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The British Journal of Surgery Mar 2024Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of...
BACKGROUND
Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.
METHOD
Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.
RESULTS
One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.
CONCLUSIONS
EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
Topics: Humans; Treatment Outcome; Quality of Life; Pelvis; Pelvic Exenteration; Health Personnel; Delphi Technique; Research Design
PubMed: 38456677
DOI: 10.1093/bjs/znae042 -
International Journal of Computer... Feb 2018To develop a hybrid augmented marker-based navigation system for acetabular reorientation during peri-acetabular osteotomy (PAO).
OBJECTIVE
To develop a hybrid augmented marker-based navigation system for acetabular reorientation during peri-acetabular osteotomy (PAO).
METHODS
The system consists of a tracking unit attached to the patient's pelvis, augmented marker attached to the acetabular fragment and a host computer to do all the computations and visualization. The augmented marker is comprised of an external planar Aruco marker facing toward the tracking unit and an internal inertial measurement unit (IMU) to measure its orientation. The orientation output from the IMU is sent to the host computer. The tracking unit streams a live video of the augmented marker to the host computer, where the planar marker is detected and its pose is estimated. A Kalman filter-based sensor fusion combines the output from marker tracking and the IMU. We validated the proposed system using a plastic bone study and a cadaver study. Every time, we compared the inclination and anteversion values measured by the proposed system to those from a previously developed optical tracking-based navigation system.
RESULTS
Mean absolute differences for inclination and anteversion were 1.34 ([Formula: see text]) and 1.21 ([Formula: see text])[Formula: see text], respectively, for the cadaver study. Mean absolute differences were 1.63 ([Formula: see text]) and 1.55 ([Formula: see text])[Formula: see text] for inclination and anteversion for the plastic bone study. In both validation studies, very strong correlations were observed.
CONCLUSION
We successfully demonstrated the feasibility of our system to measure the acetabular orientation during PAO.
Topics: Acetabulum; Cadaver; Equipment Design; Hip Joint; Humans; Materials Testing; Models, Anatomic; Osteotomy; Pelvis; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 29188423
DOI: 10.1007/s11548-017-1690-6 -
European Surgical Research. Europaische... 2023Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients...
INTRODUCTION
Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management, and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdominopelvic surgery.
METHODS
Patients who had major intraoperative pelvic hemorrhage during complex abdominopelvic surgery at 11 tertiary referral centers between 1997 and 2017 were included. Patient characteristics, management strategies to control bleeding, short- and long-term postoperative outcomes were evaluated retrospectively.
RESULTS
There were 120 patients with a mean age of 56.6 ± 2.4 years and a mean BMI of 28.3 ± 1 kg/m2. While 104 (95%) of the patients were operated for malignancy, 16 (5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90 (75%). Major pelvic hemorrhage was managed simultaneously in 114 (95%) patients. Electrocauterization 27 (23%), pelvic packing 26 (22%), suturing 7 (6%), thumbtacks application 7 (6%), muscle welding 4 (4%), use of energy devices 2 (2%), and topical hemostatic agents 2 (2%) were the management tools. Combined techniques were used in 43 (36%) patients. Short-term morbidity and mortality rates were 48 (40%) and 2 (2%), respectively. High preoperative CRP levels (p = 0.04), history of preoperative radiotherapy (p = 0.04), longer bleeding time (p = 0.006), and increased blood transfusion (p = 0.005) were the factors associated with postoperative morbidity.
CONCLUSION
Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdominopelvic surgery.
Topics: Humans; Middle Aged; Retrospective Studies; Hemorrhage; Pelvis; Blood Transfusion
PubMed: 37816336
DOI: 10.1159/000534477 -
Polski Przeglad Chirurgiczny Sep 2022Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been...
Pelvic fractures are life-threatening injuries with mortality as high as 40%. The major cause of death is pelvic exsanguination. Extraperitoneal pelvic packing has been suggested in recent years to be an effective method for hemorrhage control. This article briefly reviews the various aspects related to this procedure with emphasis on history, outcomes, technique and complications.
Topics: Humans; Bandages; Pelvis; Hemorrhage
PubMed: 36805990
DOI: 10.5604/01.3001.0015.9819 -
PloS One 2022The purpose of this study was to analyse the biomechanical characteristics of pedicle screws with different placement methods and diameters in the treatment of Tile C1...
OBJECTIVE
The purpose of this study was to analyse the biomechanical characteristics of pedicle screws with different placement methods and diameters in the treatment of Tile C1 pelvic fractures by finite element simulation technology and to compare them with the plate fixation model to verify the effectiveness of pedicle screw fixation.
METHODS
A three-dimensional digital model of a normal pelvis was obtained using computed tomography images. A finite element model of a normal pelvis containing major ligaments was built and validated (Model 1). Based on the verified normal pelvis finite element model, a Tile C1 pelvic fracture model was established (Model 2), and then a plate fixation model (Model 3) and a pedicle screw fixation model with different screw placement methods and diameters were established (Models 4-15). For all pelvic fracture fixation models, a vertical load of 500 N was applied on the upper surface of the sacrum to test the displacement and stress distribution of the pelvis in the standing state with both legs.
RESULTS
The finite element simulation results showed the maximum displacement of Model 1 and Models 3-15 to be less than 1 mm. The overall maximum displacement of Models 4-15 was slightly larger than that of Model 3 (the maximum difference was 177.91×10-3 mm), but the maximum displacement of iliac bone and internal fixation in Models 4-15 was smaller than that of Model 3. The overall maximum stress (maximum stress of the ilium) and maximum stress of internal fixation in Models 4-15 were less than those in Model 3. The maximum displacement difference and maximum stress difference at the fracture of the pubic ramus between each fixed model were less than 0.01 mm and 1 MPa, respectively. The greater the diameter and number of pedicle screws were, the smaller the maximum displacement and stress of the pelvic fracture models were.The maximum displacement and stress of the pelvic fracture models of the screws placed on the injured side of the pubic region were smaller than the screws on the healthy side.
CONCLUSION
Both the anterior and posterior pelvic rings are fixed with a pedicle screw rod system for treatment of Tile C1 pelvic fractures, which can obtain sufficient biomechanical stability and can be used as a suitable alternative to other implants.The greater the diameter and number of pedicle screws were, the greater the pelvic stability was, and the greater was the stability of the screws placed on the injured side of the pubic region than the screws on the healthy side.
Topics: Biomechanical Phenomena; Finite Element Analysis; Fracture Fixation, Internal; Fractures, Bone; Humans; Pedicle Screws; Pelvic Bones; Pelvis; Sacrum
PubMed: 36006983
DOI: 10.1371/journal.pone.0273351 -
International Angiology : a Journal of... Dec 2020Instrumental diagnosis of pelvic-perineal reflux is based on the use of ultrasound and radiological methods; however, the volume of their use represents a stumbling...
BACKGROUND
Instrumental diagnosis of pelvic-perineal reflux is based on the use of ultrasound and radiological methods; however, the volume of their use represents a stumbling block for various researchers. The study aimed to determine the diagnostic value and reasonability of ovarian and pelvic venography in female patients with pelvic varicose veins (PVV) and vulvar varicosities (VV).
METHODS
A total of 62 women with PVV were examined and allocated into two groups with or without the pelvic congestion syndrome (PCS) symptoms. Patients of group 1 with the PCS symptoms (N.=30) had concomitant VV (13.3%) and valvular incompetence of the left (83.3%) or right (16.7%) gonadal veins, parametrial (100%) and uterine (70%) veins, according to the duplex ultrasound scanning (DUS). Patients of group 2 without the PCS symptoms (N.=32) had valvular incompetence of the left gonadal vein (9.4%), parametrial (100%), uterine (3.1%) and vulvar veins (100%), according to the DUS. All patients underwent ovarian and pelvic venography (OPV) for imaging of the pelvic-perineal reflux.
RESULTS
In group 1, dilation and valvular incompetence of the gonadal and parametrial veins were confirmed by the OPV in 100% of patients. The imaging of the obturator vein (OV) was obtained in 6.6% patients and internal pudendal vein (IPV) in 6.6% patients; no reflux of the contrast agent in the vulvar veins was observed. In group 2, the OPV confirmed the valvular incompetence of the left gonadal vein in 9.4% patients and parametrial vein in 100% patients. The contrast agent in the OV was found in 9.4%, and in the IPV in 6.3% patients, while no reflux of the contrast agent in the dilated vulvar veins was observed.
CONCLUSIONS
Pelvic venography is a not mandatory component of the examination of women with pelvic and vulvar varicose veins without varicose veins of the lower extremities, who do not have symptoms of the PCS and valvular incompetence of the gonadal veins according to the DUS.
Topics: Female; Humans; Iliac Vein; Pelvic Pain; Pelvis; Phlebography; Varicose Veins
PubMed: 32594669
DOI: 10.23736/S0392-9590.20.04402-8 -
Journal of Orthopaedic Surgery and... Sep 2020Until recently, rasterstereographic analysis of the spine was limited to static measurements. However, understanding and evaluating the motion of the spine under dynamic... (Observational Study)
Observational Study
BACKGROUND
Until recently, rasterstereographic analysis of the spine was limited to static measurements. However, understanding and evaluating the motion of the spine under dynamic conditions is an important factor in the diagnosis and treatment of spinal pathologies. The aim of this study was to study the spinal posture and pelvic position under dynamic conditions and compare it to static measurements using a dynamic rasterstereographic system.
METHODS
A total of 121 healthy volunteers (56 females; 65 males) were included in this observational study. The parameters trunk inclination, trunk imbalance, pelvic obliquity, kyphotic angle, lordotic angle, surface rotation, and lateral deviation were studied and compared under static and dynamic (1, 2, 4, 5 km/h) conditions using the system "Formetric 4D Motion®" (DIERS International GmbH, Germany).
RESULTS
Female volunteers had a higher lordotic angle than males under static conditions (p < 0.001). Trunk inclination (5.31° vs. 6.74°), vertebral kyphotic angle (42.53° vs. 39, 59°), and surface rotation (3.35° vs. 3.81°) increase under dynamic conditions (p < 0.001). Trunk inclination and lordotic angle both show significant changes during walking compared to static conditions (p < 0.001).
CONCLUSION
The spinal posture differs between females and males during standing and during walking. Rasterstereography is a valuable tool for the dynamic evaluation of spinal posture and pelvic position, which can also be used to quantify motion in the spine and therefore it has the potential to improve the understanding and treatment of spinal pathologies.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Adult; Female; Healthy Volunteers; Humans; Male; Pelvis; Posture; Radiostereometric Analysis; Sex Characteristics; Spine; Walking; Young Adult
PubMed: 32900390
DOI: 10.1186/s13018-020-01825-0 -
The American Journal of Case Reports Jun 2020BACKGROUND The aim of this study was to report the clinical diagnosis and treatment of a case of pelvic actinomycosis in our hospital and provide a review of recent... (Review)
Review
BACKGROUND The aim of this study was to report the clinical diagnosis and treatment of a case of pelvic actinomycosis in our hospital and provide a review of recent literature. CASE REPORT The patient was a 54-year-old woman who was admitted to our hospital due to "bilateral lower abdominal tenderness accompanied with anorexia and vomiting for 3 months". After admission, a variety of imaging examinations found pelvic space-occupying lesions, which were considered as malignant. She underwent surgery and pelvic actinomycosis was diagnosed by postoperative pathology. Postoperatively, she was treated with a high-dose sufficient course of penicillin (20 million U, iv gtt) for 14 days and she is currently under close follow-up for 1 year, with no recurrent symptoms. CONCLUSIONS Pelvic actinomycosis is rare and often forms mass invasion into the tissue structure around the pelvic cavity, which is easily misdiagnosed as ovarian malignant tumor. The criterion standard for diagnosing an infection is culture, with histopathology aiding the diagnosis.
Topics: Actinomycosis; Anti-Bacterial Agents; Diagnosis, Differential; Female; Genital Diseases, Female; Humans; Intrauterine Devices; Middle Aged; Pelvis; Penicillins
PubMed: 32532952
DOI: 10.12659/AJCR.922601 -
Radiographics : a Review Publication of... Oct 2022US and MRI-guided therapeutic US (TUS) can aid in the treatment of prostate, liver, and pancreatic cancer, as well as uterine fibroids and osseous metastases, and...
US and MRI-guided therapeutic US (TUS) can aid in the treatment of prostate, liver, and pancreatic cancer, as well as uterine fibroids and osseous metastases, and understanding the selection and optimization of treatment strategies is essential to furthering TUS advances and innovations.
Topics: Abdomen; Abdominal Cavity; Humans; Pelvis
PubMed: 36190852
DOI: 10.1148/rg.220044 -
Anatomical Record (Hoboken, N.J. : 2007) Aug 2018Variation in the pelvis is intrinsically linked to life history evolution. This is perhaps best exemplified by sexually dimorphic pelvic variation in bipedal primates....
Variation in the pelvis is intrinsically linked to life history evolution. This is perhaps best exemplified by sexually dimorphic pelvic variation in bipedal primates. Yet, whether this trend is applicable to other taxa is unclear. Using turtle anatomy as a model, I tested the hypothesis that the pelvis is also sexually dimorphic in egg-laying tetrapods. I sampled a natural turtle population with female-biased sexual size dimorphism (i.e., larger females). I show that the area of the egg canal (pelvic aperture) is greater in females. Morphological differences between sexes were predicted by body size, such that skeletal shape deformation of the female ilium increased proportionally with pelvic aperture area. These results suggest that sexual pelvic dimorphism might be indirectly maintained by selection for large female size, consistent with the pelvic constraint hypothesis in reptiles. However, subsampling of similarly sized individuals revealed that pelvic aperture area and shape may vary in disproportion to body size. Comparisons of pelvic ontogenetic trajectories across multiple lineages are needed to clarify the occurrence of sexual pelvic dimorphism in turtles and other egg-laying tetrapods. My findings provide impetus to further explore how sex-specific functional demands influence the architecture of the pelvic girdle. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.
Topics: Animals; Female; Male; Pelvic Bones; Pelvis; Principal Component Analysis; Sex Characteristics; Turtles
PubMed: 29677702
DOI: 10.1002/ar.23831