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Medicine Oct 2023Laparoscopic Roux-en-Y gastric diversion is one of the most widely used surgical procedures for weight reduction and metabolic surgery, which is a hybrid approach to...
RATIONALE
Laparoscopic Roux-en-Y gastric diversion is one of the most widely used surgical procedures for weight reduction and metabolic surgery, which is a hybrid approach to restrict intake and reduce absorption. Despite the successful completion of laparoscopic Roux-en-Y gastric diversion, 10% to 20% of patients still experience regained body mass or other complications.
PATIENT CONCERNS
The patient had regained weight after all the RYGB surgeries, and after diet and exercise control, the results were not good, so she came to our department for treatment.
DIAGNOSES
Dilatation of the gastric pouch was observed on iodinated water imaging of the upper gastrointestinal tract and on abdominal CT.
INTERVENTIONS
We report 2 patients with dilated gastric bursa after RYGB, both female, who underwent gastric diversion revision.
OUTCOMES
Both patients in this case underwent laparoscopic gastric diversion correction to improve weight rebound. Their quality of life improved significantly after treatment. There were no grade 3/4 treatment-related adverse events during the treatment period.
LESSONS
The above cases suggest that patients who regain weight after RYGB should routinely undergo preoperative upper gastrointestinal endoscopy and upper gastrointestinal iodine hydrography in order to observe the muscle tone of the patient's gastric bursa and the degree of dilatation of the gastrointestinal anastomosis and consider whether to correct the dilated gastric bursa intraoperatively before converting to LSG.
Topics: Humans; Female; Obesity, Morbid; Gastric Bypass; Gastrectomy; Quality of Life; Reoperation; Laparoscopy; Dystocia; Retrospective Studies; Postoperative Complications; Treatment Outcome
PubMed: 37904354
DOI: 10.1097/MD.0000000000035077 -
Fa Yi Xue Za Zhi Feb 2024To analyze the high risk factors of obstetric brachial plexus palsy (OBPP), and to explore how to evaluate the relationship between fault medical behavior and OBPP in...
OBJECTIVES
To analyze the high risk factors of obstetric brachial plexus palsy (OBPP), and to explore how to evaluate the relationship between fault medical behavior and OBPP in the process of medical damage forensic identification.
METHODS
A retrospective analysis was carried out on 25 cases of medical damage liability disputes related to OBPP from 2017 to 2021 in Beijing Fayuan Judicial Science Evidence Appraisal Center. The shortcomings of hospitals in birth weight assessment, delivery mode selection, labor process observation and shoulder dystocia management, and the causal relationship between them and the damage consequences of the children were summarized.
RESULTS
Fault medical behavior was assessed as the primary cause in 2 cases, equal cause in 10 cases, secondary cause in 8 cases, minor cause in 1 case, no causal relationship in 1 case, and unclear causal force in 3 cases.
CONCLUSIONS
In the process of forensic identification of OBPP, whether medical behaviors fulfill diagnosis and treatment obligations should be objectively analyzed from the aspects of prenatal evaluation, delivery mode notification, standardized use of oxytocin, standard operation of shoulder dystocia, etc. Meanwhile, it is necessary to fully consider the objective risk of different risk factors and the difficulty of injury prevention, and comprehensively evaluate the causal force of fault medical behavior in the damage consequences.
Topics: Pregnancy; Female; Child; Humans; Shoulder Dystocia; Retrospective Studies; Brachial Plexus; Paralysis, Obstetric; Brachial Plexus Neuropathies; Risk Factors; Paralysis
PubMed: 38500460
DOI: 10.12116/j.issn.1004-5619.2022.220302 -
The Journal of Maternal-fetal &... Dec 2023In pregnancies complicated by maternal obesity and diabetes, a disruption in inflammatory mediators occurs, resulting in endothelial microvascular dysfunction, oxidative...
OBJECTIVE
In pregnancies complicated by maternal obesity and diabetes, a disruption in inflammatory mediators occurs, resulting in endothelial microvascular dysfunction, oxidative stress, tissue damage, and maternal and feto-neonatal complications. To outline this proinflammatory status, an innovative approach is represented by the measurement of proinflammatory cytokines. Among these biomarkers, B-cell-activating factor (BAFF) and platelet-activating factor (PAF) play a key role in metabolic regulation, immune response to infections, tissue homeostasis, and "food-related inflammation." The aim of the present study is to investigate the blood expression of BAFF and PAF in a cohort of pregnant women affected by obesity and diabetes compared with a control group of healthy pregnant women.
METHODS
A prospective longitudinal cohort study has been conducted on pregnant women referred to Fondazione Policlinico Universitario Gemelli IRCCS in Rome. For each pregnant woman, a capillary sample was collected with a swab in three different consecutive evaluations carried out in the three trimesters of pregnancy.
RESULTS
A total of 77 pregnant women have been enrolled. No significant differences in BAFF and PAF levels were longitudinally observed between groups. Focusing on the exposed group, in the third trimester of pregnancy, both PAF and BAFF levels were lower than the basal time. Among the selected group of patients who developed Gestational Diabetes, only PAF values were longitudinally lower when compared to other groups. The multivariate analysis showed that BAFF levels were positively correlated with thyroid-stimulating hormone levels. No macrosomia, no shoulder dystocia, no major perineal lacerations at birth, and no intrauterine growth restriction were observed in the whole population.
CONCLUSIONS
This study supports the involvement of metabolic and proinflammatory biomarkers in the mechanisms related to pregnancy complications. Improving a good metabolic environment for obese and diabetic pregnant women could break the vicious cycle connecting inflammation, oxidative stress, and metabolic disorders.
Topics: Female; Humans; Pregnancy; Biomarkers; Diabetes, Gestational; Inflammation; Longitudinal Studies; Obesity; Obesity, Maternal; Platelet Activating Factor; Prospective Studies
PubMed: 37872771
DOI: 10.1080/14767058.2023.2272010 -
BMJ Open Mar 2024Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated.... (Observational Study)
Observational Study
Patient characteristics, surgery outcomes, presumed aetiology and other characteristics of fistula surgeries and related procedures supported by Fistula Foundation from 2019 to 2021: a multicentre, retrospective observational study.
OBJECTIVES
Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated. Fistula repair surgery can restore a woman's health and well-being. Fistula Foundation, a non-profit organisation, works in partnership with local hospitals and community organisations in Africa and Asia to address key barriers to treatment and to increase the number of women receiving surgical care. This paper presents data on fistula and fistula repair surgery across a large global network of hospitals supported by Fistula Foundation. The data were collected between 2019 and 2021.
DESIGN
Multicentre, retrospective, observational, descriptive study.
SETTING AND PARTICIPANTS
The study analysed deidentified data from 24 568 surgical repairs supported by Fistula Foundation to treat women with obstetric fistula at 110 hospitals in 27 countries.
RESULTS
The data highlight patient characteristics and key trends and outcomes from obstetric fistula repair surgeries and related procedures. Of those surgeries, 87% resulted in a successful outcome (fistula dry and closed) at the time of discharge, highlighting the effectiveness of fistula repair in restoring continence and improving quality of life. Over the period studied, the number of supported surgeries increased by 14%, but there remains an urgent need to strengthen local surgical capacity and improve access to treatment. Women suffered an average of 5.7 years before they received surgery and only 4% of women sought care independently. This underscores the importance of enhancing community awareness and strengthening referral networks.
CONCLUSIONS
This research provides essential insight from a vast, global network of hospitals providing highly effective fistula repair surgery. Further investment is needed to strengthen surgical capacity, increase awareness of fistula and remove financial barriers to treatment if stakeholders are to make significant progress towards the United Nations' ambitious vision of ending fistula by 2030.
Topics: Pregnancy; Female; Humans; Vesicovaginal Fistula; Retrospective Studies; Quality of Life; Obstetric Surgical Procedures; Dystocia
PubMed: 38485171
DOI: 10.1136/bmjopen-2023-078426 -
AJOG Global Reports Aug 2023Fetal neck masses are uncommon but challenging to manage, particularly in limited-resource settings. We prenatally diagnosed a large fetal neck mass after consultative...
Fetal neck masses are uncommon but challenging to manage, particularly in limited-resource settings. We prenatally diagnosed a large fetal neck mass after consultative referral for polyhydramnios at 30 weeks' gestation. The pregnant patient was counseled on the findings, differential diagnoses, and the prenatal and postnatal management options. She delivered at 38 weeks' gestation through emergent cesarean delivery after presenting in labor owing to concern for labor dystocia with the large mass. The diagnosis of lymphangioma was made postnatally through imaging. Good prognosis has been reported in several cases with surgery and/or sclerotherapy, even in low-resource settings. Despite the availability of a pediatric surgeon to perform a resection, the family declined treatment because of a belief that the mass was of supernatural etiology. Patient-centered, multidisciplinary services focusing on maternal and fetal complications should assess and account for cultural beliefs to better understand and counsel families who have a fetus or neonate with a congenital anomaly.
PubMed: 37435176
DOI: 10.1016/j.xagr.2023.100242 -
Cureus Oct 2023Brachial plexus birth injury (BPBI) is a rare dystocia complication. Although it has a good prognosis, a significant number retain functional impairment to varying...
OBJECTIVES
Brachial plexus birth injury (BPBI) is a rare dystocia complication. Although it has a good prognosis, a significant number retain functional impairment to varying degrees. The data concerning shoulder function improvement and complication rates are conflicting due to variations in outcome measures between the studies. Therefore, we report our experience with this approach.
METHODS
It was a retrospective study conducted at King Faisal Specialist Hospital and Research Center in Riyadh (FSH&RC), Saudi Arabia. Data such as patient demographics, Mallet scores, and passive external rotation (PER) in adduction and abduction were retrieved from the medical records.
RESULTS
In active shoulder function, Mallet score significantly improved (P=0.00). The improvement was most remarkable in active external rotation movement (P=0.00) followed by hand to the neck. However, no significant gain was observed in active abduction and hand-to-back. At the final follow-up, with a mean of 2.9 years, the improvement in PER in adduction and abduction was maintained. Compared to six months postoperative, no significant difference was found in hand-to-neck, hand-to-back, and total Mallet score.
CONCLUSION
Subscapularis z-lengthening with coracoidectomy was consistently effective in correcting internal rotation contraction in a patient with BPBI. Significant improvements were observed in the Mallet score and PER in adduction and abduction.
PubMed: 38021901
DOI: 10.7759/cureus.47740 -
PloS One 2023To predict the interspinous distance (ISD) using the relationship between female height and pelvimetric measures on magnetic resonance (MR) images.
OBJECTIVE
To predict the interspinous distance (ISD) using the relationship between female height and pelvimetric measures on magnetic resonance (MR) images.
METHODS
We obtained measurements of the pubic arch angle (PAA), inlet-anteroposterior (AP) distance, mid-pelvis AP distance, outlet-AP distance, ISD, and ischial tuberosity distance using 710 pelvic MR images from nonpregnant reproductive-aged (21-50 years) women from January 2014 to June 2020. Patient height was also assessed from medical records. We determined the formula for predicting ISD using multiple regression analysis.
RESULTS
The mean ± standard deviation of the height, PAA, inlet-AP distance, mid-pelvis AP distance, outlet-AP distance, ISD, and ischial tuberosity distance were 160.0 ± 5.5 cm, 87.31 ± 6.6°, 129.7 ± 9.0 mm, 119.7 ± 8.5 mm, 111.71 ± 8.90 mm, 108.88 ± 8.0 mm, and 121.97 ± 11.8 mm, respectively. Two significant regression formulas for predicting ISD were identified as follows: ISD = 0.24973 × height - 0.06724 × inlet-AP distance + 0.12166 × outlet-AP distance + 0.29233 × ischial tuberosity distance + 0.32524 × PAA (P < 0.001, R2 = 0.9973 [adjusted R2 = 0.9973]) and ISD = 0.40935 × height + 0.49761 × PAA (P < 0.001, R2 = 0.9965 [adjusted R2 = 0.9965]).
CONCLUSION
ISD is the best predictor of obstructed labor. This study predicted ISD with 99% explanatory power using only the height and PAA. The PAA can be measured by transperineal ultrasound. This formula may successfully predict vaginal delivery or cephalopelvic disproportion.
Topics: Pregnancy; Humans; Female; Adult; Pelvis; Delivery, Obstetric; Pelvimetry; Dystocia; Magnetic Resonance Imaging
PubMed: 37561690
DOI: 10.1371/journal.pone.0289814 -
Journal of Veterinary Internal Medicine 2023Attainment of adequate transfer of passive immunity (TPI) is critical to health of calves; however, studies comparing available tools for measurement of TPI in...
Comparison of turbidometric immunoassay, refractometry, and gamma-glutamyl transferase to radial immunodiffusion for assessment of transfer of passive immunity in high-risk beef calves.
BACKGROUND
Attainment of adequate transfer of passive immunity (TPI) is critical to health of calves; however, studies comparing available tools for measurement of TPI in individual beef animals are limited.
OBJECTIVES
To report agreement between 4 tests evaluating individual TPI status in beef calves.
ANIMALS
One hundred ninety-six beef calves born to cows and heifers presenting for calving management or dystocia.
METHODS
Retrospective study to assess serum immunoglobulin (IgG) concentrations via turbidimetric immunoassay (TI), gamma-glutamyl transferase (GGT), serum total protein (TP), and single radial immunodiffusion (RID; reference standard). Test agreement was evaluated using Passing-Bablok regression, Bland-Altman analysis, Cohen's kappa, and receiver operating characteristic (ROC) curves with and without covariate adjustment to determine optimal thresholds.
RESULTS
Correlation between RID and test results varied: TI, ρ = 0.757; TP, ρ = 0.715; GGT: ρ = 0.413. For the TI compared to RID, regression analysis identified a constant (intercept = -0.51 [CI: -2.63, 3.05]) and proportional (slope = 1.87 [CI: 1.69, 2.08]) bias. Based on ROC, TI concentrations of ≤9.89 and ≤13.76 g/L, and TP concentrations of ≤5.5 and ≤6.0 g/dL, indicated IgG concentrations <18.0 and <25.0 g/L, respectively.
CONCLUSIONS AND CLINICAL IMPORTANCE
Within this cohort of calves, TI demonstrated the best correlation with RID; however, significant bias was identified which led to frequent underestimation of IgG concentration. Serum total protein demonstrated less correlation with RID but had less misclassification than TI. Both TI and TP demonstrated less correlation for calves that received colostrum replacement prompting clinical awareness of colostrum type when evaluating individual TPI in beef calves.
Topics: Humans; Pregnancy; Animals; Cattle; Female; Animals, Newborn; Immunity, Maternally-Acquired; Immunoglobulin G; Refractometry; gamma-Glutamyltransferase; Retrospective Studies; Immunoassay; Immunodiffusion; Colostrum
PubMed: 37549250
DOI: 10.1111/jvim.16831 -
Journal of Dairy Science Apr 2024In the United States, it is becoming common for dairy herds to mate a portion of cows to beef semen to create a value-added calf. The objectives of this study were to...
In the United States, it is becoming common for dairy herds to mate a portion of cows to beef semen to create a value-added calf. The objectives of this study were to determine if dystocia risk, stillbirth (SB) risk, gestation length (GL), probability of early-lactation clinical disease events, early-lactation culling risk, or subsequent milk production differ between cows that carried calves sired by different beef breeds and those that carried Holstein-sired calves. Records from 10 herds contained 75,256 lactations from 39,249 cows that had calves with known Holstein or beef breed sires from the years 2010 to 2023. Calf sire breeds with ≥150 records included in analyses were Holstein, Angus, Simmental, Limousin, crossbred beef, and Charolais. Additional beef sire breeds that existed in lower frequency (n < 150 records) were condensed together and classified as "other." Because GL is a continuous variable, sire breed inclusion criteria were reduced to n ≥ 100 records; thus, Wagyu sires were included as their own breed group. Some records did not contain all variables of interest, thus models included fewer lactations depending on variable. Binomial generalized mixed models evaluated dystocia risk (defined as calving ease score ≥4 or calving ease score ≥3), SB risk, clinical health event risk (defined as lameness, mastitis, metabolic, reproductive, other, or any health events occurring within 60 d in milk [DIM]), and early culling risk (defined as death or culling within 60 DIM). Gestation length and test-date milk, fat, and protein yields were evaluated with mixed models. Calves sired by crossbred beef bulls had a greater probability of being stillborn (5%; 95% confidence interval lower = 2.9% upper = 9.0%) than those sired by Holstein bulls (2%; 95% confidence interval lower = 1.5%, upper = 2.7%). All beef-sired calves increased GL from that of Holstein-sired calves (277 ± 0.15 d) with Limousin (282 ± 0.81 d) and Wagyu-sired calves (285 d ± 0.79) resulting in the longest GL. The risk of dystocia, clinical health events, and early-lactation culling did not differ by calf sire breed nor did subsequent milk and component yield. Generally, carrying a calf sired by the beef breeds included in this study did not negatively affect the dairy cow.
Topics: Pregnancy; Female; Animals; Cattle; Male; Stillbirth; Reproduction; Lactation; Milk; Dystocia; Cattle Diseases
PubMed: 37949400
DOI: 10.3168/jds.2023-24112 -
Acta Obstetricia Et Gynecologica... Feb 2024Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to...
INTRODUCTION
Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown.
MATERIAL AND METHODS
This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25-hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25-hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders.
RESULTS
Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage.
CONCLUSIONS
In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage.
Topics: Infant, Newborn; Humans; Pregnancy; Female; Postpartum Hemorrhage; Uterine Inertia; Cesarean Section; Retrospective Studies; Vitamin D Deficiency; Vitamin D
PubMed: 37960966
DOI: 10.1111/aogs.14719