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Esber A, Kopera A, Radosa MP, Runnebaum IB, Mothes HK, Mothes AR. “Locus minoris resistentiae” and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia. BMC Womens Health 2021; 21:425. [PMID: 34930209 PMCID: PMC8690437 DOI: 10.1186/s12905-021-01554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Conditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling. Case presentation Three cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general. Conclusion The simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.
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Tadbiri H, Handa VL. Association between pelvic floor disorders and hernias. Int Urogynecol J 2021; 32:3017-3022. [PMID: 33730234 DOI: 10.1007/s00192-021-04762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Connective tissue disorders may contribute to pelvic floor disorders (PFDs). Like PFDs, abdominal wall hernias are more common in patients with systemic connective tissue disorders. We conducted this study to explore the possible association between PFDs and hernias in adult women. METHODS We obtained the data for this study from a study of PFDs among parous women. At enrollment, stress urinary incontinence (SUI), overactive bladder (OAB), and anal incontinence (AI) were assessed using the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) and pelvic organ prolapse (POP) was assessed through the Pelvic Organ Prolapse Quantification (POP-Q) examination. Participants were asked to report hernia surgery and list their hernia types. We compared the prevalence of PFDs in those with and without hernias using chi-square test. We used multiple regression analysis to adjust for obstetric and sociodemographic variables. RESULTS Among 1529 women, 79 (5.2%) reported history of hernia surgery. The prevalence of POP was 7.6% (6 cases) vs. 7.4% (107 cases), the prevalence of SUI was 7.6% (6 cases) vs. 9.9% (144 cases), the prevalence of OAB was 7.6% (6 cases) vs. 5.7% (83 cases), and the prevalence of AI was 7.6% (6 cases) vs. 10.8% (156 cases) in those with hernias compared to those without hernias, respectively. None of these differences were statistically significant. There was no association between hernias and PFDs after adjustment for type of delivery, number of deliveries, age group, primary racial background, weight category, and smoking status. CONCLUSION In this study, we could not find any association between hernias and PFDs.
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Affiliation(s)
- Hooman Tadbiri
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Victoria L Handa
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ulum MF, Frastantie D, Purwantara B. Sonogram of coccygeus muscle in dairy cows with different gestational ages. JOURNAL OF ANIMAL SCIENCE AND TECHNOLOGY 2017; 59:26. [PMID: 29270304 PMCID: PMC5733873 DOI: 10.1186/s40781-017-0152-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/24/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND The change in size and weight of the female reproductive organs during gestation and birth might be affect the perineal muscles and this condition in dairy cow not been reported. This study aimed to assess the ultrasonographic image of coccygeus muscle in 11 inseminated dairy cows with different gestational ages and postpartum. METHODS Gestational age was calculated based on the record of artificial insemination and confirmed by using transrectal brightness mode ultrasonography. Perineal hair between the sacrum and ischium bones was shaved along 3-5 cm before being ultrasound. The images of perineal area were obtained by transcutaneous ultrasound using a 5.0 MHz transducer. The thickness and intensity of the coccygeus muscle were measured and analyzed by gestational status and postpartum to show the differences. RESULTS The results showed that the thickness of coccygeus muscle increased with the increase in gestational age. Muscle intensity only increased at young gestational age. However, it decreased with the increase in gestational age (P < 0.05). CONCLUSIONS The ultrasound image of coccygeus muscle was affected by gestational status, thus this method may be used as one of the new methods of indirect gestational detection on dairy cows.
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Affiliation(s)
- Mokhamad Fakhrul Ulum
- Department of Clinic Reproduction and Pathology, Faculty of Veterinary Medicine, Bogor Agricultural University, Jalan Agatis Kampus IPB Dramaga, Bogor, Jawa Barat 16680 Indonesia
| | - Dilla Frastantie
- Department of Clinic Reproduction and Pathology, Faculty of Veterinary Medicine, Bogor Agricultural University, Jalan Agatis Kampus IPB Dramaga, Bogor, Jawa Barat 16680 Indonesia
| | - Bambang Purwantara
- Department of Clinic Reproduction and Pathology, Faculty of Veterinary Medicine, Bogor Agricultural University, Jalan Agatis Kampus IPB Dramaga, Bogor, Jawa Barat 16680 Indonesia
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Harlaar JJ, Eker HH, Vakalopoulos KA, Cabezas MC, van der Ham AC, Vrijland WW, Jeekel J, Lange JF. Advanced glycation end products as a biomarker for incisional hernia. Hernia 2017; 21:537-541. [PMID: 28405811 PMCID: PMC5517588 DOI: 10.1007/s10029-017-1610-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/04/2017] [Indexed: 01/19/2023]
Abstract
Background Incisional hernia is one of the most frequent complications after abdominal surgery, with incidences up to 30%. A reliable biomarker for the prediction of this complication is lacking. Advanced glycosylation end products (AGEs), also known as non-enzymatic collagen crosslinks, are correlated with aging, smoking, hyperglycemia, hyperlipidemia and oxidative stress. In this study the accumulation of AGEs and the relation between AGEs and incisional hernia were investigated. Materials and methods In an exploratory case–control study, 23 patients with incisional hernia after midline incision were compared with 17 patients without clinical or radiological signs of incisional hernia after midline incision, AGEs were measured using a Skin Auto Fluorescence (SAF)-reader. Results Twenty-three patients with a clinically significant incisional hernia and 17 control patients were included. The study groups had significant differences in mean BMI. There was a significant difference between mean AGEs in patients with and without incisional hernia after midline incision (3.00 ± 0.15 vs. 2.56 ± 0.11, T test p = 0.03). Conclusion AGE accumulation measured in the skin indirectly with autofluorescence might be associated with incisional hernia. Prospective larger trials should confirm this finding.
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Affiliation(s)
- J J Harlaar
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands.
| | - H H Eker
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - K A Vakalopoulos
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
| | - M C Cabezas
- Department of Internal Medicine, Franciscus Hospital, Rotterdam, The Netherlands
| | - A C van der Ham
- Department of Surgery, Franciscus Hospital, Rotterdam, The Netherlands
| | - W W Vrijland
- Department of Surgery, Franciscus Hospital, Rotterdam, The Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
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Burcharth J, Andresen K, Pommergaard HC, Rosenberg J. Groin hernia subtypes are associated in patients with bilateral hernias: a 14-year nationwide epidemiologic study. Surg Endosc 2014; 29:2019-26. [DOI: 10.1007/s00464-014-3905-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
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Bortolini MAT, Shynlova O, Drutz HP, Girão MJBC, Castro RA, Lye S, Alarab M. Expression of Bone Morphogenetic Protein-1 in vaginal tissue of women with severe pelvic organ prolapse. Am J Obstet Gynecol 2011; 204:544.e1-8. [PMID: 21397208 DOI: 10.1016/j.ajog.2011.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/30/2010] [Accepted: 01/14/2011] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To analyze the differential gene and protein expression of Bone Morphogenetic Protein-1 in vaginal tissue of women with advanced pelvic organ prolapse and controls. STUDY DESIGN We sampled the anterior vaginal wall of 39 premenopausal (23 patients and 16 controls), and 18 postmenopausal women (13 patients and 5 controls) during hysterectomy. Total mRNAs and proteins were quantified by real-time RT-PCR and immunoblotting. RESULTS Bone Morphogenetic Protein-1 gene expression was decreased in pre- and postmenopausal pelvic organ prolapse patients compared with asymptomatic women (P = .01). The expression of 130 kDa, 92.5 kDa, and 82.5 kDa isoforms of Bone Morphogenetic Protein-1 were down-regulated in postmenopausal patients (P = .01), whereas the 130 kDa isoform expression was up-regulated in premenopausal patients (P = .009), when compared with respective controls. CONCLUSION The Bone Morphogenetic Protein-1 expression in human vagina was altered in patients with severe pelvic organ prolapse and influenced by menopausal status. Dysregulation of Bone Morphogenetic Protein-1 may contribute for a deficient vaginal connective tissue and support.
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Affiliation(s)
- Maria A T Bortolini
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Canada.
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The Nyhus–Wantz lectureship: etiology, herniosis, diverticulosis coli, and cancer. Hernia 2011; 15:481-3. [DOI: 10.1007/s10029-011-0833-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/29/2011] [Indexed: 11/25/2022]
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Szczesny W, Fisz J, Zuchowski P, Niedojadlo J, Szmytkowski J, Dabrowiecki S. Ultrastructural differences in rectus sheath of hernia patients and healthy controls. J Surg Res 2011; 167:e171-5. [PMID: 20926101 DOI: 10.1016/j.jss.2010.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/06/2010] [Accepted: 08/10/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND The etiology of inguinal hernia remains unclear. Research data indicate the presence of pathologic alterations within the connective tissue; their exact character remains the subject of dispute. The search for new methods to diagnose connective tissue abnormalities, and thoroughly explain the character of the ultrastructural alterations, continues. MATERIALS AND METHODS The study group included 10 male patients aged 18-60 y (five with primary inguinal hernia and five with acute appendicitis with no history of hernia). A specimen of the rectus muscle sheath was harvested from all of them upon surgery. The tissue samples were fixed and examined by spectrofluorometry and fluorescence microscopy, yielding fluorescence spectra and microscopic fluorescence images. RESULTS Both techniques have demonstrated significant differences between the biopsy samples harvested from hernia patients and healthy controls. The groups of fluorescence spectra were shifted relative to each other and showed maximum emission at different wavelengths after excitation with 350 nm light (arbitrarily chosen for one of the cross-link proteins). The spectra obtained for healthy controls were more homogenous, while the spectra of the hernia samples differed even between each other. In microscopic images, the difference was a more chaotic distribution of fluorophores in the samples obtained from hernia patients. CONCLUSIONS The evidence of significant differences between the samples harvested from the same location from hernia patients and healthy controls, found by fluorescence techniques, indicates the presence of abnormalities in the connective tissue forming the rectus muscle sheath. This area is not a part of the hernial defect, therefore, we can assume that the changes can be attributed to a generalized process.
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Affiliation(s)
- Wojciech Szczesny
- Department of General and Endocrine Surgery, Nicolaus Copernicus University College of Medicine, Bydgoszcz, Poland.
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Mohammed SD, Lunniss PJ, Zarate N, Farmer AD, Grahame R, Aziz Q, Scott SM. Joint hypermobility and rectal evacuatory dysfunction: an etiological link in abnormal connective tissue? Neurogastroenterol Motil 2010; 22:1085-e283. [PMID: 20618831 DOI: 10.1111/j.1365-2982.2010.01562.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies report an association between joint hypermobility (JHM), as a clinical feature of underlying connective tissue (CT) disorder, and pelvic organ prolapse. However, its association with rectal evacuatory dysfunction (RED) has not been evaluated. To investigate the prevalence of JHM in the general population and in patients with symptoms of RED referred for anorectal physiological investigation. METHODS Bowel symptom and Rome III questionnaires to detect irritable bowel syndrome were sent to 273 patients with RED. Patients then underwent full investigation, including evacuation proctography. A validated 5-point self-reported questionnaire was used to assess JHM in both the patient group and 100 age- and sex-matched controls [87 female, median age 55 (range 28-87)]. KEY RESULTS Seventy-three patients were excluded from analysis (incomplete questionnaire or investigation). Of 200, 65 patients [32%: 63 female, median age 52 (range 15-80)] and 14% of controls (P = 0.0005 vs patients) had features satisfying criteria for JHM. Overall constipation score (P < 0.0001), abdominal pain (P = 0.003), need for manual assistance (P = 0.009), and use of laxatives (P = 0.03) were greater in the JHM group than the non-JHM group. On proctography, 56 of JHM patients (86%) were found to have significant morphological abnormalities (e.g. functional rectocoele), compared with 64% of the non-JHM group (P = 0.001). CONCLUSIONS & INFERENCES The greater prevalence of JHM in patients with symptoms of RED, and the demonstration of significantly higher frequencies of morphological abnormalities than those without JHM, raises the possibility of an important pathoaetiology residing in either an enteric or supporting pelvic floor abnormality of CT.
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Affiliation(s)
- S D Mohammed
- GI Physiology Unit (Academic Surgical Unit) and Neurogastroenterology Group, Centre for Digestive Diseases, Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK.
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Read RC. Systemic hernial disease protects against cancer: an hypothesis. Hernia 2009; 14:119-21. [DOI: 10.1007/s10029-009-0583-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Accepted: 10/16/2009] [Indexed: 12/31/2022]
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Abstract
INTRODUCTION Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons' views differed. THE PAST The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and mass suturing to the inguinal ligament. A 2.7% recurrence rate evoked worldwide emulation. Corruption ensued. The cremaster remained and few unincised layers were stitched, without imbrications, along with reinforcement using the cremaster or rectus muscles, fascial flaps, relaxing incisions, and silver coils. Little improvement cast doubt on Bassini's work. Russell's (Lancet 2:1197-1203, 1906) ligation of the hernial sac was adopted until 1953, when the Shouldice clinic revived Bassini's tenets, becoming the gold standard for decades. Cheatle (Br Med J 2:68-69, 1920) introduced posterior pre-peritoneal repair. Acquaviva and Bourret (Presse Med 73:892, 1948) designed the first plastic prosthesis (nylon), replaced by polypropylene. Usher (Surg Gynecol Obstet 117:239-240, 1963) parietalized the cord. These contributions paved the way for the Rives, Stoppa, Wantz, and Gilbert repairs, Ger's laparoscopic approach, and less common herniorrhaphies. THE PRESENT Chevrel (1979) formed the GREPA, which evolved into the European Hernia Society (EHS), joining with the American Hernia Society (AHS) to form the journal 'Hernia.' Nilsson (1993) instituted national hernia registries, enabling less recurrences and better prospective research. THE FUTURE In the 21st century, the Lichtenstein procedure has dominated inguinal herniorrhaphy. Herniologists accepted systemic connective tissue disorder as the etiology of abdominal hernia and pelvic prolapses. This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed. CONCLUSION This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.
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Affiliation(s)
- R C Read
- University of Arkansas for Medical Sciences, Rockville, MD 20850, USA.
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Abstract
INTRODUCTION Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons' views differed. THE PAST The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and mass suturing to the inguinal ligament. A 2.7% recurrence rate evoked worldwide emulation. Corruption ensued. The cremaster remained and few unincised layers were stitched, without imbrications, along with reinforcement using the cremaster or rectus muscles, fascial flaps, relaxing incisions, and silver coils. Little improvement cast doubt on Bassini's work. Russell's (Lancet 2:1197-1203, 1906) ligation of the hernial sac was adopted until 1953, when the Shouldice clinic revived Bassini's tenets, becoming the gold standard for decades. Cheatle (Br Med J 2:68-69, 1920) introduced posterior pre-peritoneal repair. Acquaviva and Bourret (Presse Med 73:892, 1948) designed the first plastic prosthesis (nylon), replaced by polypropylene. Usher (Surg Gynecol Obstet 117:239-240, 1963) parietalized the cord. These contributions paved the way for the Rives, Stoppa, Wantz, and Gilbert repairs, Ger's laparoscopic approach, and less common herniorrhaphies. THE PRESENT Chevrel (1979) formed the GREPA, which evolved into the European Hernia Society (EHS), joining with the American Hernia Society (AHS) to form the journal 'Hernia.' Nilsson (1993) instituted national hernia registries, enabling less recurrences and better prospective research. THE FUTURE In the 21st century, the Lichtenstein procedure has dominated inguinal herniorrhaphy. Herniologists accepted systemic connective tissue disorder as the etiology of abdominal hernia and pelvic prolapses. This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed. CONCLUSION This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.
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Affiliation(s)
- R C Read
- University of Arkansas for Medical Sciences, Rockville, MD 20850, USA.
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