Comparative study of postpartum sexual function: Second-degree tears versus episiotomy outcomes

PURPOSE

The effects of episiotomy and second-degree tears on postpartum sexual function are key areas of enquiry in women's health research. Episiotomy and second-degree tears are common procedures and injuries that occur during childbirth. Understanding their impact on post-childbirth sexuality is crucial to women's overall well-being. This study aimed to examine the relationship between episiotomy, second-degree tears, and post childbirth sexuality.

METHODS

A cross-sectional design was employed, including 83 women who gave birth to Cáceres in 2017. Participants were evaluated based on sociodemographic and sexual health factors.

RESULTS

No significant differences were found in dyspareunia or sexual function between women who underwent episiotomies and those with second-degree tears. However, women who underwent episiotomies waited longer before resuming sexual activity after childbirth. Factors such as age, number of previous births, employment status, educational level, and breastfeeding status affected the timing and frequency of postpartum sexual activity.

CONCLUSION

Dyspareunia negatively affects various aspects of sexual function. When comparing episiotomy and second-degree tears, their impacts on postpartum sexual function were similar. However, episiotomy delays the resumption of sexual activity. Sociodemographic factors significantly influence postpartum sexual health. These findings highlight the importance of individualised interventions and support for new mothers during the postpartum period to address potential sexual health concerns.

Mechanical behaviors of high-strength fabric composite membrane designed for cardiac valve prosthesis replacement

Bovine pericardium has been commonly used as leaflets in cardiac valve prosthesis replacement for decades because of its good short-term hemocompatibility and hemodynamic performance. However, fatigue, abrasion, permanent deformation, calcification, and many other failure modes have been reported as well. The degradation of the performance will have a serious impact on the function of valve prostheses, posing a risk to the patient's health. This study aimed to introduce a flexible fabric composite with better mechanical performance such that it can be employed as a substitute material for bioprosthetic valve leaflets. This composite has a multilayered thin film structure made of ultrahigh molecular weight polyethylene (UHMWPE) fabric and thermoplastic polyurethane (TPU) membranes. The mechanical properties of three specifications with different design parameters were tested. The tensile strength, shear behavior, tear resistance, and bending stiffness of the composites were characterized and compared to those of bovine pericardium. A constitutive model was also established to describe the composites' mechanical behaviors and predict their strength. According to the results of the tests, the composite could maintain a flexible bending stiffness with high in-plane tensile strength and tear strength. Therefore, bioprosthetic valve made of this substitute material can withstand harsher loads in the blood flow environment than those made of bovine pericardium. Moreover, all these test results and constitutive models can be used in future research to evaluate hemodynamic performance and clinical applications of fabric composite valve prostheses.

Maximal tear secretion evoked by controlled stimulation of corneal sensory nerves in healthy individuals and dry eye subjects

PURPOSE

To measure, the tear flow changes evoked in healthy subjects and dry eye disease (DED) patients by controlled sensory stimulation of the eye surface with i-Onion™, a new stimulation device.

METHODS

Sensory corneal nerves were stimulated with an instrument (i-Onion™) that ejects puffs of CO₂ gas (99.9%) at 200 ml·min^-1 for 3s, delivered 5 mm from the cornea. Using Schirmer test strips, tear volumes were measured over 3 min in the cornea of one eye before (basal tear volume -BTV) and in the other eye after stimulation of the sensory nerves with CO₂ (stimulated tear volume -STV). These measurements were obtained from a control group of adults of either sex (17 students aged 20-30 and 29 subjects without signs of dry eye aged 25-61), a cohort of DED patients (aged 34-75) that included 12 asymptomatic, suspected DED subjects (Schirmer <7 mm and/or TBUT <10s), and 30 Sjögren's syndrome (SS) patients.

RESULTS

CO₂ stimulation significantly increased the tear volume (BTV = 14.6 ± 1.0 mm, STV = 19.0 ± 1.1 mm: n = 46) in 78% of control subjects, reflecting a mean tear reserve volume (TRV = STV-BTV) of 4.4 ± 0.8 mm. Individual differences were wide, and while no increase in reflex tearing was evoked in 30% of subjects with a BTV >10 mm, the remaining 70% responded vigorously to stimulation, even those with a BTV >18 mm. Asymptomatic DED subjects displayed weaker responses to CO₂ stimulation, with lower STVs. Both the BTV and STV of SS patients were low, significantly below those of the healthy controls.

CONCLUSIONS

Measuring the rise in reflex tearing volume evoked by controlled corneal stimulation provides objective information about the tear glands' secretory capacity in health and disease.

Etiology of Epiphora

Purpose

This study aimed to analyze the common causes of epiphora in Korean patients and their response to subsequent management.

Methods

We retrospectively analyzed the medical records of 180 patients who visited Kim’s Eye Hospital for epiphora between December 2017 and January 2019. This study included 320 eyes of 180 patients.

Results

In the 320 eyes of 180 patients, the most common etiology of epiphora was reflex tearing due to dry eye syndrome, which occurred in 167 eyes (52.19%). The other etiologies of epiphora included anatomical abnormality (68 eyes, 21.25%), multifactorial (60 eyes, 18.75%), functional epiphora (14 eyes, 4.38%), ocular surface disease (seven eyes, 2.19%), and eyelid abnormality (four eyes, 1.25%).

Conclusions

The most common etiology of epiphora in Korean patients was reflex tearing due to dry eye syndrome, followed by lacrimal passage abnormality, multifactorial, functional epiphora, anterior segment disease, and eyelid malposition. Most patients with reflex tearing reported improvement in their symptoms after lubrication.

Differential propensity of dissection along the aorta

Aortic dissections progress, in part, by delamination of the wall. Previous experiments on cut-open segments of aorta demonstrated that fluid injected within the wall delaminates the aorta in two distinct modes: stepwise progressive tearing in the abdominal aorta and a more prevalent sudden mode of tearing in the thoracic aorta that can also manifest in other regions. A microstructural understanding that delineates these two modes of tearing has remained wanting. We implemented a phase-field finite-element model of the aortic wall, motivated in part by two-photon imaging, and found correlative relations for the maximum pressure prior to tearing as a function of local geometry and material properties. Specifically, the square of the pressure of tearing relates directly to both tissue stiffness and the critical energy of tearing and inversely to the square root of the torn area; this correlation explains the sudden mode of tearing and, with the microscopy, suggests a mechanism for progressive tearing. Microscopy also confirmed that thick interlamellar radial struts are more abundant in the abdominal region of the aorta, where progressive tearing was observed previously. The computational results suggest that structurally significant radial struts increase tearing pressure by two mechanisms: confining the fluid by acting as barriers to flow and increasing tissue stiffness by holding the adjacent lamellae together. Collectively, these two phase-field models provide new insights into the mechanical factors that can influence intramural delaminations that promote aortic dissection.

Epiphora and unrecognized paranasal sinuses pathology

Purpose

to report five patients all presenting with persistent unilateral epiphora as a sign of unexpected and rare lesions causing Secondary Acquired Nasolacrimal Duct Obstruction (SANDO) and the risks associated to an incomplete diagnostic work-up.

Observations

the cases presented are: (1) Fungus ball, (2) Pyogenic granuloma, (3) Sinonasal inverted papilloma (4) Sinonasal inverted papilloma with synchronous squamous cell carcinoma, (5) Squamous cell carcinoma of the lacrimal sac.

Conclusions and importance

masses are uncommon but not a rare cause of nasolacrimal duct obstruction. Surgical teams performing large numbers of dacryocystorhinostomies should be aware of such pathology and perform a systematic multidisciplinary approach.

A manifold-based approach to sparse global constraint satisfaction problems

We consider square, sparse nonlinear systems of equations whose Jacobian is structurally nonsingular, with reasonable bound constraints on all variables. We propose an algorithm for finding good approximations to all well-separated solutions of such systems. We assume that the input system is ordered such that its Jacobian is in bordered block lower triangular form with small diagonal blocks and with small border width; this can be performed fully automatically with off-the-shelf decomposition methods. Five decades of numerical experience show that models of technical systems tend to decompose favorably in practice. Once the block decomposition is available, we reduce the task of solving the large nonlinear system of equations to that of solving a sequence of low-dimensional ones. The most serious weakness of this approach is well-known: It may suffer from severe numerical instability. The proposed method resolves this issue with the novel backsolve step. We study the effect of the decomposition on a sequence of challenging problems. Beyond a certain problem size, the computational effort of multistart (no decomposition) grows exponentially. In contrast, thanks to the decomposition, for the proposed method the computational effort grows only linearly with the problem size. It depends on the problem size and on the hyperparameter settings whether the decomposition and the more sophisticated algorithm pay off. Although there is no theoretical guarantee that all solutions will be found in the general case, increasing the so-called sample size hyperparameter improves the robustness of the proposed method.

Botulinum neurotoxin A injection for the treatment of epiphora with patent lacrymal ducts

HEADINGS

Retrospective longitudinal study to evaluate the efficacy of botulinum neurotoxin A (BoNT/A) therapy for epiphora with patent lacrimal ducts.

BACKGROUND/PURPOSE

BoNT/A has been used since 2000 in axillary hyperhidrosis to reduce sweat secretion. Some isolated cases of hyperlacrimation or crocodile tear syndrome have been treated with BoNT/A on this basis. We report our experience in the treatment of tearing despite patent lacrimal ducts by BoNT/A injection into the lacrimal gland.

METHODS

We reviewed qualitative and quantitative criteria to evaluate the degree of improvement of epiphora after BoNT/A injections in the palpebral lobe of the lacrimal gland in patients referred for epiphora despite patent lacrimal ducts between 2009 and 2016. Epiphora was graded using a functional questionnaire, Munk score and Schirmer test performed before and after the injections. Side effects were recorded.

RESULTS

Sixty-five palpebral lacrimal glands of forty-two patients with epiphora despite patent lacrimal ducts, of mean age 65 years, sex ratio 0.8, were treated with BoNT/A (IncobotulinumtoxinA, XEOMIN^®, MERZ Pharma France) from April 2009 to April 2016. The etiology of the epiphora was represented by 56 paroxysmal lacrimal hypersecretion, 2 crocodile tear syndrome and 7 facial palsies. No conventional medical or surgical treatment had been effective in these cases. The technique of injection, dilution and dosage of BoNT/A were specific. We re-injected 33/65 cases a second time upon patient request due to recurrence of epiphora, 16/65 cases three times, 8/65 cases four times, 6/65 cases five times and 3/65 six times. The Schirmer's test measured a decrease of lacrimal secretion in 51/65 glands (78%) after the first botulinum neurotoxin injection. Side effects were limited to ptosis in 2 cases (3%) and six patients (9%) with rapidly regressing diplopia. Two patients experienced immediate lacrimal gland hematoma (3%) with no sequelae. The authors describe the injection techniques, the dosage, the volume and concentration of BoNT/A.

CONCLUSION

Patients with intractable epiphora despite patent lacrimal ducts can be effectively treated with BoNT/A (IncobotulinumtoxinA) injection into the palpebral lobe of the lacrimal gland. Most of the patients (80%) were very satisfied with few side effects (hematoma, ptosis or mild diplopia lasting from 3 days to 3 weeks). More studies are needed to delineate which types of epiphora can be treated with BoNT A.

Tear and decohesion of bovine pericardial tissue

The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications.

Tearing of the left iliac vessels in lumbar surgery revealed by multiphase post-mortem CT-angiography (MPMCTA)

Lumbar surgery is regularly applied in cases of discal hernia and acquired lumbar stenosis. In this report, we present a case of a laceration in the left common iliac artery and iliac vein during a lumbar surgery and discuss the literature concerning this kind of event. In the present case, the surgical procedure was followed by a sudden decrease in blood pressure, and the surgeon discovered an intra-abdominal haemorrhage that led to the patient's death. Postmortem investigation confirmed the intra-abdominal haemorrhage and revealed a laceration of the proximal portion of the left common iliac artery and left iliac vein. The source of bleeding could be detected especially thanks to multi-phase postmortem CT angiography (MPMCTA), which was performed prior to autopsy. We also found a haemorrhagic path through the intervertebral disc between the L4-L5 vertebrae, caused by the surgeon's instrument (pituitary rongeur). To date, a few cases have been described of iatrogenic death resulting from a tear in the iliac vessels during lumbar surgery, but not from the postmortem perspective. Such investigations have recently been modernized thanks to the introduction of forensic imaging. In particular, MPMCTA offers new possibilities in postmortem investigations and can be considered the new gold standard for investigating deaths related to medical intervention. Here we describe the first case of a death during lumbar surgery using this new method.

Dacryoscintigraphic findings in the children with tearing

Purpose

To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing.

Methods

Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 µCi 99m technetium pertechnetate was measured by dacryoscintigraphy.

Results

According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up.

Conclusions

Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.

Patients undergoing dacryocystorhinostomy surgery in northern iran: an epidemiologic study

BACKGROUND

Dacryocystorhinostomy (DCR) is widely accepted as the procedure of choice for surgical correction of lacrimal drainage system obstruction distal to common canaliculus in adulthood. Although, there are only limited epidemiological data available in Iran about the patients undergoing DCR surgery.

AIM

This study was aimed to survey the demographic characteristics of patients received (DCR) surgery to achieve the newer information about these patients.

SUBJECTS AND METHODS

In this descriptive study, the demographic characters such as age, and gender, clinical findings, history of surgery, etc., extracted from archived files of the patients undergoing DCR surgery in educational and treatment center of Bu Ali Sina Hospital in Mazandaran. Data were entered into the SPSS software version 15 (Chicago, IL, USA) and analysis inferential analysis performed using t-test and Chi-square.

RESULTS

Among 40 under survey records 72.5% (29/40) were female and 27.5% (11/40) male. Patient's mean age was 48.22 (17.1). Fifty percent were from a rural area and there was a significant relationship between gender and dacryocystitis rate, it was high among female (P = 0.02(Most of the patients complained of tearing 87.5% (35/40) and recurrent attacks of acute dacryocystitis 70.3% (28/40), respectively. Conjunctivitis in 33.3% (13/40) of patients and chronic discharge was seen in 40% (16/40) of cases.

CONCLUSION

Overall finding showed in comparisons of men with the females of middle age and above included higher cases of dacryocystitis. The authors suggest regarding high prevalence of sinusitis and allergies in Northern Iran, checking by ENT specialist is beneficial to exact diagnosis and programming for treatment of this kind of patients.

Etiology of tearing in patients seen in an oculoplastic clinic in Saudi Arabia

AIM

To determine the prevalence of various causes of tearing among patients referred to an oculoplastic clinic.

MATERIALS AND METHODS

A prospective study on all patients seen in an oculoplastic clinic with a chief complaint of tearing. The cause of tearing was determined on the basis of the anatomical location of the primary etiology.

RESULTS

This study included 357 patients with a mean age 53.9 years. Punctal stenosis was the most common etiology, affecting 37.8% of the patients. Among patients with punctual stenosis, 63.4% were women over 50-year-old (P = 0.001); 55.6% had tearing for less than 6 months (P = 0.038), and all of them had associated chronic blepharitis. The remaining study participants had dry eye with reflex tearing (27.7%), nasolacrimal duct obstruction (10.1%), canalicular obstruction (4.2%), entropion or ectropion (3.4%), pterygium (1.7%), megalo-caruncle (1.7%), and functional tearing (1.7%).

CONCLUSION

The outcomes of this study indicate the most common cause of tearing is punctal pathology. Therefore, slit lamp evaluation with careful attention to the punctum is warranted in all patients with tearing.