Female pelvic floor dysfunction occurs when the integrity of the pelvic floor muscles is compromised and impacts the position and function of the pelvic organs. Physicians use international guidelines to evaluate and treat women for POP taking into account that posture and gravity impact pelvic organ position, and degree of prolapse. Our clinical focuses on the description of surface anatomy. This examination alone is insufficient. Although imaging is recommended, the modalities currently available are recognized to have flaws. MRI is performed in the supine position regardless the effect of posture and gravity on POP. A literature search was performed using databases, searching MEDLINE and PubMed using the key terms ultrasound, MRI, and CT. We describe use of a new protocol and advanced technique to evaluate the changes of POP in different positions using open MRI (MRO). POP patients underwent MRO imaging of the pelvic floor using a 0.5 T MRO scanner. The extent of displacement of prolapsed organs was determined using validated reference lines drawn on the mid-sagittal images. Manual segmentation and surface modeling were used to construct the 3D models. MRO offers new levels of anatomic detail; 3D sequences based on 2D images are an additional refinement.
Part of the book: Pelvic Floor Disorders
Recent advances in the clinical management of at-risk pregnancy and care of the newborn have reduced morbidity and mortality among sick neonates, and improved our knowledge of factors that influence the risks of brain injury. In parallel, the refinement of imaging techniques has added to the ability of clinicians to define the etiology, timing and location of pathologic changes with diagnostic and prognostic relevance to the developing fetus and newborn infant. Abnormalities of brain growth, or injury to the developing brain can occur during pregnancy; during labor and delivery, hypoxia, acidosis and ischemia pose major risks to the fetus. Defined practices for the management of pregnancy and delivery, and evidence-based strategies for care in the newborn period are influencing outcome. However, newborn infants, especially those born prematurely, remain at risk from situations that can cause or worsen brain injury. The literature reviewed here explains the mechanisms and timing of injury, and the importance of hypoxia, ischemia, hypotension and infection; describes current diagnostic strategies, neuroimaging technologies and care entities available; and outlines approaches that can be used to prevent or mitigate brain injury. Some show particular promise, and all are relevant to lowering the incidence and severity of brain damage.
Part of the book: Advancement and New Understanding in Brain Injury
Robust evidence indicates school-aged children are particularly vulnerable to malaria and need special measures to protect them. Calls are widespread for better diagnostic approaches and innovative programs that benefit children, because current levels of malaria-related morbidity and mortality are so high. Problematically, most national malaria control programs do not specifically target school-aged children; although the literature describes options for child-focused strategies, there is no consensus on the optimal intervention; and where a strategy is advocated, it is almost always one identified through systematic review. While understandably the scientific “gold standard,” such reviews exclude many potentially useful and valid approaches, because reports describing them do not meet the inclusion criteria of being randomized controlled trials. Such trials are inevitably limited in number due to cost and complexity, and many excluded reports describe locally developed innovation based on World Health Organization diagnostic and therapeutic guidelines with the potential to benefit children. This chapter frames how practical interventions such as these can be put in place by school communities, and in parallel, how approaches advocated by the WHO and Lancet Commission to promote health literacy and access to essential health services can create ways to reduce the burden of malaria on school-aged children.
Part of the book: Malaria