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Loverro M, Aloisi A, Tortorella L, Aletti GD, Kumar A. Trends and current aspects of reconstructive surgery for gynecological cancers. Int J Gynecol Cancer 2024; 34:426-435. [PMID: 38438169 DOI: 10.1136/ijgc-2023-004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Gynecologic cancers can lead to gynecologic tract destruction with extension into both the gastrointestinal and urinary tracts. Recurrent disease can also affect the surrounding bony pelvis and pelvic musculature. As opposed to advanced ovarian cancer, where cytoreduction is the goal, in these scenarios, an oncologic approach to achieve negative margins is critical for benefit. Surgeries aimed at achieving a R0 resection in gynecologic oncology can have a significant impact on pelvic anatomy, and require reconstruction. Overall, it appears that these types of radical surgery are less frequently performed; however, when required, multidisciplinary teams at high-volume centers can potentially improve short-term morbidity. There are few data to examine the long-term, quality-of-life outcomes after reconstruction following oncologic resection in advanced and recurrent gynecologic cancers. In this review we outline considerations and approaches for reconstruction after surgery for gynecologic cancers. We also discuss areas of innovation, including minimally invasive surgery and the use of 3D surgical anatomy models for improved surgical planning.In the era of 'less is more', pelvic exenteration in gynecologic oncology is still indicated when there are no other curative-intent alternatives in persistent or recurrent gynecological malignancies confined to the pelvis or with otherwise unmanageable symptoms from fistula or radiation necrosis. Pelvic exenteration is one of the most destructive procedures performed on an elective basis, which inevitably carries a significant psychologic, sexual, physical, and emotional burden for the patient and caregivers. Such complex ultraradical surgery, which requires removal of the vagina, vulva, urinary tract, and/or gastrointestinal tract, subsequently needs creative and complex reconstructive procedures. The additional removal of sidewall or perineal structures, like pelvic floor muscles/vulva, or portions of the musculoskeletal pelvis, and the inclusion of intra-operative radiation further complicates reconstruction. This review paper will focus on the reconstruction aspects following pelvic exenteration, including options for urinary tract restoration, reconstruction of the vulva and vagina, as well as how to fill large empty spaces in the pelvis. While the predominant gastrointestinal outcome after exenteration in gynecologic oncology is an end colostomy, we also present some novel new options for gastrointestinal tract reconstruction at the end.
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Affiliation(s)
- Matteo Loverro
- Department of Gynecology and Obstetrics, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Alessia Aloisi
- European Institute of Oncology IRCCS Library, Milan, Italy
| | - Lucia Tortorella
- Department of Women, Child and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Damiano Aletti
- Department of Gynecology, European Institute of Oncology, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Mburu A, Shaffi AF. Pathological pelvic fracture due to metastatic cervical cancer in a young immunosuppressed woman. Int J Gynecol Cancer 2023; 33:1983-1984. [PMID: 37857530 DOI: 10.1136/ijgc-2023-004479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Affiliation(s)
- Anisa Mburu
- Gynecology and Obstetrics, Aga Khan Hospital Mombasa, Mombasa, Kenya
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Carvalho DBDE, Dobashi ET, Gomes DJL, Dantas JM, Pajuaba AJM, Cocco LF. THE RELATIONSHIP BETWEEN FRACTURES IN PEDIATRIC POLYTRAUMA PATIENTS: EVALUATION OF CLINICAL OUTCOMES. Acta Ortop Bras 2023; 31:e268013. [PMID: 37469499 PMCID: PMC10353867 DOI: 10.1590/1413-785220233103e268013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/26/2023] [Indexed: 07/21/2023]
Abstract
Objective To evaluate children and adolescents with polytrauma and fractures of the pelvis and proximal and diaphyseal femur and correlate the impact of these conditions and clinical outcomes. Methods Retrospective study carried out in a public hospital in Taboão da Serra (SP), with pediatric patients with polytrauma from January 2012 to December 2021. In total, 44 patients were evaluated, 70.44% boys and 29.55% girls, aged from 12 to 17 years. Results Diaphyseal fracture of the femur affected 70.44% of the patients, mainly caused by a fall from a height (56.81%). Linear external fixation was the most used treatment (45.45%). All patients were discharged from hospital. Conclusion We found essential sociodemographic information: 84.11% of patients did not have associated injuries; 88.63% were hospitalized from 3 to 11 days; 90.91% did not need to be admitted to an ICU, 77.27% did not need reoperation, and 22.73% underwent another surgery; 45.45% used the external fixator to stabilize injuries; 11.36% converted the external fixator to the intramedullary nail; 9.09% needed an intramedullary nail remover; 2.27% converted to a plate (bilateral) and 2.27% to a rigid nail; 2.27% had loss of reduction and revision with rod; 2.27% underwent corrective osteotomy; 2.27% had clinical hospitalization; 2.27% had osteonecrosis of the femoral head and screws removed; 2.27% removed the plate. No deaths were recorded. Level of Evidence II, Retrospective Study.
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Affiliation(s)
| | | | | | - José Manoel Dantas
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | | | - Luiz Fernando Cocco
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
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Abstract
Objective: The purpose of this study was to assess the importance of pelvic fractures in childhood by analyzing epidemiological characteristics and associated injuries. Methods: This is a retrospective study performed between 2002 and 2012 at two trauma referral centers in São Paulo. We identified 25 patients aged 16 years old or younger with pelvic fracture. Results: The main mechanism of trauma was traffic accident (80%), followed by fall from height (16%). At hospital admission, 92% had traumatic brain injury and 40% had hemodynamic instability. Besides pelvic fractures, 56% of the children had other associated injuries (genitourinary, abdominal, vascular, chest and neurological), and 79% of them required operative treatment. According to the Torode and Zieg classification, the majority of cases were types III and IV. Seventy-two percent of all pelvic fractures were treated by surgery; 52% involved external fixation and 20% involved open reduction and internal fixation. Conclusions: The pelvic fractures in childhood can be considered a marker for injury severity, because the associated injuries usually are severe, needing operative treatment and leading to a high mortality rate (12%). Level of Evidence IV, Case Series.
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Affiliation(s)
| | | | - MIGUEL AKKARI
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
| | - CLAUDIO SANTILI
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
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Palczewski P, Sułkowska K, Świątkowski J, Kocoń H, Gołębiowski M. Ischiofemoral Impingement Syndrome: A Case Report and a Review of Literature. Pol J Radiol 2015; 80:496-8. [PMID: 26600879 PMCID: PMC4638133 DOI: 10.12659/pjr.894523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/24/2015] [Indexed: 11/14/2022] Open
Abstract
Background Ischiofemoral impingement syndrome is characterized by a hip pain associated with abnormalities in quadriceps femoris muscle and ipsilaterally reduced distance between the lesser trochanter and the ischium. Thus far, the congenital variant of this entity has been reported exclusively in women. Case Report We report a case of a 22-year old male with painful hips in whom on the basis of the imaging studies the constitutional variant of ischiofemoral impingement was diagnosed. Conclusions Ischiofemoral conflict should be taken into consideration in the differential diagnosis of hip pain, particularly among women, but also in patients with valgus hip deformity and other abnormalities leading to reduction of the space between femoral and ischial bones independent of gender.
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Affiliation(s)
- Piotr Palczewski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Sułkowska
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Jan Świątkowski
- Department of Orthopaedics and Traumatology of Locomotor System, Medical University of Warsaw, Warsaw, Poland
| | - Hanna Kocoń
- Department of Orthopaedics and Traumatology of Locomotor System, Medical University of Warsaw, Warsaw, Poland
| | - Marek Gołębiowski
- 1 Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
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Wardle B, Eslick GD, Sunner P. Internal versus external fixation of the anterior component in unstable fractures of the pelvic ring: pooled results from a systematic review. Eur J Trauma Emerg Surg 2015; 42:635-643. [PMID: 26265401 DOI: 10.1007/s00068-015-0554-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/31/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Improving reduction of the pelvic ring improves long-term functional outcomes for patients. It has been demonstrated that posterior internal fixation is necessary to adequately control fractures to the posterior ring and there is evidence that supplementing this with fixation of the anterior ring improves stability. It is accepted that internal fixation provides greater stability than external fixation of the anterior ring but long-term differences in radiographic and functional outcomes have not yet been quantified. METHODS A search of electronic databases, reference lists and review articles from 1989 to 2015 yielded 18 studies (n = 884) that met our inclusion criteria. We included studies that discussed pelvic ring injuries in adults, reported functional or radiological outcomes or complications by anterior ring intervention and exceeded 14 patients. We excluded biomechanical and cadaver studies. RESULTS Internal fixation of the anterior pelvic ring had better functional and radiographic outcomes. Residual displacement of >10 mm was less common with internal fixation (ER 0.12, 95 % CI 0.06-0.24) than external fixation (ER 0.31, 95 % CI 0.11-0.62). Unsatisfactory outcomes also occurred at a lower rate (ER 0.09, 95 % CI 0.03-0.22) compared to external fixation (ER 0.32, 95 % CI 0.18-0.50). Losses of reduction (ER 0.02, 95 % CI 0.01-0.04 versus ER 0.07, 95 % CI 0.02-0.21), malunions (ER 0.03, 95 % CI 0.01-0.08 versus ER 0.07, 95 % CI 0.02-0.21) and delayed/non-unions (ER 0.02, 95 % CI 0.01-0.05 versus ER 0.04, 95 % CI 0.02-0.07). CONCLUSIONS Internal fixation of the anterior pelvic ring as supplementary fixation for unstable injuries to the pelvic ring appears to result in better radiographic and functional outcomes as well as fewer complications. However, data that separated outcomes and complications in relation to interventions of the anterior pelvic ring were limited. More studies looking specifically at outcomes in relation to the type of anterior ring intervention are needed.
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Affiliation(s)
- B Wardle
- Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - G D Eslick
- Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia.
- Department of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, Penrith, NSW, 2750, Australia.
| | - P Sunner
- Department of Orthopaedics, Nepean Hospital, Penrith, NSW, 2750, Australia
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Crisci V, Mainenti PP, Corvino F, Lauria R, Maurea S. Bone involvement by adenocarcinoma of the uterine cervix: a rare entity. Pol J Radiol 2015; 80:81-4. [PMID: 25745521 PMCID: PMC4332296 DOI: 10.12659/pjr.892369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/11/2014] [Indexed: 11/09/2022] Open
Abstract
Background Adenocarcinoma is the second most frequent cancer of the uterine cervix after squamous carcinoma, and the most frequent histotype is the mucinous one. Endo-cervical adenocarcinoma accounts for about 10–30% of all cervical cancers and clinically the lesion can be asymptomatic or, more frequently, presenting with anomalous bleeding and/or vaginal discharge. Case Report A 41-year-old woman with a diagnosis of adenocarcinoma of the uterine cervix was subjected to chemotherapy after radical surgery. During the follow-up, the patient underwent a Positron Emission Tomography integrated with Computed Tomography and pelvic Magnetic Resonance, which showed rapid and diffuse disease progression from the site of the lesion to the pelvic bones. Conclusions Bone involvement in patients with cervical cancer, being a rare event, is significant since it greatly reduces life expectancy. The majority of metastatic bone lesions in cervical cancer seem to be of osteolytic nature. In our patient, Positron Emission Tomography integrated with Computed Tomography and Magnetic Resonance were the imaging methods used during the follow-up and both techniques clearly showed diffuse and rapid tumour spread to the bones.
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Affiliation(s)
- Vincenzina Crisci
- Department of Diagnostic Imaging, University of Naples "Federico II", Naples, Italy ; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Department of Diagnostic Imaging, Institute of Biostructure and Bioimaging CNR Foundation, Naples, Italy
| | - Fabio Corvino
- Department of Diagnostic Imaging, University of Naples "Federico II", Naples, Italy ; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rossella Lauria
- Department of Integrated Activities of Clinical Medicine, University of Naples "Federico II", Naples, Italy
| | - Simone Maurea
- Department of Radiology and Institute of Biostructures, University of Naples "Federico II", Naples, Italy
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Preece SJ, Willan P, Nester CJ, Graham-Smith P, Herrington L, Bowker P. Variation in pelvic morphology may prevent the identification of anterior pelvic tilt. J Man Manip Ther 2011; 16:113-7. [PMID: 19119397 DOI: 10.1179/106698108790818459] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Pelvic tilt is often quantified using the angle between the horizontal and a line connecting the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). Although this angle is determined by the balance of muscular and ligamentous forces acting between the pelvis and adjacent segments, it could also be influenced by variations in pelvic morphology. The primary objective of this anatomical study was to establish how such variation may affect the ASIS-PSIS measure of pelvic tilt. In addition, we also investigated how variability in pelvic landmarks may influence measures of innominate rotational asymmetry and measures of pelvic height. Thirty cadaver pelves were used for the study. Each specimen was positioned in a fixed anatomical reference position and the angle between the ASIS and PSIS measured bilaterally. In addition, side-to-side differences in the height of the innominate bone were recorded. The study found a range of values for the ASIS-PSIS of 0-23 degrees, with a mean of 13 and standard deviation of 5 degrees. Asymmetry of pelvic landmarks resulted in side-to-side differences of up to 11 degrees in ASIS-PSIS tilt and 16 millimeters in innominate height. These results suggest that variations in pelvic morphology may significantly influence measures of pelvic tilt and innominate rotational asymmetry.
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Affiliation(s)
- Stephen J Preece
- Research Fellow, Centre for Rehabilitation and Human Performance, University of Salford, Manchester, UK
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