Threadcraft, Marcus

Introduction A retrospective chart review was conducted of visual analog scale (VAS) scores completed before and after trigger point injections (TPIs) for pelvic floor myofascial spasm to evaluate response. Methods Sixty-eight female patients who underwent TPIs from October 9, 2007 to March 12, 2015 were included. The primary end point was the difference between scores. Secondary analyses were conducted for patients who needed repeat TPIs. Descriptive and paired t test analyses were used. Results The key result was an improvement in VAS scores for 65% (44/68) of patients (p<0.0001). The median pre-injection VAS score was 7 (1 to 10), (mean 6.3). The median post-injection VAS score was 4 (0 to 9), (mean 4.3). The median difference between scores in patients who improved was 3 (1 to 8), (mean 3.6). Seventeen of 68 (25%) patients needed repeat TPI, and the median time between injections was 1.5 months (1 to 7 months), (mean 2.2 months). When analyzing pre-injection VAS scores in patients who underwent subsequent repeat injection when compared to patients who did not require repeat injection, there was no difference (p = 0.32). In addition, the differences between pre- and post-injection VAS scores in the patients who underwent repeat injection and those who did not was not significant (p = 0.26). Conclusions We report on 68 women who underwent TPIs, with an improvement in VAS pain scores in 65%. It appears that TPIs for pelvic floor myofascial spasm are successful in reducing pain scores for patients who are refractory to primary therapy.

INTRODUCTION: Female patients being evaluated for liver transplantation (LT) routinely undergo a gynecologic exam including cervical cancer screening. The prevalence of cervical cytologic abnormalities in this high risk population is unknown. Our study determines prevalence of cervical cytologic abnormalities, HPV positive status, and risk factors for abnormal cervical screening for this population. METHODS: With Institutional review board approval, we reviewed 375 charts of women undergoing evaluation for LT from 2008‒2013 at Mayo Clinic Florida. We recorded demographics, Pap smear results, High risk HPV positive results, and co-morbid conditions. Univariate analysis was done to determine risk factors. We compared the result of the LT group to the general female population getting cervical cancer screening during the same time period. RESULTS: 37 of 375 (9.86%) LT patients had abnormal Pap smear, compared to 1784 of 26118 (6.83%) of the general population patients (p < 0.01). Among LT patients with cervical cytologic abnormalities, 40.5% were ASCUS, HPV positive (64.8% for non-LT patients), 29.7% were LSIL (28.1% for non-LT patients), 5.4% were HSIL (6.7% for non-LT patients) and 24.3% were cytology negative with HPV positive (0.2% for non-LT patients, p < 0.05). Younger age and presence of hypertension were associated with higher risk of having an abnormal cervical cytology or positive HPV status among LT patients. CONCLUSION: Patients undergoing evaluation for LT have increased prevalence of abnormal cervical cytology, or a positive High risk HPV test. Gynecologic surveillance for this high risk population is recommended.