Browsing by Author "Prado, Cynthia"
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Item Major Musculoskeletal Injuries and the Menstrual Cycle: A Case Study(2023) Prado, Cynthia; Maddux, Scott D.Background: There is a clear difference between males and females in the incidence of certain sports injuries. For example, females are about 9 times more likely to experience anterior cruciate ligament (ACL) tears, while males are about 7 times more likely to experience calcaneal (Achilles) tears. These discrepancies warrant further evaluation into the core differences between males and females, one of which is the menstrual cycle. During the first 15 days of the of the menstrual cycle, estrogen levels rise. There is discussion in medical literature about estrogen’s effects on the musculoskeletal system, which may begin to correlate these injury rates and menstruation. One study measured estrogen levels and presynaptic inhibition in males and females during day 1 and day 15 of the menstrual cycle, and found that both measurements were significantly different on day 15. This suggests that as estrogen concentration increases in the first half of the menstrual cycle, gamma-aminobutyric acid (GABA) in the spinal cord is attenuated, decreasing pre-synaptic inhibition, resulting in altered skeletal motor control. Another study evaluated estrogen’s effect on failure load, which is the force necessary to break or tear a certain object. It analyzed two groups of ovariectomized rabbits, administering estrogen supplementation to one and not the other. It found a reduction in failure load in the hormonal substitution group, implying that tendons and ligaments under estrogen’s influence could rupture at a lower applied force. Another study analyzed the extracellular matrix (ECM) enzyme lysyl oxidase (LOX), which oxidizes lysin in collagen and elastin, mediating the cross-linking between these ECM fibrils. It showed that estrogen inhibits LOX activity in engineered ligaments, implying that the increased estrogen in vivo may decrease the stiffness of tendons/ligaments in women, leading to increased risk of injury. This case illustrates two major musculoskeletal injuries in a young female patient that both occurred within the first fifteen days of her menstrual cycle. Case information: 17-year-old female sustained a right ACL tear during a track meet on day 5 of her menstrual cycle. The same female at age 27 sustained a left Achilles tear during a recreational volleyball game on day 6 of her menstrual cycle. In both occurrences, the patient had no previous injury to the area, no medical conditions, and was not taking any medication. Conclusions: The fact that both of this patient’s major musculoskeletal tears occurred during the first week of her menstrual cycle suggests that changing hormones may have influenced these injuries. The studies that support this conclusion have evaluated estrogen’s effects on the musculoskeletal system and concluded that estrogen has been shown to 1) decrease presynaptic inhibition, 2) reduce failure load, and 3) decrease the stiffness of tendons/ligaments. This research together may begin to explain the correlation between this patient’s injuries and her menstrual cycle. More research is needed on this topic, so that we can definitively identify all risk factors for these kinds of injuries and begin to take steps toward prevention for the appropriate athletes.Item A Rare Case of Paraumbilical Hernia Containing and Obstructing the Stomach(2024-03-21) Martinez, Maria Francesca Ysabelle; Prado, Cynthia; Cao, Ngan; Ngo, Wayne; Salinas, Miguel; Maheshwari, MukulBackground: Abdominal hernias occur when peritoneal lined organs protrude through the abdominal wall. They are common with an estimated prevalence of 25% in adults. Patients may be asymptomatic but surgical intervention may be advised if patients are at risk for complications such as incarceration and strangulation. Initial diagnosis of abdominal hernias is made clinically but may be assisted with imaging. Computed tomography (CT) is the current modality of choice. In this case report, we specifically focus on midline abdominal hernias. These include epigastric, paraumbilical, umbilical, and hypogastric hernias. The most frequent abdominal hernia is the paraumbilical/umbilical hernia which account for 13.9% of all hernias. These occur due to weakness or defect in the linea alba and/or abdominal rectus muscles. Patient presentation varies but many have a visible bulge that may or may not be tender to palpation. Typical contents of paraumbilical/umbilical hernias include peritoneal fat, omentum, small bowel, and large bowel. We present a unique case of stomach herniation into a pre-existing ventral abdominal hernia that has been described only a few times in the last century. Identification with CT allowed for appropriate anatomical resolution to assess for bowel obstruction and strangulation of hernia contents. Case Presentation: A 72-year-old female presented to the emergency department with abdominal pain, nausea, and emesis. Prior computed tomography (CT) studies completed one month before presentation showed a large, ventral abdominal paraumbilical hernia without obstruction or strangulation. However, one month later she presented with worsening symptoms of abdominal pain, nausea, and emesis. Repeat abdominal and pelvis CT showed interval herniation of the distal stomach and proximal bowel into the patient’s known paraumbilical hernia. This resulted in gastric outlet obstruction. Immediate management included intravenous fluids, nasogastric tube placement and surgical correction. Operative report revealed a large ventral abdominal hernia with viable stomach, proximal duodenum (D1), cecum, ascending and transverse colon, and multiple loops of small bowel without evidence of strangulation. The patient successfully recovered after surgery. Conclusion: A rare complication in paraumbilical/umbilical hernias is gastric herniation into an existing hernia. Patients may present with red flag symptoms such as abdominal pain, nausea, and emesis. Quick identification of these symptoms and rapid visualization with CT will help identify the extent of herniation and other complications such as bowel obstruction, strangulation, and incarceration. A major risk factor for gastric herniation is weakened abdominal muscles and increased laxity of stomach ligaments found in populations such as multiparous women of middle to late ages. Healthcare professionals should be aware of patients who fit this demographic to educate them on the risk of herniation and recommend them for prophylactic surgical treatment.