PERINEOLOGY: A NEW AREA

Perineology is the result of the merging between urogynecology and coloproctology. This “three-axis approach” is now becoming widely accepted but Perineology is more than a “three axis approach” of the perineum… Perineology deals only with the perineum functional troubles (including pains). Organic diseases (cancer, stones, polyps,...) at any of the three levels must be treated as usual by urologist, gynecologist or coloproctologist. This approach has to be interdisciplinary and not multidisciplinary. There is only one boss who is the “architect of the perineum”, somebody who knows a lot about the anatomy and the physiology of the three axis. This new specialist is called “perineologist”. This person could be the surgeon or somebody who tells the surgeon what to do. The perineologist should have a holistic view (integration of the psychology, the way of life, the abdominal wall muscles... in the approach) of the women and should respect the limits of the concept. The aim of Perineology is to restorate “ad integrum” the anatomy in the respect of biomechanics and physiology. Ideally, each defect must be corrected without inducing troubles on the other levels (primum non nocere). The benefit - risk ratio has to be evaluated for each of the procedures. In surgery, seven key procedures are proposed to obtain such a result (defect specific, efficient and low risk) in the majority of the cases. The functional state of the perineum can be summarized by a T.A.P.E. (Three Axis Perineal Evaluation diagram): - gynecological axis = sexual troubles - prolapse - urological axis = urinary incontinence-dysuria - coloproctological axis = constipation - fecal incontinence. The normal shape of the T.A.P.E is hexagonal. It is a good tool to introduce all the practitioner of this area in a more holistic approach of the woman. It is based on the history of the patient not on the clinical examination

Pudendal nerve decompression in perineology : a case series

BACKGROUND: Perineodynia (vulvodynia, perineal pain, proctalgia), anal and urinary incontinence are the main symptoms of the pudendal canal syndrome (PCS) or entrapment of the pudendal nerve. The first aim of this study was to evaluate the effect of bilateral pudendal nerve decompression (PND) on the symptoms of the PCS, on three clinical signs (abnormal sensibility, painful Alcock's canal, painful "skin rolling test") and on two neurophysiological tests: electromyography (EMG) and pudendal nerve terminal motor latencies (PNTML). The second aim was to study the clinical value of the aforementioned clinical signs in the diagnosis of PCS. METHODS: In this retrospective analysis, the studied sample comprised 74 female patients who underwent a bilateral PND between 1995 and 2002. To accomplish the first aim, the patients sample was compared before and at least one year after surgery by means of descriptive statistics and hypothesis testing. The second aim was achieved by means of a statistical comparison between the patient's group before the operation and a control group of 82 women without any of the following signs: prolapse, anal incontinence, perineodynia, dyschesia and history of pelvi-perineal surgery. RESULTS: When bilateral PND was the only procedure done to treat the symptoms, the cure rates of perineodynia, anal incontinence and urinary incontinence were 8/14, 4/5 and 3/5, respectively. The frequency of the three clinical signs was significantly reduced. There was a significant reduction of anal and perineal PNTML and a significant increase of anal richness on EMG. The Odd Ratio of the three clinical signs in the diagnosis of PCS was 16,97 (95% CI = 4,68 – 61,51). CONCLUSION: This study suggests that bilateral PND can treat perineodynia, anal and urinary incontinence. The three clinical signs of PCS seem to be efficient to suspect this diagnosis. There is a need for further studies to confirm these preliminary results

Establishing a meaningful human rights due diligence process for corporations : learning from experience of human rights impact assessment

The United Nations Special Representative of the Secretary-General on Business and Human Rights, Professor John Ruggie, has constructed a new international framework, which is set to become the cornerstone for all action on human rights and business at the international level. The principle of human rights due diligence (HRDD) is the central component of the corporate duty to respect human rights within that framework. This article argues that Ruggie's HRDD principle contains the majority of the core procedural elements that a reasonable human rights impact assessment (HRIA) process should incorporate. It is likely that the majority of corporations will adopt HRIA as a mechanism for meeting their due diligence responsibilities. However, in the context of the contentious debate around corporate human rights performance, the current state of the art in HRIA gives rise to concerns about the credibility and robustness of likely practice. Additional requirements are therefore essential if HRDD is to have a significant impact on corporate human rights performance – requirements in relation to transparency; external participation and verification; and independent monitoring and review

Prescribing practices of primary-care veterinary practitioners in dogs diagnosed with bacterial pyoderma

Concern has been raised regarding the potential contributions of veterinary antimicrobial use to increasing levels of resistance in bacteria critically important to human health. Canine pyoderma is a frequent, often recurrent diagnosis in pet dogs, usually attributable to secondary bacterial infection of the skin. Lesions can range in severity based on the location, total area and depth of tissue affected and antimicrobial therapy is recommended for resolution. This study aimed to describe patient signalment, disease characteristics and treatment prescribed in a large number of UK, primary-care canine pyoderma cases and to estimate pyoderma prevalence in the UK vet-visiting canine population

Cloud computing and RESERVOIR project

The support for complex services delivery is becoming a key point in current internet technology. Current trends in internet applications are characterized by on demand delivery of ever growing amounts of content. The future internet of services will have to deliver content intensive applications to users with quality of service and security guarantees. This paper describes the RESERVOIR project and the challenge of a reliable and effective delivery of services as utilities in a commercial scenario. It starts by analyzing the needs of a future infrastructure provider and introducing the key concept of a service oriented architecture that combines virtualisation-aware grid with grid-aware virtualisation, while being driven by business service management. This article will then focus on the benefits and the innovations derived from the RESERVOIR approach. Eventually, a high level view of RESERVOIR general architecture is illustrated

Evaluating synergy between marbofloxacin and gentamicin in Pseudomonas aeruginosa strains isolated from dogs with otitis externa

The aim of this study was to determine antimicrobial susceptibility of Pseudomonas aeruginosa strains to marbofloxacin and gentamicin, and investigate the possible synergistic, additive, indifferent or antagonistic effects between the two agents. P. aeruginosa strains can develop resistance quickly against certain antibiotics if used alone, thus the need emerges to find synergistic combinations. A total of 68 P. aeruginosa strains isolated from dogs were examined. In order to describe interactions between marbofloxacin and gentamicin the checkerboard microdilution method was utilized. The MICs (minimum inhibitory concentrations) for marbofloxacin and gentamicin were in the range 0.25–64 mg/L and 0.25–32 mg/L, respectively. The combination of marbofloxacin and gentamicin was more effective with a MIC range of 0.031–8 mg/L and a MIC90 of 1 mg/L, compared to 16 mg/L for marbofloxacin alone and 8 mg/L for gentamicin alone. The FIC (fractional inhibitory concentration) indices ranged from 0.0945 (pronounced synergy) to 1.0625 (indifference). Synergy between marbofloxacin and gentamicin was found in 33 isolates. The mean FIC index is 0.546, which represents a partial synergistic/additive effect close to the full synergy threshold. In vitro results indicate that marbofloxacin and gentamicin as partially synergistic agents may prove clinically useful in combination therapy against P. aeruginosa infections. Although marbofloxacin is not used in the human practice, the interactions between fluoroquinolones and aminoglycosides may have importance outside the veterinary field