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1.
J Pediatr Surg ; 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33736877

RESUMO

PURPOSE: Interactive courses play an important role in meeting the educational needs of pediatric surgical trainees. We investigated the impact of a multimodal pediatric colorectal and pelvic reconstruction course on pediatric surgery trainees. METHODS: A retrospective evaluation was performed of pre- and post-course surveys for an annual colorectal and pelvic reconstruction course over 3 consecutive years (2017-2019). The course included didactic and case-based content, interactive questions, video, and live case demonstration, and a hands-on lab. Pre- and post-course surveys were distributed to participants. Comfort with operative/case procedures was scored on a 5-point Likert scale (1 uncomfortable, 5 very comfortable). The primary outcome was improved confidence and content knowledge for pediatric colorectal surgical conditions. RESULTS: 165 pediatric surgical fellow participants with a 70 responses (42.4% response rate) comprised the cohort. Participants had limited advanced pediatric colorectal experience. At the time of the course, participants reported a median of 5 [3,10] Hirschsprung pull-throughs, 6 [3,10] anorectal malformation, and 1 [0,1] cloaca cases. Participants transitioned from discomfort to feeling comfortable with pediatric colorectal operative set-up and case management (pre-course 2 [2,3] and post-course 4 [4,5] p<0.001). CONCLUSION: Pediatric surgery trainees report limited exposure to advanced pediatric colorectal and pelvic reconstruction cases and management during their pediatric surgical fellowship training but report improved content knowledge- and technical understanding of complex pediatric disorders upon completion of a dedicated course. The course is an important adjunct to the experience gained in pediatric surgery fellowship for achieving competency in managing patients with Hirschsprung disease, anorectal malformation, and cloacal reconstructions.

2.
J Pediatr Surg ; 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33752911

RESUMO

BACKGROUND: Patients with anorectal malformations (ARM) commonly have associated urologic anomalies. Few large studies exist to accurately characterize the incidence or associations between severity of malformation and urologic diagnosis. The purpose of our study was to determine the incidence of urologic diagnoses in a large cohort of children with ARM and evaluate for any correlation between severity of ARM and the incidence and number of associated urologic diagnoses. METHODS: A retrospective review was performed of patients with ARM treated at our pediatric colorectal center. All patients underwent protocolized urologic screening. ARM subtypes were ordered with increasing severity as follows in males: perineal, bulbar, prostatic and bladder neck fistulae. Females were similarly categorized as perineal, vestibular and vaginal fistulae followed by cloaca with <3 cm common channel and cloaca with >3 cm common channel. The following urologic diagnoses were assessed to determine whether a correlation existed with the severity of the ARM subtype: hydronephrosis, vesicoureteral reflux (VUR), solitary kidney, renal ascent anomalies (ectopic or pelvic), renal fusion anomalies (horseshoe or cross fused kidney), duplex kidney, hypospadias and undescended testicle. ARM subtypes were defined by distal rectal anatomy. RESULTS: A total of 712 patients were included in our study with a mean age of 4 years and of whom 45% were male. The overall rate of urologic anomalies was greater in males than females (65% vs 56% p < 0.026). In both sexes, the rate of urologic anomalies increased with increasing severity of ARM subtype (p<0.00010) finding that males with bladder neck fistula and females with cloacal malformations, particularly with long common channels, being the highest incidence. In males and females, the rate of hydronephrosis increased as the complexity of ARM increased and this correlated significantly (p < 0.0001 vs p < 0.0003 respectively). Similarly, the incidence of VUR also increased as complexity of ARM increased in both males and females (p = 0.01 and p<0.0001 respectively). The remaining urologic diagnoses were not significantly correlated with severity of ARM. CONCLUSIONS: Urologic anomalies occur at a high rate in children with ARM and appear to increase in frequency with increasing complexity of ARM subtype. These findings stress the importance of proper ARM screening and proactive collaboration with a clinician with expertise in pediatric urology early in the management of such children to improve early recognition of urologic diagnoses. LEVEL OF EVIDENCE: Level III.

4.
Clin J Gastroenterol ; 14(2): 626-632, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33460019

RESUMO

Immunoglobulin G subclass 4 (IgG4)-related disease is a recently described fibroinflammatory condition. Reports of appendix involvement are extremely limited. A young man with abdominal pain and symptoms of acute appendicitis accompanied by the finding of an appendix-dependent tumor during surgery is presented. Histopathological study revealed lymphoplasmocytic infiltrate, storiform fibrosis and obliterative phlebitis. The number of IgG4-positive plasma cells was greater than 50 per high power field. Postsurgical steroid treatment and radiological findings are also described.

6.
Semin Pediatr Surg ; 29(6): 150985, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33288133

RESUMO

The treatment of patients with colorectal disorders and their associated urologic, gynecologic, gastrointestinal, spinal, and orthopedic anomalies requires care from various medical and surgical specialties over the course of their lifetime. This is ideally handled by a collaborative center which facilitates the assessment and development of a long-term patient care plan among multiple specialties which can enhance the quality of care, improve communication among different specialties, and improve patient satisfaction and outcomes. We describe the process, as well as lessons learned in developing such a center.

8.
Arch Med Res ; 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33248817

RESUMO

BACKGROUND: SARS-CoV-2, the etiological agent causing COVID-19, has infected more than 27 million people with over 894000 deaths worldwide since its emergence in December 2019. Factors for severe diseases, such as diabetes, hypertension, and obesity have been identified however, the precise pathogenesis is poorly understood. To understand its pathophysiology and to develop effective therapeutic strategies, it is essential to define the prevailing immune cellular subsets. METHODS: We performed whole circulating immune cells scRNAseq from five critically ill COVID-19 patients, trajectory and gene ontology analysis. RESULTS: Immature myeloid populations, such as promyelocytes-myelocytes, metamyelocytes, band neutrophils, monocytoid precursors, and activated monocytes predominated. The trajectory with pseudotime analysis supported the finding of immature cell states. While the gene ontology showed myeloid cell activation in immune response, DNA and RNA processing, defense response to the virus, and response to type 1 interferon. Lymphoid lineage was scarce. Expression of genes such as C/EBPß, IRF1and FOSL2 potentially suggests the induction of trained immunity. CONCLUSIONS: Our results uncover transcriptomic profiles related to immature myeloid lineages and suggest the potential induction of trained immunity.

9.
Surg Obes Relat Dis ; 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33234465

RESUMO

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is present in 80% of patients evaluated for bariatric surgery (BS). Extensive evaluation is not widely available, but treatment is mandatory for severe cases. The Snore, Tiredness, Observed apneas and Pressure - Body mass index, Age, Neck circumference and Gender (STOP-Bang) and Epworth questionnaires and neck-to-height ratio (NHtR) are accessible clinical tools to screen for sleep and metabolic disturbances, but their utility to detect severe OSAHS in patients with severe obesity has not been determined. OBJECTIVES: To evaluate the cutoff point of those clinical tools that may predict severe OSAHS, confirmed by polysomnography in patients referred for BS. SETTING: Tertiary referral center in Mexico City. METHODS: We applied the STOP-Bang and Epworth questionnaires, evaluated anthropometric characteristics, and collected samples for arterial gasometry and metabolic parameters from 68 patients with severe obesity, who were then referred for polysomnography before their evaluation for BS. RESULTS: Of the 68 patients participating in the study, 67.7% were female, with a median age of 43 years (35-49 years) and a body mass index (BMI) of 45.5 kg/m2 (42.4-50.9 kg/m2; 28.3% had a BMI ≥ 50 kg/m2). A STOP-Bang cutoff >5 points had a sensitivity of 60% and specificity of 90% for detecting severe OSAHS (area under the curve [AUC] = .962); meanwhile, an NHtR >.25 had a sensitivity of 90% and specificity of 52.5% (AUC = .759). The Epworth scale score >11 points had a sensitivity of 57.1% and specificity of 83.3% (AUC = .802). CONCLUSION: Clinical data may be useful to detect severe sleep apnea in high-risk populations, allowing for rapid referral and better use of resources.

10.
Polymers (Basel) ; 12(10)2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33050366

RESUMO

The objective of this research was to investigate the development of epoxides from Chlorella vulgaris lipids to obtain a novel bio-based resin. The process involved the production of fatty acid methyl esters (FAMEs) by in situ transesterification of microalgal biomass, followed by epoxidation of the FAMEs to obtain bioresin. During the FAME production process, an assessment was made of the main factors affecting the production of unsaturated fatty acid methyl esters (UFAMEs), such as catalyst dosage and methanol:hexane volume ratio. For step epoxidation, an evaluation of the catalyst concentration, temperature and formic acid:hydrogen peroxide ratio was made. From the results obtained, UFAME production was maximized using 20 wt% of catalyst dosage and a volume ratio of 1:2 (v/v, methanol:hexane). Then, in the epoxidation stage, a higher yield was obtained using 1 wt% of catalyst with a volume ratio of 1:1 and maintaining a temperature of 70 °C. The bioresin was blended with neat epoxy resin (DGEBA) and cured with tetraethylenepentamine (TEPA). Bio-based resin was characterized via Fourier transform infrared spectroscopy (FTIR), Raman spectroscopy, thermogravimetric analysis (TGA) and dynamic mechanical analysis (DMA) to evaluate this material as an alternative source for oleochemistry.

11.
Angiol. (Barcelona) ; 72(5): 265-268, sept.-oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195496

RESUMO

Los aneurismas de la arteria carótida extracraneal son raros y representan una minoría de la cirugía carotídea en la mayoría de las unidades vasculares. Se presenta un caso clínico de un aneurisma sacular de la arteria carótida interna en un paciente joven, sin causa aparente. La mayoría de estos aneurismas son asintomáticos, aunque, en este paciente debutó como ictus por embolización distal. El manejo consistió en un abordaje quirúrgico abierto a las 4 semanas tras el episodio inicial. En la intervención se extirpó el aneurisma con sutura termino-terminal de la arteria carótida interna


Aneurysms of the extracranial carotid artery are rare and represent a minority of the carotid surgery in most vascular units. A clinical case of a saccular aneurism of the internal carotid artery, in a young patient without apparent cause, is showcased. They are often asymptomatic, but they also may show (as it was in this patient) stroke from distal embolisation as a debut. The management consisted in an open surgical approach (by meaning, aneurysm excision with termino-terminal suture of the internal carotid artery, without shunt), 4 weeks after the initial episode


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Angiografia por Tomografia Computadorizada/métodos
12.
Nutr Hosp ; 2020 Sep 30.
Artigo em Espanhol | MEDLINE | ID: mdl-32993304

RESUMO

INTRODUCTION: promoting healthy eating habits among childhood is one of the key aspects to improve medium and long-term health outcomes. OBJECTIVES: the main aims are to improve eating habits, promote the Mediterranean diet (MD) and prevent and/or reverse overweight and obesity in children from 3 to 12 years old. METHODS: the program has a one-year follow-up and includes three to five visits with registered dietitians, one telephone control and one practical workshop. Anthropometric, body composition and eating habits data are collected, and nutritional education is carried out. A total sample of 1,000 children will be included. RESULTS: until now, 622 participants have been included (51.6 % boys; median age 8.5 years). At the beginning, 32.2 % of participants were overweight or obese and 38.9 % had an adequate MD. Although no differences were found in the assessment of the Kidmed questionnaire regarding sex (p = 0.214) or body mass index (BMI) subgroups (p = 0.181), differences were found regarding age (p = 0.023) and BMI Z-score (p = 0.004), showing slightly lower values in those having and adequate MD. At the moment, 362 participants have made the six-month visit, of which 61.6 % presented an adequate MD, with statistically significant differences compared to the baseline visit (p < 0.0001). CONCLUSIONS: preliminary results show the need for nutritional education in children and suggest that Programa Nutriplato® can be effective in improving eating habits.

13.
Eur J Pediatr Surg ; 30(5): 413-419, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32987436

RESUMO

Chronic idiopathic constipation, also known as functional constipation, is defined as difficult and infrequent defecation without an identifiable organic cause. Medical management with laxatives is effective for the majority of constipated children. However there is a subset of patients who may need evaluation by a surgeon. As constipation progresses, it can lead to fecal retention and rectal and sigmoid distension, which impairs normal colorectal motility. Surgical interventions are influenced by the results of: a rectal biopsy, transit studies, the presence of megacolon/megarectum on contrast enema, the degree of soiling/incontinence, anorectal manometry findings, and colonic motility evaluation. In this review, we describe the different surgical options available (intestinal diversion, antegrade enemas, sacral nerve stimulation, colonic resections, and Botulinum toxin injection) and provide guidance on how to choose the best procedure for a given patient.

14.
Am J Trop Med Hyg ; 103(3): 1158-1161, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32729460

RESUMO

COVID-19 represents the greatest health challenge of modern years. The spectrum of illness comprises respiratory and non-respiratory manifestations. We report the case of an adult man with COVID-19 who presented with rhabdomyolysis as a principal extrapulmonary manifestation. Our patient presented with dyspnea, fever, and muscle pain. After a comprehensive approach, the diagnosis of COVID-19 and rhabdomyolysis was made. He developed acute kidney injury requiring renal replacement therapy without reversibility, despite optimal treatment. We performed a literature search for similar cases, discuss the potential mechanisms implied, and propose a diagnostic-therapeutic algorithm.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Rabdomiólise/etiologia , Lesão Renal Aguda/etiologia , Algoritmos , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Rabdomiólise/diagnóstico , Rabdomiólise/terapia
15.
J Pediatr Surg ; 55(10): 2159-2165, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682544

RESUMO

BACKGROUND AND AIM: Patients with a previously repaired anorectal malformation (ARM) can suffer from complications which lead to incontinence. Reoperation can improve the anatomic result, but its impact on functional outcomes is unclear. METHODS: We performed a retrospective cohort study of patients with a previously repaired ARM who underwent redo PSARP at our Center and compared results at initial assessment and 12 months after redo. RESULTS: One hundred fifty-three patients underwent a redo PSARP for anoplasty mislocation (n=93, 61%), stricture (n=55, 36%), remnant of the original fistula (n=28, 18%), or rectal prolapse (n=11, 7%). Post-redo complications included stricture (n=33, 22%) and dehiscence (n=5, 3%). At 1-year post-redo, 75/153 (49%) are on laxatives only, of whom 57 (76%) are continent of stool. Of the remaining 78 (51%) patients, 61 (78%) are clean (≤1 accident per week) on enemas. Interestingly, 16/79 (20%) of patients with expected poor continence potential were continent of stool on laxatives. Overall, 118/153 (77%) are clean after their redo. Quality of life (76.7 vs. 83.8, p=0.05) and Baylor continence (29.2 vs. 17.7, p=<0.0001) scores improved. CONCLUSION: Patients with fecal incontinence after an ARM repair can, with a reoperation, have their anatomy corrected which can restore continence for many, and improve their quality of life. LEVEL OF EVIDENCE: IV. TYPE OF STUDY: Retrospective cohort study.

16.
Ecotoxicol Environ Saf ; 195: 110460, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32199216

RESUMO

Biopurification systems (BPS) or biobeds have been developed to attenuate point-source contamination due to inappropriate pesticide handling or disposal of agricultural wastewaters. The biomixture used for this strategy should be able to remove different active ingredients but its efficiency can vary due to the constant load of pesticides from crop application programs. For that reason, the performance of biomixtures in conditions that mimic the real pesticide treatment before their implementation in field settings should be assayed. This study aimed to evaluate the removal and detoxifying capacity of a previously formulated biomixture (coconut fiber, 50% v/v; compost, 25%; and soil pre-exposed to pesticides, 25%) during a simulated cycle of pesticide application (93 days) for potato production. The scheme included a first application of linuron followed by a weekly alternated treatment of the mixtures chlorpyrifos/metalaxyl and malathion/dimethomorph, and antibiotics at day 72. The biomixture showed efficient removal of linuron (half-life <15 days), and a fluctuating transformation rate for the other compounds. A constant and sustained removal was observed for malathion and methalaxyl. In contrast, lower efficiency and accumulation was described for chlorpyrifos and dimethomorph. Following antibiotic treatment, changes on pesticide removal were observed only in the case of chlorpyrifos, whose removal was slightly enhanced. Furthermore, acute toxicity assays showed limited detoxification of the matrix, especially when compounds began to accumulate. Summarizing, our experiments showed that the proposed biomixture does not support a proper removal of the pesticides during the simulated application cycle of potato production. Further optimization of a biopurification system is required to guarantee the successful elimination of pesticide combinations when applied in field conditions.


Assuntos
Praguicidas/metabolismo , Poluentes Químicos da Água/metabolismo , Agricultura , Biotransformação , Clorpirifos/metabolismo , Cocos , Linurona/metabolismo , Malation/metabolismo , Morfolinas/metabolismo , Praguicidas/toxicidade , Solo/química , Clima Tropical , Águas Residuárias/química , Poluentes Químicos da Água/toxicidade
17.
BMC Endocr Disord ; 20(1): 20, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024495

RESUMO

BACKGROUND: Currently, bariatric surgery is the most effective treatment for severe obesity and its metabolic complications; however, 15-35% of the patients that undergo bariatric surgery do not reach their goal for weight loss. The aim of this study was to determine the proportion of patients that didn't reach the goal of an excess weight loss of 50% or more during the first 12 months and determine the factors associated to this failure. METHODS: We obtained the demographic, anthropometric and biochemical information from 130 patients with severe obesity who underwent bariatric surgery in our institution between 2012 and 2017. We used self-reports of physical activity, caloric intake and diet composition. An unsuccessful weight loss was considered when the patient lost < 50% or more of the excess weight 12 months after surgery. We compared the characteristics between the successful and unsuccessful groups in order to find the factors associated with success. RESULTS: We included 130 patients (mean age 48 ± 9 years, 81.5% were women). One year after surgery, 26 (20%) had loss < 50% EBW. Unsuccessful surgery was associated with an older age, previous history of hypertension, abdominal surgery or depression/anxiety, also the number of comorbidities and unemployment affected the results. These patients loss enough weight to improve some of their comorbidities, but they are more prone to regain weight 2 years after surgery. CONCLUSIONS: A fifth of the patients undergoing bariatric surgery may not lose enough weight to be considered successful by current standards. Some patients may benefit from the surgery in the short term, but they are more likely to regain weight after 2 years. The factors influencing this result are still controversial but may be population-specific. Early detection of the patients that are more likely to fail is imperative to establish additional therapeutic strategies, without denying them the opportunity of surgery or waiting for weight re-gain to occur.


Assuntos
Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Obesidade/cirurgia , Ganho de Peso , Perda de Peso , Dieta , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/patologia , Estudos Retrospectivos , Resultado do Tratamento
18.
Ann Hepatol ; 19(3): 295-301, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31899127

RESUMO

INTRODUCTION AND OBJECTIVES: Cases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the "Hospital Infantil de Mexico Federico Gomez". MATERIALS AND METHODS: The study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced. RESULTS: ELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p<0.05) and malnutrition (p<0.005) were significant factors for high PCR prevalence and could increase the possibility of infection. Two samples were sequenced and confirmed the presence of HEV genotype 3. CONCLUSIONS: This report reveals the incidence of HEV in pediatric patients in Mexico. Moreover, the identification of HEV genotype 3 in human samples suggests a potential zoonotic risk that requires further research.

19.
J Pediatr Surg ; 55(1): 90-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704044

RESUMO

INTRODUCTION: Gastrointestinal (GI) operations represent a significant proportion of the surgical site infection (SSI) burden in pediatric patients, resulting in significant morbidity. We have previously demonstrated that a GI bundle decreases SSI rates, length of stay (LOS), and hospital charges. Following this success, we hypothesized that by targeting the preoperative antibiotics for stoma closures based on organisms found in infected wounds, we could further decrease SSI rates. METHODS: As part of a broad quality improvement effort to reduce SSI rates, we reviewed the responsible pathogens and their sensitivities as well as the preoperative antibiotic used, and found that 15% of wound infections were caused by enterococcus. Based on this information, starting in April 2017, we changed the prior preoperative antibiotic cefoxitin to ampicillin-sulbactam, which more accurately targeted the prevalent pathogens from April 2017 to October 2018. RESULTS: The baseline SSI rate for all stoma takedown patients was 21.4% (25 of 119). After bundle implementation, this decreased to 7.9% (17 of 221; p = 0.03) over a period of 2.5 years. Then, after changing the preoperative antibiotics, our rate of SSI decreased further to 2.2% (1 of 44; p = 0.039) over a period of 1.5 years. CONCLUSION: Significant reduction of SSI in GI surgery can be accomplished with several prevention strategies (our GI bundle). Then a change of the preoperative antibiotic choice, chosen based on causative wound infection organisms, may further decrease SSI rates. We recommend an institution specific analysis of wound infections and modification of preoperative antibiotics if the responsible organisms are resistant to the original antibiotic choice. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Estomas Cirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Ampicilina/uso terapêutico , Criança , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Ileostomia/efeitos adversos , Tempo de Internação , Masculino , Pacotes de Assistência ao Paciente , Estudos Retrospectivos , Sulbactam/uso terapêutico , Infecção da Ferida Cirúrgica/microbiologia
20.
J Pediatr Surg ; 55(1): 71-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31711744

RESUMO

BACKGROUND: A subset of patients with cloacal malformations requires vaginal replacement during their primary reconstruction, increasing the surgical complexity. Identifying factors which predict the need for vaginal replacement would facilitate operative planning. METHODS: We retrospectively reviewed patients who underwent primary cloacal reconstruction at our Center (2014-2018) and assessed the length of the common channel, urethra, and vagina. The presence of hydrocolpos at birth, Müllerian anomalies, sacral ratio, and tethered cord were also assessed between patients who did and did not require vaginal replacement. RESULTS: 50 patients were identified. 17/50 patients (34%) underwent a total urogenital mobilization (TUM), and none required vaginal replacement. 33/50 (66%) patients underwent a urogenital separation. 19/33 (58%) required vaginal replacement. This group had a shorter vagina (4.2 cm vs 6.6 cm, p < 0.01). There was no difference in urethral or common channel length, number of cervices, sacral ratio, presence of a vaginal septum, hydrocolpos, or tethered cord between those who did and those who did not require vaginal replacement. CONCLUSIONS: Urethral and common channel lengths were used to successfully determine the operative plan (TUM or urogenital separation) to reconstruct cloacal malformations. The need for urogenital separation and a shorter vaginal length were predictive of the need for vaginal replacement. LEVEL OF EVIDENCE: Level IV. TYPE OF STUDY: Case series with no comparison groups.


Assuntos
Cloaca/anormalidades , Procedimentos Cirúrgicos Reconstrutivos , Reimplante , Uretra/anormalidades , Anormalidades Urogenitais/cirurgia , Vagina/anormalidades , Cloaca/cirurgia , Feminino , Humanos , Hidrocolpos , Defeitos do Tubo Neural , Estudos Retrospectivos , Sacro/anatomia & histologia , Uretra/cirurgia , Útero/anormalidades , Vagina/cirurgia
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