1.
How repeatable is assessment of external anal sphincter trauma by exoanal 4D ultrasound?
Turel Fatakia, F.; Subramaniam, N.; Bienkiewicz, J. ...
Ultrasound in obstetrics & gynecology,
June 2019, 2019-Jun, 2019-06-00, 20190601, Letnik:
53, Številka:
6
Journal Article
ABSTRACT
Objective
Three‐/four‐dimensional translabial ultrasound (TLUS) is gaining popularity for the assessment of anal sphincter trauma, although repeatability data are lacking. This study aimed ...
to determine the repeatability of tomographic ultrasound imaging (TUI) on TLUS for the diagnosis of external anal sphincter (EAS) trauma and compare the performance of a novice with that of an experienced investigator.
Methods
This was a retrospective study of archived ultrasound datasets of patients who presented with symptoms of pelvic floor dysfunction and were examined twice between 2012 and 2016 at an average interval of 260 (range, 1–1100) days. All volumes were obtained using a GE Medical Systems Voluson 730 Expert or E8 ultrasound system. Post‐processing of volumes was performed independently by two investigators, one with over 1 year's experience and another with no prior experience in using TUI, who were blinded to clinical data, each other's results and the results obtained at the first timepoint. Significant trauma on EAS was diagnosed if four of the six TUI slices showed a defect of ≥ 30°. Intra‐ and interobserver agreement were determined using Cohen's kappa (κ) and intraclass correlation coefficients.
Results
During the study period, 105 women underwent two TLUS assessments of the anal sphincter. Of these, 103 patients with ultrasound volumes available for both timepoints were included in the analysis. The novice investigator demonstrated average repeatability for assessment of significant EAS trauma and single‐slice defect (κ, 0.30 and 0.22, respectively) despite relatively high agreement between measurements obtained at the two timepoints (84.5% and 79.3%, respectively). The experienced investigator demonstrated good to very good repeatability for significant EAS trauma and single‐slice defect (κ, 0.91 and 0.78, respectively) between the two assessments, which equates to 98.1% and 94.7% agreement, respectively.
Conclusion
The repeatability of TLUS measurements for diagnosis of EAS trauma seems to be very good when imaging is undertaken with state‐of‐the‐art equipment and the analysis is performed by an experienced observer; however, the performance of a novice investigator is much poorer. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
2.
Vaginal laxity: which measure of levator ani distensibility is most predictive?
Manzini, C.; Friedman, T.; Turel, F. ...
Ultrasound in obstetrics & gynecology,
20/May , Letnik:
55, Številka:
5
Journal Article
ABSTRACT
Objective
To assess the predictive value of measures of levator hiatal distension at rest and on maximum Valsalva maneuver for symptoms of vaginal laxity.
Methods
This was a retrospective ...
study of women seen at a tertiary urogynecological unit. All women underwent a standardized interview, clinical examination and four‐dimensional translabial ultrasound examination. Area, anteroposterior diameter (APD) and coronal diameter (CD) of the levator hiatus were measured at rest and on maximum Valsalva maneuver in the plane of minimal hiatal dimensions using the rendered volume technique, by an operator blinded to all clinical data. The association between levator hiatal measurements and vaginal laxity was assessed, and receiver‐operating‐characteristics (ROC)‐curve analysis was used to determine their predictive value.
Results
Data from 490 patients were analyzed. Mean age was 58 (range, 18–88) years, and vaginal laxity was reported by 111 (23%) women. Measurements obtained on maximum Valsalva were significantly larger in women who reported vaginal laxity than in those who did not, with mean levator hiatal area, APD and CD of 30.45 ± 8.74 cm2, 7.24 ± 1.16 cm and 5.60 ± 0.89 cm, respectively, in the vaginal‐laxity group, compared with 24.84 ± 8.63 cm2, 6.64 ± 1.22 cm and 5.01 ± 0.97 cm in the no‐laxity group (P < 0.001 for all). Measurements obtained at rest were not significantly different between the groups. Multiple logistic regression analysis controlling for age, body mass index, vaginal parity and levator avulsion confirmed these results. The best regression model for the prediction of vaginal laxity included age, vaginal parity and levator hiatal area on maximum Valsalva. ROC‐curve analysis of levator hiatal measurements on maximum Valsalva in the prediction of vaginal laxity demonstrated areas under the curve of 0.68 (95% CI, 0.63–0.73) for area, 0.63 (95% CI, 0.57–0.68) for APD and 0.68 (95% CI, 0.62–0.73) for
CD.
Conclusions
Levator hiatal area on maximum Valsalva seems to be the measure of levator ani distensibility that is most predictive of symptoms of vaginal laxity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
3.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
4.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
5.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
6.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
7.
Naroči gradivo
8.
Naroči gradivo
9.
Naroči gradivo
10.
Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross‐sectional, multicentre study of 263 patients
Sarıkaya Solak, S.; Kara Polat, A.; Kilic, S. ...
Clinical and experimental dermatology,
January 2022, 2022-Jan, 2022-01-00, 20220101, Letnik:
47, Številka:
1
Journal Article
Summary
Background
Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce.
Aim
To investigate ...
the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP.
Methods
We conducted a cross‐sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey.
Results
In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001).
Conclusion
Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy‐induced paradoxical PPP have reduced quality of life and are more likely to have PsA.
več
Dostopno za:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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