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Sigmoidoscopy, cystoscopy, and stenting
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Louis J. Vitone, Peter A. Davis, David J. Corless
Rigid sigmoidoscopy can be performed with relative ease in the outpatient clinic. Patients are usually placed in the left lateral (Sims) position with hips and knees flexed and parallel on a couch or bed. The buttocks should ideally overhang the edge of the couch marginally, thus providing better maneuverability of the sigmoidoscope. The more transverse the patient is positioned, the easier the examination will be. The prone knee-elbow or jackknife position, where the patient lays prone in an inverted position, is a less commonly used alternative position. A DRE of the rectum should be performed prior to the sigmoidoscopy.
Treatment of uncomplicated hemorrhoids
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
HAL is performed best in the lithotomy position. All the other procedures, however, are usually performed with the patient in the left lateral Sims position. Alternatively, the patient may be placed in the semi-inverted (jack-knife) position on a proctological table.
Management of Conditions and Symptoms
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
Individuals receiving palliative care in a home care setting as well as inpatient settings are at risk for decubitus ulcers. In home care, body mass index, Braden Scale, and Karnofsky Performance Scale are accurate in predicting the risk of the development of pressure ulcers.12 Additionally, in inpatient palliative care settings, hyponatremia and hypotension have been found to be contributing factors to pressure ulcers.13 Screening for individual risk factors, and the implementation of mitigation strategies, is appropriate. Evidence points to the greatest benefits from the type of mattress used over other interventions; however, expert opinion should be sought for an appropriate positioning plan.14 Positioning schedules can promote the redistribution of pressure to skin/superficial tissues throughout the day, and skin inspection should occur during each repositioning. For patients unable to maintain the side-lying (lateral) position, wedge pillows can be helpful for propping the back to create a degree of side-lying. The Sims position is used for positioning between side-lying and prone, with the use of pillows to the chest and under the flexed top lower extremity. For patients using an adjustable bed, altering the angle into semi-reclined (45°: Fowler’s position; 30°: Semi-Fowler’s position) can promote an upright posture for improved lung function; however, caution should be taken as the position can also simultaneously increase pressure on the sacrum. Attention to the angle of flexion between the femur and pelvis is essential to not place the spine in undue flexion; also, elevation of the knees with the bed controls will lessen the tendency to slide down toward the foot of the bed and minimize the need to reposition. Prone positioning has several contraindications (e.g. pelvic fracture, spinal instability, increased intracranial pressure, recent cardiac surgery) but has the benefits of shifting fluid from the posterior lung allowing for improved pulmonary capillary perfusion and oxygenation for such individuals as those with acute respiratory distress syndrome (ARDS), and acute infection with the COVID-19 novel coronavirus (see Chapter 11: Respiratory Diseases).
Botulinum toxin injection is an effective alternative for the treatment of chronic anal fissure
Published in Acta Chirurgica Belgica, 2023
Injection was performed in all patients in lateral Sims position under sedation. After January 2018, pTcPNB was performed before the procedure. In order to block the rectal branches of the pudendal nerve, pTcPNB was performed by injecting a total of 20 mL of 0.025% bupivacaine from 4 different points on both sides of the anal canal to anteromedial and posteromedial portions of the tuberositas ischii. An anal retractor (a plastic Ferguson’s anal retractor; 4 cm diameter) was used in all patients. A total of 100 IU BTA was diluted with 1 mL of isotonic saline and injected into the IAS using an insulin needle (26 G) in two equal doses, right and left anterolateral (in lithotomy position at 2 and 10 o'clock; in Sims position at 1 and 5 o'clock) for fissures located at the posterior, and right and left posterolateral (in lithotomy position at 4 and 8 o'clock; in Sims position at 7 and 11 o'clock) for fissures located at the anterior (Figures 1 and 2). Patients were discharged on the same day.
Recurrent incarceration of the severely retroverted uterus with successful second-trimester reduction
Published in Journal of Obstetrics and Gynaecology, 2019
Alexandra Lackey, Prajwal Dara, Christine Burkhardt
Manual reduction is recommended for the treatment of maternal symptoms and to prevent devastating complications. After the patient voids, she is placed in the dorsal lithotomy position. Anterior pressure is applied by the clinician’s fingers to the gravid uterus through the posterior fornix. The failure of this initial manoeuvre may be repeated with a finger in the rectum also applying anterior pressure. The patient may also be placed on all fours or in the Sims position. Strategies including uterine relaxants, conscious sedation, and regional or general anaesthesia may be necessary to achieve appropriate relaxation and successful reduction. If a manual reduction fails, a colonoscopic release and a laparotomy may be considered (Seubert et al. 1999; Hooker et al. 2009).
Screening for Squamous Cell Anal Cancer in HIV Positive Patients: A Five-Year Experience
Published in Journal of Investigative Surgery, 2018
Chiara Santorelli, Cosimo Alex Leo, Jonathan D. Hodgkinson, Franco Baldelli, Francesco Cantarella, Emanuel Cavazzoni
The anoscopy was performed using a high-resolution video proctoscope. The HR-VPS consists of a Proctostation THD© device (THD SPA, 2016; Correggio RE, Italy), which is a portable touch screen 16–9 connected to a high-resolution camera (Figure 3). The camera is wrapped in a disposable cover and connected with a disposable self-illuminating anoscope (Figure 4), which is equipped with side windows to perform biopsies and ablative treatments under visual control. The “patient management” software allows to include epidemiologic and clinical data in the patients' personal folder, which can be updated anytime. Each examination is recorded as a complete video associated with audio; the operator can also take pictures at all times. Contrary to what happens when using a colposcope adjusted for anoscopy, VPS with proctostation is performed in the Sims position as an ordinary anal examination, therefore patients need no bowel preparation. The operator inserts the anoscope with the aid of an introducer, which is then replaced by the camera. The operator then uses the tool with a single hand, observing the examination on the monitor (Figures 5 and 6). A pedal allows the operator to turn the recording on/off and to take pictures of areas of interest. Afterwards, acetic acid is introduced. If necessary, biopsies can be performed under visual control by introducing forceps through side windows without changing the position of or switching off the instrument. Once the examination is concluded, VPS is extracted and the disposable part is thrown away enTABLE 1 bloc.