Body image, self-compassion, and sexual distress in individuals living with endometriosis.

OBJECTIVE: Extensive psychological burden is associated with the experience of living with endometriosis, including negative changes to body image and sexual functioning. Emerging evidence suggests that potential protective factors such as body appreciation and self-compassion may help mitigate these adverse impacts of endometriosis. This study aimed to investigate the association of body image, both positive (body appreciation) and negative (body image disturbance) dimensions, with sexual distress and the potential buffering effect of self-compassion on the body image-sexual distress link. METHODS: Data were collected via an online cross-sectional survey (N = 471) assessing body image disturbance, body appreciation, self-compassion and sexual distress in individuals with endometriosis. A series of hierarchical linear regression analyses were conducted to explore the relationship between key variables. RESULTS: >80% of the sample reported clinically significant sexual distress and high levels of body image disturbance. Regression analyses indicated a moderate positive effect of body image disturbance with sexual distress, and a weaker inverse effect of self-compassion with sexual distress. Body appreciation was not associated with sexual distress, and no moderating effects of self-compassion were evident. CONCLUSION: The high prevalence of sexual distress identified in this sample, along with the finding that body image disturbance was strongly associated with sexual distress, suggest that psychosocial interventions addressing body image may help ameliorate sexual distress in individuals with endometriosis.

Delineating sociodemographic, medical and quality of life factors associated with psychological distress in individuals with endometriosis.

STUDY QUESTION: What is the relationship between specific quality of life domains and depression, anxiety and stress in the endometriosis population? SUMMARY ANSWER: Psychosocial domains of quality of life, such as a perception of social support and self-image, are more strongly associated with depression, anxiety and stress than pain and medical factors. WHAT IS KNOWN ALREADY: Prior research indicates a high prevalence of anxiety and depression in individuals with endometriosis. Pain is thought to be critical in the development of psychological distress, however prior research has investigated this association without consideration of psychosocial quality of life domains such as social functioning, perceived social support and self-image. STUDY DESIGN, SIZE, DURATION: This study is a cross-sectional analysis of baseline data collected in a longitudinal study exploring psychological distress in endometriosis (n = 584). PARTICIPANTS/MATERIALS, SETTING, METHODS: Individuals living with endometriosis participated in this study and were recruited via online platforms of community organizations and support groups. Demographic and medical information concerning endometriosis treatment and diagnosis was self-reported. Psychological distress and quality of life was measured using the Depression, Anxiety and Stress Scale (DASS-21), Endometriosis Health Profile-30 (EHP-30) and the Short Form Survey (SF-36v2). A series of linear regression analyses explored the relationship between specific quality of life domains and the primary outcomes of depression, anxiety and stress. MAIN RESULTS AND THE ROLE OF CHANCE: Approximately half of the participants in this sample reported moderate to severe anxiety, depression and stress. Quality of life domains, particularly perceived social support, social functioning and self-image, were more strongly associated with psychological distress than medical or demographic factors. Pain was associated with anxiety, but not depression or stress. A greater number of endometriosis symptoms was only associated with depression. LIMITATIONS, REASONS FOR CAUTION: These data are cross-sectional and, therefore, causality cannot be inferred from this analysis. Information about endometriosis diagnosis and treatment was self-reported, and not verified against medical records. WIDER IMPLICATIONS OF THE FINDINGS: This study indicates that psychosocial factors may be more salient factors underlying depression, anxiety and stress in the endometriosis population than pain and medical factors. There is a need for interventions that target psychological distress in this population with a focus on the broader impact of endometriosis beyond pain and physical symptomatology. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by the Research Training Program (RTP) Scholarship awarded to C.S.M. by Macquarie University. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER: ACTRN12619001508167.

Thermoluminescent dosimetry of the Symmetra 125I model I25.S06 interstitial brachytherapy seed.

As the efficacy of brachytherapy prostate treatment is becoming realized, new models of 125I seeds are being introduced. In this article we present thermoluminescent dosimetry (TLD) in a solid water phantom for a new design of 125I seed (UroMed/Bebig Symmetra, Model I25.S06). TLD cubes, LiF TLD-100, from Bicron (Solon, OH) with dimension 1 x 1 x 1 mm3 were irradiated at various distances from the seed at angles ranging from 0 degrees to 90 degrees in 10 degrees increments. The TLD detectors were calibrated by irradiation in a 60Co teletherapy beam. Monte Carlo simulation was used to account for TLD energy dependence and the deviation of solid water composition (as determined by chemical analysis of a sample) from liquid water. Dose rates per unit air kerma strength were determined based on calibrations traceable to the 1999 NIST standard (corrected for NIST measurement errors made in 1999) for the Symmetra seed. Dose data is presented in TG-43 format as a function of distance and angle. Values for lambda, F(r, theta), g(r), and the anisotropy constant are obtained for use in radiation treatment planning (RTP) software. The dose rate constant was determined to be 1.033+/-6.4% cGy h(-1) U(-1), which is comparable to model 6702 and higher than model 6711. We find the relative dose distributions of the Symmetra seed are similar to model 6702, and less anisotropic than model 6711. After accounting for deviation of measured solid water composition from the manufacturer's specification, good agreement between TLD results and Monte-Carlo-aided values was found.

The Viladot implant in flatfooted children.

In 1991, Viladot described an implant for the treatment of painless flatfeet in children. This was inserted through a double approach to allow the talus to function while limiting its ability to slide off the calcaneus. The wineglass shaped prosthesis was inserted into the sinus tarsi with a tibialis posterior advancement and soft tissue correction to allow the foot to adopt a neutral position. This is in keeping with other procedures described for the correction of flatfoot. Viladot reported excellent results in 234 feet operated on in such a manner using clinical, radiological and photopodographic parameters. In Sheffield, over three years, 22 implants were inserted for similar painless flatfeet in children. The results were assessed using clinical, radiological and pedobarographic parameters. Viladot was able to demonstrate an improvement in all cases, clinically, radiologically and photopodographically with little or no discomfort and a return to preoperative levels of activity including sport. We found that in all cases, postoperative pain was a major feature which limited activity in all but 2 feet and which reduced the ability to take part in sport and other preoperative pastimes. Unlike Viladot, we were unable to demonstrate consistent improvements radiologically. Pedobarographically, the loading of the first metatarsal head remained unchanged and the centre of pressure was corrected in only 14%.

Fracture healing of chick femurs in tissue culture.

Embryonic chick femurs were isolated, and a transverse osteotomy was performed at the midshaft. The femurs were transplanted individually onto the host chorioallantoic membrane and incubation continued. Cultured femurs were harvested at intervals from 1 to 9 days after the transplant. Histologic examinations showed that repair progressed rapidly: the fracture gap was invaded by blood vessels and fibrous ingrowth. Ossification followed, and the repair process was completed by Day 9.

Quantification of the major urinary metabolite of prostaglandin D2 by a stable isotope dilution mass spectrometric assay.

Prostaglandin D2 (PGD2) has been found to be an important pathophysiological mediator in a number of human disorders. Thus a means to assess the endogenous production of PGD2 is of considerable clinical value. To accomplish this goal, we developed a method for the quantification of the major urinary metabolite of PGD2, 9 alpha, 11 beta-dihydroxy-15-oxo-2,3,18,19-tetranorprost-5-ene-1,20-dioic acid, by gas chromatography/negative ion chemical ionization mass spectrometry. This metabolite was chemically synthesized and converted to an 18O4-labeled derivative for use as an internal standard. Novel derivatization and purification procedures were incorporated in the assay taking advantage of the ability of the lower side chain of this molecule to undergo cyclization at acidic pH to form a hemiketal, gamma-lactone, and uncyclization with methoximation. Precision of the assay is +/- 7% and accuracy is 96%. The lower limit of sensitivity is approximately 50 pg. Normal levels for the urinary excretion of this metabolite in 18 normal adults was found to be 1.08 +/- 0.72 ng/mg creatinine (mean +/- 2SD). Substantial elevations in the urinary excretion of the metabolite were found in clinical situations in which prostaglandin D2 has been shown to be released in increased quantities. Thus, this assay provides a sensitive and accurate method to assess endogenous production of prostaglandin D2 as a means to explore the pathophysiological role of prostaglandin D2 in human disease.

A stable isotope dilution mass spectrometric assay for the major urinary metabolite of PGD2.

1. A sensitive and specific negative ion chemical ionization mass spectrometric assay for the major urinary metabolite of PGD2 has been developed employing a chemically synthesized [18(0)4]-labelled internal standard. 2. The finding that increased urinary excretion of this metabolite occurs in a number of clinical situations suggests that the assay may prove to be a valuable tool to explore the role of PGD2 in the pathophysiology of human disease.

The importance of the valgus hindfoot in forefoot surgery in rheumatoid arthritis.

The relationship between hindfoot deformity and forefoot pressure was assessed in 28 rheumatoid patients who had undergone forefoot reconstruction four years previously. Patients with valgus hindfoot deformities tended to have high forefoot pressures whereas those with a normal hindfoot recorded normal pressures on the dynamic pedobarograph. All patients with residual forefoot pain recorded abnormal forefoot pressures. We believe that orthotic control of hindfoot deformities should be considered for those patients who require forefoot surgery as a combination of surgical and orthotic management may offer the best chance of success.

Features of algodystrophy after Colles' fracture.

We report the results of a prospective study of the incidence of algodystrophy following Colles' fracture in 60 patients, using sensitive or quantitative techniques for the assessment of each feature of the syndrome. Nine weeks after fracture, 24 patients had evidence of vasomotor instability, 23 had significant tenderness of the fingers and 23 had lost finger movement. These three abnormalities were significantly associated (p less than 0.001). Swelling was also significantly associated with these three variables. There was no statistical association between the occurrence of algodystrophy and the patient's age or sex, the severity of the fracture, the number of reductions performed or the adequacy of the reduction. We conclude that algodystrophy constitutes a precisely definable and quantifiable syndrome which is more common than has been suspected.

A prospective study of forefoot arthroplasty.

The Kates et al. metatarsal head resection arthroplasty has been modified and evaluated clinically and objectively using a dynamic pedobarograph in 35 adult rheumatoid arthritis patients. Preoperatively, all patients complained of severe forefoot pain, but only 70% recorded abnormal plantar pressure measurements. After a mean follow-up time of 36 months, 91% of the patients were satisfied with the result following surgery. Forty-two feet were pain-free, 16 feet still painful but less than preoperatively, and two feet worse. Thirteen of the 18 painful feet recorded abnormal pressure, but 16 additional feet with normal pressures were symptomatic. The clinical and pedobarographic results show that, in the majority of patients, the Kates et al. forefoot arthroplasty relieves pain, improves mobility, effectively decreases high abnormal plantar pressures, and should be considered when conservative methods of treatment have failed.

Is callus calcium content an indicator of the mechanical strength of healing fractures? An experimental study in rat metatarsals.

Changes in the mechanical properties and the calcium content of healing fracture callus were followed, using rat metatarsals. By 24 weeks post-fracture the mean ultimate tensile stress and elastic modulus were still less than half that of the contralateral unfractured bone, whereas the mean torsional modulus had almost reached that of the unfractured bone. The calcium content of the callus formed immediately between the fractured ends of the bone showed changes which coincided with the increases in mechanical strength and the moduli, thus measurement of callus calcium content would enable the prediction of the strength of a healing fracture.

Algodystrophy following Colles' fracture.

The prevalence of algodystrophy in the hand was determined at nine weeks and six months following Colles' fracture. At nine weeks, 27 of 109 patients showed signs of algodystrophy, all of whom demonstrated more than one feature of the disorder. Thereafter, no unaffected patient developed the disorder. At six months, 62% of the previously affected patients showed some residual abnormalities. In 66% of these, there was evidence of continuing vasomotor instability or swelling, suggesting that the syndrome was still active. These observations suggest that algodystrophy of the hand is a more common complication of Colles' fracture than is generally realised.

The management of dropfoot using the Lambrinudi arthrodesis.

The results of 12 Lambrinudi arthrodeses in 10 patients with spinal dysraphism were compared with 11 operations performed in patients with only motor nerve deficits performed over the same 10 year period. The early failure and complications were more common in these patients and the tendency to recurrence of dropfoot occurred earlier. Despite this, the operation was effective in the management of these patients, especially for the improvement of co-existent sores or the fitting of shoewear.

Foot pressure studies in the assessment of forefoot arthroplasty in the rheumatoid foot.

To assess the results of forefoot arthroplasty, dynamic and static foot pressure studies have been made of the rheumatoid foot in both a prospective study group of 60 feet and in a retrospective study group of 18 feet. Significant reductions of pressure in the forefoot were found. Problems associated with the first and fifth metatarsals were considered.

Experimental study in rat metatarsals to determine whether callus vascularity is an indicator of the mechanical strength of healing fractures.

Changes in the mechanical properties and percentage area of blood vessels of healing fracture callus were followed using rat metatarsals. By 24 weeks after fracture the mean ultimate tensile stress and elastic modulus were still less than half that of the contralateral unfractured bone, whereas the mean torsional modulus had almost reached that of the unfractured bone. The percentage area of blood vessels declined from five days post-fracture and showed no changes which coincided with the increases in mechanical strength or moduli. We conclude that studies of vascularity would not justify a prediction of the strength of a healing fracture.

The natural history of foot pressure abnormalities in neuropathic diabetic subjects.

The pressures under the feet of 39 subjects with diabetic neuropathy were initially assessed during walking using an optical pedobarograph. The upper limit of normality for pressure readings in non-diabetic subjects had previously been established as 10 kg/sq.cm. These subjects were then followed for a mean period of 3 years after which foot pressure studies were repeated. 39 feet had abnormal results when initially studied, compared with 33 at the follow-up study (p = NS). However, changes in the distribution of pressure under the metatarsal heads were seen in 13 feet, while 20 feet showed changes in abnormal pressures under the same site. Recurrent metatarsal ulcers occurred in 6 feet during the study, with 5 occurring at documented sites of high pressure. It is concluded that important changes in the distribution and level of pressures under diabetic neuropathic feet occur during a relatively short time. As it has previously been demonstrated that increased foot pressures are associated with foot ulceration, it is important for the orthotist to re-assess the feet regularly to establish whether significant changes in pressure distribution that might warrant new insoles or footwear have occurred.

Abnormalities of foot pressure in early diabetic neuropathy.

Dynamic foot pressure has been studied in 44 diabetic subjects of mean age 52 years with no clinical evidence of neuropathy and in an age and sex matched non-diabetic control group. Vibration perception threshold (VPT), sensory (SCV), and motor conduction velocities (MCV) were also measured in the diabetic subjects. Sixteen diabetic subjects (Group A) had abnormally high pressures under the metatarsal heads (greater than 10 kg/cm2), whereas the remaining 28 diabetic subjects had normal results (Group B). The ratio of toe to metatarsal head loading (normal 0.112) was significantly reduced in Group A (0.077) compared to Group B (0.127: p less than 0.05). VPT and sural nerve SCV were also significantly abnormal in Group A subjects compared with Group B (p less than 0.005 and p less than 0.02, respectively), though there were no differences in MCV. A significant inverse correlation was obtained between toe loading and VPT. It is concluded that abnormalities of foot pressure occur in early sensory neuropathy and may precede clinical abnormalities. Assessment of the toe-loading ratio may provide a sensitive measure of motor dysfunction in early diabetic neuropathy.

Os calcis osteotomy in the management of deformities of the hindfoot in spinal dysraphism.

The results of 52 primary os calcis osteotomies in 44 patients with spinal dysraphism are reviewed. There were 42 varus hindfoot deformities and ten valgus hindfoot deformities. The results indicate that the operation is simple and uncomplicated, but over a mean 5.8 year follow-up for the varus feet and 6.5 years for the valgus feet, over 50% of the feet developed either a moderate or severe recurrence of deformity. Os calcis osteotomy appeared from this series to be a moderately successful interim operation for the equinus varus foot, delaying the need for premature triple arthrodesis, but the long-term results in cavo-varus feet with claw toes were uniformly poor. Furthermore, it appeared to be unsatisfactory in the mobile flail valgus foot unless the subtalar joint had been stabilised by fusion. Correction of proximal joint or bone deformity and muscle imbalance is considered necessary if satisfactory results are to be achieved from the osteotomy.

A prospective trial comparing operative and manipulative treatment of ankle fractures.

A series of 42 ankle fractures have been randomised into two groups respectively undergoing either open reduction and internal fixation or manipulative reduction and plaster. Their progress after removal of all external splintage has been followed using simple gait analysis techniques. There appears to be no difference in the outcome of treatment of the two groups in the early recovery period (up to 20 weeks).

The long-term results of the surgical management of paralytic pes cavus by soft tissue release and tendon transfer.

Twenty-six patients with paralytic pes cavus were managed by early soft tissue correction and tendon transfer. Eighteen had spina bifida, 6 had peroneal muscular atrophy and two had cerebral palsy. The most frequent operations were flexor hallucis longus tenodesis, Girdlestone's flexor to extensor tendon transfer and plantar release. The indications for these procedures are discussed and the results presented, with particular reference to static and dynamic foot pressure studies performed at review. Follow-up averaged 5.2 years. Toe correction was found to be successful in most cases but plantar release failed in 55% of feet, with many progressing to fusion. Many failed feet had presented at an earlier age and it was felt that the initial procedures had delayed the need for bony correction thus minimising growth disturbance.