1/9. ehlers-danlos syndrome associated with multiple spinal meningeal cysts--case report.A 40-year-old female with ehlers-danlos syndrome was admitted because of a large pelvic mass. Radiological examination revealed multiple spinal meningeal cysts. The first operation through a laminectomy revealed that the cysts originated from dilated dural sleeves containing nerve roots. Packing of dilated sleeves was inadequate. Finally the cysts were oversewed through a laparotomy. The cysts were reduced, but the postoperative course was complicated by poor wound healing and diffuse muscle atrophy. ehlers-danlos syndrome associated with spinal cysts may be best treated by endoscopic surgery.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/9. Pelvic stress fracture: assessment and risk factors.OBJECTIVE: To discuss the case of a patient with a pelvic stress fracture and the differential considerations among patients presenting with hip and/or groin pain. FEATURES: A 42-year-old woman had hip pain after running. Initial radiograph of the pelvis was negative. Subsequent films showed a right inferior pubic ramus stress fracture. Stress fractures of the pelvis are relatively uncommon, accounting for only 1% to 2% of all stress fractures. INTERVENTION AND OUTCOME: Treatment included high-velocity, low-amplitude chiropractic manipulation, ultrasound, and stretching of the psoas and piriformis muscles. After 8 weeks, care was discontinued because the patient's hip pain had resolved. The pelvic fracture was left to heal with time. After 1 year, the patient still had delayed union of the fracture. CONCLUSION: When predisposing factors are present, such as osteoporosis and rheumatoid arthritis, pelvic stress fracture should be suspected in patients with groin or hip-area pain. However, because pelvic stress fractures are relatively rare, radiographic studies are often postponed, making diagnosis difficult.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/9. cystoscopy-assisted laparoscopic resection of extramucosal bladder endometriosis.BACKGROUND AND PURPOSE: Involvement of the bladder is seen in only 1% to 2% of patients with endometriosis. The diagnosis of vesical endometriosis is difficult to formulate, and it should be confirmed by cystoscopy with biopsy. However, this examination is often insufficient because of the submucosal-transmural location of the lesion. Therefore, laparoscopic examination represents the gold standard for the diagnosis of pelvic endometriosis. We describe a case of recurrent bladder endometriosis treated by a combined endoscopy technique. Case Report: A 43-year-old woman presented with pelvic pain, dysmenorrhea, and persistent cystitis. The endometriotic lesion on the posterior wall of the bladder consisted in a 2.5-cm nodule growing into the vesical muscularis and raising the overlying peritoneum. We performed laparoscopic resection employing a cystoscopy-assisted technique in order to preserve the integrity of the vesical mucosa. Resection was carried out and monitored from inside the bladder with the cystoscope and laparoscope lights turned on during the whole procedure ("light-to-light" technique). CONCLUSION: This minimally invasive combined endoscopic procedure could represent a good alternative to partial cystectomy for muscle-infiltrating bladder endometriosis that does not involve the vesical mucosa.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
4/9. Interstitial cystitis, pelvic pain, and the relationship to myofascial pain and dysfunction: a report on four patients.Treatment of chronic pelvic pain (CPP), interstitial cystitis (IC), prostatodynia, and irritative voiding symptoms can be frustrating for both patients and physicians. The usual approaches do not always produce the desired results. We found that when we treated myofascial trigger points (TrP) in pelvic floor muscles as well as the gluteus, piriform, infraspinatus, and supraspinatus muscles, symptoms improved or resolved. Various palpation techniques were used to isolate active myofascial TrPs in these muscles of four patients with severe CPP, IC, and irritative voiding symptoms. Injection and stretch techniques for these muscles were performed. Visual twitch responses at the skin surface and in the muscles were used to verify successful needle piercing of a TrP. The patients were asked to verbally describe exactly where the flash of distant pain was felt, a process that permitted an accurate recording of the precise pattern of pain referred by that TrP. The findings involved with the four patients substantiate the need for myofascial evaluation prior to considering more invasive treatments for IC, CPP, and irritative voiding symptoms. Referred pain and motor activity to the pelvic floor muscles (sphincters), as well as to the pelvic organs, can be the sole cause of IC, CPP, and irritative voiding dysfunction and certainly needs further investigation.- - - - - - - - - - ranking = 6keywords = muscle (Clic here for more details about this article) |
5/9. Botulinum toxin for the treatment of genital pain syndromes.Our purpose was to test the effect of botulinum toxin injections on hypertonic pelvic floor muscles of patients suffering from genital pain syndromes. We report two cases of women complaining of a genital pain syndrome resistant to pharmacological therapies and rehabilitation exercises associated with a documented involuntary tonic contraction of the levator ani muscle as a defense reaction triggered by vulvar pain. We performed botulinum toxin injections into the levator ani with the intent to relieve pelvic muscular spasms. Within a few days after the injections both the patients reported a complete resolution of the painful symptomatology, lasting for several months. Our experience suggests that botulinum injections are indicated in patients with genital pain syndrome with documented pelvic muscle hyperactivity, whose symptoms arise not only from genital inflammation and lesions, but also, and sometimes chiefly, from levator ani myalgia.- - - - - - - - - - ranking = 3keywords = muscle (Clic here for more details about this article) |
6/9. Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain.Chronic perineal pain is often a difficult condition to manage. Current treatments include pudendal nerve injections and pudendal nerve release surgery. The obturator internus muscle has a close relationship to the pudendal nerve and might be a potential target for therapeutic intervention. PERSPECTIVE: A case is presented of refractory perineal pain that was successfully treated by injecting the obturator internus muscle with botulinum toxin A.- - - - - - - - - - ranking = 6keywords = muscle (Clic here for more details about this article) |
7/9. Endocervicosis of the bladder: a case report.BACKGROUND: Endocervicosis of the bladder is a rare, benign lesion characterized by mucinous endocervical epithelium within the detrusor muscle of the bladder. CASE: A 48-year-old woman presented with a history of dysuria for the past week and pelvic pain for the past 6 months. Her history was significant for 2 prior cesarean sections. Transvaginal pelvic ultrasound revealed a mass protruding into the bladder. cystoscopy and magnetic resonance imaging of the pelvis confirmed this finding. A total abdominal hysterectomy ing. A total abdominal hysterectomy and partial cystectomy were performed. pathology of the bladder wall revealed endocervicosis. The patient remained symptom free at 6 months. CONCLUSION: Endocervicosis of the bladder wall is a rare lesion, and the diagnosis is difficult to make both clinically and pathologically. The diagnosis should be considered in any woman presenting with pelvic pain, dysuria and frequency. Gynecologists should be aware of this condition for proper diagnostic and surgical management.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
8/9. Not all pain in the left iliac fossa is diverticular disease: A case study of a psoas myxoma and review.Intramuscular myxomas are rare, benign, mesenchymal tumours that may present to a wide variety of specialties. We present a case study of an intramuscular myxoma in the psoas muscle, followed by a review of the literature regarding the diagnosis and treatment of intramuscular myxomas- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
9/9. osteitis pubis: a diagnosis for the family physician.BACKGROUND: osteitis pubis was first described in 1924 in patients who had had suprapubic surgery. Since that time many theories concerning the cause of the disease have been developed. Published case reports and retrospective record reviews of specific, isolated patient populations have been used to postulate an infectious, inflammatory, or traumatic cause of this condition. Such confusion reduces the likelihood of an accurate diagnosis of osteitis pubis, particularly in the primary care setting, where it is becoming increasingly likely that patients afflicted with this frustrating illness will initially seek treatment. methods: This article describes a case report and provides a review of the literature. The medical literature was searched using the following key words: "abdominal pain," "pelvic pain," "inflammation," "symphysis pubis," and "enthesopathy." RESULTS AND CONCLUSIONS: osteitis pubis, considered to be the most common inflammatory disease of the pubic symphysis, is a self-limiting inflammation secondary to trauma, pelvic surgery, childbirth, or overuse, and it can be found in almost any patient population. Occurring more commonly in men during their 30s and 40s, osteitis pubis causes pain in the pubic area, one or both groins, and in the lower rectus abdominis muscle. The pain can be exacerbated by exercise or specific movements, such as running, kicking, or pivoting on one leg, and is relieved with rest. Pain can occur with walking and can be in one or several of many distributions: perineal, testicular, suprapubic, inguinal, and postejaculatory in the scrotum and perineum. Symptoms are described as "groin burning," with discomfort while climbing stairs, coughing, or sneezing. A greater understanding and awareness of osteitis pubis will reduce patient and physician frustration while improving overall outcomes.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |