Can pelvic organ prolapse in postmenopausal women be treated with laser therapy?

PURPOSE

This study aims to assess the effectiveness of the non-ablative photothermal erbium laser (Er:YAG laser) for managing anterior and/or posterior vaginal compartment prolapse.

METHODS

A randomized, single-blind, 1:1 trial was performed comparing Er:YAG laser treatment to watchful waiting in postmenopausal women with symptomatic cystocele and/or rectocele stage 2 or 3 who opted to undergo surgery due to bothersome prolapse symptoms. Three Er:YAG laser treatments at monthly intervals were applied for the Er:YAG laser group, while there was no treatment for the watchful-waiting group. The primary outcome was the proportion of patients with stage 0 or 1 following laser treatment, while secondary outcomes included the Pelvic Organ Prolapse Quantification System (POP-Q points), Pelvic Floor Distress Inventory Questionnaire short-form, Pelvic Floor Impact Questionnaire short-form, and Patients Global Impression of Improvement (PGI-I). All outcomes were evaluated at baseline and 4 months post baseline.

RESULTS

Thirty women (15 vs. 15) were eligible to be included. No participants (0%) in either group had POP-Q stage 0 or 1 at 4 months. Moreover, no change was present in the secondary outcomes. In the PGI-I, 2/15 (14%) and 0/15 (0%) participants declared much better/very much better in the laser and watchful-waiting group, respectively.

CONCLUSIONS

The findings of this study do not support use of the intravaginal Er:YAG laser for treatment of the anterior/posterior vaginal wall. Clinical trial identification number: NCT03714607.

Prospective study of transcutaneous oxygen tension (TcPO2) measurement in the testing period of spinal cord stimulation in diabetic patients with critical lower limb ischaemia

BACKGROUND

Spinal cord stimulation improves microcirculatory blood flow, relieves diabetic neuropathic and ischaemic pain and reduces the amputation rate in patients with severe peripheral arterial occlusive disease.

AIM

To evaluate whether transcutaneous oxygen tension (TcPO2) measurements can be used as a specific prognostic parameter in the assessment of suitability for permanent device implantation in a prospective controlled study on diabetic patients with peripheral arterial occlusive disease.

METHODS

Sixty patients (39 men, 21 women; mean age: 60 years; range: 46-75) were submitted to implantation of a spinal cord electrical generator for severe peripheral vascular disease, after failed conservative or surgical treatment. The clinical status was classified as Fontaine's stage III and IV and the main pathology was diabetic vascular disease. Pedal TcPO2 was assessed on the dorsum of the foot and ankle and toe pressure Doppler measurements were performed before, two weeks and four weeks after implantation.

RESULTS

Pain relief of over 75% and limb salvage were achieved in 35 diabetic patients, while in 12 a partial success with pain relief over 50% and limb salvage for at least 6 months was obtained. In 13 patients the method failed and the affected limbs were amputated. Clinical improvement and spinal cord stimulation success were associated with increases of TcPO2, within the first two weeks after implantation (temporary period). Limb salvage was achieved with significant increase of TcPO2 within the first two weeks of the testing period (from 21.4 to 31.5 mmHg in rest pain patients, p=0.030, from 15.1 to 22.0 mmHg, p=0.030 in patients with trophic lesions under 3 cm2 in size and in those with trophic lesions over 3 cm2, from 12.1 to 17.9 mmHg, p=0.025) unrelated to the stage of the disease and the initial TcPO2 value. TcPO2 changes were related to the presence of adequate paraesthesias and warmth in the painful area during the trial period. The systolic ankle/brachial blood pressure index and toe pressure did not change under stimulation.

CONCLUSIONS

A two-week testing period should be performed in all diabetic patients treated with spinal cord stimulation for peripheral arterial occlusive disease to identify the candidates for permanent implantation. Only diabetic patients with significant increases of TcPO2 and clinical improvement, during the test period, should be considered for permanent implantation and not merely all patients with pain relief. TcPO2 changes could be used as a predictive index of the therapy success and should be considered in terms of cost effectiveness before the final decision to permanent implantation.

Visuoperceptual speed of karate practitioners at three levels of skill

The Identical Pictures Test was administered to 50 male and 45 female volunteer karateka who were classified by Fitts' level of learning and karate belt-rank color system (kyu-dan) into three groups. A 2 (sex) x 3 (skill) analysis of variance gave a significant difference for skill and sex. Over-all, the practitioners in the autonomous stage (black belts) and the women had faster visuoperceptual speed.

Relation of physical education to self-concept

This study investigated the relation of an elementary school program in physical education to the self-concepts of children in Grades 1 to 4. Two parochial schools were selected, one with a physical education program (n = 126 children) and one without such a program (n = 86 children). The Martinek-Zaichkowsky Self-concept Scale was administered during the first two weeks of September and again during the last two weeks of April. A 2 (pre-posttest) x 2 (group) x 4 (grade) analysis of variance with repeated measures on the first factor was used to analyze each measure, with post hoc tests to follow up. The self-concept results indicated that physical education did not enhance the self-concepts of children, except for those children in the second grade.

Relationship between figure-ground perception and viewing time in a ball-catching task

This investigation determined the relationship between figure-ground perception and viewing time in a ball-catching task of 34 beginning, 34 intermediate, and 30 advanced tennis players. Also analyzed were the differences between the sexes and levels of tennis skill on figure-ground perception, on the ball-catching task, and viewing time. Findings indicated that there is no relationship between figure-ground perception and viewing time. No differences were noted between the sexes or levels of tennis skill on figure-ground perception; however, there were significant differences in success in ball-catching and viewing times.