Rejected

Background Anal symptoms may indicate serious pathology. Receptive anal intercourse (RAI) and sexually transmissible infections (STIs) may contribute to a higher prevalence of symptoms among gay and bisexual men (GBM). This study investigated associations with anal symptoms among GBM.

Prepectoral reconstruction using prosthetic devices has demonstrated a notable increase in popularity and confers a number of advantages over subpectoral placement, including minimal animation, no pain secondary to muscle spasm, and less device displacement or malposition. As such, more women with implants in the dual-plane position are seeking a remedy for animation deformities, chronic pain caused by muscle spasm, and implant malposition. The purpose of this study was to review outcomes following the conversion from subpectoral to prepectoral implant placement.

Targeted muscle reinnervation (TMR) surgery has been shown to aid in prevention and treatment of neuropathic pain. Technical and anatomical descriptions of TMR surgery for upper extremity amputees (including transradial, transhumeral, and forequarter amputations) have been reported, yet such descriptions of TMR surgery for partial hand amputations are currently lacking. Herein we outline the technique of different types of partial hand amputation TMR surgeries to serve as a reference and guide. A retrospective review was performed by our multi-institutional team to identify clinical cases where partial hand TMR surgeries were performed. Patient demographics, characteristics, amputation subtype, nerve transfer, pain score, pain outcome, and functional outcome data were collected and analyzed. From January 2018 to September 2019, 13 patients underwent partial hand TMR procedures. Eight cases resulted from trauma, and 6 were secondary to oncologic procedures. The amputations consisted of 8 ray, 2 trans-metacarpal, 2 radial-sided hand, and 1 index finger amputation with recurrent painful neuromas. Twelve patients were weaned off narcotics completely and only 3 remained on a neuromodulator for ongoing pain control. Technical considerations for partial hand TMR surgery have been outlined, with early pilot data showing beneficial pain control outcomes.

Visceral artery aneurysms, which could be either true or pseudo, are abnormal focal dilations of vessels supplying the abdominal organs. True aneurysms, by definition, suggest dilation of the vessel in response to increased blood flow, ultimately causing a blood-filled sac to form. Pseudoaneurysm, however, is the pooling of blood in surrounding tissues secondary to trauma or rupture. A 43-year-old woman G9 P9, known hypertensive was admitted electively for investigation of melena, hematemesis, hematochezia for one week along with weight loss and epigastric pain. Laboratory studies showed mild anemia with a hemoglobin level of 9.6 g/dL, hematocrit 29.5%, mean corpuscular hemoglobin (MCH) 26.7, upon which she was transfused two pints of blood and commenced at Injectable Vitamin K, injectable transamine, and infusion omeprazole. Two days later her levels improved to HB 12.4 g/dL, hematocrit 37.5%, MCH 26.7 pg, RBC 4.64 × 10*12/L. while being on treatment, a computed tomography (CT) mesenteric angiography was also conducted that showed multiple splanchnic pseudoaneurysms involving celiac axis trifurcation, gastroduodenal artery, superior/inferior pancreaticoduodenal artery, and jejunoileal branch of the superior mesenteric artery, and a large partially thrombosed pseudoaneurysm arising from superior pancreaticoduodenal branch causing significant mass effect on the second part of duodenum. On the basis of such findings, it was advised to perform coiling and embolization of the corresponding arteries. Multiple other small aneurysms with secondary arteriovenous malformations (AVM) were also seen. The whole circuit of flow retrograde and antegrade along with the aneurysm sac was blocked with multiple coils of variable sizes. An angiogram was repeated that revealed a good outcome. Pseudoaneurysms of the visceral arteries are very rare and affect mainly the splenic artery. The rarest of which is gastroduodenal artery (1.5%), pancreaticoduodenal artery (2%), and coeliac truck (4%). Therefore, this can be an incidental finding. The diagnosis is usually made with an angiography combined with clinical presentation. Variable treatment options are available depending on the patient's fitness and hemodynamic stability. The endovascular approach, however, is mostly used in such cases.

Neuromas are an under-recognized contributor to chronic abdominal pain. Other than after mesh inguinal hernia repair, surgical management of painful abdominal wall neuromas has not been well established in the literature.

Cryopyrin-associated Periodic Syndrome (CAPS) is a rare, genetic autoinflammatory condition associated with NLRP3 gene mutations, causing upregulated innate immunity. CAPS manifests as systemic inflammation, causing a constellation of symptoms on a clinical spectrum of phenotypical severity: Familial Cold Autoinflammatory Syndrome being the mildest, Muckle-Wells Syndrome moderate, and Neonatal Onset Multisystem Inflammatory Disease the most severe, with phenotype spectrum overlap. The treatment in Australia for CAPS is interleukin-1 blockade with receptor antagonist, anakinra. We describe the case of a 46-year-old female with CAPS who presented to the emergency department with severe abdominal pain. Sigmoidoscope revealed severe colitis with deep ulceration, which did not respond to hydrocortisone and azathioprine and was ultimately resolved by infliximab rescue therapy, maintained in combination with anakinra.

To assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse cream®), either as monotherapy (non-infectious VV) or adjuvant to antimicrobial therapy (infectious VV).

Neck pain (NP) is a common musculoskeletal problem; however, the prevalence and years lived with disability (YLD) of NP in China are still unclear. This study sought to estimate the age-, sex- and province-specific prevalence and YLD of NP in China.