Background: Vesicocutaneous fistula is a rare type of urinary fistula. It is often distressing and may negatively impact on the quality of life of an affected person. Our aim in this case report is to document a case ...Background: Vesicocutaneous fistula is a rare type of urinary fistula. It is often distressing and may negatively impact on the quality of life of an affected person. Our aim in this case report is to document a case of vesicocutaneous fistula following pelvic trauma from road traffic accident and share our experience in the management of this condition. Case Report: We report the case of a 30 year-old primipara who had urinary incontinence following pelvic trauma sustained from road traffic accident. Examination findings were in keeping with vesicocutaneous fistula. She subsequently had surgical repair of vesicocutaneous fistula which was successful. Conclusion: This case report highlights pelvic trauma as one of the causes of urinary fistula and the key role of surgery in its management.展开更多
Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,...Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury(HVI),especially in the early stage after injury.The delayed diagnosis of HVI could result in a high morbidity and mortality.The bowel injury prediction score(BIPS)applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary.We recently found another clinical variable(iliac ecchymosis,IE)which appeared at the early stage of injury,could be predicted for HVI.The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI,and thus reduce complications and mortalities.Methods:We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital.The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention.The exclusion criteria were abdominal CT insufficiency before operation,abdominal surgery before CT scan,and CT mesenteric injury grade being 5.The MBIPS was defined as BIPS plus IE,which was calculated according to 4 variables:white blood cell counts of 17.0 or greater,abdominal tenderness,CT scan grade for mesenteric injury of 4 or higher,and the location of IE.Each clinical variable counted 1 score,totally 4 scores.The location and severity of IE was also noted.Results:In total,635 cases were hospitalized and 62 patients were enrolled in this study.Of these included patients,77.4%(40 males and 8 females)were operated by exploratory laparotomy and 22.6%(8 males and 6 females)were treated conservatively.In the 48 patients underwent surgical intervention,46 were confirmed with HVI(45 with IE and 1 without IE).In 46 patients confirmed without HVI,only 3 patients had IE and the rest had no IE.The sensitivity and specificity of IE in predicting HVI was calculated as 97.8%(45/46)and 81.3%(13/16),respectively.The median MBIPS score for surgery group was 2,while 0 for the conservative treatment group.The incidence of HVI in patients with MBIPS score≥2 was significantly higher than that in patients with MBIPS score less than≤2(OR=17.3,p<0.001).Conclusion:IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity,which is a valuable sign for HVI in blunt pelvic trauma patients.MBIPS can be used to predict HVI in blunt pelvic trauma patients.When the MBIPS score is≥2,HVI is strongly suggested.展开更多
BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioem...BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma.METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; Clinical Trials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using randomeffects models. Results are reported as the odds ratio(OR) and 95% confidence interval(CI).RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation(n=60) or pelvic packing(n=60) for pelvic trauma. Reporting of the Injury Severity Score(ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery(OR=1.99; 95% CI= 0.83–4.78, P=0.12). There was mild between-study heterogeneity(I^2=0%, P=0.65).CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.展开更多
AIM To compare the prevalence of psychiatric disorders and early emotional traumas between women with chronic pelvic pain(CPP) and healthy women.METHODS One hundred women in reproductive age,50 of them had CPP(accordi...AIM To compare the prevalence of psychiatric disorders and early emotional traumas between women with chronic pelvic pain(CPP) and healthy women.METHODS One hundred women in reproductive age,50 of them had CPP(according to the criteria set by the International Association for Study of Pain),and 50 were considered healthy after the gynecological evaluation.The eligibility criteria were defined as follows:chronic or persistent pain perceived in the pelvis-related structures(digestive,urinary,genital,myofascial or neurological systems).Only women in reproductive age with acyclic pain for 6 mo,or more,were included in the present study.Menopause was the exclusion criterion.The participants were grouped according to age,school level and socioeconomic status and were individually assessed through DSM-IV Structured Clinical Interview(SCID-I) and Early Trauma Inventory Self-report-short form(ETISR-SF Brazilian version).Descriptive statistics,group comparison tests and multivariate logistics regression were used in the data analysis.RESULTS The early emotional traumas are highly prevalent,but their prevalence did not differ between the two groups.The current Major Depressive Disorder was more prevalent in women with CPP.The CPP was associatedwith endometriosis in 48% of the women.There was no difference in the prevalence of disorders when endometriosis was taken into account(endometriosis vs other diseases:P > 0.29).The current Major Depressive Disorder and the Bipolar Disorder had greater occurrence likelihood in the group of women with CPP(ODDS = 5.25 and 9.0).CONCLUSION The data reinforce the link between mood disorders and CPP.The preview evidences about the association between CPP and early traumas tended not to be significant after a stronger methodological control was implemented.展开更多
AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was perfor...AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.展开更多
目的构建骨盆创伤诊治的全流程专业数据库。方法基于既往大量骨盆创伤数据,研究骨盆创伤救治流程及临床信息组成,分析辅助检查、诊疗环节元数据。以SQL server 2005数据库为基础,现有医院信息系统(HIS)、检验信息管理系统(LIS)和影像归...目的构建骨盆创伤诊治的全流程专业数据库。方法基于既往大量骨盆创伤数据,研究骨盆创伤救治流程及临床信息组成,分析辅助检查、诊疗环节元数据。以SQL server 2005数据库为基础,现有医院信息系统(HIS)、检验信息管理系统(LIS)和影像归档和信息系统(PACS)等信息系统为依托,整理骨盆创伤全流程信息,开发骨盆创伤数据库。结果将复杂的骨盆创伤救治流程进行结构化、流程化表达,整合大量历史数据,成功构建骨盆创伤专业数据库。检验结果、指标参数实现可视化表达,临床参数实现结构化分类管理。数据库将骨盆创伤患者就诊全流程分为基本信息、早期诊治及围手术期诊治、手术治疗、预后随访4个部分。结论该骨盆创伤数据库的初步开发及应用有助于改善数据管理,便于数据挖掘,优化了临床诊治流程。展开更多
文摘Background: Vesicocutaneous fistula is a rare type of urinary fistula. It is often distressing and may negatively impact on the quality of life of an affected person. Our aim in this case report is to document a case of vesicocutaneous fistula following pelvic trauma from road traffic accident and share our experience in the management of this condition. Case Report: We report the case of a 30 year-old primipara who had urinary incontinence following pelvic trauma sustained from road traffic accident. Examination findings were in keeping with vesicocutaneous fistula. She subsequently had surgical repair of vesicocutaneous fistula which was successful. Conclusion: This case report highlights pelvic trauma as one of the causes of urinary fistula and the key role of surgery in its management.
文摘Purpose:Pelvic fractures are characterized by high energy injuries and often accompanied with abdominal and pelvic organ injury.CT has been applied for several decades to evaluate blunt pelvic trauma patients.However,it has a certain rate of inaccurate diagnosis of abdominal hollow viscus injury(HVI),especially in the early stage after injury.The delayed diagnosis of HVI could result in a high morbidity and mortality.The bowel injury prediction score(BIPS)applied 3 clinical variables to determine whether an early surgical intervention for blunt HVI was necessary.We recently found another clinical variable(iliac ecchymosis,IE)which appeared at the early stage of injury,could be predicted for HVI.The main objective of this study was to explore the novel combination of IE and BIPS to enhance the early diagnosis rate of HVI,and thus reduce complications and mortalities.Methods:We conducted a retrospective analysis from January 2008 to December 2018 and recorded blunt pelvic trauma patients in our hospital.The inclusion criteria were patients who were verified with pelvic fractures using abdomen and pelvis CT scan in the emergency department before any surgical intervention.The exclusion criteria were abdominal CT insufficiency before operation,abdominal surgery before CT scan,and CT mesenteric injury grade being 5.The MBIPS was defined as BIPS plus IE,which was calculated according to 4 variables:white blood cell counts of 17.0 or greater,abdominal tenderness,CT scan grade for mesenteric injury of 4 or higher,and the location of IE.Each clinical variable counted 1 score,totally 4 scores.The location and severity of IE was also noted.Results:In total,635 cases were hospitalized and 62 patients were enrolled in this study.Of these included patients,77.4%(40 males and 8 females)were operated by exploratory laparotomy and 22.6%(8 males and 6 females)were treated conservatively.In the 48 patients underwent surgical intervention,46 were confirmed with HVI(45 with IE and 1 without IE).In 46 patients confirmed without HVI,only 3 patients had IE and the rest had no IE.The sensitivity and specificity of IE in predicting HVI was calculated as 97.8%(45/46)and 81.3%(13/16),respectively.The median MBIPS score for surgery group was 2,while 0 for the conservative treatment group.The incidence of HVI in patients with MBIPS score≥2 was significantly higher than that in patients with MBIPS score less than≤2(OR=17.3,p<0.001).Conclusion:IE can be recognized as an indirect sign of HVI because of the high sensitivity and specificity,which is a valuable sign for HVI in blunt pelvic trauma patients.MBIPS can be used to predict HVI in blunt pelvic trauma patients.When the MBIPS score is≥2,HVI is strongly suggested.
文摘BACKGROUND: The management of complex pattern of bleeding associated with pelvic trauma remains a big challenge for trauma surgeons. We aimed to conduct a comprehensive meta-analysis to compare the outcomes of angioembolisation and pelvic packing in patients with pelvic trauma.METHODS: We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the CENTRAL; the World Health Organization International Clinical Trials Registry; Clinical Trials.gov; ISRCTN Register, and bibliographic reference lists. The primary outcome was defined as mortality. Combined overall effect sizes were calculated using randomeffects models. Results are reported as the odds ratio(OR) and 95% confidence interval(CI).RESULTS: We identified 3 observational studies reporting a total of 120 patients undergoing angioembolisation(n=60) or pelvic packing(n=60) for pelvic trauma. Reporting of the Injury Severity Score(ISS) was variable, with higher ISS in the pelvic packing group. The risk of bias was low in two studies, and moderate in one. The pooled analysis demonstrated that angioembolisation did not significantly reduce mortality in patients with pelvic trauma compared to surgery(OR=1.99; 95% CI= 0.83–4.78, P=0.12). There was mild between-study heterogeneity(I^2=0%, P=0.65).CONCLUSION: Our analysis found no significant difference in mortality between angioembolisation and pelvic packing in patients with traumatic pelvic haemorrhage. The current level of evidence in this context is very limited and insufficient to support the superiority of a treatment modality. Future research is required.
基金Supported by CNPq-National Counsel of Technological and Scientific Development,No.471441/2012-0
文摘AIM To compare the prevalence of psychiatric disorders and early emotional traumas between women with chronic pelvic pain(CPP) and healthy women.METHODS One hundred women in reproductive age,50 of them had CPP(according to the criteria set by the International Association for Study of Pain),and 50 were considered healthy after the gynecological evaluation.The eligibility criteria were defined as follows:chronic or persistent pain perceived in the pelvis-related structures(digestive,urinary,genital,myofascial or neurological systems).Only women in reproductive age with acyclic pain for 6 mo,or more,were included in the present study.Menopause was the exclusion criterion.The participants were grouped according to age,school level and socioeconomic status and were individually assessed through DSM-IV Structured Clinical Interview(SCID-I) and Early Trauma Inventory Self-report-short form(ETISR-SF Brazilian version).Descriptive statistics,group comparison tests and multivariate logistics regression were used in the data analysis.RESULTS The early emotional traumas are highly prevalent,but their prevalence did not differ between the two groups.The current Major Depressive Disorder was more prevalent in women with CPP.The CPP was associatedwith endometriosis in 48% of the women.There was no difference in the prevalence of disorders when endometriosis was taken into account(endometriosis vs other diseases:P > 0.29).The current Major Depressive Disorder and the Bipolar Disorder had greater occurrence likelihood in the group of women with CPP(ODDS = 5.25 and 9.0).CONCLUSION The data reinforce the link between mood disorders and CPP.The preview evidences about the association between CPP and early traumas tended not to be significant after a stronger methodological control was implemented.
文摘AIM: To determine the association of unstable pelvic ring injuries with trauma code status.METHODS: A retrospective review of all pelvic ring injuries at a single academic center from July 2010 to June 2013 was performed. The trauma registry was used to identify level 1 and level 2 trauma codes for each injury. The computed tomography scans in all patients were classified as stable or unstable using the Abbreviated Injury Scale. Pelvic injury classifications in level 1 and level 2 groups were compared. Patient disposition at discharge in level 1 and level 2 groups were also compared.RESULTS: There were 108 level 1 and 130 level 2 blunt trauma admissions. In the level 1 group, 67% of pelvic injuries were classified as stable fracture patterns and 33% were classified as unstable. In the level 2 group, 62% of pelvic injuries were classified as stable fracture patterns and 38% were classified as unstable. level 1 trauma code was not associated with odds of having an unstable fracture pattern(OR = 0.83, 95%CI: 0.48-1.41, P = 0.485). In the level 1 group with unstable pelvic injuries, 33% were discharged to home, 36% to a rehabilitation facility, and 32% died. In the level 2 group with unstable pelvic injuries, 65% were discharged to home, 31% to a rehabilitation facility, and 4% died. For those with unstable pelvic fractures(n = 85), assignment of a level 2 trauma code was associated with reduced odds of death(OR = 0.07, 95%CI: 0.01-0.35, P = 0.001) as compared to being discharged to home.CONCLUSION: Trauma code level assignment is not correlated with severity of pelvic injury. Because an unstable pelvis can lead to hemodynamic instability, these injuries may be undertriaged.
文摘目的构建骨盆创伤诊治的全流程专业数据库。方法基于既往大量骨盆创伤数据,研究骨盆创伤救治流程及临床信息组成,分析辅助检查、诊疗环节元数据。以SQL server 2005数据库为基础,现有医院信息系统(HIS)、检验信息管理系统(LIS)和影像归档和信息系统(PACS)等信息系统为依托,整理骨盆创伤全流程信息,开发骨盆创伤数据库。结果将复杂的骨盆创伤救治流程进行结构化、流程化表达,整合大量历史数据,成功构建骨盆创伤专业数据库。检验结果、指标参数实现可视化表达,临床参数实现结构化分类管理。数据库将骨盆创伤患者就诊全流程分为基本信息、早期诊治及围手术期诊治、手术治疗、预后随访4个部分。结论该骨盆创伤数据库的初步开发及应用有助于改善数据管理,便于数据挖掘,优化了临床诊治流程。
