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Annals of Surgery Jul 2023To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy.
SUMMARY BACKGROUND DATA
Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking.
METHODS
We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link.
RESULTS
We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%).
CONCLUSIONS
Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Premature Birth; Maternal Mortality; Fetus; Abdomen
PubMed: 34966066
DOI: 10.1097/SLA.0000000000005362 -
Diseases of the Colon and Rectum Dec 2012The learning curve for laparoscopic colorectal surgery has not been conclusively analyzed. No reliable framework for case selection during training is available. (Review)
Review
BACKGROUND
The learning curve for laparoscopic colorectal surgery has not been conclusively analyzed. No reliable framework for case selection during training is available.
OBJECTIVE
The aim of this study was to analyze the length of the learning curve of laparoscopic colorectal surgeons and to recommend a case selection framework at the early stage of independent practice.
DATA SOURCES
Medline (1988-2010, October week 4) and Embase (1988-2010) were used for the literature review, databases were retrieved from the authors, and expert opinion was surveyed.
STUDY SELECTION
Studies describing the learning curve of laparoscopic or laparoscopically assisted colorectal surgery were selected.
INTERVENTION
No interventions were performed.
MAIN OUTCOME MEASURES
Learning curves were analyzed by using risk-adjusted, bootstrapped cumulative sum curves. Conversions and complications were independent variables in a multilevel random-effects regression model. Recommendations are based on analysis of ORs and a structured expert opinion gauging process.
RESULTS
Twenty-three studies were identified, showing great disparity on the length of the learning curve. Seven studies, representing 4852 cases (19 surgeons), were analyzed. Risk-adjusted cumulative sum charts demonstrated the length of the learning curves to be 152 cases for conversions, 143 for complications, 96 for operating time, 87 for blood loss, and 103 for length of stay. Body mass index and pelvic dissection (rectum), especially in male patients, independently increased the risk of complication and conversion. The expert survey revealed that increasing T stage and complicated inflammatory disease are likely to increase the complexity of the case. Based on this evidence, a framework for case selection in training was proposed.
LIMITATIONS
The generalizability of the study results maybe reduced because of inconsistent data quality and individual variations in the length of the learning curve
CONCLUSIONS
This multicenter database suggests a length of the learning curve of 88 to 152 cases. The use of the suggested framework may prevent high conversion and complication rates during the learning curve.
Topics: Clinical Competence; Colorectal Surgery; Humans; Laparoscopy; Learning Curve; Postoperative Complications; Regression Analysis
PubMed: 23135590
DOI: 10.1097/DCR.0b013e31826ab4dd -
Sexually Transmitted Infections Jun 2006To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening. (Review)
Review
OBJECTIVE
To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening.
METHODS
Systematic review. A search of 11 electronic bibliographic databases from the earliest date available to August 2004 using keywords including chlamydia, pelvic inflammatory disease, economic evaluation, and cost. We included studies of chlamydia screening in males and/or females over 14 years, including studies of diagnostic tests, contact tracing, and treatment as part of a screening programme. Outcomes included cases of chlamydia identified and major outcomes averted. We assessed methodological quality and the modelling approach used.
RESULTS
Of 713 identified papers we included 57 formal economic evaluations and two cost studies. Most studies found chlamydia screening to be cost effective, partner notification to be an effective adjunct, and testing with nucleic acid amplification tests, and treatment with azithromycin to be cost effective. Methodological problems limited the validity of these findings: most studies used static models that are inappropriate for infectious diseases; restricted outcomes were used as a basis for policy recommendations; and high estimates of the probability of chlamydia associated complications might have overestimated cost effectiveness. Two high quality dynamic modelling studies found opportunistic screening to be cost effective but poor reporting or uncertainty about complication rates make interpretation difficult.
CONCLUSION
The inappropriate use of static models to study interventions to prevent a communicable disease means that uncertainty remains about whether chlamydia screening programmes are cost effective or not. The results of this review can be used by health service managers in the allocation of resources, and health economists and other researchers who are considering further research in this area.
Topics: Adolescent; Adult; Aged; Bacteriological Techniques; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Cost-Benefit Analysis; Female; Humans; Male; Mass Screening; Middle Aged
PubMed: 16731666
DOI: 10.1136/sti.2005.017517 -
Annals of Palliative Medicine Nov 2021The combination of shear wave elastography (SWE) and gray-scale ultrasound is widely used in the measurement of female pelvic floor muscle. However, the value of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The combination of shear wave elastography (SWE) and gray-scale ultrasound is widely used in the measurement of female pelvic floor muscle. However, the value of gray-scale ultrasound combined with SWE in the evaluation of primipara pregnancy and delivery is still controversial.
METHODS
Using the PubMed, Web of Science, Spring and Science Direct databases, clinical studies on gray-scale ultrasound combined with SWE on the diagnosis of primiparous pregnancy and childbirth published from January 2010 to December 2020 were searched. The RevMan5.3 software was used to conduct a meta-analysis of the indicators of gray-scale ultrasound combined with SWE for primiparas and non-primiparas, including: age, body mass index (BMI), gestational age at examination, gestational age at delivery, fetal weight, cervical length, shear wave velocity (SWV), front lip SWV, back lip SWV, Young's modulus and SWE index. Heterogeneity of the assessment results was tested using Cochran's chi-square.
RESULTS
A total of 13 articles were included. Age, BMI before delivery, gestational age (when gray-scale ultrasound was combined with SWE examination), gestational age at delivery, neonatal weight, cervical depth, SWV of placental margin, SWV of anterior lip, SWV of posterior lip and Young's modulus of the study group were significantly different from those of the control group. The elastic modulus of the perineal body and the SWE of the anterior lip of the study group were significantly higher than those of the control group [mean difference (MD) =8.11, 4.39, 95% confidence interval (CI): 3.90-12.31, 0.94-7.83; Z=3.78, 2.49, P=0.0002, 0.01]. The SWE of the posterior lip in the study group was significantly lower than that in the control group (MD =-4.34, 95% CI: -7.23 to 1.44; Z=2.93, P=0.003).
DISCUSSION
The number of cases in the control group in the included articles was significantly more than that in the observation group, and there were fewer descriptions of gray-scale ultrasound combined with SWE indicators in the included articles. There may be a certain degree of bias for indicators without obvious heterogeneity, and further analysis was required through a large number of clinical verifications. However, this study can provide certain reference values for the diagnosis of primipara pregnancy.
Topics: Elasticity Imaging Techniques; Female; Humans; Infant, Newborn; Placenta; Pregnancy; Ultrasonography
PubMed: 34872291
DOI: 10.21037/apm-21-2672 -
Urologia Internationalis 2013A systematic review of the published data on the prevalence, incidence and risk factors of female urinary incontinence (UI) and obstetric treatment of UI in Europe. (Review)
Review
OBJECTIVES
A systematic review of the published data on the prevalence, incidence and risk factors of female urinary incontinence (UI) and obstetric treatment of UI in Europe.
DATA SOURCES
Epidemiologic studies were sought via PubMed to identify articles published in English, French, Spanish, German and Italian between 2000 and September 30, 2010, in Europe.
RESULTS
The prevalence of UI ranged from 14.1 to 68.8% and increased with increasing age. Significant risk factors for UI in pregnancy were maternal age ≥35 years and initial body mass index, a family history of UI and parity. UI in women who delivered 'at term' ranged from 26 to 40.2%, with a remission rate of 3 months after childbirth of up to 86.4%. Pelvic floor muscle training may help to prevent postpartum UI in primiparous women without UI during pregnancy.
CONCLUSION
UI definition, outcome measures, survey methods and validation criteria are still heterogeneous, and thus it is difficult to compare data and impossible to draw definite conclusions.
Topics: Adult; Body Mass Index; Europe; Exercise Therapy; Female; Humans; Incidence; Maternal Age; Odds Ratio; Parity; Parturition; Pelvic Floor; Pregnancy; Prevalence; Prognosis; Risk Factors; Urinary Incontinence
PubMed: 22868349
DOI: 10.1159/000339929 -
Journal of Minimally Invasive Gynecology 2008We report a case of retroperitoneal leiomyoma and a systematic review of the literature regarding this finding. A 45-year-old woman with menorrhagia and a complex pelvic... (Review)
Review
We report a case of retroperitoneal leiomyoma and a systematic review of the literature regarding this finding. A 45-year-old woman with menorrhagia and a complex pelvic mass underwent preoperative imaging and consequent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathology revealed a 13-cm retroperitoneal, pedunculated leiomyoma arising from the uterus anterior to the internal cervical os. Literature review identified 105 cases of retroperitoneal leiomyomata from 1941 through 2007, with 37 cases, including our own, containing sufficient information for analysis. Abstracted variables included patient age, race, obstetric and gynecologic history, presentation and duration of symptoms, investigations, management, surgical findings, pathologic and immunohistochemical characteristics, duration of follow-up, evidence of recurrence and its management. Mean age (+/-SD) of the population was 46.27 +/- 13.19 years. More than 40% of patients had either undergone hysterectomy for uterine leiomyomata previously or had concurrent uterine leiomyomata. Of patients, 25% were asymptomatic, 31.3% experienced abdominal fullness, 18.8% had urinary symptoms, 18.8% had weight loss, and 18.8% had pelvic pain. Diagnostic evaluation was inconclusive and surgical excision was undertaken in all but 1 case. Median leiomyoma size was 12.0 cm (range 2.0-37.0 cm) with most in the posterior retroperitoneum, independent of the uterus. Pathologic and immunohistochemical investigations were comparable with those of uterine leiomyomata. Surgery was mostly curative with 5 reported cases of recurrence, 3 of which were then considered sarcomatous. Retroperitoneal leiomyomata present diagnostic and therapeutic challenges, and as such require heightened surveillance.
Topics: Adult; CA-125 Antigen; Female; Humans; Leiomyoma; Middle Aged; Prognosis; Retroperitoneal Neoplasms; Retroperitoneal Space; Uterine Neoplasms
PubMed: 18312983
DOI: 10.1016/j.jmig.2007.12.009 -
Frontiers in Oncology 2019Newer technologies such as near-infrared (NIR) imaging of the fluorescent dye indocyanine green (ICG) and daVinci Xi Surgical System have become promising tools for...
Newer technologies such as near-infrared (NIR) imaging of the fluorescent dye indocyanine green (ICG) and daVinci Xi Surgical System have become promising tools for sentinel lymph node (SLN) mapping. This meta-analysis was conducted to comprehensively evaluate the diagnostic value of SLN in assessing lymph nodal metastasis in pelvic malignancies, using ICG with NIR imaging in robotic-assisted surgery. A literature search was conducted using PubMed for studies in English before April 2019. The detection rate, sensitivity of SLN detection of metastatic disease, and factors associated with successful mapping (sample size, study design, mean age, mean body mass index, type of cancer) were synthesized for meta-analysis. A total of 17 articles including 1,059 patients were finally included. The reported detection rates of SLN ranged from 76 to 100%, with a pooled average rate of 95% (95% CI: 93-97; 17 studies). The sensitivity of SLN detection of metastatic disease ranged from 50 to 100% and the pooled sensitivity was 86% (95% CI: 75-94; 8 studies). There were no complications related to ICG administration reported. NIR imaging system using ICG in robotic-assisted surgery is a feasible and safe method for SLN mapping. Due to its promising performance, it is considered to be an alternative to a complete pelvic lymph node dissection.
PubMed: 31312614
DOI: 10.3389/fonc.2019.00585 -
Clinical Obesity Aug 2021Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary... (Meta-Analysis)
Meta-Analysis
Weight loss with bariatric surgery or behaviour modification and the impact on female obesity-related urine incontinence: A comprehensive systematic review and meta-analysis.
Women with obesity are at risk of pelvic floor dysfunction with a 3-fold increased incidence of urge urinary incontinence (UUI) and double the risk of stress urinary incontinence (SUI). The National Institute for Health and Care Excellence (NICE) and European Association of Urology (EAU) recommend that women with a body mass index ≥30 kg/m should consider weight loss prior to consideration for incontinence surgery. This systematic review and meta-analysis will assess this recommendation to aid in the counselling of women with obesity-related urinary incontinence (UI). Medical Literature Analysis and Retrieval System online (MEDLINE), EMBASE, Cochrane, ClinicalTrials.gov, and SCOPUS were systematically and critically appraised for all peer reviewed manuscripts that suitably fulfilled the inclusion criteria established a priori and presented original, empirical data relevant to weight loss intervention in the management of urinary incontinence. Thirty-three studies and their outcomes were meta-analysed. Weight loss interventions were associated in a decreased prevalence in UI (OR 0.222, 95% CI [0.147, 0.336]), SUI (OR 0.354, 95% CI [0.256, 0.489]), UUI (OR 0.437, 95% CI [0.295, 0.649]) and improved quality of life (PFDI-20, SMD -0.774 (95% CI [-1.236, -0.312]). This systematic review and meta-analysis provide evidence that weight loss interventions are effective in reducing the prevalence of obesity-related UI symptoms in women. Bariatric surgery in particular shows greater sustained weight loss and improvements in UI prevalence. Further large scale, randomized control trials assessing the effect of bariatric surgery on women with obesity-related UI are needed to confirm this study's findings.
Topics: Bariatric Surgery; Behavior Therapy; Female; Humans; Obesity; Quality of Life; Urinary Incontinence; Weight Loss
PubMed: 33955687
DOI: 10.1111/cob.12450 -
Gynecologic and Obstetric Investigation 2017Endometriosis in adolescent girls is often diagnosed after a long delay. This diagnostic delay can be associated with more advanced stages of endometriosis and with a... (Review)
Review
BACKGROUND
Endometriosis in adolescent girls is often diagnosed after a long delay. This diagnostic delay can be associated with more advanced stages of endometriosis and with a higher likelihood of fertility problems at a later age.
MATERIAL AND METHODS
A systematic review of literature and quality assessment was performed in order to identify questionnaires that were developed to identify adult women with endometriosis. Based on these questionnaires, specific questions that had been reported to be predictive for endometriosis were selected and included in a newly composed questionnaire with the aim to identify adolescents at risk of developing endometriosis.
RESULTS
Based on the literature, we identified 5 questionnaires developed to identify adult women with endometriosis; this questionnaire contained 6 questions that had been reported to be predictive for adult endometriosis. These questions query age of menarche, cycle duration, dysmenorrhea, pain descriptors, dyschezia and urinary symptoms and were combined into a new self-report questionnaire aimed to identify adolescents at risk to develop endometriosis.
CONCLUSION
We developed a self-report questionnaire aimed to identify adolescents at risk to develop endometriosis based on questions from self-report questionnaires that have been reported to identify adult women with endometriosis.
Topics: Adolescent; Adult; Age Factors; Constipation; Delayed Diagnosis; Dysmenorrhea; Endometriosis; Female; Humans; Mass Screening; Menarche; Risk Assessment; Surveys and Questionnaires; Young Adult
PubMed: 27816976
DOI: 10.1159/000452098 -
Turning problems and freezing of gait in Parkinson's disease: a systematic review and meta-analysis.Disability and Rehabilitation Dec 2019To understand the differences of step and turn parameters between freezers and non-freezers during turning and determine the influence of turn angle and turn... (Meta-Analysis)
Meta-Analysis
To understand the differences of step and turn parameters between freezers and non-freezers during turning and determine the influence of turn angle and turn characteristics on freezing of gait. PubMed and Web of Science were searched from the earliest data available to August 2017. Case-control studies that examined the differences in turning while walking between freezers and non-freezers were included. Two reviewers selected studies independently. Methodological quality was evaluated by two independent reviewers using the STROBE checklist for case-control studies. Mean differences and 95% confidence intervals were calculated from pooled data for turn duration, peak turn velocity, number of steps and cadence. Center of mass deviation, segmental rotation, phase coordination and freezing of gait frequency were also extracted. When possible, different turning angles or spatial confounds were compared. Sixteen studies met the inclusion criteria. Freezing of gait occurred in 38.2% of the freezers. Freezing appeared most frequently at the end of a turn and at the inner leg of the turn cycle. The meta-analysis revealed that turning in freezers was characterized by an increased turn duration, cadence and number of steps and a decreased peak turn velocity. Qualitative analysis showed that results concerning step width, step length and step time variability were inconsistent. Turning was characterized by an increased head-pelvis coupling and worse coordination in freezers compared to non-freezers. A decreased medial deviation of the center of mass was present prior to a freezing episode. Both step and rotational parameters differed in freezers compared to non-freezers while turning. These differences increased with increasing task complexity (i.e., larger turning angle or spatial confounds during turning). The results suggest that improving axial rotation could be a valuable rehabilitation target to ameliorate freezing.Implications for rehabilitationPatients with freezing of gait turn with a larger arc and a smaller angle compared to non-freezing patientsFreezing-related turning deficits have both spatiotemporal and rotational motor control componentsImproving axial rotation could be a novel rehabilitation target to ameliorate freezing.
Topics: Gait Disorders, Neurologic; Humans; Parkinson Disease; Postural Balance; Rotation
PubMed: 29961369
DOI: 10.1080/09638288.2018.1483429