Rapid oral hydration: A cause of pelvic fluid collections at sonography

In a controlled study, rapid oral hydration was found to result in sonographically visible pelvic fluid collections in six of 12 healthy women volunteers. These pelvic fluid collections were in many ways indistinguishable from those seen in a variety of pelvic diseases. An awareness of this association should result in a further reduction of false-positive diagnoses at pelvic sonography.     

Pelvic organ prolapse: An unusual cause of small bowel obstruction

We present the rare case of a small bowel obstruction secondary to pelvic organ prolapse (POP). A 77-year-old female presented with four days of abdominal pain, nausea, and vomiting. She had a history of abdominal hysterectomy with bilateral salpingo-opherectomy and a mildly symptomatic cystocele. She was found to have an enterocele causing small bowel obstruction. The enterocele was manually reduced and subsequently managed non-operatively with a pessary. Prior case reports of small bowel obstructions secondary to POP required emergent surgical intervention. Post-menopausal women should be asked about symptoms or presence of pelvic organ prolapse and in the correct patient population, pelvic examination can be important for diagnosis and treatment of small bowel obstruction. If the enterocele is manually reduced non-operative management can be safe and effective.     

The value of C-reactive protein in emergency medicine

C-reactive protein (CRP) is a commonly used tool in emergency department (ED), especially in febrile and infectious patients. It was identified in 1930 and was subsequently classified into an “acute phase protein”, an early indicator of infectious or inflammatory situations in the ED, CRP must be a diagnostic reference and no single value can be indicated to rule in or rule out a specific diagnosis or disease. CRP is a comprehensively assisted tool for evaluation and diagnosis of tissue damage (rheumatologic diseases, stroke, cancer, pancreatitis, burn injury, sepsis and gout) and infection (urinary tract infection, pelvic inflammatory disease, meningitis and lung infection). It can be used for treatment monitoring and severity evaluation in pneumonia, pancreatitis, pelvic inflammatory disease (PID), and urinary tract infections (UTI). Otherwise, it also plays the role of prognostic indicator of acute coronary syndrome. C-reactive protein adds little to the diagnosis of pneumonia, urinary tract infections, and pancreatitis. A single CRP value should not straightly make the decision to treat these patients. That is, CRP has no role in diagnosing these clinical entities, and a normal CRP level should never delay antibiotic coverage in ED. Faster and more interpretable tools such as image studies (X-ray, sonography and computed tomography) are available to help diagnose suspected cases of aortic dissection, appendicitis, cholecystitis, pancreatitis, pneumonia and stroke in ED.     

Protection of continence in pregnancy,labor and postpartum periods

Urinary incontinence (UI) is a common problem among women. Pregnancy and labor are the major risk factors for UI among young and middle‐aged women. In some studies, the presence of incontinence before and during pregnancy has been shown to be an independent risk factor for urinary and anal incontinence after delivery and beyond. Recently, the need and consequences of many routine interventions applied during each delivery are questioned on an evidence‐based basis. Episiotomy and interventions (forceps, fundal pressure) at the second phase of delivery result in pelvic floor injury by perineal trauma. Similar interventions during delivery pose a risk for urinary and fecal incontinence. Therefore, episiotomy should be avoided as much as possible during delivery, and spontaneous and non‐interventional labor opportunities should be created. Pelvic floor muscle training (PFMT) is often advised as a conservative management method in UI during pregnancy. Investigations suggest that women with stress, urge or mixed UI should be advised to perform PFMT that is part of the conservative management program. There is some evidence in primiparous women that PFMT may prevent UI on the late weeks of pregnancy and the postpartum period. When postpartum pelvic floor exercises are applied along with feedback, they induce a decrease in postpartum incontinence. Furthermore, motivation and the initiative in reminding women regarding kegel exercises were not found to be effective in the postpartum prevention of UI. Postpartum pelvic floor exercises were not found to be consistent with decreased incidence of fecal incontinence. Multidisciplinary approaches are needed to inform women about the risk of postpartum UI.     

Simple adnexal cysts diagnosed by ultrasound in postmenopausal women

Thirty simple adnexal cysts in postmenopausal women detected by sonography were followed prospectively. The cysts were totally anechoic or with at most two septations. Size varied from 2 cm to 8 cm, but one was as large as 17 cm. Only seven were discovered at the pelvic examination prior to the scan. Fifteen underwent surgery and no malignant tumor was found. The remaining 15 were followed by sonography only. Six lesions had disappeared after one month, altogether 12 had disappeared after seven months. After two years, only two 2-cm cysts remained. The results indicate that surgery on simple adnexal cysts may not be necessary but they should be followed by sonography.     

Ovarian varicocele: ultrasonic and phlebographic evaluation

The aim of this work is to suggest a new diagnostic approach to the "female varicocele syndrome" which utilizes transvaginal ultrasonography. The presence of circular or linear anechogenic structures with a diameter greater than 5 mm, which were found in transverse and oblique sections of the lateral fornices, was indicative of pelvic varices. The vascular nature of these structures was confirmed with the Valsalva's maneuver and in the upright position. The presence of "pelvic varices" was confirmed by retrograde phlebography of the left ovarian vein in 46% of the cases. In such cases the parity was greater than in subjects without "pelvic varices" (chi square = 12.75, p less than 0.001), and the principal symptoms were characterized by pelvic pains and menstrual cycle disorders.     

High Prevalence of Sexually Transmitted Diseases in Women with Urinary Infections

Objective: To determine the prevalence and factors associated with unrecognized sexually transmitted diseases (STDs) in women who had pelvic examinations and were subsequently released from the ED with a sole diagnosis of urinary tract infection (UTI).
Methods: A 3-month retrospective chart review was performed in an urban teaching hospital ED (>70,000 visits/year). Women aged 12–45 years who had pelvic examinations and were released from the ED with a sole diagnosis of UTI were included. Patient complaints, physical findings, and laboratory results were reviewed. Laboratory evaluations included the complete blood count, urinalysis, urine pregnancy test, and cervical cultures for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas.
Results: Of the 94 women who met study criteria, 53% had proven STDs (19% N. gonorrhoeae 22% C. trachornaris 33% Trichomonas). There was no difference between the patients with positive and negative tests for STDs with regard to complaints, physical findings, and laboratory results (all p > 0.05).
Conclusions: Women undergoing pelvic examinations who are subsequently released, from this urban ED with the diagnosis of UTI have a high (>50%) prevalence of occult STDs. No complaint, physical finding, or laboratory result reviewed was associated with the risk of an STD. Consideration should be given to empirical antibiotic therapy in similar urban populations.     

Comparison of pelvic ultrasonography and pneumography for ovarian size

Thirty-two females undergoing pelvic pneumography or gynecography for question of ovarian size, fertility, or pelvic mass also had pelvic ultrasonography. The latter examinations were compared, predominantly retrospectively, with the radiographs in an attempt to establish criteria for locating ovaries and evaluating their size. Almost equal groups of normal, Stein-Levinthal syndrome, and miscellaneous pelvic lesions were established. The author concludes that pelvic echography can usually visualize normal ovaries, is a reliable diagnostic technique for polycystic ovaries (Stein-Levinthal syndrome), and is useful for confirming the presence of a pelvic mass. Other investigative techniques such as anemography, culdoscopy, laparoscope's, or exploratory surgery are more uncomfortable, hazardous, and expensive. It is suggested that pelvic ethnography should be the primary diagnostic approach in these cases.     

改良腹腔镜全子宫切除术中盆腔韧带悬吊对盆底重建的影响

目的探讨改良腹腔镜全子宫切除术中盆腔韧带悬吊对盆底重建的影响。方法行全子宫切除术47例作为研究对象,随机分成两组,观察组（A组）25例,行改良腹腔镜全子宫切除术＋盆腔韧带悬吊,对照组（B组）22例,行常规腹腔镜全子宫切除术。分析改良腹腔镜全子宫切除术中盆腔韧带悬吊对盆底重建的影响。结果两组手术时间、术中出血量及平均住院日无差异（P〉0．05）;观察组术后阴道长度及性生活满意度明显优于对照组（P〈0．05）,观察组25例术后无阴道顶端脱垂、张力性尿失禁发生．对照组22例术后一年有ll例阴道顶端脱垂,4例张力性尿失禁,两组相比差异有统计学意义（P〈O．05）。结论改良腹腔镜全子宫切除术＋盆腔韧带悬吊对于盆底重建,防止术后盆腔脏器脱垂有积极意义,值得推广．     

三维超声评价晚孕期女性盆膈裂孔的形态结构

目的 应用三维超声评价晚孕期女性盆膈裂孔形态结构,为妊娠期女性盆底功能障碍(PFD)的诊治提供影像学依据。 方法 选取在我院产科定期产检的单胎妊娠、孕周为30~40周的初次妊娠女性40人(晚孕组);选择同期20例因月经不调、盆腔炎等就诊的未育妇女作为对照组。对所有受检者行三维盆底超声检查,分别观察在静息期、缩肛期、张力期盆膈裂孔的形态结构,测量盆膈裂孔的面积、前后径和左右径,并进行统计学分析。 结果 晚孕组盆膈裂孔的面积、前后径和左右径在静息期、缩肛期和张力期均较对照组明显增大(P均<0.05)。与静息期相比,两组盆膈裂孔的三个参数在缩肛期均减小而在张力期均增大(P均<0.05)。晚孕组超声异常表现包括盆膈裂孔明显增大,形态为"类椭圆形",盆膈裂孔中轴线偏移。 结论 三维超声能有效评价妊娠期女性盆膈裂孔的形态结构。晚孕期女性的盆膈裂孔较未育妇女明显增大,部分存在形态或位置异常。     

绝经后妇女良恶性盆腔包块超声诊断价值的 ROC 曲线研究简

目的 研究超声鉴别诊断绝经后妇女恶性盆腔包块的效能,探讨超声在绝经后妇女盆腔包块诊断中的价值.方法 选取2011年1月至2013年1月有明确的病理以及临床诊断的120例绝经后盆腔包块患者作为研究对象,回顾性分析患者的临床资料以及超声声像图的特点.结果 120例绝经后盆腔包块患者中良性盆腔包块87例（72.5%）,恶性包块33例（27.5%）.超声诊断绝经后妇女恶性盆腔包块的敏感度为93.9%,特异度为93.1%;其中良性盆腔包块的诊断符合率为97.4%,恶性盆腔包块的诊断符合率为81.1%,超声误诊10例（8.33%）.超声诊断绝经后妇女恶性盆腔包块受试者工作特征曲线（ROC曲线）下面积为0.870.结论 超声在鉴别诊断绝经后妇女盆腔包块方面,具有无创、快速、灵敏度高等特点,具有较高的诊断价值,可以作为诊断绝经后妇女盆腔包块性质的首选检查方法.     

A United Kingdom-wide survey of physiotherapy practice in the treatment of pelvic organ prolapse

Background and purpose Pelvic organ prolapse is a common female condition. It is estimated that 50% of parous women experience some degree of prolapse and that 10-20% seek medical care [Br. Med. J. 324 (2002) 1258]. The aim of the survey was to investigate current physiotherapy practice in the treatment of pelvic organ prolapse, specifically the use of pelvic floor muscle training, across the United Kingdom. An additional aim was to gauge the level of interest of individuals and centres in becoming involved in planned multi-centre research exploring the effectiveness of pelvic floor muscle training in the treatment of pelvic organ prolapse.Methods A questionnaire was mailed out to 484 physiotherapist members of the Association of Chartered Physiotherapists in Women’s Health, and 54 non-member physiotherapists working in women’s health, which asked about current practice in the treatment of pelvic organ prolapse.Results A total of 364 physiotherapists completed the questionnaire (a response rate of 71%, after excluding 27 cases) representing a range of clinical experience and practice. Of the respondents 92% (n=333) were assessing or treating women with pelvic organ prolapse.

The questionnaire data showed that the various elements of pelvic floor muscle training and outcome measurement were being practised by physiotherapists working across the United Kingdom.

However, access to pelvic floor muscle training may be inconsistent, as more than three-quarters of the study respondents reported that they did not have access to clinical guidelines (n=264, 79.3%) or referral guidelines (n=296, 88.9%) for the management of pelvic organ prolapse.

The majority of the sample expressed an interest in being involved in future research in this area of practice. There was interest at both an individual level (n=275, 82.5%) and as a centre (n=205, 86.1%).

Conclusions This survey has revealed that physiotherapy treatment for prolapse is being offered throughout the country despite the poor evidence base and lack of clinical and referral guidelines. There is a gap in the research evidence and therefore a need for randomised controlled trials looking at the effectiveness of pelvic floor muscle training, in the management of pelvic organ prolapse. Evidence-based guidelines should follow on from this. Standardised referral guidelines are also required to ensure equal access to assessment and physiotherapy treatment.     

Development of a biotensegrity focused therapy for the treatment of pelvic organ prolapse: A retrospective case series

IntroductionPelvic organ prolapse (POP), the bulging of pelvic organs into the vagina, is a common condition thought to be caused by weak pelvic tissue. There is a paucity of evidence supporting current treatment approaches. This case series proposes a new biotensegrity-focused hypothesis that POP is caused by taut pelvic tissue and that releasing pelvic tension will improve POP.MethodsThree retrospective patient cohorts are presented illustrating the development of the new biotensegrity-focused therapy (BFT) approach. All women received: postural assessment; pelvic tissue examination; and myofascial release of taut pelvic tissue, trigger points, and scar tissue. A standard assessment protocol (SOTAP) recorded patients' Subjective experience, the therapist's Objective assessment, the Treatment plan, Assessment of treatment outcomes, and subsequent treatment and self-care Plans. Cohort three additionally self-reported symptoms using the short-form PDFI-20 questionnaire at baseline and after final treatment.ResultsTwenty-three women participated (Cohort 1 n = 7; Cohort 2 n = 7; Cohort 3 n = 9). Fourteen (61%) presented with cystocele, 10 (44%) urethracele, 7 (30%), cervical descent, and 17 (74%) rectocele. Seven (30%) presented with single prolapse, 8 (35%) double, 6 (26%) triple, and 2 (9%) quadruple. Median treatments received was 5 (range 3–8). All women reported improved prolapse symptoms. Cohort 3 (n = 9) reported clinically meaningful reductions (mean 56%) in PFDI-20 total after final treatment.ConclusionsThis case series offers preliminary evidence for the association between POP and pelvic tissue tension. Further research is needed to explore these findings and to determine the efficacy of BFT for treating POP in a wider sample.     

经阴道彩超对盆腔淤血综合征的诊断价值评估

目的探讨经阴道彩色多普勒超声（transvaginalcolorDopplersonography,TVCDS）在盆腔淤血综合征（pleviccongestionsyndrome）中的应用价值。方法应用TVCDS对73例盆腔淤血综合征（PCS）患者和50例健康妇女作为正常对照组进行盆腔静脉的二维及彩色频谱多普勒检查。结果73例病变组中,均有盆腔静脉曲张、增宽,流速减低。与正常组对照比较,有显著性差异,（P〈0．01）。结论经阴道彩色多普勒超声是诊断盆腔淤血综合征的一种有效方法。     

Pseudo-Meigs' syndrome

Meigs' syndrome is defined as a hydrothorax with ascites and a pelvic tumor, both of which resolve on removal of the tumor. Pseudo-Meigs' is a variant not possessing the original tumor cell types described by Meigs. Both these syndromes should be considered in otherwise healthy women who present with either new or recurrent hydrothorax and ascites. This case concerns a 21-year-old woman who presented to the emergency department (ED) with a recurrent hydrothorax. After performing a pelvic examination that was suspicious for a pelvic mass, further evaluation by ultrasonography showed ascites and a pelvic tumor. Surgeons from the Obstetrics and Gynecology Department performed an exploratory laparotomy with removal of the tumor. Subsequently, there was no recurrence of the ascites and hydrothorax. The tumor was diagnosed histologically as a benign mature teratoma. The literature of Meigs' and Pseudo-Meigs' is reviewed, focusing on the history, pathology, and clinical characteristics. The clinical significance for the emergency physician is discussed.     

盆腔脂肪增多症的超声诊断及漏误诊原因分析

目的:探讨盆腔脂肪增多症(pelvic lipomatosis,PL)的超声诊断价值,并分析漏误诊原因。方法:回顾性分析2000年1月至2018年12月在北京协和医院经手术或影像学确诊为PL的68例患者,总结其超声图像特征。结果:68例PL患者的声像图表现如下:盆腔内脂肪样强回声增多6例(8.8%),膀胱异常60例(88.2%),肾盂扩张42例(61.7%),合并输尿管扩张24例(35.3%)。其中超声正确诊断6例(8.8%);漏诊54例(79.4%);误诊为其他疾病8例(11.8%),包括膀胱肿瘤性占位7例(10.3%),腹膜后巨大占位1例(1.5%)。结论:PL具有特征性的声像图表现,当发现泌尿系统梗阻及膀胱壁增厚等超声表现时,需考虑PL存在的可能,并进一步观察膀胱形态及盆腔内有无脂肪样强回声增多等表现,这有助于降低PL超声诊断的漏误诊率。     

个体化指导产妇盆底肌锻炼的临床效果观察

目的探讨产妇进行盆底肌肉锻炼（PFMT）促进产后盆底器官功能康复的效果。方法将194例孕产期妇女随机分为观察组和对照组。观察组（98例）在产后第一天进行个体化指导盆底肌锻炼;对照组（96例）只采用产后常规指导。产褥期满（即产后42d）进行盆底组织器官评定。结果产妇42d盆底PC肌张力评分、盆底器官脱垂情况POP-Q分度观察组与对照组差异有显著意义（P〈0.01;P〈0.05）;观察组产妇压力性尿失禁、痔疮的发生率也较对照组明显降低（P〈0.01）。结论对产妇进行盆底肌锻炼,能明显促进产后盆底组织器官功能的恢复。     

经会阴二维超声动态观察和评估未育女性盆底

目的 应用经会阴二维超声动态观察并评估未育女性盆底器官的形态、位置及运动,探索一种可有效观察盆底器官的影像学方法。方法 对50例未育女性行经会阴二维超声检查,分别在静息期、缩肛期和张力期动态观察盆底器官的形态、位置及运动,并获取位置的测量参数。结果 经会阴二维超声可清晰显示未育女性盆底器官的形态和位置。盆底器官静息期位于参照线头侧,缩肛期向头腹侧移动,张力期向足背侧移动,但始终位于参照线头侧;盆底器官有一定的向正常方向的移动度。结论 经会阴二维超声能清晰地显示女性盆底器官的形态、位置及运动,是一种有效的影像学方法。     

腹腔镜卵巢囊肿剔除术后盆腔感染相关因素分析与预防措施

目的分析腹腔镜卵巢囊肿剔除术后盆腔感染相关因素,制定相应控制措施,以降低感染率。方法选取2017年6月至2019年5月我院收治的100例行腹腔镜卵巢囊肿剔除术治疗患者为研究对象,分析患者基本情况、手术效果、卫生习惯、基础病症、术后抗菌药物使用、医护人员素质等相关因素与感染的相关性。结果发生盆腔感染25例,共培养出致病菌36株,其中G^菌11株,G^菌21株,真菌4株;其中最常见分别为大肠埃希菌9株,肺炎克雷伯菌7株,表皮葡萄球菌4株。年龄>60岁、术前存在感染病史、术后留置引流管、住院时间>7 d、不良卫生习惯与医护人员专业素质是行腹腔镜下卵巢囊肿剔除术后患者发生盆腔感染的独立危险因素(P<0.05)。结论盆腔感染是腹腔镜下卵巢囊肿剔除术后较为常见并发症,其发生与多种因素相关,治疗过程中需加强防范,采取有效的预防措施,以降低盆腔感染发生风险。     

绝经后妇女盆腔包块的超声诊断价值

目的 探讨超声在绝经后妇女盆腔包块诊断中的价值.方法 回顾性分析经手术证实的130例绝经后妇女盆腔包块的临床资料及超声声像图特点.结果 良性肿瘤94例（72.3％）,恶性肿瘤36例（27.7％）,超声对绝经后期盆腔肿物性质的诊断,其敏感性为93.9％,特异性为94.8％.良性盆腔肿物诊断符合率为97.8％,恶性为86.1％,超声误诊14例,误诊率10.7％.结论 超声诊断绝经后妇女盆腔包块,具有快速、无创、诊断率高等特点,对肿瘤良恶性的鉴别较为可靠,可作为绝经后妇女盆腔包块首选检查手段.