Reference For Management Of Patients Research Articles

Reference Data on the Normal Abdominal Wall Anatomy and Baseline Characteristics in Seventy-One Nulliparous Women.

Aims: The aim of this study was to describe the prepartum anatomy of the abdominal wall in a cohort of nulliparous women, for use as a reference for management of patients with postpartum abdominal wall insufficiency with or without rectus diastasis. Materials and Methods: Seventy-one women were examined with ultrasonography of the abdominal wall. The inter-recti distance (IRD), anatomical variations of the linea semilunaris, and the oblique muscles were assessed. The waistline was measured during activation and relaxation of the abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7), and quality-of-life (SF-36) were answered. Results: Mean age was 30.5years (range 19-50years) and mean BMI 23.5kg/m2 (range 18-37). Ultrasonography showed a mean IRD of 10mm (range 3-24) at the superior border of the umbilicus, 9mm (4-20) 3cm above the umbilicus, and 2mm (-5-10) 2cm below the umbilicus. The mean thickness of the linea alba was 3mm (1.5-5) and mean distances between the lateral edge of the rectus muscle and the external, internal, and transverse oblique muscles were 12mm (-10-28), 1mm (-14-13) and 15mm (-14-32) at umbilicus level. Responses to the DRI, UDI-6, IIQ-7 and Oswestry questionnaires showed generally lower scores than the normal population whereas Baecke and SF-36 scores were similar. Conclusion: This study provides baseline data on normal abdominal wall anatomy in a healthy nulliparous female cohort, as well as levels of activity, physical function, disability, and quality-of-life.

OC-063 BASELINE DATA AND NORMAL ANATOMY OF THE ABDOMINAL WALL IN AN OBSERVATIONAL PROSPECTIVE COHORT STUDY OF NULLIPAROUS WOMEN

Abstract Aims The aim of this study was to describe the pre-partum anatomy of the abdominal wall in a cohort of nulliparous women, with the main purpose to use as a reference for management of patients with postpartum abdominal core instability. Materials & Methods Seventy consecutive women were examined with ultrasonography measuring inter-recti distance (IRD), anatomical variations of linea semilunaris and the oblique muscles. Waistline was assessed during activated and relaxed abdominal core. Participant characteristics were registered. Questionnaires regarding habitual physical activity (Baecke), low back pain (Oswestry), physical functioning (DRI), urinary incontinence (UDI-6 and IIQ-7) and quality of life (SF-36) were answered. Results Response rate was 100%. Mean age was 30.5 years (19–50), mean BMI 23.5 kg/m2 (18.4–37.1). Ultrasonography showed a mean IRD 1.02 mm (0.27–2.35) at the superior border of the umbilicus, 0.93 mm (0.36–2.01) three cm above the umbilicus, 0.21 mm (-0.53–0.98) two cm below the umbilicus; mean thickness of the linea alba 0.28 mm (0.15–0.5); mean distance between the lateral lining of the rectus muscle and the external, internal and transverse oblique muscles of respectively 1.19 (-0.99–2.82), 0.09 mm (-1.37–1.3) and 1.46 mm (-1.36–3.19) at umbilicus level. Responses to the questionnaires showed overall low values on DRI, UDI-6, IIQ-7 and Oswestry; and overall values on Baecke and SF-36 similar to the normative population. Conclusions This study provides baseline data on the normal abdominal wall anatomy as well as mean values of activity, physical function, disabilities and quality of life, in a healthy nulliparous female cohort.

Carotid Disease and Stroke

Carotid Disease and Stroke. Stroke is a major cause of disability, mortality, dementia, and depression in the world. Carotid atherosclerosis is recognized as an important cause of stroke and a modifiable factor for the risk reduction of subsequent stroke. Randomized clinical trials have shown efficacy of carotid endarterectomy (CEA) in secondary stroke prevention. Carotid stenting has emerged as a new and less invasive alternative to CEA. Continuous advances in medical therapy have made remarkable success in stroke risk reduction. These new treatment modalities were not widely applied in most interventional trials, making extrapolation of an optimal intervention strategy evermore complex in patients with symptomatic and asymptomatic carotid disease. The determination between “symptomatic” and “asymptomatic” carotid stenosis is a pivotal determinant of management of carotid disease. This special issue provides an updated synopsis of risk factors, imaging modalities, and different treatment options of atherosclerotic carotid disease. Some of the highlights are included in the following: In the basic science rat model, the neurotrophic effect of an immunosuppressant agent after transient global cerebral ischemia is presented by Z. N. Sharifi et al. A paper of S. Kovacic and M. Bakran provides a discussion of the main genetic investigations associated with human atherosclerotic vascular diseases. The paper by A. Chatzikonstantinou et al. summarizes the literature of the natural history of the carotid disease and provides evidence that carotid stenosis is a sensitive marker of systemic atherosclerosis. The causal relationship between stroke-free patients with advanced carotid stenosis and cognitive decline is presented in the paper by I. Martinic-Popovic et al. The paper by V. Vukovic-Cvetkovic presents a comprehensive review of (microembolic signal) MES detection and stroke risk by transcranial doppler (TCD)—an important ultrasound technique shown to successfully stratify asymptomatic patients at high risk for future cerebrovascular events. The paper by M. Roje-Bedekovic et al. explores the visual evoked response in patients with severe carotid stenosis, a marker which serves as an important preoperative functional assessment of intracranial circulation. The paper by L. Pedrini et al. discusses near infrared spectroscopy (NIRS) during CEA as a reliable method in detection of clamping ischemia and in the prevention of clamping-related neurologic deficits during CEA. In the paper by H. Koerner et al., periprocedural ischemic lesions on diffusion-weighted imaging (DWI) during stenting procedures of supra-aortal arteries are discussed. The level of platelet inhibition is presented as an intriguing approach to determining the relationship between nonresponders to clopidogrel and clinically silent microembolization. The paper by F. Sallustio et al. presents a case series data suggesting that early carotid artery stenting may be considered as a safe alternative to CEA after IV thrombolysis in selected patients who are at high risk of stroke recurrence. The primary and secondary stroke prevention approaches are exciting clinical topics in evolution with many opportunities and options for both current treatment and future discoveries. Innovations in genetics, pharmacogenomics, and vascular imaging will likely provide specific pathophysiological targets, tailored treatments, and personalized medical management for individuals with atherosclerotic carotid disease. We hope that this special issue will serve as an overview of the accomplishments, current practices, and controversies in the field as well as a useful reference for management of patients with carotid disease and future research opportunities. Arijana Lovrencic-Huzjan Tatjana Rundek Michael J. Katsnelson

Repository of SMAD4 Mutations: Reference for Genotype/ Phenotype Correlation

Mutations in the SMAD4 gene have been found in patients with Juvenile Polyposis Syndrome (JPS), patients with combined Juvenile Polyposis/ Hereditary Hemorrhagic Telangiectasia (JP/HHT) or patients with HHT, but without reported symptoms of juvenile polyposis. We have developed a publicly available, searchable SMAD4 database to aid in genotype/phenotype correlations, using the Human Genome Variation Society recommendations for mutation nomenclature and database content. The purpose of this database is to serve as a repository for all known SMAD4 mutations, variants of uncertain signi fi cance, or polymorphisms including sequence based changes and large deletion/ duplications that have been linked to JPS, JP/HHT, or HHT as well as any clinical information or signi fi cant literature related to the disorder. Each database entry lists the SMAD4 mutation’s location, mutation type, pathogenicity classi fi cation, disease-speci fi c phenotype, literature references, and comments (which may include clinical features, complex genotypes, and links to additional literature references). The majority of the SMAD4 database entries consist of missense sequence changes and small deletions with 67 JPS mutations, 23 JP/HHT mutations, and one HHT-causing mutation. Novel SMAD4 variants and updated phenotypic information for any existing database entry can be submitted electronically on the database website (www.arup.utah.edu/database/SMAD4/SMAD4_welcome.php). In conclusion, with links to detailed clinical descriptions and all published references, this database hopes to serve as a valuable reference for the clinical management of patients with JPS, JP/HHT and HHT.

Diabetic ketoacidosis

This article reviews the pathogenesis of diabetic ketoacidosis (DKA) and provides a rational approach to the management of patients with DKA. The therapeutic discussion includes the use of low-dose insulin, no bicarbonate, or phosphate therapy on the majority of DKA patients, based on numerous prospective randomized studies. The article also discusses controversial subjects such as the use of hypotonic versus isotonic saline with and without colloids, hydration of subjects before insulin therapy, and admission of DKA patients to the general ward versus emergency ward versus intensive care unit. A concise, simple protocol is also presented as a suitable reference for management of patients with DKA.