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1.
Anat Rec (Hoboken) ; 305(4): 952-967, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35202515

RESUMO

Medical education's treatment of obstetric-related anatomy exemplifies historical sex bias in medical curricula. Foundational obstetric and midwifery textbooks teach that clinical pelvimetry and the Caldwell-Moloy classification system are used to assess the pelvic capacity of a pregnant patient. We describe the history of these techniques-ostensibly developed to manage arrested labors-and offer the following criticisms. The sample on which these techniques were developed betrays the bias of the authors and does not represent the sample needed to address their interest in obstetric outcomes. Caldwell and Moloy wrote as though the size and shape of the bony pelvis are the primary causes of "difficult birth"; today we know differently, yet books still present their work as relevant. The human obstetric pelvis varies in complex ways that are healthy and normal such that neither individual clinical pelvimetric dimensions nor the artificial typologies developed from these measurements can be clearly correlated with obstetric outcomes. We critique the continued inclusion of clinical pelvimetry and the Caldwell-Moloy classification system in biomedical curricula for the racism that was inherent in the development of these techniques and that has clinical consequences today. We call for textbooks, curricula, and clinical practices to abandon these outdated, racist techniques. In their place, we call for a truly evidence-based practice of obstetrics and midwifery, one based on an understanding of the complexity and variability of the physiology of pregnancy and birth. Instead of using false typologies that lack evidence, this change would empower both pregnant people and practitioners.


Assuntos
Pelvimetria , Pelve , Feminino , Humanos , Parto , Gravidez
2.
Can J Urol ; 29(1): 10976-10978, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35150217

RESUMO

INTRODUCTION: To evaluate the use of preoperative magnetic resonance imaging (MRI) as a predictor of positive margins after radical prostatectomy (RP). This is important as such patients may benefit from postoperative radiotherapy. With the advent of preoperative MRI, we posited that pelvimetry could predict positive margins after RP in patients with less-than ideal pelvic dimensions undergoing robotic-assisted laparoscopic surgery. MATERIALS AND METHODS: After IRB approval, data from patients undergoing RP at our center between 1/1/2018 and 12/31/2019 (n = 314) who had undergone prior prostate MRI imaging (n = 102) were analyzed. All RPs were performed using robotic-assisted laparoscopic technique. Data from the cancer center data warehouse were retrieved, to include postoperative T-stage, gland size, responsible surgeon, PSA, patient body mass index, and surgical margin status. These data were analyzed with corresponding pelvimetry data from 91 preoperative scans with complete data and imaging. RESULTS: On multivariable analysis, pathologic T-stage (p = 0.004), anteroposterior pelvic outlet (p = 0.015) and pelvic depth (length of the pubic symphysis; p = 0.019) were all statistically correlated with positive surgical margins. CONCLUSIONS: With the widespread use of MRI in the initial staging of prostate cancer, automated radiomic analysis could augment the critical data already being accumulated in terms of seminal vesical involvement, extracapsular extension, and suspicious lymph nodes as risk factors for postoperative salvage radiation. Such automated data could help screen patients preoperatively for robotic RP.


Assuntos
Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Imageamento por Ressonância Magnética , Masculino , Margens de Excisão , Pelvimetria , Antígeno Prostático Específico , Prostatectomia/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
3.
Am J Hum Biol ; 34(2): e23619, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34028115

RESUMO

OBJECTIVE: This study aimed to analyze the correlations between maternal size, neonatal size, and gestational variables. METHODS: Our sample comprises 131 mother-infant dyads. We investigated correlations between five neonatal traits (gestational age, birthweight, head, suboccipito-brematic, and abdominal girths), three maternal traits (height, BMI, and uterus height), and three pelvic variables (conjugate, inter-spinous diameters, and sub-pubic angle) using computed tomography pelvimetry. RESULTS: We found that the five neonatal traits were significantly intercorrelated. BMI was not correlated with neonatal traits while maternal height was correlated with birthweight, suboccipito-brematic, and abdominal girth. In the multiple regression models, gestational age was correlated with birthweight, head, and abdominal girth. Among the neonatal and pelvimetry correlations, conjugate diameter was slightly correlated with suboccipito-bregmatic girth, but inter-spinous and sub-pubic angle were not correlated with neonatal traits. Uterus height predicted all neonatal variables, but it was not correlated with gestational age. DISCUSSION: Our results suggest that fetal growth is shaped by maternal phenotype rather than external ecological factors. The association of the inlet size with suboccipito-bregmatic girth reflects the tight fit between the neonatal brain and the maternal pelvis dimensions, an adaptation that would reduce the risk of cephalo-pelvic disproportion, while the absence of tight fit at the midplane and outlet could be due to the effect of the pelvic relaxation. Uterus distention is not the only mechanism involved in the initiation of parturition. Birth and pregnancy are complex processes and we suggest that maternal-neonatal associations are the result of a combination of multiple obstetric tradeoffs.


Assuntos
Desproporção Cefalopélvica , Pelvimetria , Evolução Biológica , Peso ao Nascer , Feminino , Humanos , Pelve , Gravidez
4.
Int J Colorectal Dis ; 36(12): 2613-2620, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34338870

RESUMO

PURPOSE: Selection of an open or minimally invasive approach to total mesorectal excision (TME) is generally based on surgeon preference and an intuitive assessment of patient characteristics but there consensus on criteria to predict surgical difficulty. Pelvimetry has been used to predict the difficult surgical pelvis, typically using only bony landmarks. This study aimed to assess the relationship between pelvic soft tissue measurements on preoperative MRI and surgical difficulty. METHODS: Preoperative MRIs for patients undergoing laparoscopic rectal resection in the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT) were retrospectively reviewed by two blinded surgeons and pelvimetric variables measured. Pelvimetric variables were analyzed for predictors of successful resection of the rectal cancer, defined by clear circumferential and distal resection margins and completeness of TME. RESULTS: There was no association between successful surgery and any measurement of distance, area, or ratio. However, the was a strong association between the primary outcome and the estimated total pelvic volume on adjusted logistic regression analysis (OR = 0.99, P = 0.01). For each cubic centimeter increase in the pelvic volume, there was a 1% decrease in the odds of successful laparoscopic rectal cancer surgery. Intuitive prediction of unsuccessful surgery was correct in 43% of cases, and correlation between surgeons was poor (ICC = 0.18). CONCLUSIONS: A surgeon's intuitive assessment of the difficult pelvis, based on visible MRI assessment, is not a reliable predictor of successful laparoscopic surgery. Further assessment of pelvic volume may provide an objective method of defining the difficult surgical pelvis.


Assuntos
Laparoscopia , Neoplasias Retais , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelvimetria , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Reto , Estudos Retrospectivos , Resultado do Tratamento
5.
J Orthop Surg Res ; 16(1): 430, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217332

RESUMO

INTRODUCTION: Diastasis of the pubic symphysis has been reported to occur in 13-16% of pelvic ring injuries. In Asians, there are only a few data showing the width of the pubic symphysis. The aim of this study is to see the width of pubic symphysis relating to age and sex in Koreans. METHODS: Width of pubic symphysis was measured in pelvis AP and pelvic CT of 784 peoples (392 males, 392 females). RESULTS: In supine AP, the width at the upper end was 4.8±2.5 mm (males; 3.46±1.38 mm, females; 4.04±2.76 mm). The width at the midpoint was 4.7±2.0 mm (males; 4.64±1.58 mm, females; 4.75±2.29 mm). The width at the lower end was 4.8±2.5 mm (males; 4.58±2.19 mm, females; 5.08±2.76 mm). In abducted AP, the width at the upper end was 3.8±2.9 mm (males; 3.65±1.50 mm, females; 3.97±3.85 mm). The width at the midpoint was 4.6±2.3 mm (males; 4.45±2.16 mm, females; 5.18±3.79 mm). The width at the lower end was 4.8±3.1 mm (males; 4.55±1.30 mm, females; 4.74±3.06 mm). In axial CT, the width at the anterior border was 15.0±6.2 mm (males; 14.50±6.62 mm, females; 16.44±6.22 mm). The width at the narrowest point was 3.1±1.5 mm (males; 3.19±1.53 mm, females; 3.09±1.50 mm). The width at the widest point was 4.1±1.6 mm (males; 4.27±1.60 mm, females; 4.00±1.50 mm). The width at the posterior border was 2.3±1.3 mm (males: 2.20±1.30 mm, females; 2.44±1.40 mm). Axial thickness was 27.1±5.3 mm (males; 29.48±4.60 mm, females; 24.70±4.82 mm). In coronal CT, the width at the upper end was 3.1±4.1 mm (males; 2.28±1.26 mm, females; 3.83±5.48 mm). The width at beginning of widening was 3.6±4.5 mm (males; 2.68±1.63 mm, females; 4.54±6.08 mm). The width at the lower end was 20.5±8.2 mm (males; 17.49±4.53 mm, females; 23.60±9.86 mm). Coronal thickness was 20.4±7.1 mm (males; 24.50±5.98 mm, females; 16.23±5.61 mm). In supine film, width significantly increased with age at the upper end (p=0.022) and midpoint (p< 0.001); however, it decreased at the lower end (p< 0.001). In abduction film, width at midpoint increased with age (p=0.003). CONCLUSION: Pelvic malunion should be defined according to the population and age. These results could be a reference in assessing the quality of reduction after internal fixation of the patients with traumatic diastasis of the pubic symphysis.


Assuntos
Fatores Etários , Pelvimetria/estatística & dados numéricos , Sínfise Pubiana/anatomia & histologia , Radiografia , Fatores Sexuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pelvimetria/métodos , Sínfise Pubiana/diagnóstico por imagem , Valores de Referência , República da Coreia , Estudos Retrospectivos , Adulto Jovem
6.
J Orthop Surg Res ; 16(1): 424, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217347

RESUMO

BACKGROUND: The purpose of total hip arthroplasty (THA) post-surgery and proper physiotherapy is positive recovery for the patient. Consideration is given to hip replacement biomechanics by ensuring no discrepancies in limb length (LL) and a stable prosthesis. Therefore, the patient must have proper preoperative planning and communication and a clear understanding of what to expect. METHODS: A prospective series of 59 THA operated by a single surgeon via Hardinge approach was studied, using an intraoperative calliper (CAL) to predict the change of LL and offset. We compared the results of the intraoperative changes before and after THA implantation with the reference of these values on anteroposterior x-ray pelvis. The importance of leg length balance and a good offset restoration is questioned, and the effect of component subsidence on leg length is considered. RESULTS: The average preoperative leg length discrepancy was -6.0 mm, postoperatively +3.6 mm. There was a strong correlation between the CAL measurements and the values on the x-ray (LL, r=0.873, p<0.01; offset, r=0.542, p<0.01). Reliability is better for limb length than for offset. These results are comparable within the literature and the statistical results from other studies reviewed. In addition, we evaluate the importance of subsidence of the prosthesis components for long-term results. CONCLUSION: The intraoperative use of CAL gives excellent results in predicting the final LL and offset after THA. Considering subsidence of prosthesis components, a target zone around +5 mm might be more suitable for leg length directly postoperatively. Moreover, surgeons must discuss the topic of leg length discrepancy (LLD) intensively with the patient pre-operatively. LEVEL OF EVIDENCE: Level 4, prospective cohort study.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cuidados Intraoperatórios/instrumentação , Desigualdade de Membros Inferiores/diagnóstico , Pelvimetria/instrumentação , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Artroplastia de Quadril/métodos , Fenômenos Biomecânicos , Feminino , Prótese de Quadril , Humanos , Período Intraoperatório , Desigualdade de Membros Inferiores/etiologia , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/fisiopatologia , Pelvimetria/métodos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Radiografia , Reprodutibilidade dos Testes , Adulto Jovem
8.
Arch Gynecol Obstet ; 304(4): 919-927, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33791843

RESUMO

PURPOSE: To evaluate the obstetrical prognosis of term breech delivery in case of asymmetric pelvis. METHODS: An observational, comparative, retrospective, bi-centric study of 559 patients who had a computer tomography pelvimetry prior to delivery of a term breech presentation was conducted between August 2013 and August 2019. Patients with an attempted vaginal delivery were divided into two groups: a group of asymmetric pelvis (AP) when the difference between the lengths of both oblique diameters was ≥ 1 cm and a group of symmetric pelvis (SP) when the two oblique diameters differed by < 1 cm. The primary outcome was the rate of vaginal delivery. Secondary outcomes were a composite variable of neonatal and maternal morbidity and mortality. RESULTS: Of the 370 patients who attempted a vaginal breech delivery, 8% (n = 29) had an AP and 92% (n = 341) had a SP. In the AP group, the vaginal delivery rate was higher (93% versus 78%, p = 0.05). There was no statistically significant difference in neonatal (3% versus 1% in the AP and SP groups, respectively, p = 0.4) and maternal (17% versus 23% in the AP and SP groups, respectively, p = 0.5) morbidity and mortality. CONCLUSION: When a pelvimetry is performed before an attempt of vaginal breech delivery, a difference of less than two centimetres between both oblique diameters does not seem to reduce the rate of vaginal birth and is not an indication for an elective caesarean section.


Assuntos
Apresentação Pélvica , Pelvimetria/métodos , Pelve/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Cesárea , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos
9.
World J Surg ; 45(7): 2261-2269, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33821350

RESUMO

AIM: Laparoscopic total mesorectal excision (LaTME) following preoperative chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC) is technically demanding. The present study is intended to evaluate predictive factors of surgical difficulty of LaTME following PCRT by using pelvimetric and nutritional factors. METHOD: Consecutive LARC patients receiving LaTME after PCRT were included. Surgical difficulty was classified based upon intraoperative (operation time, blood loss, and conversion) and postoperative outcomes (postoperative hospital stay and morbidities). Pelvimetry was performed using preoperative T2-weighted MRI. Nutritional factors such as albumin-to-globulin ratio (AGR) and prognostic nutritional index (PNI) were calculated. Multivariable logistic analysis was used to identify predictors of high surgical difficulty. A predictive nomogram was developed and validated internally. RESULTS: Among 294 patients included, 36 (12.4%) patients were graded as high surgical difficulty. Logistic regression analysis demonstrated that previous abdominal surgery (OR = 6.080, P = 0.001), tumor diameter (OR = 1.732, P = 0.003), intersphincteric resection (vs. low anterior resection, OR = 13.241, P < 0.001), interspinous distance (OR = 0.505, P = 0.009), and preoperative AGR (OR = 0.041, P = 0.024) were independently predictive of high surgical difficulty of LaTME after PCRT. Then, a predictive nomogram was built (C-index = 0.867). CONCLUSION: Besides previous abdominal surgery, type of surgery (intersphincteric resection), tumor diameter, and interspinous distance, we found that preoperative AGR could be useful for the prediction of surgical difficulty of LaTME after PCRT. A predictive nomogram for surgical difficulty may aid in planning an appropriate approach for rectal cancer surgery after PCRT.


Assuntos
Laparoscopia , Protectomia , Neoplasias Retais , Quimiorradioterapia , Feminino , Humanos , Pelvimetria , Neoplasias Retais/cirurgia
10.
Surg Today ; 51(7): 1144-1151, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33420827

RESUMO

PURPOSE: Laparoscopic total mesorectal excision (LaTME) is technically demanding in rectal cancer after neoadjuvant chemoradiotherapy (NCRT). This study aimed to predict the surgical difficulty of LaTME after NCRT based on pelvimetric parameters. METHODS: This study enrolled 147 patients who underwent LaTME after NCRT. The surgical difficulty was graded as high or low according to the operative time, estimated blood loss, conversion to open surgery, postoperative hospital stay, and postoperative complications. Pelvimetry parameters were collected based on preoperative MRI. A logistic regression analysis was performed to identify predictors of high surgical difficulty, and a nomogram was developed. RESULTS: Totally, 18 (12.2%) patients were graded as high surgical difficulty. High surgical difficulty was correlated with a shorter interspinous distance (P = 0.014), a small angle α and γ (P = 0.008, P = 0.008, respectively), and a larger mesorectal area and mesorectal fat area (P = 0.041, P = 0.046, respectively). Tumor distance from the anal verge (OR = 0.619, P = 0.024), tumor diameter (OR = 3.747, P = 0.004), interspinous distance (OR = 0.127, P = 0.007), and angle α (OR = 0.821, P = 0.039) were independent predictors of high surgical difficulty. A predictive nomogram was developed with a C-index of 0.867. CONCLUSION: A shorter tumor distance from the anal verge, larger tumor diameter, shorter interspinous distance, and smaller angle α could help to predict high surgical difficulty of LaTME in male LARC patients after NCRT.


Assuntos
Endoscopia Gastrointestinal/métodos , Laparoscopia/métodos , Imageamento por Ressonância Magnética/métodos , Terapia Neoadjuvante , Pelvimetria/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Reto/cirurgia , Idoso , Canal Anal/patologia , Terapia Combinada , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Reto/patologia
11.
J Perinat Med ; 49(3): 241-253, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33068385

RESUMO

During labor mother and fetus are evaluated at intervals to assess their well-being and determine how the labor is progressing. These assessments require skillful physical diagnosis and the ability to translate the acquired information into meaningful prognostic decision-making. We describe a coordinated approach to the assessment of labor. Graphing of serial measurements of cervical dilatation and fetal station creates "labor curves," which provide diagnostic and prognostic information. Based on these curves we recognize nine discrete labor abnormalities. Many may be related to insufficient or disordered contractile mechanisms. Several factors are strongly associated with development of labor disorders, including cephalopelvic disproportion, excess analgesia, fetal malpositions, intrauterine infection, and maternal obesity. Clinical cephalopelvimetry involves assessing pelvic traits and predicting their effects on labor. These observations must be integrated with information derived from the labor curves. Exogenous oxytocin is widely used. It has a high therapeutic index, but is easily misused. Oxytocin treatment should be restricted to situations in which its potential benefits clearly outweigh its risks. This requires there be a documented labor dysfunction or a legitimate medical reason to shorten the labor. Normal labor and delivery pose little risk to a healthy fetus; but dysfunctional labors, especially if stimulated excessively by oxytocin or terminated by complex operative vaginal delivery, have the potential for considerable harm. Conscientiously implemented, the approach to the evaluation of labor outlined in this review will result in a reasonable cesarean rate and minimize risks that may accrue from the labor and delivery process.


Assuntos
Parto Obstétrico/métodos , Monitorização Fetal/métodos , Trabalho de Parto/fisiologia , Complicações do Trabalho de Parto/prevenção & controle , Monitorização Uterina/métodos , Feminino , Humanos , Pelvimetria/métodos , Gravidez , Risco Ajustado
12.
Surg Endosc ; 35(5): 2134-2143, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32410082

RESUMO

AIM: The impact of pelvis on the development of anastomotic leak (AL) in rectal cancer (RC) patients who underwent anterior resection (AR) remains unclear. The aim of this study was to evaluate the impact of pelvic dimensions on the risk of AL. METHODS: A total of 1058 RC patients undergoing AR from January 2013 to January 2016 were enrolled. Pelvimetric parameters were obtained using abdominopelvic computed tomography scans. RESULTS: Univariate analyses showed that pelvic inlet, pelvic outlet, interspinous distance, and intertuberous distance were significantly associated with the risk for AL (P < 0.05). Multivariate analysis confirmed that pelvic inlet and intertuberous distance were independent risk factors for AL (P < 0.05). Significant factors from multivariate analysis were assembled into the nomogram A (without pelvic dimensions) and nomogram B (with pelvic dimensions). The area under curve (AUC) of nomogram B was 0.72 (95% CI 0.67-0.77), which was better than the AUC of nomogram A (0.69, [95% CI 0.65-0.74]), but didn't reach a statistical significance (P = 0.199). Decision curve supported that nomogram B was better than nomogram A. CONCLUSION: Pelvic dimensions, specifically pelvic inlet and intertuberous distance, seemed to be independent predictors for postoperative AL in RC patients. Pelvic inlet and intertuberous distance incorporated with preoperative radiotherapy, preoperative albumin, conversion, and tumor diameter in the nomogram might provide a clinical tool for predicting AL.


Assuntos
Fístula Anastomótica/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Pelve/anatomia & histologia , Neoplasias Retais/cirurgia , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nomogramas , Pelvimetria/métodos , Pelve/diagnóstico por imagem , Fatores de Risco , Tomografia Computadorizada por Raios X
14.
Int J Colorectal Dis ; 36(5): 977-986, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33230658

RESUMO

PURPOSE: Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution. METHODS: A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses. RESULTS: Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape. CONCLUSION: Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.


Assuntos
Neoplasias Colorretais , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Masculino , Pelvimetria , Pelve/diagnóstico por imagem , Reto
15.
Reprod Domest Anim ; 55(11): 1592-1598, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32885509

RESUMO

Pelvis size plays an important role to prevent dystocia in cattle caused by the foeto-maternal disproportion in commonly primiparous females. The reproducibility and repeatability are two important aspects for the reliability of the measurements to use in the selection of cattle for culling. Pelvic measures were taken with a Rice pelvimeter from 224 young cattle (180 females and 44 males) of four beef breeds in South Africa. One experienced and two inexperienced observers each measured pelvic height and width twice. The proportion measurements with a maximum difference of 0.5 cm within animal compared with the first measurement by the experienced observer are around 80% and by the inexperienced observers around 50% for pelvic height and around 60% for pelvic width. Breed and sex do not affect the reliability of pelvimetry by an experienced observer. Under- and overestimation of pelvis size were observed in inexperienced observers, which seems to be unrelated to breed and sex.


Assuntos
Variações Dependentes do Observador , Pelvimetria/veterinária , Animais , Bovinos , Estudos Transversais , Feminino , Humanos , Masculino , Pelvimetria/métodos , Pelve/anatomia & histologia , Reprodutibilidade dos Testes , Especificidade da Espécie
16.
Tech Coloproctol ; 24(10): 991-1000, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32623536

RESUMO

BACKGROUND: The difficulty of performing total mesorectal excision (TME) for rectal cancer partly relies on the surgeon's subjective assessment of the individual patient's pelvic anatomy and tumour characteristics, which generally influences the choice of platform used (open, laparoscopic, robotic or trans-anal surgery). Recent studies have found associations between several anatomical pelvic measurements and surgical difficulty. The aim of this study was to systematically review existing data reporting the use of magnetic resonance imaging (MRI)-based pelvic measurements to predict technical difficulty and outcomes of TME, and determine whether pelvimetry could optimise patient-specific selection of a particular surgical approach. METHODS: MEDLINE, Embase and Cochrane Library databases were systematically searched for studies reporting MRI-based pelvic measurements in patients undergoing surgery for rectal cancer, and the effect of these measurements on surgical difficulty. RESULTS: Eleven studies reporting the association between MRI-pelvimetry measurements and rectal cancer surgical outcomes were included. Indicators for surgical difficulty used in the included studies were involved circumferential resection margin, longer operative time, incomplete TME, higher blood loss, anastomotic leak, conversion to open surgery and overall complications. Bony pelvic measurements which were associated with increased surgical difficulty in more than one study were a smaller interspinous distance, a smaller intertubercle distance, a smaller pelvic inlet and larger pubic tubercle height. Two studies identified larger mesorectal fat area as a predictor of surgical difficulty. CONCLUSIONS: Bony pelvic measurements may predict surgical difficulty during TME, however, use of different indicators of difficulty limit comparison between studies. Early data suggest MRI soft tissue measurements may predict surgical difficulty and warrants further investigation.


Assuntos
Laparoscopia , Neoplasias Retais , Feminino , Humanos , Imageamento por Ressonância Magnética , Pelvimetria , Pelve , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Resultado do Tratamento
17.
BJS Open ; 4(4): 666-677, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32342670

RESUMO

BACKGROUND: Technical difficulties in rectal surgery are often related to dissection in a limited surgical field. This study investigated the clinical value of MRI pelvimetry in the prediction of surgical difficulty associated with minimally invasive rectal surgery. METHODS: Patients with rectal cancer who underwent laparoscopic or robotic total mesorectal excision between 2005 and 2017 were reviewed retrospectively and categorized according to surgical difficulty on the basis of duration of surgery, conversion to an open procedure, use of the transanal approach, postoperative hospital stay, blood loss and postoperative complications. Preoperative clinical and MRI-related parameters were examined to develop a prediction model to estimate the extent of surgical difficulty, and to compare anastomotic leakage rates in the low- and high-grade surgical difficulty groups. Prognosis was investigated by calculating overall and relapse-free survival, and cumulative local and distant recurrence rates. RESULTS: Of 121 patients analysed, 104 (86·0 per cent) were categorized into the low-grade group and 17 (14·0 per cent) into the high-grade group. Multivariable analysis indicated that high-grade surgical difficulty was associated with a BMI above 25 kg/m2 (odds ratio (OR) 4·45, P = 0·033), tumour size 45 mm or more (OR 5·42, P = 0·042), anorectal angle 123° or more (OR 5·98, P = 0·028) and pelvic outlet less than 82·7 mm (OR 6·62, P = 0·048). All of these features were used to devise a four-variable scoring model to predict surgical difficulty. In patients categorized as high grade for surgical difficulty, the anastomotic leakage rate was 53 per cent (9 of 17 patients), compared with 9·6 per cent (10 of 104) in the low-grade group (P < 0·001). The high-grade group had a significantly higher local recurrence rate than the low-grade group (P = 0·002). CONCLUSION: This study highlights the impact of clinical variables and MRI pelvimetry in the prediction of surgical difficulty in minimally invasive rectal surgery.


ANTECEDENTES: Las dificultades técnicas en la cirugía del recto a menudo están relacionadas con la disección en un campo quirúrgico limitado. Este estudio se propuso investigar la utilidad clínica de la pelvimetría con MRI para predecir la dificultad quirúrgica asociada con la cirugía mínimamente invasiva del recto. MÉTODOS: Pacientes con cáncer de recto sometidos a resección total del mesorrecto laparoscópica o robótica entre 2005 y 2017 fueron revisados retrospectivamente y categorizados de acuerdo con la dificultad técnica en base al tiempo operatorio, conversión, uso de abordaje transanal, estancia hospitalaria postoperatoria, pérdida sanguínea y complicaciones postoperatorias. Se examinaron parámetros clínicos preoperatorios y relacionados con la MRI para desarrollar un modelo de predicción que estimara el grado de dificultad técnica y pudiera comparar la tasa de dehiscencias anastomóticas en los grupos de bajo y alto riesgo. También se evaluó el pronóstico con el cálculo de la supervivencia global, supervivencia libre de recidiva y tasas acumuladas de recidiva local y a distancia. RESULTADOS: De un total de 121 pacientes analizados, 104 pacientes (85,9%) fueron categorizados en el grupo con bajo grado de dificultad técnica, mientras que 17 pacientes (14,1%) lo fueron en el grupo de alto grado. En el análisis multivariable, un alto grado de dificultad técnica se asociaba con un índice de masa corporal (body mass index, BMI) > 25 kg/m2 (razón de oportunidades, odds ratio (OR), 4,5; P = 0,033), tamaño tumoral ≥ 45 mm (OR, 5,4; P = 0,042), ángulo anorrectal ≥ 123 grados (OR, 6,0; P = 0,028), estrecho pélvico < 82,7 mm (OR, 6,6; P = 0,048); en consecuencia, todas estas características fueron utilizadas para establecer un modelo de puntuación con 4 variables que pudiera predecir la dificultad técnica. En los pacientes categorizados como de alto grado de dificultad técnica, la tasa de dehiscencia anastomótica fue del 52,9%, mientras que en el grupo de bajo grado fue del 9,6% (P < 0,001). Finalmente, el grupo con alto grado mostró una tasa significativamente más elevada de recidiva local en comparación con el grupo de bajo grado (P = 0,002). CONCLUSIÓN: Este estudio pone de relieve el impacto de variables clínicas y de la pelvimetría con MRI para predecir la dificultad técnica en la cirugía mínimamente invasiva del recto.


Assuntos
Laparoscopia/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Idoso , Fístula Anastomótica/etiologia , Feminino , Humanos , Laparoscopia/efeitos adversos , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pelvimetria , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos
18.
J Gynecol Obstet Hum Reprod ; 49(3): 101681, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926348

RESUMO

INTRODUCTION: To estimate the association between an abnormal pelvic dimension at pelvimetry and the occurrence of severe neonatal morbidity after trial of labor after cesarean (TOLAC). MATERIALS AND METHODS: Retrospective observational cases-controls study conducted at a level 3 maternity units between 2006 and 2016. Included women were patient with trial of labor after one previous cesarean section, alive singleton fetus in cephalic presentation ≥ 37WG. Two groups were compared according to pelvic mesures at pelvimetry: pelvic dimension considered as abnormal, defined by Conjugate Diameter <10.5cm and/or Transverse Diameter <12cm and pelvic dimension considered as normal for other women. The primary outcome was a composite criterion of neonatal morbidity and mortality. A logistic multivariate regression model was use to estimate the association between an abnormal pelvic dimension at pelvimetry and the occurrence of severe neonatal morbidity. RESULTS: 2474 women were included. 863 (34.8 %) have a normal pelvic dimension and 1611 (65.2 %) an abnormal. Characteristics of labor were similar in two groups. Success of TOLAC was 84.7 % in normal pelvic group and 64.6 % in abnormal dimension of pelvic group. Neonatal morbidity was similar between two groups (1.7 % in normal pelvic dimension group versus 2.3 % in abnormal pelvic dimension group, p=0.26; crude OR: 1.39 (0.77-2.49) ; adjusted OR : 0.93 (0.51-1.68)). DISCUSSION: There were no association between pelvic dimension at pelvimetry and neonatal morbidity. In case of abnormal pelvic dimension, a combination of more prudence, and stringent user practices, achieve a high rate of vaginal delivery and a neonatal morbidity comparable to the normal pelvic dimension group.


Assuntos
Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Pelvimetria , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Gravidez , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
Artigo em Japonês | MEDLINE | ID: mdl-31956183

RESUMO

PURPOSE: X-ray pelvimetry is typically performed for the diagnosis of the cephalopelvic disproportion (CPD). The purpose of this study was to assess the utility of new computed tomography (CT) reconstruction "deep learning based reconstruction (DLR) " in ultra-low dose CT pelvimetry. METHOD: CT pelvimetry was performed 320-row CT. All CT images were reconstructed with and without DLR and transferred for workstation to processing martius and guthmann view. Radiologist and obstetrician-gynecologist subjectively ranked overall image quality of each CT image from the best to the worst. Exposure dose of the CT pelvimetry used a following calculated value, displayed CT dose index (CTDI) vol multiplied by measured value using the thimble chamber and pelvic phantom, and of the X-ray pelvimetry used Japan-Diagnositic Refernce Levels 2015 as a reference, were compared. RESULT: 3D images obtained from CT pelvimetry with DLR showed accurate biparietal diameter and obstetric conjugate as compared to without DLR. Radiation dose of CT pelvimetry is 0.39 mGy, of X-ray pelvimetry is 1.18 mGy, respectively. Conculusion: Although the visualizing high contrast object, such as bone morphology, is likely to reduce exposure dose in CT examination generally, DLR enable to further dose reduction to keep image quality. 3D image processing from CT pelvimetry solves the problem of expansion rate in X-P pelvimetry and provide accurate measurements. Furthermore, CT pelvimetry can undergo more comfortable position for Pregnant Woman in Labor.


Assuntos
Desproporção Cefalopélvica , Aprendizado Profundo , Pelvimetria , Desproporção Cefalopélvica/diagnóstico por imagem , Feminino , Humanos , Japão , Gravidez , Doses de Radiação , Tomografia Computadorizada por Raios X
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