity and to identify risk factors of urinary incontinence (UI) and anal incontinence during pregnancy and after delivery in previously continent nulliparous women. We designed a cohort study of healthy, continent, nulliparous pregnant women attending public health care services. The field work was conducted during the control visits of the three trimesters of pregnancy, at the time of delivery, and postpartum. A self-administered questionnaire was used to assess UI (validated and adapted) and anal incontinence. Frequency of UI and anal incontinence and their confidence intervals (95% CIs) were calculated. The correlations between the severity of UI and the degree of effect on daily life were also estimated. Multivariable Cox models were applied to estimate hazard ratios for both incontinences (urinary/anal) during pregnancy and postpartum. The cumulative incidence rate during pregnancy was 39.1% (95% CI 36.3-41.9) for UI and 10.3% (95% CI 8.3-12.3) for anal incontinence. The correlation between severity of UI and effect on daily life was moderate. Age, baseline body mass index, and family history of UI were significantly associated with the occurrence of UI during pregnancy, while age and excess weight gain during pregnancy were associated with the occurrence of anal incontinence during pregnancy. Postpartum, the identified risk factors for both incontinences were incontinence during pregnancy and vaginal delivery. The occurrence of UI and anal incontinence during the postpartum period is related to the presence of incontinence in pregnancy, and vaginal delivery increases the risk of persistent incontinence. Some risk factors for both incontinences during pregnancy and postpartum are related to lifestyles and obstetric practices.

  7. Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence.

    Science.gov (United States)

    Wang, Cuili; Li, Jingjing; Wan, Xiaojuan; Wang, Xiaojuan; Kane, Robert L; Wang, Kefang

    2015-04-01

    To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity. Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood. This was a cross-sectional community-based study. We enrolled a sample of 305 women aged 40-65 years with stress urinary incontinence from three communities in a Chinese city between May-October in 2011. Data were collected on socio-demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self-reported questionnaire. Effects of stigma were analysed using path analysis. Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment-seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment-seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment-seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence. Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment-seeking attitudes through internalisation of social messages. Stigma reduction may help incontinent women to form positive treatment-seeking attitudes and engage them in treatment. Interventions should specifically target

  8. Prevention of urinary and anal incontinence: role of elective cesarean delivery.

    Science.gov (United States)

    Lal, Mira

    2003-10-01

    Currently, prophylactic elective cesarean to prevent incontinence is being promoted without robust evidence supporting it, this has created confusion among health personnel [corrected]. Past research centered on defining the damaging effect of vaginal birth on continence whilst the limited research on elective cesarean considered it protective. Cesarean delivery has economic, obstetric, gynecological and psychosocial consequences, but incontinence is not uncommon with a persistent morbidity. There is confusion among health personnel about advocating elective cesarean delivery to prevent incontinence. Reviewing current research would facilitate obstetric thinking. Multiplanar endosonography and three-dimensional magnetic resonance imaging scanning are reportedly better in delineating structural alterations in the continence mechanism following vaginal birth and could be applied to postcesarean incontinence. Incontinence can follow vaginal or elective cesarean delivery and the severity following either mode is comparable. Urinary incontinence can resolve, persist or start de novo and the primiparous prevalence is similar following cesarean or vaginal birth. Transient anal incontinence can manifest during pregnancy. Paradoxically, pelvic floor strengthening exercises are beneficial for pregnancy-related incontinence, yet urinary incontinence occurs in nulliparas notwithstanding a strong pelvic floor. Improved imaging techniques should promote a better understanding of postcesarean incontinence. Since severe incontinence can occur after elective cesarean, its reportedly preventative role deserves more scrutiny. When incontinence occurs without labor, it is transient or shows exercise-related improvement; the role of elective cesarean delivery seems tenuous and needs careful evaluation. Current evidence does not support the routine use of elective cesarean to prevent incontinence so the delivery mode should continue to be dictated by obstetric considerations.

  9. Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity.

    Science.gov (United States)

    Wolin, Kathleen Y; Luly, Jason; Sutcliffe, Siobhan; Andriole, Gerald L; Kibel, Adam S

    2010-02-01

    Urinary incontinence is one of the most commonly reported and distressing side effects of radical prostatectomy for prostate carcinoma. Several studies have suggested that symptoms may be worse in obese men but to our knowledge no research has addressed the joint effects of obesity and a sedentary lifestyle. We evaluated the association of obesity and lack of physical activity with urinary incontinence in a sample of men who had undergone radical prostatectomy. Height and weight were abstracted from charts, and obesity was defined as body mass index 30 kg/m(2) or greater. Men completed a questionnaire before surgery that included self-report of vigorous physical activity. Men who reported 1 hour or more per week of vigorous activities were considered physically active. Men reported their incontinence to the surgeon at their urology visits. Information on incontinence was abstracted from charts at 6 and 58 weeks after surgery. At 6 weeks after surgery 59% (405) of men were incontinent, defined as any pad use. At 58 weeks after surgery 22% (165) of men were incontinent. At 58 weeks incontinence was more prevalent in men who were obese and physically inactive (59% incontinent). Physical activity may offset some of the negative consequences of being obese because the prevalence of incontinence at 58 weeks was similar in the obese and active (25% incontinent), and nonbese and inactive (24% incontinent) men. The best outcomes were in men who were nonobese and physically active (16% incontinent). Men who were not obese and were active were 26% less likely to be incontinent than men who were obese and inactive (RR 0.74, 95% CI 0.52-1.06). Pre-prostatectomy physical activity and obesity may be important factors in post-prostatectomy continence levels. Interventions aimed at increasing physical activity and decreasing weight in patients with prostate cancer may improve quality of life by offsetting the negative side effects of treatment. Copyright 2010 American Urological

  10. Mutations in STRA6 cause a broad spectrum of malformations including anophthalmia, congenital heart defects, diaphragmatic hernia, alveolar capillary dysplasia, lung hypoplasia, and mental retardation

    NARCIS (Netherlands)

    Pasutto, Francesca; Sticht, Heinrich; Hammersen, Gerhard; Gillessen-Kaesbach, Gabriele; Fitzpatrick, David R.; Nuernberg, Gudrun; Brasch, Frank; Schirmer-Zimmermann, Heidemarie; Tolmie, John L.; Chitayat, David; Houge, Gunnar; Fernandez-Martinez, Lorena; Keating, Sarah; Mortier, Geert; Hennekam, Raoul C. M.; von der Wense, Axel; Slavotinek, Anne; Meinecke, Peter; Bitoun, Pierre; Becker, Christian; Nuernberg, Peter; Reis, Andre; Rauch, Anita

    2007-01-01

    We observed two unrelated consanguineous families with malformation syndromes sharing anophthalmia and distinct eyebrows as common signs, but differing for alveolar capillary dysplasia or complex congenital heart defect in one and diaphragmatic hernia in the other family. Homozygosity mapping

  11. Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome.

    Science.gov (United States)

    Stępiński, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szymańska, Anna; Marczak, Jakub; Cichoń, Romuald

    2016-06-01

    A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

  12. Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome

    OpenAIRE

    St?pi?ski, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szyma?ska, Anna; Marczak, Jakub; Cicho?, Romuald

    2016-01-01

    A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

  13. Diaphragmatic rupture causing repeated vomiting in a combined abdominal and head injury patient: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Symeonidis Dimitrios

    2012-07-01

    Full Text Available Abstract Background Diaphragmatic rupture after blunt abdominal injury is a rare trauma condition. Delayed diagnosis is not uncommon especially in the emergency room setting. Associated injuries often shift diagnosis and treatment priorities towards other more life-threatening conditions. Case presentation We present a challenging case of a young male with combined abdominal and head trauma. Repeated episodes of vomiting dominated on clinical presentation that in the presence of a deep scalp laceration and facial bruising shifted differential diagnosis towards a traumatic brain injury. However, a computed tomography scan of the brain ruled out any intracranial pathology. Finally, a more meticulous investigation with additional imaging studies confirmed the presence of diaphragmatic rupture that justified the clinical symptoms. Conclusions The combination of diaphragmatic rupture with head injury creates a challenging trauma scenario. Increased level of suspicion is essential in order to diagnose timely diaphragmatic rupture in multiple trauma patients.

  14. The predictive value of demonstrable stress incontinence during basic office evaluation and urodynamics in women without symptomatic urinary incontinence undergoing vaginal prolapse surgery

    NARCIS (Netherlands)

    van der Ploeg, J. Marinus; Zwolsman, Sandra E.; Posthuma, Selina; Wiarda, Hylco S.; van der Vaart, C. Huub; Roovers, Jan-Paul W. R.

    2017-01-01

    Women with pelvic organ prolapse without symptoms of urinary incontinence (UI) might demonstrate stress urinary incontinence (SUI) with or without prolapse reduction. We aimed to determine the value of demonstrable SUI during basic office evaluation or urodynamics in predicting SUI after vaginal

  15. The Effect of Reduced Physical Activity and Retraining on Blood Lipids and Body Composition in Young and Older Adult Men

    DEFF Research Database (Denmark)

    Nørregaard, Jesper; Gram, Martin; Vigelsø, Andreas

    2015-01-01

    . Daily physical activity decreased by 31±9 (Y) and 37±9 (O) % (Polder adults. FFA and glycerol......We studied the effect of physical inactivity and subsequent re-training on cardiovascular risk factors in seventeen young (Y; 23.4±0.5) and fifteen older adult (O; 68.1±1.1 yrs.) men who underwent 14 days of one leg immobilization followed by six weeks of training. Body weight remained unchanged...... increased with reduced activity (Pphysical activity for two weeks increases blood lipids in both Y and O men. Six weeks of training improved...

  16. Effects of aging on muscle mechanical function and muscle fiber morphology during short-term immobilization and subsequent retraining

    DEFF Research Database (Denmark)

    Hvid, Lars; Aagaard, Per; Justesen, Lene

    2010-01-01

    Very little attention has been given to the combined effects of aging and disuse as separate factors causing deterioration in muscle mechanical function. Thus the purpose of this study was to investigate the effects of 2 wk of immobilization followed by 4 wk of retraining on knee extensor muscle...... to the deleterious effects of short-term muscle disuse on muscle fiber size and rapid force capacity than YM. Furthermore, OM seems to require longer time to recover and regain rapid muscle force capacity, which may lead to a larger risk of falling in aged individuals after periods of short-term disuse....

  17. Retrocrural Lymph Node Metastasis Disclosed by 18F-FDG PET/CT: A Predictor of Supra-diaphragmatic Spread in Ovarian Cancer

    International Nuclear Information System (INIS)

    Im, Hyung Jun; Kim, Yong il; Paeng, Jin Chul; Chung, June Key; Kang, Soon Beom; Lee, Dong Soo

    2012-01-01

    Retrocrual lymph nodes (RCLNs) communicate with retroperitoneal and posterior mediastinal LNs. It is possible that, when RCLNs are involved, supra diaphragmatic extension will occur in abdomino pelvic cancers. The authors investigated performance of 18F FDG PET/CT to diagnose RCLN metastasis and whether RCLN metastases were associated with supra diaphragmatic lymphatic metastases of ovarian cancer. Sixty seven patients with stage IV ovarian cancer who had undergone 18F FDG PET/CT were included in this retrospective study. Diagnostic performance of 18F FDG PET/CT for RCLN metastasis was evaluated. Patients were divided into two groups by presence or absence of supra diaphragmatic LN metastasis. The prevalences of RCLN metastasis between the two groups were compared and the odds ratio was calculated. Sensitivity and specificity of 18F FDG PET/CT for RCLN metastasis were 96.3 and 100%, respectively. Of the 67 study subjects, 27 patients had RCLN metastases (40.3%). Fifty patients had supra diaphragmatic LN metastases. 18F FDG PET/CT showed 26 RCLN metastases in patients with supra diaphragmatic LN metastases (54.5%), and only 1 in patients without supra diaphragmatic LN metastasis (5.9%), and the difference between two groups was statistically significant (P 18F FDG PET/CT to diagnose RCLN metastasis was excellent. RCLN metastasis revealed by 18F FDG PET/CT was strongly associated with supra diaphragmatic LN spread of ovarian cancer. Thus, RCLN metastasis could be used as a predictor of supra diaphragmatic lymphatic metastasis of ovarian cancer

  18. Role of urodynamics in stress urinary incontinence: A critical appraisal

    Science.gov (United States)

    Yande, Shirish Dattatraya; Joglekar, Omkar Vinay; Joshi, Maya

    2016-01-01

    Introduction: Role of urodynamics prior to surgery of stress urinary incontinence (SUI) is under constant debate. Demonstration of the presence of detrusor overactivity is the only aspect that has been emphasized in the literature so far. We believe that there are number of other factors which may influence the evaluation and in turn the choice of surgical management and prediction of outcome of treatment. They are as follows: (1) Presence of voiding inefficiency, (2) asymptomatic detrusor overactivity, (3) and severity of SUI. These features may complicate the precise evaluation of patients of SUI. The main objective of this study is to analyze the dynamics of leakage and voiding using urodynamics. This study also aims at correlating these findings with clinical information. Materials and Methods: One hundred consecutive cases referred to our center for preoperative evaluation of SUI were recruited in the study prospectively. All patients were interrogated using International Consultation on Incontinence Questionnaire. All patients underwent complete urodynamic evaluation including uroflowmetry, filling cystometry, leak point pressure measurement, and pressure flow studies, according to Good Urodynamic Practice guidelines. Patients’ symptoms were correlated with urodynamic findings, with special emphasis on the presence of detrusor overactivity, severity of SUI, voiding efficiency, and presence of bladder outlet obstruction. Clinical information and urodynamic findings were correlated using Chi-square test. Results: There is a statistically significant correlation between the presence of symptoms of urge urinary incontinence and urodynamic findings of detrusor overactivity at P incontinence (in addition to SUI) and urodynamic findings of intrinsic sphincter deficiency at P incontinence and incidental finding of detrusor overactivity at P urinary incontinence can predictably diagnose detrusor overactivity in these cases. However, the incidence of asymptomatic

  19. Evaluation of a simple, non-surgical concept for management of urinary incontinence (minimal care) in an open-access, interdisciplinary incontinence clinic

    DEFF Research Database (Denmark)

    Sander, P; Mouritsen, L; Andersen, J T

    2000-01-01

    influence on lower urinary tract function. More than half of the patients had urge or mixed incontinence. Most of the patients were managed with conservative treatment. Fifteen percent were referred to in-hospital treatment, with 5% to incontinence surgery. In total 44% felt cured or very much improved......Our objective was to evaluate a new concept for assessment and treatment of urinary incontinence in an open-access, interdisciplinary incontinence clinic. A standardized program for investigation and treatment of incontinence was based on minimal relevant investigations, primarily non......-surgical treatment with a limited consumption of resources ("minimal care"). This was a prospective observational study of 408 consecutive women examined and treated in the clinic. The main characteristics of the women were a high median age and a high prevalence of severe concomitant diseases with possible...

  20. Associated morbidities to congenital diaphragmatic hernia and a relationship to human milk.

    Science.gov (United States)

    Froh, Elizabeth B; Spatz, Diane L

    2012-08-01

    The majority of what is known in the recent literature regarding human milk studies in the neonatal intensive care setting is specific to term and/or preterm infants (including very-low-birth-weight preterm infants). However, there is a lack of human milk and breastfeeding literature concerning infants with congenital anomalies, specifically infants diagnosed with congenital diaphragmatic hernia (CDH). By applying human milk research conducted among other populations of infants, this article highlights how human milk may have a significant impact on infants with CDH. Recent human milk studies are reviewed and then applied to the CDH population in regard to respiratory and gastrointestinal morbidities, as well as infection and length of stay. In addition, clinical implications of these relationships are discussed and suggestions for future research are presented.

  1. Contribution of respiratory muscle blood flow to exercise-induced diaphragmatic fatigue in trained cyclists

    DEFF Research Database (Denmark)

    Vogiatzis, Ioannis; Athanasopoulos, Dimitris; Boushel, Robert Christopher

    2008-01-01

    We investigated whether the greater degree of exercise-induced diaphragmatic fatigue previously reported in highly trained athletes in hypoxia (compared with normoxia) could have a contribution from limited respiratory muscle blood flow. Seven trained cyclists completed three constant load 5 min...... exercise tests at inspired O(2) fractions (FIO2) of 0.13, 0.21 and 1.00 in balanced order. Work rates were selected to produce the same tidal volume, breathing frequency and respiratory muscle load at each FIO2 (63 +/- 1, 78 +/- 1 and 87 +/- 1% of normoxic maximal work rate, respectively). Intercostals......(-1) and 95.1 +/- 7.8 ml (100 ml)(-1) min(-1), respectively). Neither IMBF was different across hypoxia, normoxia and hyperoxia (53.6 +/- 8.5, 49.9 +/- 5.9 and 52.9 +/- 5.9 ml (100 ml)(-1) min(-1), respectively). We conclude that when respiratory muscle energy requirement is not different between...

  2. Distal 4p microdeletion in a case of Wolf-Hirschhorn syndrome with congenital diaphragmatic hernia.

    Science.gov (United States)

    Casaccia, Germana; Mobili, Luisa; Braguglia, Annabella; Santoro, Francesco; Bagolan, Pietro

    2006-03-01

    Wolf-Hirschhorn syndrome (WHS) is a well-known genetic condition characterized by typical facial anomalies, midline defects, skeletal anomalies, prenatal and postnatal growth retardation, hypotonia, mental retardation, and seizures. Affected patients with a microdeletion on distal 4p present a milder phenotype that lacks congenital malformations. WHS is rarely associated with congenital diaphragmatic hernia (CDH), and only 8 cases are reported in the literature. In almost all cases of CDH and WHS a large deletion of the short arm of chromosome 4 is present. A microdeletion of 2.6 Mb on distal 4p associated with CDH and multiple congenital malformations (i.e., cleft palate) is reported for the first time. Such a microdeletion should prompt a molecular study for WHS when in a fetus/newborn with CDH the association with cleft lip/palate and typical facial appearance (flat facial profile, hypertelorism) is found. Copyright 2006 Wiley-Liss, Inc.

  3. Rare combination of left-sided congenital diaphragmatic hernia and omphalocele.

    Science.gov (United States)

    Chee, Yuet Yee; Wong, Siu Chun Mabel; Wong, Ming Sum Rosanna

    2017-08-07

    We reported a rare case of left-sided posterolateral congenital diaphragmatic hernia (CDH) and omphalocele, which is not associated with chromosomal abnormalities or other syndromes. Omphalocele was detected antenatally (CDH was not detected in antenatal ultrasound). The patient suffered from respiratory failure secondary to severe pulmonary hypertension. As the combination of CDH and omphalocele is rare and with the abdominal content herniating into the omphalocele instead of the thorax, antenatal diagnosis of such condition can be difficult. Unlike other reported cases in the literature, our patient's respiratory condition has been improving with time and is surviving beyond the infancy period. We believe this to be the first such survival case reported in the literature. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Peritoneopericardial diaphragmatic hernia: a retrospective study of 31 cats and eight dogs.

    Science.gov (United States)

    Banz, Angela C; Gottfried, Sharon D

    2010-01-01

    The records of 31 cats and eight dogs undergoing surgical correction of peritoneopericardial diaphragmatic hernia (PPDH) from 2000 through 2007 were reviewed. Weimaraners and long-haired cats of varying breeds, particularly Maine Coon cats, appear to be at higher risk of PPDH. Presenting complaints were most commonly related to the respiratory and gastrointestinal tracts in both dogs and cats, although respiratory signs were more prevalent in cats, and gastrointestinal signs were more common in dogs. The most common herniated organs were liver, gallbladder, and small intestine. Mortality associated with surgical repair of PPDH in cats and dogs was low in the first 2 weeks postoperatively, and prognosis for return to normal function was excellent. Peri-and postoperative complications were typically minor and self-limiting.

  5. Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho [Armed Forces Capital Hospital, Seongnam (Korea, Republic of)

    2007-01-15

    Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect.

  6. Budd-chiari syndrome caused by diaphragmatic hernia of the liver: a case report

    International Nuclear Information System (INIS)

    Song, Jae Min; Yoon, Jung Won; Kim, Jae Wook; Chung, Woo Kyoung; Chung, Hee Sun; Kim, Joo Hyung; Choi, Jun Ho; Kim, Seung Ho

    2007-01-01

    Budd-Chiari syndrome is an uncommon disorder, and it is caused by obstruction of the hepatic venous out-flow or inferior vena cava above the hepatic vein. It may result from a large number of conditions, including primary congenital obstructions of the hepatic veins or inferior vena cava by webs or bands. Secondary causes include trauma, polycythemia vera, chronic leukemia, pregnancy, tumors and use of oral contraceptives. No definitive etiologic factors have been identified in two thirds of all cases. We recently experienced a case of Budd-Chiari syndrome caused by diaphragmatic hernia in 21-year-old man. Postoperative follow up CT showed normal venous flow after reintroduction of the liver into the abdominal cavity and closure of the diaphragm defect

  7. CONGENITAL DIAPHRAGMATIC HERNIA IN A TWO-DAY-OLD NEONATE: ANAESTHETIC MANAGEMENT AND CHALLENGES

    Directory of Open Access Journals (Sweden)

    Tridip Jyoti

    2016-04-01

    Full Text Available INTRODUCTION Congenital diaphragmatic hernia in a neonate is a challenging task to any anaesthesiologist. CDH occurs due to an early developmental defect that results in the extrusion of intra-abdominal organs (i.e. stomach, small intestines, spleen, liver into the thoracic cavity. In 85% of the cases it is left sided. This leads to lung hypoplasia, pulmonary hypertension, and pulmonary arteriolar dysregulation/reactivity. Historically, CDH was considered to be a surgical emergency and aggressive hyperventilatory strategies with high peak inspiratory pressures were employed to improve survival. But recent multicentre studies have shown the beneficial effect of conservative low volume ventilation with low inflation pressures and permissive hypercapnia. We present to you the successful management of a two day old neonate with this ventilation strategy.

  8. Mesentro-axial gastric volvulus in a morgagni diaphragmatic hernia in an old female

    International Nuclear Information System (INIS)

    Fansur, M.; Atiq, S.

    2011-01-01

    A Morgagni diaphragmatic hernia is a rare congenital anteromedial defect in adults (5%). Symptoms of visceral herniation are attributable to the organs involved. Imaging is the mainstay of diagnosis either in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms, ultimately requiring surgical intervention because of the risk of incarceration. We present a rare case of 80 years old female with vague upper abdominal pain and recurrent vomiting. An anteromedial parasternal defect was established on conventional as well as on cross-sectional imaging in right hemi diaphragm through which the upper abdominal contents were protruding in the right hemi thorax, all enclosed in a peritoneal sac. The herniation resulted in mesentro-axial gastric volvulus. Due to age and anaesthesia risk, patient was conservatively managed. (author)

  9. Ultrasound assessment of diaphragmatic function in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Fantini, Riccardo; Mandrioli, Jessica; Zona, Stefano; Antenora, Federico; Iattoni, Andrea; Monelli, Marco; Fini, Nicola; Tonelli, Roberto; Clini, Enrico; Marchioni, Alessandro

    2016-07-01

    Evaluation of diaphragm function in Amyotrophic Lateral Sclerosis (ALS) is critical in determining when to commence non-invasive mechanical ventilation (NIV). Currently, forced vital capacity (FVC) and sniff nasal inspiratory pressure (SNIP) are volitional measures for this evaluation, but require collaboration and are poorly specific. The primary aim of this study was to assess whether diaphragmatic thickness measured by ultrasound (US) correlates with lung function impairment in ALS patients. The secondary aim was then to compare US diaphragm thickness index (ΔTdi) with a new parameter (ΔTmax index). 41 patients with ALS and 30 healthy subjects were enrolled in the study. All subjects underwent spirometry, SNIP and diaphragm US evaluation, while arterial blood gases were measured in some patients only. US assessed diaphragm thickness (Tdi) at tidal volume (Vt) or total lung capacity (TLC), and their ratio (ΔTmax) were recorded. Changes (Δ) in Tdi indices during tidal volume (ΔTdiVt) and maximal inspiration (ΔTdiTLC) were also assessed. ΔTdiTLC (p <0.001) and ΔTmax (p = 0.007), but not ΔTdiVt, differed between patients and controls. Significant correlation (p < 0.05) was found between ΔTdiTLC, ΔTmax and FVC. The ROC curve analysis for comparison of individual testing showed better accuracy with Δtmax than with ΔtdiTLC for FVC (AUC 0.76 and 0.27) and SNIP (AUC 0.71 and 0.25). Diaphragm thickness assessed by ultrasound significantly correlates with global respiratory alterations in patients with ALS. ΔTmax represents a new US index of early diaphragmatic dysfunction, better related with the routinely performed lung function tests. © 2016 Asian Pacific Society of Respirology.

  10. Paresia diafragmática bilateral idiopática Idiopathic bilateral diaphragmatic paresis

    Directory of Open Access Journals (Sweden)

    Mônica Corso Pereira

    2006-10-01

    Full Text Available Relata-se o caso de um paciente com dispnéia intensa ao se deitar, em que foram excluídas doenças pulmonares, neuromusculares ou cardíacas, cuja investigação revelou paresia diafragmática bilateral. Um sinal chave para o diagnóstico foi a evidência de respiração paradoxal com o doente em decúbito supino. Havia piora da oxigenação e da capacidade vital forçada com a mudança da posição ortostática para supina. A fluoroscopia ortostática foi normal. A pressão inspiratória máxima estava muito reduzida. A estimulação elétrica transcutânea do diafragma foi normal, e a eletroestimulação do nervo frênico mostrou ausência de resposta, permitindo o diagnóstico de paresia bilateral do diafragma.We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.

  11. Effect of a vaginal device on quality of life with urinary stress incontinence

    DEFF Research Database (Denmark)

    Sander, P; Thyssen, H; Lose, G

    1999-01-01

    OBJECTIVE: To assess the effect of a vaginal device (Continence Guard) on urine leakage and quality of life. METHODS: Fifty-five women with stress incontinence participated in a 3-month study. They were assessed by the Incontinence Impact Questionnaire, two incontinence-related quality-of-life qu......OBJECTIVE: To assess the effect of a vaginal device (Continence Guard) on urine leakage and quality of life. METHODS: Fifty-five women with stress incontinence participated in a 3-month study. They were assessed by the Incontinence Impact Questionnaire, two incontinence-related quality......-to-treat basis, the vaginal device was associated with subjective cure in 11 women (20%) and improvement in 27 (49%). The mean 24-hour pad test leakage and leakage episodes in the voiding diary decreased significantly. Fifty-eight percent of the 55 women enrolled wanted to continue using the device after 3...

  12. The impact of urinary incontinence on self-efficacy and quality of life

    Directory of Open Access Journals (Sweden)

    Broome Barbara

    2003-08-01

    Full Text Available Abstract Urinary incontinence impacts 15 to 35% of the adult ambulatory population. Men after the removal of the prostate for cancer can experience incontinence for several weeks to years after the surgery. Women experience incontinence related to many factors including childbirth, menopause and surgery. It is important that incontinence be treated since it impacts not only the physiological, but also the psychological realms of a person's life. Depression and decreed quality of life have been found to co-occur in the person struggling with incontinence. Interventions include pharmacological, surgical as well as behavioral interventions. Effective treatment of incontinence should include the use of clinical guidelines and research to promote treatment efficacy.

  13. [Prevalence and risk factors of urinary incontinence in female workers of hotels].

    Science.gov (United States)

    Fontana, L; Falconi, G; Di Martino, T; Iavicoli, I

    2007-01-01

    The International Continence Society defines urinary incontinence (UI) as "a condition in which involuntary loss of urine is a social or hygienic problem and is objectively demonstrable". There are three different jorms of UI. stress urinary incontinence, urge urinary incontinence and mixed incontinence. The aim of this study was to investigate the prevalence of UI in a group of female workers in the hotel sector. The International Consultation on Incontinence Questionnaire Urinary Incontinence short form (ICIQ-UI Short Form) was administered to all female workers and data were collected about age, body mass index, number of vaginal and Caesarean delivery. Results showed a prevalence of UI widely bigger in the plans waitress than in video display terminal workers and suggest the hypothesis that manual handling of loads representing a possible occupational risk for UI.

  14. The management of stress urinary incontinence: A case report

    Directory of Open Access Journals (Sweden)

    Preshani Reddy

    2015-05-01

    Full Text Available Introduction: Conservative management is the first option for patients with stress urinary incontinence (SUI. However, successful management of women diagnosed with SUI is dependent on a proper assessment and a tailored treatment plan. This case report aims to show the effectiveness of physiotherapy management in a 42-year-old patient diagnosed with SUI. Patient presentation: The patient’s main complaints were involuntary loss of urine on coughing, sneezing and lifting of heavy objects, which started following the birth of her third child. Management and outcome: The patient was taught the ‘Knack’ manoeuvre and provided with a tailored pelvic floor exercise programme. Improvement was noted at the third visit and the patient no longer had involuntary episodes. Conclusion: This case report shows the successful outcome of conservative management in a patient with stress urinary incontinence.

  15. Management of occult stress urinary incontinence with prolapse surgery.

    Science.gov (United States)

    Al-Mandeel, H; Al-Badr, A

    2013-08-01

    Pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are two common health-related conditions, each affecting up to 50% women worldwide. Stress urinary incontinence only observed after the reduction of co-existent prolapse is called occult SUI (OSUI), and is found in up to 80% of women with advanced POP. Although there is no consensus on how to diagnose OSUI, there are several reported methods to better diagnose. Counseling symptomatically continent women with POP concerning the potential risk for developing SUI postoperatively cannot be overstated. Evidence suggests that positive OSUI in symptomatically continent women who are planning to have POP repair is associated with a high risk of POSUI, furthermore, adding continence procedure is found to reduce postoperative SUI. Therefore, adding continence surgery at the time of POP surgery in patients who are found to have OSUI preoperatively is advocated.

  16. Radiation therapy in carcinoma of the prostate: a contributing cause of urinary incontinence

    International Nuclear Information System (INIS)

    Kaufman, J.J.; Smith, R.B.; Raz, S.

    1984-01-01

    The authors believe that radiation therapy as a postoperative adjuvant or preceding salvage prostatectomy for carcinoma is particularly conducive to the complication of urinary incontinence by virtue of its sclerosing effect on residual sphincter mechanisms. Obviously, such dual therapy will continue to prevail in the foreseeable future but patients should be notified of the added risk and be prepared for further treatment of the incontinence. Unfortunately, these patients have an extra risk of complications and failure from anti-incontinence operations

  17. Urinary leakage during sexual intercourse among women with incontinence: Incidence and risk factors

    OpenAIRE

    Lau, Hui-Hsuan; Huang, Wen-Chu; Su, Tsung-Hsien

    2017-01-01

    Background Coital incontinence is an under-reported disorder among women with urinary incontinence. Women seldom voluntarily report this condition, and as such, related data remains limited and is at times conflicting. Aims and objectives To investigate the incidence and quality of life in women with coital incontinence and to determine associated predictors. Methods This observational study involved 505 sexually active women attending the urogynecologic clinic for symptomatic urinary inconti...

  18. Specific obstetrical risk factors for urinary versus anal incontinence 4years after first delivery.

    OpenAIRE

    Fritel , Xavier; Khoshnood , Babak; Fauconnier , Arnaud

    2013-01-01

    International audience; AIM: Delivery can be complicated by urinary or anal incontinence (UI or AI). We hypothesized that the mechanisms of injury may differ for UI and AI. Hence, obstetrical risk factors may be specific for different types of incontinence. DESIGN: Data on maternal characteristics were collected at first delivery. Data on incontinence were obtained by a questionnaire completed by 627 women 4years after first delivery. UI was defined by "Do you have involuntary loss of urine" ...

  19. Urinary and fecal incontinence in a community-residing older population in Japan.

    Science.gov (United States)

    Nakanishi, N; Tatara, K; Naramura, H; Fujiwara, H; Takashima, Y; Fukuda, H

    1997-02-01

    To estimate the prevalence and risk factors of urinary and fecal incontinence among a community-residing older population in Japan. Population-based cross-sectional study. A randomly selected sample of 1473 people aged 65 years and older living in the City of Settsu, Osaka, in 1992. Data collected via in-home visits were used to estimate the prevalence of urinary and fecal incontinence and to provide information regarding potential risk factors of urinary and fecal incontinence. Data were obtained from 1405 older adults, a response rate of 95.4%. The prevalence of any degree of urinary incontinence was 98/1000 in both sexes, and 87/ 1000 men and 66/1000 women admitted to some degree of fecal incontinence. Daily, 34/1000 and 20/1000 of the population were incontinent of urine and feces, respectively. There was an increasing prevalence of urinary and fecal incontinence with age in both sexes, but the expected greater prevalence in women was not found. By univariate analyses, age older than 75 years, poor general health as measured by Activities of Daily Living, stroke, dementia, no participation in social activities, and lack of life worth living (Ikigai) were associated significantly with both urinary and fecal incontinence. In the multivariate analyses using logistic regression, age older than 75 years, poor general health, and stroke were independent risk factors for any type of incontinence. Diabetes was an independent risk factor for isolated fecal incontinence, and dementia and no participation in social activities were independent risk factors for double incontinence. Incontinence of urine and feces is a prevalent condition among very old people living in the community in Japan and is associated highly with health and psychosocial conditions.

  20. Analysis of computed X-ray tomography of the brain in incontinence patients with senile dementia

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Yasuyuki; Machida, Toyohei; Oishi, Yukihiko [Jikei Univ., Tokyo (Japan). School of Medicine; Kamachi, Chikahumi; Okabe, Tsutomu; Akazawa, Kouhei; Takasaka, Satoshi

    1994-02-01

    To evaluate the condition of incontinence in patients with senile dementia, we performed computed tomography X-rays to the brain and analyzed the relationship among the circulatory defect of the brain, the brain atrophy and the degree of incontinence. There were 92 patients subjected to this study who were hospitalised due to senile dementia; 74 patients had vascular dementia, 10 patients had senile dementia of Alzheimer type, and 8 patients had the mixed type. (age range: 54-95 years; mean: 80.3 years). The degree of incontinence in these patients varied as follows: 18 patients with continence, 16 patients with moderate incontinence, 58 patients with total incontinence. The diagnosis of circulatory defect of the brain was based on computed tomography observation of periventricular lucency (P.V.L.), and the degree of brain atrophy was evaluated based on 4 criteria: the Lateral body ratio, the Huckman number, the Evans ratio, and the enlargement of the subarachnoid space. Among the 92 patients, P.V.L. was present in 31 patients, among them 27 patients suffered from incontinence. There was a significant correlation between P.V.L. and incontinence (p<0.001). As the incontinence progressively worsened (Continence, Moderate incontinence, Total incontinence), the lateral body ratio increased to 24.8, 27.8, 28.6, (p<0.05). The Huckman number also increased to 18.3, 19.3, 21.3, (p<0.01), and the evans ratio likewise 29.9, 32.3, 33.7 (p<0.01). The enlargement of the subarachnoid space was also correlated with the severity of incontinence. We conclude that urinary incontinence originating from senile dememtia is connected to brain atrophy and is strongly influenced by the circulatory disorders of the brain. (author).

  1. Dutch guidelines for physiotherapy in patients with stress urinary incontinence: an update

    OpenAIRE

    Bernards, Arnold T. M.; Berghmans, Bary C. M.; Slieker-ten Hove, Marijke C. Ph.; Staal, J. Bart; de Bie, Rob A.; Hendriks, Erik J. M.

    2013-01-01

    textabstractIntroduction and hypothesis: Stress urinary incontinence (SUI) is the most common form of incontinence impacting on quality of life (QOL) and is associated with high financial, social, and emotional costs. The purpose of this study was to provide an update existing Dutch evidence-based clinical practice guidelines (CPGs) for physiotherapy management of patients with stress urinary incontinence (SUI) in order to support physiotherapists in decision making and improving efficacy and...

  2. Why Irish women delay seeking treatment for urinary incontinence : a focus group study

    OpenAIRE

    Ni Aileasa, Mairead

    2011-01-01

    non-peer-reviewed Background: Urinary Incontinence is defined as "any involuntary leakage of urine" (Abrams et al, 2002). Living with incontinence can effect one's life greatly. Many women delay seeking treatment and often do not seek any help (Dolan et al, 1999), despite physiotherapy being an effective treatment (Neumann et al, 2005). Therefore, there is a need to discover why women delay seeking help, such as physiotherapy and continue to live with incontinence. Objectives: To establ...

  3. EFFICACY OF PELVIC FLOOR THERAPY IN TREATING URINARY INCONTINENCE AMONG FEMALE COPD PATIENTS

    OpenAIRE

    Mohankumar Thekkinkattil; T. S. Muthukumar; R. Monisha

    2016-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The major manifestation of COPD includes dyspnea, decreased oxygenation and reduced exercise tolerance. The other manifestations such as urinary incontinence are less noted and treated inadequately. The prevalence of urinary incontinence in Indian COPD population has not been well documented. The treatment of urinary incontinence includes pelvic floor exercises (Kegel’s exercises)...

  4. Effects of physiotherapy treatment for urinary incontinence in patient with multiple sclerosis

    OpenAIRE

    Pereira, Carla Maria de Abreu; Castiglione, Mariane; Kasawara, Karina Tamy

    2017-01-01

    [Purpose] The aim of the study was to evaluate the benefits of physical therapy for urinary incontinence in patients with multiple sclerosis and to verify the impact of urinary incontinence on the patient?s quality of life. [Subject and Methods] A case study of a 55-year-old female patient diagnosed with multiple sclerosis and mixed urinary incontinence was conducted. Physical therapy sessions were conducted once a week, in total 15 sessions, making use of targeted functional electrical vagin...

  5. Association between urinary incontinence in women and a previous history of surgery

    DEFF Research Database (Denmark)

    Mommsen, S.; Foldspang, Anders; Elving, L.

    1993-01-01

    In a cross-sectional study, 85% of 3114 women responded to a questionnaire on urinary incontinence and a history of abdominal, gynaecological and urological surgery. In 1987 the prevalence of urinary incontinence was 17%; 63% had undergone surgery, mainly gynaecological, and almost one......-third of the respondents had had more than one operation. Bivariate and multivariate analysis showed stress urinary incontinence to be associated with previous exposure to surgery....

  6. Identifying the quality of life effects of urinary incontinence with depression in an Australian population

    Directory of Open Access Journals (Sweden)

    Avery Jodie C

    2013-02-01

    Full Text Available Abstract Background To explore the additive effect of urinary incontinence, in people with comorbid depression, on health related quality of life. Methods Males and females, 15 to 95 years (n = 3010, response rate 70.2% were interviewed face to face in the 1998 Autumn South Australian Health Omnibus Survey. Results Self-reported urinary incontinence was found in 20.3% (n=610, and depression as defined by the PRIME-MD in 15.2% (n=459 of the survey population. Urinary incontinence with comorbid depression was found in 4.3% of the overall population. Univariate analysis showed that respondents with urinary incontinence and comorbid depression were more likely to be aged between 15 and 34 years and never married when compared to those with incontinence only. Multivariate analysis demonstrated that in people with incontinence, the risk of having comorbid depression was increased by an overall health status of Fair or Poor, or the perception that their incontinence was moderately or very serious. Respondents reporting that they experienced incontinence with comorbid depression scored significantly lower than those experiencing incontinence without depression on all dimensions of the SF-36. The interaction of the presence of incontinence and the presence of depression was significantly associated with the dimensions of physical functioning. Conclusions Depression and incontinence both reduce QOL. When they occur together there appears to be an additive effect which affects both physical and mental health, perhaps by increasing a person’s negative perceptions of their illness. Clinicians should identify and manage comorbid depression when treating patients who have incontinence to improve their overall QOL.

  7. Treatment of urinary incontinence in women in general practice: observational study.

    OpenAIRE

    Seim, A.; Sivertsen, B.; Eriksen, B. C.; Hunskaar, S.

    1996-01-01

    OBJECTIVE--To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN--Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING--General practice in the rural district of Rissa, Norway. SUBJECTS--105 women aged 20 or more with urinary incontinence. INTERVENTIONS--Treatment with pelvic floor exercises, electrostimula...

  8. Six weeks' aerobic retraining after two weeks' immobilization restores leg lean mass and aerobic capacity but does not fully rehabilitate leg strenght in young and older men

    DEFF Research Database (Denmark)

    Vigelsø Hansen, Andreas; Gram, Martin; Wiuff, Caroline

    2015-01-01

    OBJECTIVE: To determine the effect of aerobic retraining as rehabilitation after short-term leg immobilization on leg strength, leg work capacity, leg lean mass, leg muscle fibre type composition and leg capillary supply, in young and older men. SUBJECTS AND DESIGN: Seventeen young (23 ± 1 years...... immobilization had marked effects on leg strength, and work capacity and 6 weeks' retraining was sufficient to increase, but not completely rehabilitate, muscle strength, and to rehabilitate aerobic work capacity and leg lean mass (in the young men)....

  9. The impact of incontinence etiology on artificial urinary sphincter outcomes

    Directory of Open Access Journals (Sweden)

    Adam R. Miller

    2017-07-01

    Full Text Available Purpose: To evaluate the impact of incontinence etiology on artificial urinary sphincter (AUS device outcomes. Materials and Methods: We identified 925 patients who underwent primary AUS placement from 1983 to 2011. The etiology of incontinence was categorized as radical prostatectomy alone, radical prostatectomy with radiation, benign prostate resection, and those with cryotherapy as a salvage prostate cancer treatment. Hazard regression and competing risk analyses were used to determine the association of the etiology of incontinence with device outcomes. Results: The distribution of the 4 etiologies of incontinence included: 598 patients (64.6% treated with prostatectomy alone, 206 (22.2% with prostatectomy and pelvic radiation therapy, 104 (11.2% with benign prostate resection, and 17 (1.8% with prior cryotherapy. With a median follow-up of 4.9 years (interquartile range, 1.2–8.8 years, there was significant difference in the cumulative incidence of device infection/urethral erosion events between the four etiologies (p=0.003. On multivariable analysis, prior cryotherapy (reference prostatectomy alone; hazard ratio [HR], 3.44; p=0.01, older age (HR, 1.07; p=0.0009 and history of a transient ischemic attack (HR, 2.57; p=0.04 were associated with an increased risk of device infection or erosion. Notably, pelvic radiation therapy with prostatectomy was not associated with an increased risk of device infection or erosion (reference prostatectomy alone, p=0.30. Conclusions: Compared to prostatectomy alone, prior treatment with salvage cryotherapy for recurrent prostate cancer was associated with an increased risk of AUS infection/erosion, whereas radiation (in addition to prostatectomy was not.

  10. Dietary Macronutrient and Energy Intake and Urinary Incontinence in Women

    OpenAIRE

    Maserejian, Nancy N.; Giovannucci, Edward L.; McVary, Kevin T.; McGrother, Catherine; McKinlay, John B.

    2010-01-01

    Weight loss involving diet modification improves urinary incontinence (UI) in women, but little is known about dietary correlates of UI. The authors examined intakes of total energy, carbohydrate, protein, and fats in relation to UI in a cross-sectional sample of 2,060 women in the population-based Boston Area Community Health Survey (2002–2005). Data were collected from in-person home interviews and food frequency questionnaires. Logistic regression was used to calculate odds ratios and 95% ...

  11. Physiotherapy for Women with Stress Urinary Incontinence: A Review Article

    OpenAIRE

    Ghaderi, Fariba; Oskouei, Ali E.

    2014-01-01

    [Purpose] This review article is designed to expose physiotherapists to a physiotherapy assessment of stress urinary incontinence (SUI) and the treatment and possibly preventive roles that they might play for women with SUI. Specifically, the goal of this article is to provide an understanding of pelvic floor muscle function and the implications that this function has for physiotherapy treatment by reviewing articles published in this area. [Methods] A range of databases was searched to ident...

  12. Prevalence and factors associated with urinary incontinence in climacteric

    Directory of Open Access Journals (Sweden)

    Máyra Cecilia Dellú

    Full Text Available SUMMARY Objective: To estimate the prevalence and identify associated factors to urinary incontinence (UI in climacteric women. Method: In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0. Results: Women had a mean age of 51.9 years, most were in menopause (59.4%, married (87.5%, Catholic (48.9%, and declared themselves black or brown (47.2%. The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%. The factors associated with UI were urinary loss during pregnancy (p=0.000 and after delivery (p=0.000, genital prolapse (p=0.000, stress (p=0.001, depression (p=0.002, and obesity (p=0.006. Conclusion: The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.

  13. Findings of universal cystoscopy at incontinence surgery and their sequelae

    Science.gov (United States)

    Zyczynski, Halina M.; Sirls, Larry T.; Greer, W. Jerod; Rahn, David D.; Casiano, Elizabeth; Norton, Peggy; Kim, Hae-Young; Brubaker, Linda

    2014-01-01

    OBJECTIVE The purpose of this study was to report the frequency of abnormal cystoscopy at incontinence surgery and to identify risk factors and sequelae of injury. STUDY DESIGN Findings of cystoscopy were collected prospectively in 3 multicenter surgical trials. Clinical, demographic, and procedure characteristics and surgeon experience were analyzed for association with iatrogenic injury and noninjury abnormalities. Impact of abnormalities on continence outcomes and adverse events during 12 months after the procedure were assessed. RESULTS Abnormal findings in the bladder or urethra were identified in 95 of 1830 women (5.2%). Most injuries (75.8%) were iatrogenic. Lower urinary tract (LUT) injury was most common at retropubic urethropexy and retropubic midurethral sling procedures (MUS; 6.4% each), followed by autologous pubovaginal sling procedures (1.7%) and transobturator MUS (0.4%). Increasing age (56.9 vs 51.9 years; P = .04), vaginal deliveries (3.2 vs 2.6; P = .04), and blood loss (393 vs 218 mL; P=.01) were associated with LUT injury during retropubic urethropexy; however, only age (62.9 vs 51.4 years; P = .02) and smoking history (P = .04) were associated for pubovaginal sling procedures. No factors correlated with increased risk of injury at retropubic and transobturator MUS. Notably, previous incontinence surgery, concomitant procedures, anesthesia type, and trainee participation did not increase LUT injury frequency. Although discharge with an indwelling catheter was more common after trocar perforation compared with the noninjury group (55.6% vs 18.5%; P urinary tract infections, or urge urinary incontinence. CONCLUSION Universal cystoscopy at incontinence surgery detects abnormalities in 1 in 20 women. Urinary trocar perforations that are addressed intraoperatively have no long-term adverse sequelae. PMID:24380742

  14. Surgery for stress urinary incontinence in women: A 2006 review

    Directory of Open Access Journals (Sweden)

    Bertil FM Blok

    2007-01-01

    Full Text Available The surgical treatment of female stress urinary incontinence is a rapidly changing field. This review discusses recent advances in various injectables, minimally invasive techniques and open procedures. It particularly evaluates data from long-term outcome studies and describes peri- and postoperative complications from several procedures, such as bulking agents, tension-free vaginal tape and its modifications (TOT, TVT-O as well as open and laparoscopic colposuspension.

  15. Neuromodulation for fecal incontinence: An effective surgical intervention

    OpenAIRE

    Chiarioni, Giuseppe; Palsson, Olafur S; Asteria, Corrado R; Whitehead, William E

    2013-01-01

    Fecal incontinence is a disabling symptom with medical and social implications, including fear, embarrassment, isolation and even depression. Most patients live in seclusion and have to plan their life around the symptom, with secondary impairment of their quality of life. Conservative management and biofeedback therapy are reported to benefit a good percentage of those affected. However, surgery must be considered in the non-responder population. Recently, sacral nerve electrostimulation, la...

  16. Effect of Gait Retraining on Balance, Activities of Daily Living, Quality of Life and Depression in Stroke Patients

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    Majid Farhadian

    2015-12-01

    Full Text Available Objectives: Stroke is one of the most common neurological disease and it is the main cause of physical and mental disability and staying in house. Gait difficulties have high incidence in patients with stroke. So the aim of this study was to investigate the effect of gait retraining on balance, activities of daily living, quality of life and depressionin stroke patients. Methods: This study was a clinical trial without control group. Sampling was performed by convenience sampling method and 18 patients participated. After recording demographic data, Berg Balance Scale, Barthel Index, SF36 questionnaire and Beck Depression Inventory-II used in pre-test and post-test to assess balance, activities of daily living, quality of life and depression, respectively .Data were analyzed using Pearson correlation coefficient and paired T-test. Results: The results showed statistically significant correlation in pre-test and difference between mean score of the all instruments before and after the intervention. Discussion: According to high prevalence of gait difficulties in stroke patients, it seems interventions in this area is necessary. Statistical results showed that the gait retraining intervention may have a positive effect on improving balance, activities of daily living, quality of life and depression of these patients. According to lack of information in this area, further research is needed.

  17. Neuromuscular Retraining in Female Adolescent Athletes: Effect on Athletic Performance Indices and Noncontact Anterior Cruciate Ligament Injury Rates

    Directory of Open Access Journals (Sweden)

    Frank R. Noyes

    2015-05-01

    Full Text Available While many anterior cruciate ligament (ACL prevention programs have been published, few have achieved significant reductions in injury rates and improvements in athletic performance indices; both of which may increase compliance and motivation of athletes to participate. A supervised neuromuscular retraining program (18 sessions was developed, aimed at achieving both of these objectives. The changes in neuromuscular indices were measured after training in 1000 female athletes aged 13–18 years, and the noncontact ACL injury rate in 700 of these trained athletes was compared with that of 1120 control athletes. There were significant improvements in the drop-jump test, (p < 0.0001, effect size [ES] 0.97, the single-leg triple crossover hop (p < 0.0001, ES 0.47, the t-test (p < 0.0001, ES 0.64, the multi-stage fitness test (p < 0.0001, ES 0.57, hamstring strength (p < 0.0001, and quadriceps strength (p < 0.01. The trained athletes had a significant reduction in the noncontact ACL injury incidence rate compared with the controls (1 ACL injury in 36,724 athlete-exposures [0.03] and 13 ACL injuries in 61,244 exposures [0.21], respectively, p = 0.03. The neuromuscular retraining program was effective in reducing noncontact ACL injury rate and improving athletic performance indicators.

  18. Women with urinary incontinence: self-perceived worries and general practitioners' knowledge of problem.

    Science.gov (United States)

    Lagro-Janssen, T L; Smits, A J; Van Weel, C

    1990-01-01

    In the context of a large scale survey of health problems in women aged 50 to 65 years, a study was undertaken on the effects of incontinence on daily life. For this purpose 1442 women randomly selected from the practice files of 75 general practitioners in the eastern part of the Netherlands were interviewed at home (response rate 60%). In cases of moderate or severe incontinence the general practitioner of the woman concerned was asked whether this problem had been diagnosed in general practice. Incontinence was reported in 22.5% of the women. Overall, 77.8% of the women did not feel worried about it and 75.4% did not feel restricted in their activities; even for women with severe incontinence (daily frequency and needing protective pads) only 15.6% experienced much worry and 15.7% much restriction. About a third of the women with incontinence (32.0%) had been identified by their general practitioner. The greater the worries and restrictions owing to incontinence, the greater the chance that the incontinence was known to the general practitioner concerned. Only a small minority of the women who felt severely restricted were not identified by their general practitioner. There was a positive relation between recognized incontinence and a history of hysterectomy. This study contradicts the image of the incontinent woman as isolated and helpless; most women in this study seemed able to cope. PMID:2121179

  19. Risperidone-associated urinary incontinence in patients with autistic disorder with mental retardation.

    Science.gov (United States)

    Kumazaki, Hirokazu; Watanabe, Koichiro; Imasaka, Yasushi; Iwata, Kazuhiko; Tomoda, Akemi; Mimura, Masaru

    2014-10-01

    We report several cases in which patients with autistic disorder with mental retardation who received risperidone experienced urinary incontinence. We retrospectively investigated the medical records of patients housed in facilities for patients with autistic disorder with mental retardation. Those who had undergone a medical examination at a hospital in Tokyo from April 1999 to March 2009 were included in the study.Retrospective data were gathered including age, sex, IQ, birth weight, dosage of risperidone, urinary density, as well as existence of urinary and fecal incontinence. We divided the participants into those who did and did not experience urinary incontinence after taking risperidone and compared the 2 groups. Risperidone had been prescribed to 35 patients. In spite of the fact that no patient had a history of urinary incontinence, 14 patients experienced urinary incontinence after receiving risperidone. Moreover, 4 of these 14 patients also had fecal incontinence. Among the variables we examined, the only significant difference between groups was in sex, with significantly more women experiencing incontinence compared with men. When the dose of risperidone was reduced or the patients switched to other drugs, urinary incontinence of the patients improved.Hence, risperidone may have a casual relationship with urinary incontinence. Further research is needed to understand the pathophysiology of possible effect.

  20. Risk of stress urinary incontinence twelve years after the first pregnancy and delivery.

    Science.gov (United States)

    Viktrup, Lars; Rortveit, Guri; Lose, Gunnar

    2006-08-01

    To estimate the impact of onset of stress urinary incontinence in first pregnancy or postpartum period, for the risk of symptoms 12 years after the first delivery. In a longitudinal cohort study, 241 women answered validated questions about stress urinary incontinence after first delivery and 12 years later. Twelve years after first delivery the prevalence of stress urinary incontinence was 42% (102 of 241). The 12-year incidence was 30% (44 of 146). The prevalence of stress urinary incontinence 12 years after first pregnancy and delivery was significantly higher (Ppregnancy (56%, 37 of 66) and in women with onset shortly after delivery (78%, 14 of 18) compared with those without initial symptoms (30%, 44 of 146). In 70 women who had onset of symptoms during first pregnancy or shortly after the delivery but remission 3 months postpartum, a total of 40 (57%) had stress urinary incontinence 12 years later. In 11 women with onset of symptoms during the first pregnancy or shortly after delivery but no remission 3 months postpartum, a total of 10 (91%) had stress urinary incontinence 12 years later. Cesarean during first delivery was significantly associated with a lower risk of incontinence. Other obstetric factors were not significantly associated with the risk of incontinence 12 years later. Patients who were overweight before their first pregnancy were at increased risk. Onset of stress urinary incontinence during first pregnancy or puerperal period carries an increased risk of long-lasting symptoms.