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Sample records for pelvic cancers study

  1. High energy neutron treatment for pelvic cancers: study stopped because of increased mortality.

    PubMed Central

    Errington, R D; Ashby, D; Gore, S M; Abrams, K R; Myint, S; Bonnett, D E; Blake, S W; Saxton, T E

    1991-01-01

    OBJECTIVE--To compare high energy fast neutron treatment with conventional megavoltage x ray treatment in the management of locally advanced pelvic carcinomas (of the cervix, bladder, prostate, and rectum). DESIGN--Randomised study from February 1986; randomisation to neutron treatment or photon treatment was unstratified and in the ratio of 3 to 1 until January 1988, when randomisation was in the ratio 1 to 1 and stratified by site of tumour. SETTING--Mersey regional radiotherapy centre at Clatterbridge Hospital, Wirral. PATIENTS--151 patients with locally advanced, non-metastatic pelvic cancer (27 cervical, 69 of the bladder, seven prostatic, and 48 of the rectum). INTERVENTION--Randomisation to neutron treatment was stopped in February 1990. MAIN OUTCOME MEASURES--Patient survival and causes of death in relation to the development of metastatic disease and treatment related morbidity. RESULTS--In the first phase of the trial 42 patients were randomised to neutron treatment and 14 to photon treatment, and in the second phase 48 to neutron treatment and 47 to photon treatment. The relative risk of mortality for photons compared with neutrons was 0.66 (95% confidence interval 0.40 to 1.10) after adjustment for site of tumour and other important prognostic factors. Short term and long term complications were similar in both groups. CONCLUSIONS--The trial was stopped because of the increased mortality in patients with cancer of the cervix, bladder, or rectum treated with neutrons. PMID:1903663

  2. Gut microbial dysbiosis may predict diarrhea and fatigue in patients undergoing pelvic cancer radiotherapy: a pilot study.

    PubMed

    Wang, Aiping; Ling, Zongxin; Yang, Zhixiang; Kiela, Pawel R; Wang, Tao; Wang, Cheng; Cao, Le; Geng, Fang; Shen, Mingqiang; Ran, Xinze; Su, Yongping; Cheng, Tianmin; Wang, Junping

    2015-01-01

    Fatigue and diarrhea are the most frequent adverse effects of pelvic radiotherapy, while their etiologies are largely unknown. The aim of this study is to investigate the correlations between fatigue, diarrhea, and alterations in gut microbiota induced by pelvic radiotherapy. During the 5-week treatment of pelvic radiotherapy in 11 cancer patients, the general fatigue score significantly increased and was more prominent in the patients with diarrhea. The fatigue score was closely correlated with the decrease of serum citrulline (an indicator of the functional enterocyte mass) and the increases of systemic inflammatory proteins, including haptoglobin, orosomuoid, α1-antitrypsin and TNF-α. Serum level of lipopolysaccharide (LPS) was also elevated, especially in the patients with diarrhea indicating epithelial barrier breach and endotoxemia. Pyrosequencing analysis of 16S rRNA gene revealed that microbial diversity, richness, and the Firmicutes/Bacteroidetes ratio were significantly altered prior to radiotherapy in patients who later developed diarrhea. Pelvic radiotherapy induced further changes in fecal microbial ecology, some of which were specific to the patients with or without diarrhea. Our results indicate that gut microbial dysbiosis prior to radiation therapy may be exploited to predict development of diarrhea and to guide preventive treatment options. Radiation-induced dysbiosis may contribute to pelvic radiation disease, including mucositis, diarrhea, systemic inflammatory response, and pelvic radiotherapy-associated fatigue in cancer patients.

  3. Quality Assurance of Multifractionated Pelvic Interstitial Brachytherapy for Postoperative Recurrences of Cervical Cancers: A Prospective Study

    SciTech Connect

    Shukla, Pragya; Chopra, Supriya; Engineer, Reena; Mahantshetty, Umesh; Paul, Siji Nojin; Phurailatpam, Reena; SV, Jamema; Shrivastava, Shyam K.

    2012-03-15

    Purpose: To evaluate three-dimensional needle displacements during multifractionated interstitial brachytherapy (BT) for cervical cancers. Methods and Materials: Patients scheduled to undergo pelvic interstitial BT for postoperative and or postradiation vault recurrences were included from November 2009 to December 2010. All procedures were performed under spinal anesthesia. Postprocedure BT planning CT scans were obtained with patients in supine position with arms on the chest (interslice thickness of 3 mm). Thereafter, verification CT was repeated at every alternate fraction. Needle displacements were measured in reference to a relocatable bony point. The mean cranial, caudal, anteroposterior, and mediolateral displacements were recorded. Statistical significance of mean interfraction displacements was evaluated with Wilcoxon Test. Results: Twenty patients were included. Seventeen received boost BT (20 Gy/5 fractions/3 days) after external radiation, three received radical BT alone (36 Gy/9 fractions/5-8 days). An average of three scans (range, 2-3) were available per patient, and 357 needle displacements were analyzed. For the entire study cohort, the average of mean needle displacement was 2.5 mm (range, 0-7.4), 17.4 mm (range, 0-27.9), 1.7 mm (range, 0-6.7), 2.1 mm (range, 0-9.5), 1.7 mm (range, 0-9.3), and 0.6 mm (range, 0-7.8) in cranial, caudal, anterior, posterior, right, and left directions, respectively. The mean displacement in the caudal direction was higher between Days 1 and 2 than that between Days 2 and 3 (13.4 mm vs. 3.8 mm; p = 0.01). The average caudal displacements were no different between reirradiation and boost cohort (15.2 vs. 17.8 mm). Conclusions: Clinically significant caudal displacements occur during multifractionated pelvic brachytherapy. Optimal margins need to be incorporated while preplanning brachytherapy to account for interfraction displacements.

  4. Pelvic radiation - discharge

    MedlinePlus

    Radiation of the pelvis - discharge; Cancer treatment - pelvic radiation; Prostate cancer - pelvic radiation; Ovarian cancer - pelvic radiation; Cervical cancer - pelvic radiation; Uterine cancer - pelvic radiation; Rectal cancer - ...

  5. Enumerating pelvic recurrence following radical cystectomy for bladder cancer: A Canadian multi-institutional study

    PubMed Central

    Eapen, Libni J.; Jones, Edward; Kassouf, Wassim; Lambert, Carole; Morgan, Scott C.; Moussa, Madeleine; Nam, Robert; Parliament, Matthew; Russell, Laurie; Saad, Fred; Siemens, D. Robert; Souhami, Luis; Szumacher, Ewa; Tyldesley, Scott; Xu, Yan; Zbieranowski, Ingrid; Breau, Rodney H.; Belanger, Eric; Black, Peter; Estey, Eric; Bowan, Julie; Bora, Bishwajit; Brundage, Michael; Chung, Peter; Fleshner, Neil; Evans, Andrew; Bauman, Glenn; Izawa, Jonathan; Davidson, Chris; Brimo, Fadi

    2016-01-01

    Introduction: We aimed to enumerate the rate of pelvic recurrence following radical cystectomy at university-affiliated hospitals in Canada. Methods: Canadian, university-affiliated hospitals were invited to participate. They were asked to identify the first 10 consecutive patients undergoing radical cystectomy starting January 1, 2005, who had urothelial carcinoma stages pT3/T4 N0-2 M0. The first 10 consecutive cases starting January 1, 2005 who met these criteria were the patients submitted by that institution with information regarding tumour stage, age, number of nodes removed, and last known clinical status in regard to recurrence and patterns of failure. Results: Of the 111 patients, 80% had pT3 and 20% pT4 disease, with 62% being node-negative, 14% pN1, and 27% pN2; 57% had 10 or more nodes removed. Cumulative incidence of pelvic relapse was 40% among the entire group Conclusions: This review demonstrates a high rate of pelvic tumour recurrence following radical cystectomy for pT3/T4 urothelial cancer. PMID:27217852

  6. Pharmacokinetics of mitomycin C in pelvic stopflow infusion and hypoxic pelvic perfusion with and without hemofiltration: a pilot study of patients with recurrent unresectable rectal cancer.

    PubMed

    Guadagni, S; Aigner, K R; Palumbo, G; Cantore, M; Fiorentini, G; Pozone, T; Deraco, M; Clerico, M; Chaudhuri, P K

    1998-10-01

    This pilot study was conducted to evaluate the advantage in drug delivery for regional chemotherapy in patients with unresectable recurrent rectal carcinoma by different methods. For this research, the pharmacokinetic advantages of mitomycin C delivery by four different methods were compared: intraaortic infusion with aortic stopflow; intraaortic infusion with inferior vena cava stopflow; intraaortic infusion with aortic and inferior caval vein stopflow (hypoxic pelvic perfusion); and hypoxic pelvic perfusion with hemofiltration. The results of this study indicate that pelvic stopflow infusion followed by hypoxic pelvic perfusion significantly increases mitomycin C concentrations in the blood coming from the tumor site. Also, use of hemofiltration reduces mitomycin C levels in peripheral blood after high-dose regional chemotherapy. Further investigations involving more patients should be carried out in the future to validate these results.

  7. Pouchitis Associated With Pelvic Radiation for Prostate Cancer

    PubMed Central

    Kulkarni, Geeta; Liu, Xiuli

    2016-01-01

    Radiation therapy is a viable option in managing potentially life-threatening malignancies including prostate cancer. It is known that pelvic radiation can result in injury of the distal large bowel with the development of radiation proctitis. Despite reports from retrospective studies, there is a lack of direct endoscopic and histologic evidence of external pelvic radiation injury to the ileal pouch-anal anastomosis. We present a case of a 68-year-old male with pouchitis resulting from pelvic radiation for prostate cancer. PMID:27807581

  8. Dosimetric Study of Pelvic Proton Radiotherapy for High-Risk Prostate Cancer

    SciTech Connect

    Chera, Bhishamjit S.; Vargas, Carlos; Morris, Christopher G.; Louis, Debbie; Flampouri, Stella; Yeung, Daniel; Duvvuri, Srividya; Li Zuofeng; Mendenhall, Nancy Price

    2009-11-15

    Purpose: To compare dose distributions in targeted tissues (prostate, seminal vesicles, pelvic regional nodes) and nontargeted tissues in the pelvis with intensity-modulated radiotherapy (IMRT) and forward-planned, double-scattered, three-dimensional proton radiotherapy (3D-PRT). Methods and Materials: IMRT, IMRT followed by a prostate 3D-PRT boost (IMRT/3D-PRT), and 3D-PRT plans were created for 5 high-risk prostate cancer patients (n = 15 plans). A 78-CGE/Gy dose was prescribed to the prostate and proximal seminal vesicles and a 46-CGE/Gy was prescribed to the pelvic nodes. Various dosimetric endpoints were compared. Results: Target coverage of the prostate and nodal planning target volumes was adequate for all three plans. Compared with the IMRT and IMRT/3D-PRT plans, the 3D-PRT plans reduced the mean dose to the rectum, rectal wall, bladder, bladder wall, small bowel, and pelvis. The relative benefit of 3D-PRT (vs IMRT) at reducing the rectum and rectal wall V5-V40 was 53% to 71% (p < 0.05). For the bladder and bladder wall, the relative benefit for V5 to V40 CGE/Gy was 40% to 63% (p < 0.05). The relative benefit for reducing the volume of small bowel irradiated from 5 to 30 CGE/Gy in the 3D-PRT ranged from 62% to 69% (p < 0.05). Use of 3D-PRT did not produce the typical low-dose 'bath' of radiation to the pelvis seen with IMRT. Femoral head doses were higher for the 3D-PRT. Conclusions: Use of 3D-PRT significantly reduced the dose to normal tissues in the pelvis while maintaining adequate target coverage compared with IMRT or IMRT/3D-PRT. When treating the prostate, seminal vesicles, and pelvic lymph nodes in prostate cancer, proton therapy may improve the therapeutic ratio beyond what is possible with IMRT.

  9. Whole-pelvic radiotherapy with spot-scanning proton beams for uterine cervical cancer: a planning study

    PubMed Central

    Hashimoto, Shingo; Shibamoto, Yuta; Iwata, Hiromitsu; Ogino, Hiroyuki; Shibata, Hiroki; Toshito, Toshiyuki; Sugie, Chikao; Mizoe, Jun-etsu

    2016-01-01

    The aim of this study was to compare the dosimetric parameters of whole-pelvic radiotherapy (WPRT) for cervical cancer among plans involving 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), or spot-scanning proton therapy (SSPT). The dose distributions of 3D-CRT-, IMRT-, and SSPT-based WPRT plans were compared in 10 patients with cervical cancer. All of the patients were treated with a prescribed dose of 50.4 Gy in 1.8-Gy daily fractions, and all of the plans involved the same planning target volume (PTV) constrictions. A 3D-CRT plan involving a four-field box, an IMRT plan involving seven coplanar fields, and an SSPT plan involving four fields were created. The median PTV D95% did not differ between the 3D-CRT, IMRT and SSPT plans. The median conformity index 95% and homogeneity index of the IMRT and SSPT were better than those of the 3D-CRT. The homogeneity index of the SSPT was better than that of the IMRT. SSPT resulted in lower median V20 values for the bladder wall, small intestine, colon, bilateral femoral heads, skin, and pelvic bone than IMRT. Comparing the Dmean values, SSPT spared the small intestine, colon, bilateral femoral heads, skin and pelvic bone to a greater extent than the other modalities. SSPT can reduce the irradiated volume of the organs at risk compared with 3D-CRT and IMRT, while maintaining excellent PTV coverage. Further investigations of SSPT are warranted to assess its role in the treatment of cervical cancer. PMID:27380800

  10. Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

    SciTech Connect

    Oh, Dongryul; Huh, Seung Jae Nam, Heerim; Park, Won; Han, Youngyih; Lim, Do Hoon; Ahn, Yong Chan; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho

    2008-03-15

    Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer. Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed. Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age {>=}55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose {>=}50.4 Gy (p = 0.005) were the predisposing factors for development of PIF. Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age {>=}55 years (p < 0.001), body weight <55 kg (p = 0.02), curative treatment (p = 0.03), and radiation dose {>=}50.4 Gy (p = 0.04) were significant predisposing factors for development of PIF. Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight.

  11. Chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life: a population-based cross-sectional study.

    PubMed

    Feddern, Marie-Louise; Jensen, Troels Staehelin; Laurberg, Søren

    2015-09-01

    The aim of this investigation was to examine the prevalence of and factors associated with chronic pain in the pelvic area or lower extremities after rectal cancer treatment and its impact on quality of life (QoL). This is a population-based cross-sectional study of chronic pain and QoL in patients treated for rectal cancer from 2001 to 2007. A modified version of the Brief Descriptive Danish Pain Questionnaire and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire were mailed to 1713 Danish patients. Informative answers were obtained from 1369 patients (80%). A total of 426 patients (31%) reported chronic pain in the pelvic area or lower extremities, 173 (41%) of whom had daily pain. Pain in other parts of the body was associated with the presence of pain in the pelvic region (odds ratio [OR] 4.81 [3.63-6.38], P < 0.001). Multivariate logistic regression analysis showed an association with chronic pain in female patients (OR 1.91 [1.51-2.43], P < 0.001) and in those who received radio(chemo)therapy (OR 1.31 [1.01-1.7], P = 0.041) or underwent abdominoperineal excision (OR 1.71 [1.19-2.44], P = 0.003), total mesorectal excision (OR 1.39 [1.01-1.90], P = 0.041), and Hartmann procedure (OR 1.72 [1.04-2.84], P = 0.33) compared with partial mesorectal excision. Ordinal regression analysis showed a strong association between all QoL subgroups and pelvic pain. Chronic pain in the pelvic region or lower extremities after rectal cancer treatment is a common but largely neglected problem that is associated with female gender, type of surgery, radio(chemo)therapy, and young age, all of which impact the patient's QoL.

  12. Treatment of Endometrial Cancer in Association with Pelvic Organ Prolapse

    PubMed Central

    Vanichtantikul, Asama; Tharavichitkul, Ekkasit; Chitapanarux, Imjai

    2017-01-01

    Background. Uterine malignancy coexistent with pelvic organ prolapse (POP) is uncommon and standardized treatment is not established. The objective of this case study was to highlight the management of endometrial cancer in association with pelvic organ prolapse. Case Report. An 87-year-old woman presented with POP Stage IV combined with endometrioid adenocarcinoma of the uterus: clinical Stage IV B. She had multiple medical conditions including stroke, deep vein thrombosis, and pulmonary embolism. She was treated with radiotherapy and pessary was placed. Conclusion. Genital prolapse with abnormal uterine bleeding requires proper evaluation and management. Concurrent adenocarcinoma and POP can be a difficult clinical situation to treat, and optimum management is controversial.

  13. Low rate of lymphedema after extended pelvic lymphadenectomy followed by pelvic irradiation of node-positive prostate cancer

    PubMed Central

    2013-01-01

    Background The aim of the present study was to evaluate the prevalence and severity of lower limb lymphedema after pelvic lymphadenectomy and radiotherapy to the pelvic lymph nodes in patients with prostate cancer. Methods Twenty-six patients underwent combined treatment for high-risk node-positive prostate cancer at Skåne University Hospital between April 2008 and March 2011. The treatment consisted of extended pelvic lymphadenectomy followed by androgen deprivation therapy and radiotherapy. The pelvic lymphnodes, prostate and seminal vesicles were treated with external beam radiotherapy (EBRT) to an absorbed dose of 50 Gy followed by a brachytherapy (BT) boost of 2x10 Gy to the prostate only. Twenty-two patients accepted an invitation to a clinical examination with focus on lower limb swelling. The median time between the end of radiotherapy and examination was 2.2 years (range 1.2–4.1). Results Six patients (27%) experienced grade 1 lymphedema and two patients (9%) grade 2 while none had grade 3 or 4 according to the CTC Common Toxicity Criteria scale 4.0. Three patients required treatment with compression stockings. Conclusion Brachytherapy and pelvic EBRT have a low incidence of lymphedema (at median 2.2 y after treatment) in patients with high-risk node-positive prostate cancer that have undergone pelvic lymph node dissection. PMID:24252686

  14. A qualitative study of cancer survivors' responses to information on the long-term and late effects of pelvic radiotherapy 1-11 years post treatment.

    PubMed

    Boulton, M; Adams, E; Horne, A; Durrant, L; Rose, P; Watson, E

    2015-09-01

    As more patients survive cancer for longer term, the long-term and late effects of treatments become increasingly important issues for cancer survivors and providing information to enable survivors to recognise and manage them becomes an increasingly pressing challenge for health care professionals. The aim of this study was to explore the experiences of cancer survivors regarding information given on potential long-term and late effects of pelvic radiotherapy. Semi-structured interviews were conducted with 28 cancer survivors who had had radiotherapy to the pelvic area for a range of cancers 1-11 years previously. Participants were recruited using maximum variation sampling from a larger questionnaire survey of patients treated at one hospital. Interviews were recorded, transcribed and analysed using Framework. Participants recognised the value of information to reassure and to inform action but also its potentially undesirable effects to frighten or raise anxieties about future problems and its inherent limitations in meeting their wider needs. They identified the timing, amount of information and context in which it was given as of particular importance. Information based on personal experience was also valued. These findings highlight the importance of appropriate, individualised information during treatment, at hospital discharge and subsequently in primary care.

  15. Prolonged pegylated liposomal doxorubicin treatment for recurrent pelvic cancers: a feasibility study.

    PubMed

    Rabinovich, Alex; Ramanakumar, Agnihotram V; Lau, Susie; Gotlieb, Walter H

    2015-07-01

    We conducted a proof of concept study evaluating prolonged treatment with pegylated liposomal doxorubicin for recurrent ovarian, tubal and peritoneal carcinoma. Thirteen consecutive patients received an average of 22.6 cycles of pegylated liposomal doxorubicin, with an average cumulative dose of 1409 mg/m(2) . Progression-free survival at 18 months was 61.5%, and was longer than the previous progression-free survival in 10 of the 13 patients. Overall 5-year survival was 78.8%. Despite prolonged use and relatively large cumulative doses of pegylated liposomal doxorubicin, most of the patients had mild to moderate side-effects, none of the patients had detectable cardio-toxic side-effects, and a positive impact on the performance status was noticed. Thus, in our group of patients, continued pegylated liposomal doxorubicin treatment was associated with a longer progression-free interval and allowed improved performance status with manageable toxicity.

  16. Insufficiency Fractures After Pelvic Radiation Therapy for Uterine Cervical Cancer: An Analysis of Subjects in a Prospective Multi-institutional Trial, and Cooperative Study of the Japan Radiation Oncology Group (JAROG) and Japanese Radiation Oncology Study Group (JROSG)

    SciTech Connect

    Tokumaru, Sunao; Toita, Takafumi; Oguchi, Masahiko; Ohno, Tatsuya; Kato, Shingo; Niibe, Yuzuru; Kazumoto, Tomoko; Kodaira, Takeshi; Kataoka, Masaaki; Shikama, Naoto; Kenjo, Masahiro; Yamauchi, Chikako; Suzuki, Osamu; Sakurai, Hideyuki; Teshima, Teruki; Kagami, Yoshikazu; Nakano, Takashi; Hiraoka, Masahiro; and others

    2012-10-01

    Purpose: To investigate pelvic insufficiency fractures (IF) after definitive pelvic radiation therapy for early-stage uterine cervical cancer, by analyzing subjects of a prospective, multi-institutional study. Materials and Methods: Between September 2004 and July 2007, 59 eligible patients were analyzed. The median age was 73 years (range, 37-84 years). The International Federation of Gynecologic Oncology and Obstetrics stages were Ib1 in 35, IIa in 12, and IIb in 12 patients. Patients were treated with the constant method, which consisted of whole-pelvic external-beam radiation therapy of 50 Gy/25 fractions and high-dose-rate intracavitary brachytherapy of 24 Gy/4 fractions without chemotherapy. After radiation therapy the patients were evaluated by both pelvic CT and pelvic MRI at 3, 6, 12, 18, and 24 months. Diagnosis of IF was made when the patients had both CT and MRI findings, neither recurrent tumor lesions nor traumatic histories. The CT findings of IF were defined as fracture lines or sclerotic linear changes in the bones, and MRI findings of IF were defined as signal intensity changes in the bones, both on T1- and T2-weighted images. Results: The median follow-up was 24 months. The 2-year pelvic IF cumulative occurrence rate was 36.9% (21 patients). Using Common Terminology Criteria for Adverse Events version 3.0, grade 1, 2, and 3 IF were seen in 12 (21%), 6 (10%), and 3 patients (5%), respectively. Sixteen patients had multiple fractures, so IF were identified at 44 sites. The pelvic IF were frequently seen at the sacroileal joints (32 sites, 72%). Nine patients complained of pain. All patients' pains were palliated by rest or non-narcotic analgesic drugs. Higher age (>70 years) and low body weight (<50 kg) were thought to be risk factors for pelvic IF (P=.007 and P=.013, Cox hazard test). Conclusions: Cervical cancer patients with higher age and low body weight may be at some risk for the development of pelvic IF after pelvic radiation therapy.

  17. The re-construction of women's sexual lives after pelvic radiotherapy: a critique of social constructionist and biomedical perspectives on the study of female sexuality after cancer treatment.

    PubMed

    White, I D; Faithfull, S; Allan, H

    2013-01-01

    Pelvic radiotherapy creates physical effects and psychological responses that negatively affect the sexual health of women and couples, yet these sexual consequences are not frequently researched or clinically assessed. This focused ethnographic study explored factors that influence the clinical assessment of treatment-induced female sexual difficulties after pelvic radiotherapy within routine medical follow-up. Participant observation of follow-up clinics (n = 69) and in-depth interviews with 24 women, 5 partners and 20 health professionals were undertaken at two cancer centres in the South East of England from 2005 to 2006. Thematic analysis of interview transcripts resulted in five emergent themes, two of which are explored in detail within this paper. A social constructionist approach to human sexuality was used to explore representations of female sexuality in oncology follow-up constructed by clinicians, women and their partners. Yet neither social constructionist nor biomedical (the predominant model in medical follow-up) perspectives on human sexuality provided an adequate interpretation of these study findings. This paper argues that the comprehensive study and practice of sexual rehabilitation in oncology requires a synthesis of both biomedical and social constructionist perspectives in order to capture the complex, subjective and embodied nature of the female sexual response in both health and illness.

  18. [Pelvic irradiation in prostate cancer: what place for what volumes?].

    PubMed

    Chapet, O; Enachescu, C; Lorchel, F

    2013-10-01

    External beam radiotherapy alone is a standard treatment for prostate cancer. According to clinical, histological and biological characteristics of the tumour, lymph node irradiation can be done in combination with irradiation of the prostate. The completion of pelvic irradiation remains controversial and may cause complications by increasing volumes of irradiated healthy tissues. The accuracy of the delineation of lymph node becomes an important issue. This article proposes to take on the characteristics of the pelvic lymph node drainage of the prostate, to review the literature on pelvic irradiation and the definition of volumes to be irradiated.

  19. Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

    SciTech Connect

    Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

    2010-07-01

    Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

  20. SU-E-T-13: A Comparative Dosimetric Study On Radio-Dynamic Therapy for Pelvic Cancer Treatment: Strategies for Bone Marrow Dose and Volume Reduction

    SciTech Connect

    Li, C; Wang, B; Dong, Z; Ma, C; Ge, W; Xu, L

    2015-06-15

    Purpose: Radio-dynamic therapy (RDT) is a potentially effective modality for local and systemic cancer treatment. Using RDT, the administration of a radio-sensitizer enhances the biological effect of high-energy photons. Although the sensitizer uptake ratio of tumor to normal tissue is normally high, one cannot simply neglect its effect on critical structures. In this study, we aim to explore planning strategies to improve bone marrow sparing without compromising the plan quality for RDT treatment of pelvic cancers. Methods: Ten cervical and ten prostate cancer patients who previously received radiotherapy at our institution were selected for this study. For each patient, nine plans were created using the Varian Eclipse treatmentplanning-system (TPS) with 3D-CRT, IMRT, and VMAT delivery techniques containing various gantry angle combinations and optimization parameters (dose constraints to the bone marrow). To evaluate the plans for bone marrow sparing, the dose-volume parameters V5, V10, V15, V20, V30, and V40 for bone marrow were examined. Effective doseenhancement factors for the sensitizer were used to weigh the dose-volume histograms for various tissues from individual fractions. Results: The planning strategies had different impacts on bone marrow sparing for the cervical and prostate cases. For the cervical cases, provided the bone marrow constraints were properly set during optimization, the dose to bone marrow sparing was found to be comparable between different IMRT and VMAT plans regardless of the gantry angle selection. For the prostate cases, however, careful selection of gantry angles could dramatically improve the bone marrow sparing, although the dose distribution in bone marrow was clinically acceptable for all prostate plans that we created. Conclusion: For intensity-modulated RDT planning for cervical cancer, planners should set bone marrow constraints properly to avoid any adverse damage, while for prostate cancer one can carefully select gantry

  1. Prospective study of nutritional support during pelvic irradiation

    SciTech Connect

    Kinsella, T.J.; Malcolm, A.W.; Bothe, A. Jr.; Valerio, D.; Blackburn, G.L.

    1981-04-01

    A prospective study of nutritional support during pelvic irradiation was carried out in 32 patients with a primary pelvic malignancy and prior weight loss. Both curative and palliative patients were eligible for the study. Seventeen patients were randomized to receive intravenous hyperalimentation (IVH) and fifteen patients served as controls who were maintained on their regular diet. Patients were stratified by percent body weight loss. Tolerance to therapy was assessed by evaluation of functional status and by using nutritional parameters of body weight change, change in serum protein levels, and response to delayed hypersensitivity skin tests. The curative IVH group tolerated therapy well by both functional and nutritional measurements. All curative IVH patients completed the planned radiation therapy without a treatment break and were fully active following treatment. Patients gained an average of 4.0 kg body weight during irradiation, which was significantly different from the curative control patients. They demonstrated a significant increase in serum transferrin reflecting an improvement in visceral protein. In addition, all showed a positive response to delayed hypersensitivity skin tests at the completion of irradiation. The palliative IVH patients often did poorly because of progression of disease and demonstrated only an elevation of serum transferrin during treatment. The results in the curative IVH group suggest a potential adjunctive role for intravenous hyperalimentation in the malnourished cancer patient undergoing pelvic irradiation. Clearly, further study of nutritional support during pelvic irradiation is needed using curative patients with a single tumor type and significant prior weight loss.

  2. How important is the number of pelvic lymph node retrieved to locorregional staging of cervix cancer?

    PubMed Central

    Batista, Thales Paulo; Bezerra, Artur Lício Rocha; Martins, Mário Rino; Carneiro, Vandré Cabral Gomes

    2013-01-01

    ABSTRACT Objective: To explore how important is the number of pelvic lymph nodes dissected for the nodal staging in FIGO IA2-IB2 cervical cancer, submitted to radical surgical treatment. Methods: A cross-sectional study was carried out on patients who underwent Piver class II radical hysterectomy and pelvic lymphadenectomy, in two centers in the state of Pernambuco, from January, 2001 to December, 2008. The analysis of the area under the ROC curve was adopted as a summary-measure of discriminatory power of the number of nodes dissected in predicting the pelvic nodal status. Additionally, we also confirm our findings using logistic regression and the Fisher's exact test. Results: The postoperative pathological study included 662 pelvic lymph nodes dissected (median per-patient=9, q25=6 − q75=13) from 69 patients. The ROC curve analysis revealed AUC=0.642, for the discriminatory value of the number of nodes dissected in predicting the pelvic nodal status. Similar findings were found after categorization using 10 and 15 lymph nodes as cut-offs (AUC=0.605 and 0.526, respectively). Logistic regression revealed odds ratio of 0.912 (95% CI=0.805-1.032; p=0.125) for the predictive value of the number of nodes dissected, and a number of nodes ≥10 or ≥15 lymph nodes was not significantly associated with the nodal status by the Fischer's exact test (p=0.224 and p=0.699, respectively). Conclusion: The number of pelvic lymph nodes dissected did not correlate with pelvic lymph node metastatic involvement. This study suggests that dissection of a greater number of lymph nodes does not increase locoregional nodal staging in cervical cancer. PMID:24488383

  3. [Experience with radiofrequency ablation in the treatment of unresectable pelvic recurrence of rectal cancer].

    PubMed

    Mátrai, Zoltán; Fehér, István; Péley, Gábor; Rényi Vámos, Ferenc; Farkas, Emil; Sulyok, Zoltán; Kovács, Tibor; Köves, István

    2005-02-01

    More than half of colorectal cancers are located in the rectum, and the number of such cancers is increasing. In Hungary colorectal cancers are diagnosed predominantly in advanced stages. In the last five years 736 patients with colorectal cancer were operated on at our Department, with the following stage distribution: Dukes A 10%, BI 10%, B2 31%, C 36% and D 13%. The local recurrence rate is decreasing since the introduction of total mesorectal excision and preoperative radiation. Effective treatment options are however poor for unresectable pelvic recurrences. Chemo- and radiotherapy have severe limitations in this advanced stage cancer. In recent years there are a few publications on the minimal-invasive radiofrequency tumour ablation (RFTA) technique, which is an effective treatment for primary and metastatic liver carcinomas and is a new palliative for the local treatment of pelvic recurrence. The aim of this study was to assess the response to treatment using ultrasound-guided radiofrequency ablation in two patients with unresectable pelvic recurrent rectal cancer.

  4. Pelvic pain after childbirth: a longitudinal population study.

    PubMed

    Bjelland, Elisabeth Krefting; Owe, Katrine Mari; Pingel, Ronnie; Kristiansson, Per; Vangen, Siri; Eberhard-Gran, Malin

    2016-03-01

    In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7 to 18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by 4 self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0 to 3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted OR: 0.48; 95% CI: 0.31-0.74 and adjusted OR: 0.65; 95% CI: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P = 0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.

  5. Dosimetric planning study for the prevention of anal complications after post-operative whole pelvic radiotherapy in cervical cancer patients with hemorrhoids

    PubMed Central

    Baek, J G; Kim, E C; Kim, S K

    2015-01-01

    Objective: Radiation-induced anal toxicity can be induced by low radiation doses in patients with haemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in post-operative patients with cervical cancer. Methods: The planning CT images of 10 patients with cervical cancer undergoing postoperative radiotherapy were used for comparison of three different plans. All patients had been treated using the conventional box technique WPRT (CV-WPRT), and we tried low-margin-modified WPRT (LM-WPRT), three-dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of the anal canal, retrospectively. Results: Mean anal canal doses of the IM-WPRT were significantly lower (p < 0.05) than those of CV-WPRT, LM-WPRT and CF-WPRT, and V10, V20, V30 and V40 to the anal canal were also significantly lower for IM-WPRT (p < 0.05). The proportion of planning target volumes (PTVs) that received ≥98% of the prescribed dose for all plans was >99%, and the proportion that received ≥108% of the prescribed dose for IM-WPRT was <2%. Volumes of bladders and rectums that received ≥30 or ≥40 Gy were significantly lower for IM-WPRT than for three of the four-field WPRT plans (p = 0.000). Conclusion: IM-WPRT can significantly reduce radiation dose delivered to the anal canal and does not compromise PTV coverage. In patients with haemorrhoids, IM-WPRT may be of value for the prevention of anal complications. Advances in knowledge: Although tolerance of the anal canal tends to be ignored in patients undergoing post-operative WPRT, patients with haemorrhoids may suffer complications at low radiation doses. The present study shows IM-WPRT can be meaningful in these patients. PMID:26395671

  6. External beam boost irradiation for clinically positive pelvic nodes in patients with uterine cervical cancer

    PubMed Central

    Ariga, Takuro; Toita, Takafumi; Kasuya, Goro; Nagai, Yutaka; Inamine, Morihiko; Kudaka, Wataru; Kakinohana, Yasumasa; Aoki, Youichi; Murayama, Sadayuki

    2013-01-01

    The purpose of this study was to retrospectively analyze the treatment results of boost external beam radiotherapy (EBRT) to clinically positive pelvic nodes in patients with uterine cervical cancer. The study population comprised 174 patients with FIGO stages 1B1–4A cervical cancer who were treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT). Patients with positive para-aortic or common iliac nodes (≥10 mm in the shortest diameter, as evaluated by CT/MRI) were ineligible for the study. Fifty-seven patients (33%) had clinically positive pelvic nodes. The median maximum diameter of the nodes was 15 mm (range, 10–60 mm) and the median number of positive lymph nodes was two (range, one to four). Fifty-two of 57 patients (91%) with positive nodes were treated with boost EBRT (6–10 Gy in three to five fractions). The median prescribed dose of EBRT for nodes was 56 Gy. The median follow-up time for all patients was 66 months (range, 3–142 months). The 5-year overall survival rate, disease-free survival rate and pelvic control rate for patients with positive and negative nodes were 73% and 92% (P = 0.001), 58% and 84% (P < 0.001), and 83% and 92% (P = 0.082), respectively. Five of 57 node-positive patients (9%) developed pelvic node recurrences. All five patients with nodal failure had concomitant cervical failure and/or distant metastases. No significant difference was observed with respect to the incidence or severity of late complications by application of boost EBRT. The current retrospective study demonstrated that boost EBRT to positive pelvic nodes achieves favorable nodal control without increasing late complications. PMID:23365264

  7. Long-Term Follow-Up of Preoperative Pelvic Radiation Therapy and Concomitant Boost Irradiation in Locally Advanced Rectal Cancer Patients: A Multi-Institutional Phase II Study (KROG 04-01)

    SciTech Connect

    Lee, Jong Hoon; Kim, Dae Yong; Nam, Taek-Keun; Yoon, Sei-Chul; Lee, Doo Seok; Park, Ji Won; Oh, Jae Hwan; Chang, Hee Jin; Yoon, Mee Sun; Jeong, Jae-Uk; Jang, Hong Seok

    2012-11-15

    Purpose: To perform a prospective phase II study to investigate the efficacy and safety of preoperative pelvic radiation therapy and concomitant small-field boost irradiation with 5-fluorouracil and leucovorin for 5 weeks in locally advanced rectal cancer patients. Methods and Materials: Sixty-nine patients with locally advanced, nonmetastatic, mid-to-lower rectal cancer were prospectively enrolled. They had received preoperative chemoradiation therapy and total mesorectal excision. Pelvic radiation therapy of 43.2 Gy in 24 fractions plus concomitant boost radiation therapy of 7.2 Gy in 12 fractions was delivered to the pelvis and tumor bed for 5 weeks. Two cycles of 5-fluorouracil and leucovorin were administered for 3 days in the first and fifth week of radiation therapy. The pathologic response, survival outcome, and treatment toxicity were evaluated for the study endpoints. Results: Of 69 patients, 8 (11.6%) had a pathologically complete response. Downstaging rates were 40.5% for T classification and 68.1% for N classification. At the median follow-up of 69 months, 36 patients have been followed up for more than 5 years. The 5-year disease-free survival (DFS) and overall survival rates were 66.0% and 75.3%, respectively. Higher pathologic T (P = .045) and N (P = .032) classification were significant adverse prognostic factors for DFS, and high-grade histology was an adverse prognostic factor for both DFS (P = .025) and overall survival (P = .031) on the multivariate analysis. Fifteen patients (21.7%) experienced grade 3 or 4 acute toxicity, and 7 patients (10.1%) had long-term toxicity. Conclusion: Preoperative pelvic radiation therapy with concomitant boost irradiation with 5-fluorouracil and leucovorin for 5 weeks showed acceptable acute and long-term toxicities. However, the benefit of concomitant small-field boost irradiation for 5 weeks in rectal cancer patients was not demonstrated beyond conventional irradiation for 6 weeks in terms of tumor response and

  8. Metachronous penile metastasis from rectal cancer after total pelvic exenteration.

    PubMed

    Kimura, Yuta; Shida, Dai; Nasu, Keiichi; Matsunaga, Hiroki; Warabi, Masahiro; Inoue, Satoru

    2012-10-14

    Despite its abundant vascularization and extensive circulatory communication with neighboring organs, metastases to the penis are a rare event. A 57-year-old male, who had undergone total pelvic exenteration for rectal cancer sixteen months earlier, demonstrated an abnormal uptake within his penis by positron emission tomography/computed tomography. A single elastic nodule of the middle penis shaft was noted deep within Bucks fascia. No other obvious recurrent site was noted except the penile lesion. Total penectomy was performed as a curative resection based on a diagnosis of isolated penile metastasis from rectal cancer. A histopathological examination revealed an increase of well differentiated adenocarcinoma in the corpus spongiosum consistent with his primary rectal tumor. The immunohistochemistry of the tumor cells demonstrated positive staining for cytokeratin 20 and negative staining for cytokeratin 7, which strongly supported a diagnosis of penile metastasis from the rectum. The patient is alive more than two years without any recurrence.

  9. Radiation alone in the treatment of cancer of the uterine cervix: Analysis of pelvic failure and dose response relationship

    SciTech Connect

    Kim, R.Y.; Trotti, A.; Wu, C.J.; Soong, S.J.; Salter, M.M. )

    1989-11-01

    This retrospective analysis involves 569 patients with invasive cancer of the uterine cervix treated with irradiation alone between 1969 and 1980. Treatment consisted of external and intracavitary irradiation and treatment policy remained consistent throughout the study interval. In early stage disease (FIGO IA, IB, and IIA), pelvic failure was 4.6%, 11.2%, and 8.2%, respectively. In late stage disease (FIGO IIB, III, and IVA), pelvic failure was 30.1%, 52.3%, and 69.2%, respectively. Further analysis revealed that total dose at point A is well correlated with pelvic control. An aggressive treatment is crucial in late stage disease in determining the probability of pelvic tumor control and survival. Methods of dose prescription, dose-response relationships, treatment philosophy and its therapeutic implications are discussed.

  10. Pelvic Radiotherapy for Cancer of the Cervix: Is What You Plan Actually What You Deliver?

    SciTech Connect

    Lim, Karen; Kelly, Valerie; Stewart, James; Xie, Jason; Cho, Young-Bin; Moseley, Joanne B.; Brock, Kristy; Fyles, Anthony; Lundin, Anna; Rehbinder, Henrik; Milosevic, Michael

    2009-05-01

    Purpose: Whole pelvic intensity-modulated radiotherapy (IMRT) is increasingly being used to treat cervix cancer and other gynecologic tumors. However, tumor and normal organ movement during treatment can substantially detract from the benefits of this approach. This study explored the effect of internal anatomic changes on the dose delivered to the tumor and organs at risk using a strategy integrating deformable soft-tissue modeling with simulated dose accumulation. Methods and Materials: Twenty patients with cervix cancer underwent baseline and weekly pelvic magnetic resonance imaging during treatment. Interfraction organ motion and delivered (accumulated) dose was modeled for three treatment scenarios: four-field box, large-margin whole pelvic IMRT (20-mm planning target volume, but 10 mm inferiorly) and small-margin IMRT (5-mm planning target volume). Results: Individually, the planned dose was not the same as the simulated delivered dose; however, when taken as a group, this was not statistically significant for the four-field box and large-margin IMRT plans. The small-margin IMRT plans yielded adequate target coverage in most patients; however, significant target underdosing occurred in 1 patient who displayed excessive, unpredictable internal target movement. The delivered doses to the organs at risk were significantly reduced with the small-margin plan, although substantial variability was present among the patients. Conclusion: Simulated dose accumulation might provide a more accurate depiction of the target and organ at risk coverage during fractionated whole pelvic IMRT for cervical cancer. The adequacy of primary tumor coverage using 5-mm planning target volume margins is contingent on the use of daily image-guided setup.

  11. Surgical and obstetrical outcomes after laparoscopic radical trachelectomy and pelvic lymphadenectomy for early cervical cancer

    PubMed Central

    Yoo, So-Eun; So, Kyeong A; Kim, Seon-Ah; Kim, Mi Kyung; Lee, Yoo Kyung; Lee, In-Ho; Kim, Tae-Jin

    2016-01-01

    Objective The aim of this study was to evaluate the surgical and obstetrical outcomes of patients with early cervical cancer who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy. Methods We analyzed data from women who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy between July 2000 and October 2014. Results Of a total of 12 patients, 91.7% were FIGO (International Federation of Gynecology and Obstetrics) stages IA2 and IB1. Seven patients (58.3%) had squamous cell carcinoma. The median tumor size was 1.87 cm (range, focal to 4.6 cm) and two patients (16.7%) had a tumor lager than 2 cm. Lymphovascular space invasion in the tumor lesion was reported in six patients (50%). The following surgical complications were observed: neurogenic bladder (one patient), hemoperitoneum (one patient), and infection (one patient). A total of 33.3% had attempted to conceive, resulting in two pregnancies and two healthy babies. All pregnancies were achieved by in vitro fertilization and embryo transfer. Each woman underwent cesarean delivery because of premature pre-labor rupture of membranes at gestational weeks 27.3 and 33.3. After a median follow-up time of 4.4 years (range, 1 to 8 years), there were no recurrences or deaths. Conclusion Laparoscopic radical trachelectomy and pelvic lymphadenectomy should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility. PMID:27668200

  12. Neoadjuvant Treatment With Single-Agent Cetuximab Followed by 5-FU, Cetuximab, and Pelvic Radiotherapy: A Phase II Study in Locally Advanced Rectal Cancer

    SciTech Connect

    Bertolini, Federica Chiara, Silvana; Bengala, Carmelo; Antognoni, Paolo; Dealis, Cristina; Zironi, Sandra; Malavasi, Norma; Scolaro, Tindaro; Depenni, Roberta; Jovic, Gordana; Sonaglio, Claudia; Rossi, Aldo; Luppi, Gabriele; Conte, Pier Franco

    2009-02-01

    Purpose: Preoperative chemoradiotherapy followed by surgery represents the standard of care for locally advanced rectal cancer (LARC). Cetuximab has proved activity in advanced colorectal cancer, and its incorporation in preoperative treatment may increase tumor downstaging. Methods and Materials: After biopsy and staging, uT3/uT4 N0/+ LARC received single-agent cetuximab in three doses, followed by weekly cetuximab plus 5-fluorouracil (5-FU), concomitantly with RT. Sample size was calculated according to Bryant and Day test, a two-stage design with at least 10 pathologic complete remissions observed in 60 patients (pts) able to complete the treatment plan. Results: Forty pts with LARC were entered: male/female = 34/6; median age: 61 (range, 28-77); 12 uT3N0 Ed(30%); 25 uT3N1 (62%); 3 uT4N1 (8%); all Eastern Cooperative Oncology Group = 0. Thirty-five pts completed neoadjuvant treatment; 5 (12%) withdrew therapy after one cetuximab administration: three for hypersensitivity reactions, one for rapid progression, and one for purulent arthritis. They continued 5-FU in continuous infusion in association with RT. Thirty-one pts (77%) presented with acnelike rash; dose reduction/interruption of treatment was necessary in six pts (15%): two for Grade 3 acnelike rash, two for Grade 3 gastrointestinal toxicity, and two for refusal. Thirty-eight pts were evaluable for pathological response (one patient refused surgery, and one was progressed during neoadjuvant treatment). Pathological staging was: pT0N0 three pts (8%), pT1N0 1 pt (3%); pT2N0 13 pts (34%), and pT3 19 pts (50%) (N0:9, N1:5; N2:5); pT4 2 pts (5%). Conclusions: Preoperative treatment with 5-FU, cetuximab, and pelvic RT is feasible with acceptable toxicities; however, the rate of pathologic responses is disappointingly low.

  13. Phase 2 study of (99m)Tc-trofolastat SPECT/CT to identify and localize prostate cancer in intermediate- and high-risk patients undergoing radical prostatectomy and extended pelvic lymph node dissection.

    PubMed

    Goffin, Karolien E; Joniau, Steven; Tenke, Peter; Slawin, Kevin; Klein, Eric A; Stambler, Nancy; Strack, Thomas; Babich, John; Armor, Thomas; Wong, Vivien

    2017-03-16

    Rationale:(99m)Tc-trofolastat ((99m)Tc-MIP-1404), a small-molecule inhibitor of prostate-specific membrane antigen (PSMA), shows high potential to detect prostate cancer (PCa) non-invasively using single-photon-emission-computed-tomography (SPECT). We therefore wanted to assess the performance of (99m)Tc-trofolastat SPECT/CT in a phase 2 multi-center, multi-reader prospective study in patients with intermediate- and high-grade PCa, prior to radical prostatectomy and extended pelvic lymph node dissection, with histopathology as gold standard. Methods: 105 PCa patients with an increased risk of lymph node involvement (LNI) received a pelvic (99m)Tc-trofolastat SPECT/CT prior to radical prostatectomy with extended pelvic lymph node dissection. Sensitivity of (99m)Tc-trofolastat for detection of PCa on a patient- and lobe-basis, using visual and semi-quantitative (tumor-to-background ratio, TBR) scores and of LNI was evaluated as well as correlation of uptake within the gland to Gleason scores (GS) and assessment of the predictive potential of (99m)Tc-trofolastat-uptake for LNI. Results: PCa was detected in 98 patients (94%) with acceptable variability between readers. There was a significantly higher visual score and TBR in positive lobes compared to tumor-negative lobes. ROC analysis showed that visual scores more accurately discriminated lobes with GS ≤3+3 from ≥3+4, while TBRs discriminated high-grade disease from normal lobes better. Visual scores and TBRs correlated significantly with GS. (99m)Tc-trofolastat SPECT/CT detected LNI with sensitivity of 50%, and specificity of 87% and TBR values significantly predicted LNI with a sensitivity of 90%. Conclusion:(99m)Tc-trofolastat SPECT/CT detects PCa with high sensitivity in patients with intermediate- and high-risk PCa compared to histology. It has potential to be used as surrogate marker for Gleason scores and predict LNI.

  14. Occult Pelvic Lymph Node Involvement in Bladder Cancer: Implications for Definitive Radiation

    SciTech Connect

    Goldsmith, Benjamin; Baumann, Brian C.; He, Jiwei; Tucker, Kai; Bekelman, Justin; Deville, Curtiland; Vapiwala, Neha; Vaughn, David; Keefe, Stephen M.; Guzzo, Thomas; Malkowicz, S. Bruce; Christodouleas, John P.

    2014-03-01

    Purpose: To inform radiation treatment planning for clinically staged, node-negative bladder cancer patients by identifying clinical factors associated with the presence and location of occult pathologic pelvic lymph nodes. Methods and Materials: The records of patients with clinically staged T1-T4N0 urothelial carcinoma of the bladder undergoing radical cystectomy and pelvic lymphadenectomy at a single institution were reviewed. Logistic regression was used to evaluate associations between preoperative clinical variables and occult pathologic pelvic or common iliac lymph nodes. Percentages of patient with involved lymph node regions entirely encompassed within whole bladder (perivesicular nodal region), small pelvic (perivesicular, obturator, internal iliac, and external iliac nodal regions), and extended pelvic clinical target volume (CTV) (small pelvic CTV plus common iliac regions) were calculated. Results: Among 315 eligible patients, 81 (26%) were found to have involved pelvic lymph nodes at the time of surgery, with 38 (12%) having involved common iliac lymph nodes. Risk of occult pathologically involved lymph nodes did not vary with clinical T stage. On multivariate analysis, the presence of lymphovascular invasion (LVI) on preoperative biopsy was significantly associated with occult pelvic nodal involvement (odds ratio 3.740, 95% confidence interval 1.865-7.499, P<.001) and marginally associated with occult common iliac nodal involvement (odds ratio 2.307, 95% confidence interval 0.978-5.441, P=.056). The percentages of patients with involved lymph node regions entirely encompassed by whole bladder, small pelvic, and extended pelvic CTVs varied with clinical risk factors, ranging from 85.4%, 95.1%, and 100% in non-muscle-invasive patients to 44.7%, 71.1%, and 94.8% in patients with muscle-invasive disease and biopsy LVI. Conclusions: Occult pelvic lymph node rates are substantial for all clinical subgroups, especially patients with LVI on biopsy. Extended

  15. Factors for Predicting Rectal Dose of High-Dose-Rate Intracavitary Brachytherapy After Pelvic Irradiation in Patients With Cervical Cancer: A Retrospective Study With Radiography-Based Dosimetry

    SciTech Connect

    Huang Engyen; Wang Chongjong; Lan Jenhong; Chen Huichun; Fang Fumin; Hsu, H.-C.; Huang Yujie; Wang Changyu; Wang Yuming

    2010-02-01

    Purpose: To evaluate the predictive factors for rectal dose of the first fraction of high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Methods and Materials: From March 1993 through February 2008, 946 patients undergoing pelvic irradiation and HDR-ICBT were analyzed. Examination under anesthesia (EUA) at the first implantation of the applicator was usually performed in the early period. Rectal point was determined radiographically according to the 38th Report of the International Commission of Radiation Units and Measurements (ICRU). The ICRU rectal dose (PRD) as a percentage of point A dose was calculated; multiple linear regression models were used to predict PRD. Results: Factors influencing successful rectal dose calculation were EUA (p < 0.001) and absence of diabetes (p = 0.047). Age (p < 0.001), body weight (p = 0.002), diabetes (p = 0.020), and EUA (p < 0.001) were independent factors for the PRD. The predictive equation derived from the regression model was PRD (%) = 57.002 + 0.443 x age (years) - 0.257 x body weight (kg) + 6.028 x diabetes (no: 0; yes: 1) - 8.325 x EUA (no: 0; yes: 1) Conclusion: Rectal dose at the first fraction of HDR-ICBT is positively influenced by age and diabetes, and negatively correlated with EUA and body weight. A small fraction size at point A may be considered in patients with a potentially high rectal dose to reduce the biologically effective dose if the ICRU rectal dose has not been immediately obtained in the first fraction of HDR-ICBT.

  16. Pain and Psychological Outcomes After Rehabilitative Treatment for a Woman With Chronic Pelvic Pain With Stage III Cervical Cancer: A Case Report

    PubMed Central

    Alappattu, Meryl J.

    2016-01-01

    Background Chronic pelvic pain and sexual dysfunction are adverse effects of treatment of cervical cancer. Surgery and radiation therapies may result in soft tissue pain and dysfunction, including spasms and trigger points of the pelvic floor muscles that result in pain. In addition to physical restrictions, negative mood associated with pain is believed to intensify and prolong the pain experience. Study Design The purpose of this case report was to describe outcomes of pelvic physical therapy in a 58-year-old woman with chronic pelvic pain after medical treatments for cervical cancer. Case Description The patient reported dyspareunia, hip pain, and lower abdominal, pelvic pain, and fatigue with activities lasting greater than 30 minutes. Interventions included pelvic floor massage, dilator use, and patient education. Symptoms were assessed at baseline and completion of physical therapy, using the Female Sexual Function Index, Fear of Pain Questionnaire–III, Pain Catastrophizing Scale, and Numerical Pain Rating Scale. Outcomes The Female Sexual Function Index score decreased from 7.8 to 2.8, the Fear of Pain Questionnaire– III score decreased from 85 to 73, the Pain Catastrophizing Scale score decreased from 18 to 8, and lower abdominal and pelvic pain decreased from 4 of 10 to 0 of 10, while bilateral hip pain remained at 4 of 10. In addition, she exhibited increased tolerance to mechanical pressure, evidenced by progression in size of a vaginal dilator. Discussion These results suggest that pelvic physical therapy may be useful in treating chronic pelvic pain after cervical cancer treatments and may also help decrease the magnitude of negative mood aspects such as pain-related fear and catastrophizing. PMID:27134605

  17. A Phase II/III randomized controlled trial comparing perioperative versus postoperative chemotherapy with mFOLFOX6 for lower rectal cancer with suspected lateral pelvic node metastasis: Japan Clinical Oncology Group Study JCOG1310 (PRECIOUS study).

    PubMed

    Ohue, Masayuki; Iwasa, Satoru; Kanemitsu, Yukihide; Hamaguchi, Tetsuya; Shiozawa, Manabu; Ito, Masaaki; Yasui, Masayoshi; Katayama, Hiroshi; Mizusawa, Junki; Shimada, Yasuhiro

    2017-01-01

    A randomized phase II/III trial was started in May 2015 comparing perioperative versus postoperative chemotherapy with modified infusional fluorouracil and folinic acid with oxaliplatin for lower rectal cancer patients with suspected lateral pelvic node metastasis. The standard arm is total mesorectal excision or tumor-specific mesorectal excision with lateral pelvic node dissection (LND) followed by postoperative chemotherapy (modified infusional fluorouracil and folinic acid with oxaliplatin; 12 cycles). The experimental (perioperative chemotherapy) arm is six courses of modified infusional fluorouracil and folinic acid with oxaliplatin before and six courses after total mesorectal excision with lateral pelvic node dissection. The aim of this trial is to confirm the superiority of perioperative chemotherapy. A total of 330 patients will be enrolled over 7 years. The primary endpoint in Phase II part is proportion of R0 resection and that in Phase III part is overall survival. Secondary endpoints are progression-free survival, local progression-free survival, etc. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000017603 [http://www.umin.ac.jp/ctr/index-j.htm].

  18. Prediction of Anastomotic Leakage After Laparoscopic Low Anterior Resection in Male Rectal Cancer by Pelvic Measurement in Magnetic Resonance Imaging

    PubMed Central

    Tashiro, Jo; Ishii, Toshimasa; Oka, Yasuo; Suzuki, Asami; Kondo, Hiroka; Yamaguchi, Shigeki

    2017-01-01

    Objective: Anastomotic leakage after laparoscopic low anterior resection in male rectal cancer patients with a narrow pelvis cannot be easily resolved. The objective of this study is to assess numerical information of narrow pelvis and to determine whether prediction of morbidity can be possible. Methods: Retrospective medical record review was performed. From July 2007 to January 2013, 43 consecutive male patients with low rectal cancer who underwent laparoscopic low anterior resection were divided into the anastomotic leakage–negative group and anastomotic leakage–positive group. Eleven anatomic parameters were measured from preoperative magnetic resonance imaging of pelvis and a new index called “pelvic index” was calculated. Results: The pelvic index (difference between the interspinous distance and the diameter of the mesorectum divided by the depth of the cavity of the lesser pelvis) in the leakage-positive group was significantly smaller than that in the negative group (P=0.038). Comparison between those 2 groups at the border of the cut-off value of the pelvic index (13.0) showed a significant difference. Conclusions: Preoperative assessment by the pelvic index can predict the narrow pelvis and risk of anastomotic leakage. PMID:28092330

  19. Laparoscopic radical hysterectomy with pelvic lymphadenectomy in early invasive cervical cancer.

    PubMed

    Salicrú, Sabina; Gil-Moreno, Antonio; Montero, Anabel; Roure, Marisa; Pérez-Benavente, Assumpció; Xercavins, Jordi

    2011-01-01

    Laparoscopic radical hysterectomy is one surgical procedure currently performed to treat gynecologic cancer. The objective of this review was to update the current knowledge of laparoscopic radical hysterectomy in early invasive cervical cancer. Articles indexed in the MEDLINE database using the key words "Laparoscopic radical hysterectomy" and "Cancer of the cervix" were reviewed. Studies of laparoscopic radical hysterectomy for treatment of early cervical cancer with a minimum study population of 10 patients were selected. The laparoscopic approach was associated with less surgical morbidity (surgical bleeding) and with shorter length of hospital stay, although the duration of the operation may be longer. Laparoscopic radical hysterectomy with endoscopic pelvic lymphadenectomy, and paraaortic lymphadenectomy if needed, is a safe surgical option for treatment and staging of early invasive cervical cancer considering surgical risk, intraoperative bleeding, intraoperative and postoperative complications, and patient recovery. It is important to respect the learning curve. Surgical advances including new laparoscopic instrumentation and, in particular, use of robotics will contribute to reducing the duration of the operation and to facilitating learning and teaching of the procedure.

  20. Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler.

    PubMed

    Schulman, H; Conway, C; Zalud, I; Farmakides, G; Haley, J; Cassata, M

    1994-09-01

    Our objective was to find the prevalence of non-symptomatic endometrial and ovarian neoplasms in a volunteer population of women, aged 40 and over. We offered a free volunteer screening program to asymptomatic women for a study using transvaginal ultrasound and color flow Doppler for the detection of pelvic cancer. In the first 2 years, 2117 women were examined, 51.3% post-menopausal. An ovarian cyst was defined as having a maximum diameter of more than 2.4 cm. Color flow was used to identify blood vessels feeding pelvic organs and adnexal enlargements. An abnormal Doppler flow velocity for the ovary was defined as a resistance index of less than 0.41. Ovarian cysts of less than 5 cm with normal Doppler indices were followed up in 6 months to 1 year. An adnexal morphology score was created to quantify the usefulness of this parameter, particularly in postmenopausal women. Indications for surgery were pre-defined as a persistent ovarian cyst of more than 5 cm, a persistent suspicious Doppler and a total endometrial thickness of greater than 0.59 cm in postmenopausal women not taking hormones.A total of 202 women (9.5%) had ovarian cysts. Fourteen women were operated upon because of size criteria, one because of family history and three for persistent abnormal flow. By Doppler study, 15 cysts were predicted to be benign and histology was confirmatory. There were two false positives and one true positive, a stage Ib ovarian cancer. There were no false negatives, although a stage I endometrioid cancer of the ovary was detected 8 months after a negative scan. In those cases in which follow-up data were available, 56% of the cysts regressed in premenopausal women. In postmenopausal women, 28% regressed. Twenty of 1086 postmenopausal women had endometrial biopsies. Three had endometrial cancer, two stage I and one stage IIA. Five had atypical or adenomatous hyperplasia, and seven had benign polyps. So many women have small asymptomatic cysts of the ovary that a major

  1. Phase II study of capecitabine and oxaliplatin given prior to and concurrently with preoperative pelvic radiotherapy in patients with locally advanced rectal cancer

    PubMed Central

    Koeberle, D; Burkhard, R; von Moos, R; Winterhalder, R; Hess, V; Heitzmann, F; Ruhstaller, T; Terraciano, L; Neuweiler, J; Bieri, G; Rust, C; Toepfer, M

    2008-01-01

    This multicentre phase II study evaluated the efficacy and safety of preoperative capecitabine plus oxaliplatin and radiotherapy (RT) in patients with locally advanced rectal cancer (T3/T4 rectal adenocarcinoma with or without nodal involvement). Treatment consisted of one cycle of XELOX (capecitabine 1000 mg m−2 bid on days 1–14 and oxaliplatin 130 mg m−2 on day 1), followed by RT (1.8 Gy fractions 5 days per week for 5 weeks) plus CAPOX (capecitabine 825 mg m−2 bid on days 22–35 and 43–56, and oxaliplatin 50 mg m−2 on days 22, 29, 43 and 50). Surgery was recommended 5 weeks after completion of chemoradiotherapy. The primary end point was pathological complete tumour response (pCR). Sixty patients were enrolled. In the intent-to-treat population, the pCR rate was 23% (95% CI: 13–36%). 58 patients underwent surgery; R0 resection was achieved in 57 (98%) patients, including all 5 patients with T4 tumours. Sphincter preservation was achieved in 49 (84%) patients. Tumour and/or nodal downstaging was observed in 39 (65%) patients. The most common grade 3/4 adverse events were diarrhoea (20%) and lymphocytopaenia (43%). Preoperative capecitabine, oxaliplatin and RT achieved encouraging rates of pCR, R0 resection, sphincter preservation and tumour downstaging in patients with locally advanced rectal cancer. PMID:18349837

  2. Phase II study of capecitabine and oxaliplatin given prior to and concurrently with preoperative pelvic radiotherapy in patients with locally advanced rectal cancer.

    PubMed

    Koeberle, D; Burkhard, R; von Moos, R; Winterhalder, R; Hess, V; Heitzmann, F; Ruhstaller, T; Terraciano, L; Neuweiler, J; Bieri, G; Rust, C; Toepfer, M

    2008-04-08

    This multicentre phase II study evaluated the efficacy and safety of preoperative capecitabine plus oxaliplatin and radiotherapy (RT) in patients with locally advanced rectal cancer (T3/T4 rectal adenocarcinoma with or without nodal involvement). Treatment consisted of one cycle of XELOX (capecitabine 1000 mg m(-2) bid on days 1-14 and oxaliplatin 130 mg m(-2) on day 1), followed by RT (1.8 Gy fractions 5 days per week for 5 weeks) plus CAPOX (capecitabine 825 mg m(-2) bid on days 22-35 and 43-56, and oxaliplatin 50 mg m(-2) on days 22, 29, 43 and 50). Surgery was recommended 5 weeks after completion of chemoradiotherapy. The primary end point was pathological complete tumour response (pCR). Sixty patients were enrolled. In the intent-to-treat population, the pCR rate was 23% (95% CI: 13-36%). 58 patients underwent surgery; R0 resection was achieved in 57 (98%) patients, including all 5 patients with T4 tumours. Sphincter preservation was achieved in 49 (84%) patients. Tumour and/or nodal downstaging was observed in 39 (65%) patients. The most common grade 3/4 adverse events were diarrhoea (20%) and lymphocytopaenia (43%). Preoperative capecitabine, oxaliplatin and RT achieved encouraging rates of pCR, R0 resection, sphincter preservation and tumour downstaging in patients with locally advanced rectal cancer.

  3. Image-guided brachytherapy (IGBT) combined with whole pelvic intensity-modulated radiotherapy (WP-IMRT) for locally advanced cervical cancer: a prospective study from Chiang Mai University Hospital, Thailand

    PubMed Central

    Wanwilairat, Somsak; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Tippanya, Damrongsak; Nopnop, Wannapa; Galalae, Razvan; Chitapanarux, Imjai

    2013-01-01

    Purpose A report of preliminary results and toxicity profiles using image-guided brachytherapy (IGBT) combined with whole pelvic intensity-modulated radiation therapy (WP-IMRT) for locally advanced cervical cancer. Material and methods Fifteen patients with locally advanced cervical cancer were enrolled into the study. WP-IMRT was used to treat the Clinical Target Volume (CTV) with a dose of 45 Gy in 25 fractions. Concurrent cisplatin (40 mg/m2) was prescribed during radiotherapy (RT) on weekly basis. IGBT using computed tomography was performed at the dose of 7 Gy × 4 fractions to the High-Risk Clinical Target Volume (HR-CTV). Results The mean cumulative doses – in terms of equivalent dose of 2 Gy (EQD2) – of IGBT plus WP-IMRT to HR-CTV, bladder, rectum, and sigmoid colon were 88.3, 85.0, 68.2 and 73.6 Gy, respectively. In comparison with standard (point A prescription) dose-volume histograms, volume-based image-guided brachytherapy improved the cumulative doses for bladder of 67%, rectum of 47% and sigmoid of 46%. At the median follow-up time of 14 months, the local control, metastasis-free survival and overall survival rates were 93%, 100% and 93%, respectively. No grade 3-4 acute and late toxicities were observed. Conclusion The combination of image-guided brachytherapy and intensity-modulated radiotherapy improved the dose distribution to tumor volumes and avoided overdose in OARs which could be converted in excellent local control and toxicity profiles. PMID:23634150

  4. Split-Course, High-Dose Palliative Pelvic Radiotherapy for Locally Progressive Hormone-Refractory Prostate Cancer

    SciTech Connect

    Gogna, Nirdosh Kumar; Baxi, Siddhartha; Hickey, Brigid; Baumann, Kathryn; Burmeister, Elizabeth; Holt, Tanya

    2012-06-01

    Purpose: Local progression, in patients with hormone-refractory prostate cancer, often causes significant morbidity. Pelvic radiotherapy (RT) provides effective palliation in this setting, with most published studies supporting the use of high-dose regimens. The aim of the present study was to examine the role of split-course hypofractionated RT used at our institution in treating this group of patients. Methods and Materials: A total of 34 men with locoregionally progressive hormone-refractory prostate cancer, treated with a split course of pelvic RT (45-60 Gy in 18-24 fractions) between 2000 and 2008 were analyzed. The primary endpoints were the response rate and actuarial locoregional progression-free survival. Secondary endpoints included overall survival, compliance, and acute and late toxicity. Results: The median age was 71 years (range, 53-88). Treatment resulted in an overall initial response rate of 91%, a median locoregional progression-free survival of 43 months, and median overall survival of 28 months. Compliance was excellent and no significant late toxicity was reported. Conclusions: The split course pelvic RT described has an acceptable toxicity profile, is effective, and compares well with other high-dose palliative regimens that have been previously reported.

  5. Enteric morbidity of postoperative pelvic external beam and brachytherapy for uterine cancer

    SciTech Connect

    Potish, R.A.; Dusenbery, K.E. )

    1990-05-01

    From 1970 through 1986, 219 women received postoperative pelvic external beam therapy and vaginal radium or cesium for uterine cancer. Prescribed external beam and total vaginal surface doses ranged from 38 to 51 Gy and from 70 to 119 Gy, respectively. Severe enteric morbidity developed in 7.8% of patients (15 small bowel, 1 sigmoid, 1 rectal). Complications occurred more frequently in patients with pelvic lymph node sampling at hysterectomy, abdominal surgery prior to hysterectomy, and low body weight. Logistic analysis demonstrated no significant effect of pelvic external beam dose, vaginal surface boost dose, or milligram hours. Five and 10-year overall survival rates were 85% and 74%, respectively. There were two proximal and one distal vaginal recurrences. Recommendations for avoiding complications are presented.

  6. Predictors of Grade 3 or Higher Late Bowel Toxicity in Patients Undergoing Pelvic Radiation for Cervical Cancer: Results From a Prospective Study

    SciTech Connect

    Chopra, Supriya; Dora, Tapas; Chinnachamy, Anand N.; Thomas, Biji; Kannan, Sadhna; Engineer, Reena; Mahantshetty, Umesh; Phurailatpam, Reena; Paul, Siji N.; Shrivastava, Shyam Kishore

    2014-03-01

    Purpose: The present study investigates relationship between dose–volume parameters and severe bowel toxicity after postoperative radiation treatment (PORT) for cervical cancer. Methods and Materials: From June 2010 to December 2012, a total of 71 patients undergoing PORT were included. Small bowel (SB) and large bowel (LB) loops were contoured 2 cm above the target volume. The volume of SB and LB that received 15 Gy, 30 Gy, and 40 Gy was calculated (V15 SB, V15 LB, V30 SB, V30 LB, V40 SB, V 40 LB). On follow-up, bowel toxicity was scored using Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. A reciever operating characteristic (ROC) curve identified volume thresholds that predicted for grade 3 or higher toxicity with highest specificity. All data was dichotomized across these identified cut-off values. Univariate and multivariate analysis was performed using SPSS, version 15. Results: The median patient age was 47 years (range, 35-65 years). Of the 71 patients, 46 received image-guided intensity modulated radiation therapy, and 25 received conformal radiation (50 Gy in 25 fractions for 5 weeks). Overall, 63 of 71 patients received concurrent chemotherapy. On a median follow-up of 18 months (range, 8-29 months), grade 2 or higher bowel toxicity was seen in 22 of 71 patients (30.9%) and grade 3 or higher bowel toxicity was seen in 9 patients (12.6%). On univariate analysis, V15 SB <275 cc (P=.01), V30 SB <190 cc (P=.02), V40 SB <150 cc (P=.01), and V15 LB <250 cc (P=.03), and V40 LB <90 cc (P=.04) predicted for absence of grade 3 or higher toxicity. No other patient- or treatment-related factors were statistically significant. On multivariate analysis, only V15 SB (P=.002) and V15 LB (P=.03) were statistically significant. Conclusions: V 15 Gy SB and LB are independent predictors of late grade 3 or higher toxicity. Restricting V15 SB and V15 LB to <275 cc and <250 cc can reduce grade 3 or higher toxicity to less than 5%.

  7. Pelvic Lymph Node Status Assessed by 18F-Fluorodeoxyglucose Positron Emission Tomography Predicts Low-Risk Group for Distant Recurrence in Locally Advanced Cervical Cancer: A Prospective Study

    SciTech Connect

    Kang, Sokbom; Park, Jung-Yeol; Lim, Myung-Chul; Song, Yong-Joong; Park, Se-Hyun; Kim, Seok-Ki; Chung, Dae-Chul; Seo, Sang-Soo; Kim, Joo-Young; Park, Sang-Yoon

    2011-03-01

    Purpose: To develop a prediction model to identify a low-risk group for distant recurrence in patients with locally advanced cervical cancer treated by concurrent chemoradiation. Methods and Materials: Prospectively, 62 patients with locally advanced cervical cancer were recruited as a training cohort. Clinical variables and parameters obtained from positron emission tomography (PET) and magnetic resonance imaging were analyzed by logistic regression. For the test set, 54 patients were recruited independently. To identify the low-risk group, negative likelihood ratio (LR) less than 0.2 was set to be a cutoff. Results: Among the training cohort, multivariate logistic analysis revealed that advanced International Federation of Gynecology and Obstetrics (FIGO) stage and a high serum squamous cancer cell (SCC) antigen level were significant risk factors (p = 0.015 and 0.025, respectively). Using the two parameters, criteria to determine a low-risk subset for distant recurrence were postulated: (1) FIGO Stage IIB or less and (2) pretreatment SCC < 2.4 (Model A). Positive pelvic node on PET completely predicted all cases with distant recurrence and thus was considered as another prediction model (Model B). In the test cohort, although Model A did not showed diagnostic performance, Model B completely predicted all cases with distant recurrence and showed a sensitivity of 100% with negative LR of 0. Across the training and test cohort (n = 116), the false negative rate was 0 (95% confidence interval 0%-7.6%). Conclusions: Positive pelvic node on PET is a useful marker in prediction of distant recurrence in patients with locally advanced cervical cancer who are treated with concurrent chemoradiation.

  8. Dosimetric evaluation of three adaptive strategies for prostate cancer treatment including pelvic lymph nodes irradiation

    SciTech Connect

    Cantin, Audrey; Gingras, Luc; Archambault, Louis; Lachance, Bernard; Foster, William; Goudreault, Julie

    2015-12-15

    Purpose: The movements of the prostate relative to the pelvic lymph nodes during intensity-modulated radiation therapy treatment can limit margin reduction and affect the protection of the organs at risk (OAR). In this study, the authors performed an analysis of three adaptive treatment strategies that combine information from both bony and gold marker registrations. The robustness of those treatments against the interfraction prostate movements was evaluated. Methods: A retrospective study was conducted on five prostate cancer patients with 7–13 daily cone-beam CTs (CBCTs). The clinical target volumes (CTVs) consisting of pelvic lymph nodes, prostate, and seminal vesicles as well as the OARs were delineated on each CBCT and the initial CT. Three adaptive strategies were analyzed. Two of these methods relied on a two-step patient positioning at each fraction. First step: a bony registration was used to deliver the nodal CTV prescription. Second step: a gold marker registration was then used either to (1) complete the dose delivered to the prostate (complement); (2) or give almost the entire prescription to the prostate with a weak dose gradient between the targets to compensate for possible motions (gradient). The third method (COR) used a pool of precalculated plans based on images acquired at previous treatment fractions. At each new fraction, a plan is selected from that pool based on the daily position of prostate center-of-mass. The dosimetric comparison was conducted and results are presented with and without the systematic shift in the prostate position on the CT planning. The adaptive strategies were compared to the current clinical standard where all fractions are treated with the initial nonadaptive plan. Results: The minimum daily prostate D{sub 95%} is improved by 2%, 9%, and 6% for the complement, the gradient, and the COR approaches, respectively, compared to the nonadaptive method. The average nodal CTV D{sub 95%} remains constant across the

  9. Prostate cancer: comparison of local staging accuracy of pelvic phased-array coil alone versus integrated endorectal-pelvic phased-array coils. Local staging accuracy of prostate cancer using endorectal coil MR imaging.

    PubMed

    Fütterer, Jurgen J; Engelbrecht, Marc R; Jager, Gerrit J; Hartman, Robert P; King, Bernard F; Hulsbergen-Van de Kaa, Christina A; Witjes, J Alfred; Barentsz, Jelle O

    2007-04-01

    To compare the visibility of anatomical details and prostate cancer local staging performance of pelvic phased-array coil and integrated endorectal-pelvic phased-array coil MR imaging, with histologic analysis serving as the reference standard. MR imaging was performed in 81 consecutive patients with biopsy-proved prostate cancer, prior to radical prostatectomy, on a 1.5T scanner. T2-weighted fast spin echo images of the prostate were obtained using phased-array coil and endorectal-pelvic phased-array coils. Prospectively, one radiologist, retrospectively, two radiologists and two less experienced radiologists working in consensus, evaluated and scored all endorectal-pelvic phased-array imaging, with regard to visibility of anatomical details and local staging. Receiver operator characteristics (ROC) analysis was performed. Anatomical details of the overall prostate were significantly better evaluated using the endorectal-pelvic phased-array coil setup (P<0.05). The overall local staging accuracy, sensitivity and specificity for the pelvic phased-array coil was 59% (48/81), 56% (20/36) and 62% (28/45), and for the endorectal-pelvic phased-array coils 83% (67/81), 64% (23/36) and 98% (44/45) respectively, for the prospective reader. Accuracy and specificity were significantly better with endorectal-pelvic phased-array coils (P<0.05). The overall staging accuracy, sensitivity and specificity for the retrospective readers were 78-79% (P<0.05), 56-58% and 96%, for the endorectal-pelvic phased-array coils. Area under the ROC curve (Az) was significantly higher for endorectal-pelvic phased-array coils (Az=0.74) compared to pelvic phased-array coil (Az=0.57), for the prospective reader. The use of endorectal-pelvic phased array coils resulted in significant improvement of anatomic details, extracapsular extension accuracy and specificity. Overstaging is reduced significantly with equal sensitivity when an endorectal-pelvic phased-array coil is used.

  10. Supporting patients following pelvic radiotherapy for endometrial cancer.

    PubMed

    Elliot, Emma

    Endometrial cancer is the commonest gynaecological cancer in the UK. Affected women often live with long-term complex and debilitating side-effects of radiotherapy treatment, such as bowel toxicity, fatigue and psychosexual problems. Women also experience negative feelings around self-image and sexuality, which contribute to a decline in their quality of life. A review of the literature and national policy showed that women had unmet needs after completing radiotherapy treatment for endometrial cancers, and that cancer nurse specialists are in a prime position to deliver a holistic package of personalized care. Staff at a nurse-led gynaecology oncology clinic performed an audit that found the clinic was not meeting the longer-term needs of most women after radiotherapy for endometrial cancers, and that women were attending multiple appointments to access different services. The clinical nurse specialist reviewed local and national policy, carried out situational analysis and engaged with service users to identify where change was needed and to examine whether a new model of service provision, where patients could consult different professionals at one appointment, would help the move forward in life after treatment.

  11. Risk of Hypogonadism From Scatter Radiation During Pelvic Radiation in Male Patients With Rectal Cancer

    SciTech Connect

    Yau, Ivan; Vuong, Te Garant, Aurelie; Ducruet, Thierry; Doran, Patrick; Faria, Sergio; Liberman, Sender; Richard, Carole; Letellier, Francois; Charlebois, Patrick; Loungnarath, Rasmy; Stein, Barry; Devic, Slobodan

    2009-08-01

    Purpose: Recent studies have reported fluctuations in sex hormones during pelvic irradiation. The objective of this study was to observe the effects of radiation on hormonal profiles for two treatment modalities: conventional external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDRBT) given neoadjuvantly for patients with rectal cancer. Methods and Materials: Routine serum follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were collected from 119 consecutive male patients receiving either EBRT, using 45.0-50.4 Gy in 25-28 fractions with concurrent 5-fluorouracil chemotherapy or HDRBT using 26 Gy in 4 fractions. Results: Thirty patients with initially abnormal profiles were excluded. Profiles included in this study were collected from 51 patients treated with EBRT and 38 patients treated with HDRBT, all of whom had normal hormonal profiles before treatment. Mean follow-up times were 17 months for the entire patient cohort-14 and 20 months, respectively-for the EBRT and HDRBT arms. Dosimetry results revealed a mean cumulative testicular dose of 1.24 Gy received in EBRT patients compared with 0.27 Gy in the HDRBT group. After treatment, FSH and LH were elevated in all patients but were more pronounced in the EBRT group. The testosterone-to-LH ratio was significantly lower (p = 0.0036) in EBRT patients for tumors in the lower third of the rectum. The 2-year hypogonadism rate observed was 2.6% for HDRBT compared with 17.6% for EBRT (p = 0.09) for tumors in the lower two thirds of the rectum. Conclusion: HDRBT allows better hormonal sparing than EBRT during neoadjuvant treatment of patients with rectal cancer.

  12. Whole pelvic intensity-modulated radiotherapy for high-risk prostate cancer: a preliminary report

    PubMed Central

    Joo, Ji Hyeon; Kim, Yeon Joo; Choi, Eun Kyung; Kim, Jong Hoon; Lee, Sang-wook; Song, Si Yeol; Yoon, Sang Min; Kim, Su Ssan; Park, Jin-hong; Jeong, Yuri; Ahn, Hanjong; Kim, Choung-Soo; Lee, Jae-Lyun; Ahn, Seung Do

    2013-01-01

    Purpose To assess the clinical efficacy and toxicity of whole pelvic intensity-modulated radiotherapy (WP-IMRT) for high-risk prostate cancer. Materials and Methods Patients with high-risk prostate cancer treated between 2008 and 2013 were reviewed. The study included patients who had undergone WP-IMRT with image guidance using electronic portal imaging devices and/or cone-beam computed tomography. The endorectal balloon was used in 93% of patients. Patients received either 46 Gy to the whole pelvis plus a boost of up to 76 Gy to the prostate in 2 Gy daily fractions, or 44 Gy to the whole pelvis plus a boost of up to 72.6 Gy to the prostate in 2.2 Gy fractions. Results The study cohort included 70 patients, of whom 55 (78%) had a Gleason score of 8 to 10 and 50 (71%) had a prostate-specific antigen level > 20 ng/mL. The androgen deprivation therapy was combined in 62 patients. The biochemical failure-free survival rate was 86.7% at 2 years. Acute any grade gastrointestinal (GI) and genitourinary (GU) toxicity rates were 47% and 73%, respectively. The actuarial rate of late grade 2 or worse toxicity at 2 years was 12.9% for GI, and 5.7% for GU with no late grade 4 toxicity. Conclusion WP-IMRT was well tolerated with no severe acute or late toxicities, resulting in at least similar biochemical control to that of the historic control group with a small field. The long-term efficacy and toxicity will be assessed in the future, and a prospective randomized trial is needed to verify these findings. PMID:24501707

  13. Whole-pelvic volumetric-modulated arc therapy for high-risk prostate cancer: treatment planning and acute toxicity

    PubMed Central

    Ishii, Kentaro; Ogino, Ryo; Hosokawa, Yukinari; Fujioka, Chiaki; Okada, Wataru; Nakahara, Ryota; Kawamorita, Ryu; Tada, Takuhito; Hayashi, Yoshiki; Nakajima, Toshifumi

    2015-01-01

    The objectives of this study were to evaluate dosimetric quality and acute toxicity of volumetric-modulated arc therapy (VMAT) and daily image guidance in high-risk prostate cancer patients. A total of 100 consecutive high-risk prostate cancer patients treated with definitive VMAT with prophylactic whole-pelvic radiotherapy (WPRT) were enrolled. All patients were treated with a double-arc VMAT plan delivering 52 Gy to the prostate planning target volume (PTV), while simultaneously delivering 46.8 Gy to the pelvic nodal PTV in 26 fractions, followed by a single-arc VMAT plan delivering 26 Gy to the prostate PTV in 13 fractions. Image-guided RT was performed with daily cone-beam computed tomography. Dose–volume parameters for the PTV and the organs at risk (OARs), total number of monitor units (MUs) and treatment time were evaluated. Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events, version 4.0. All dosimetric parameters met the present plan acceptance criteria. Mean MU and treatment time were 471 and 146 s for double-arc VMAT, respectively, and were 520 and 76 s for single-arc VMAT, respectively. No Grade 3 or higher acute toxicity was reported. Acute Grade 2 proctitis, diarrhea, and genitourinary toxicity occurred in 12 patients (12%), 6 patients (6%) and 13 patients (13%), respectively. The present study demonstrated that VMAT for WPRT in prostate cancer results in favorable PTV coverage and OAR sparing with short treatment time and an acceptable rate of acute toxicity. These findings support the use of VMAT for delivering WPRT to high-risk prostate cancer patients. PMID:25304328

  14. Radiation therapy and pelvic node dissection in the management of cancer of the prostate.

    PubMed

    Hilaris, B S; Whitmore, W F; Batata, M A; Grabstald, H

    1974-08-01

    A technique involving a pelvic lymphadenectomy and a retropubic implantation of the prostate with iodine 125 encapsulated sources is under investigation at Memorial Hospital. This technique is simple and applicable to patients with localized cancer of the prostate, clinically stage B or C. It has increased the accuracy of staging, carries no mortality and has low morbidity. The results have been encouraging with substantial local tumor control and no late urinary or rectal disturbances in the 49 patients who have been followed from 6 to 30 months.

  15. Hyperfractionated Accelerated Radiotherapy for Rectal Cancer in Patients With Prior Pelvic Irradiation

    SciTech Connect

    Das, Prajnan; Delclos, Marc E.; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J.; Eng, Cathy; Bedi, Manpreet; Krishnan, Sunil; Crane, Christopher H.

    2010-05-01

    Purpose: To retrospectively determine rates of toxicity, freedom from local progression, and survival in rectal cancer patients treated with reirradiation. Methods and Materials: Between February 2001 and February 2005, 50 patients with a history of pelvic radiotherapy were treated with hyperfractionated accelerated radiotherapy for primary (n = 2 patients) or recurrent (n = 48 patients) rectal adenocarcinoma. Patients were treated with 150-cGy fractions twice daily, with a total dose of 39 Gy (n = 47 patients) if the retreatment interval was >=1 year or 30 Gy (n = 3) if the retreatment interval was <1 year. Concurrent chemotherapy was administered to 48 (96%) patients. Eighteen (36%) patients underwent surgical resection following radiotherapy. Results: Two patients had grade 3 acute toxicity and 13 patients had grade 3 to 4 late toxicity. The 3-year rate of grade 3 to 4 late toxicity was 35%. The 3-year rate of freedom from local progression was 33%. The 3-year freedom from local progression rate was 47% in patients undergoing surgery and 21% in those not undergoing surgery (p = 0.057). The 3-year overall survival rate was 39%. The 3-year overall survival rate was 66% in patients undergoing surgery and 27% in those not undergoing surgery (p = 0.003). The 3-year overall survival rate was 53% in patients with a retreatment interval of >2 years and 21% in those with a retreatment interval of <=2 years (p = 0.001). Conclusions: Hyperfractionated, accelerated reirradiation was well tolerated, with low rates of acute toxicity and moderate rates of late toxicity. Reirradiation may help improve pelvic control in rectal cancer patients with a history of pelvic radiotherapy.

  16. Pelvic inflammatory disease increases the risk of a second primary malignancy in patients with cervical cancer treated by surgery alone.

    PubMed

    Chiou, Wen-Yen; Chen, Chien-An; Lee, Moon-Sing; Lin, Hon-Yi; Li, Chung-Yi; Su, Yu-Chieh; Tsai, Shiang-Jiun; Hung, Shih-Kai

    2016-11-01

    As the number of long-term cervical cancer survivors continues to increase because of improvements in treatment, concerns about second primary malignancy have grown. The high-risk area of second primary cancers in cervical cancer survivors is the pelvis. Pelvic inflammatory disease (PID) could be a useful marker for gynecological cancers. Thus, we designed a large-scale, nationwide, controlled cohort study to investigate whether PID or other risk factors increased the risk of second primary cancers in patients with cervical cancer treated by surgery alone.Between 2000 and 2010, a total of 24,444 cervical cancer patients were identified using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan. Patients who received definite surgery were selected. To exclude the effect on second primary malignancy by treatment modalities, all cervical patients who ever having received adjuvant or definite radiotherapy or chemotherapy for primary cervical cancer were excluded. Finally, 3860 cervical cancer patients treated by surgery alone without adjuvant treatments were analyzed.Cox proportional hazards model was used for multivariate analysis and the Kaplan-Meier method was used to assess the cumulative risks. Regarding the incidence of second primary cancers, the standardized incidence ratio (SIR) was used.The median follow-up time was 56.6 months. The 6-year cumulative risk of second primary cancers is 0.16% and 0.12% for PID and without PID, respectively. After adjustment for confounders, age of less than 50 years, the presence of diabetes mellitus, and PID were significantly positivity associated with the risk of second primary cancers. The hazard ratios (HRs) of age less than 50 years, diabetes mellitus, and PID were 1.38 (95% CI = 1.11-2.04), 1.40 (95% CI = 1.06-1.85), and 1.35 (95% CI = 1.00-1.81), respectively. A higher incidence of second primary cancers was observed in the genitals, bladder, and

  17. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    PubMed Central

    Bollini, Gérard; Legaye, Jean; Tardieu, Christine; Prat-Pradal, Dominique; Chabrol, Brigitte; Jouve, Jean-Luc; Duval-Beaupère, Ginette; Pélissier, Jacques

    2014-01-01

    Acetabular cup orientation (inclination and anteversion) is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter) emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter) could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society) providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter) could determine the safe range of pelvis tilt (positional parameter) for an individual and not a group. PMID:25006461

  18. The pain management approach to chronic pelvic pain.

    PubMed

    Rapkin, A J; Kames, L D

    1987-05-01

    Chronic pelvic pain remains a difficult management problem that is often refractory to traditional medical or surgical therapy. The pain management center approach used successfully for the treatment of cancer pain and headache can be adapted to the treatment of chronic pelvic pain. The results of this pilot study suggest that the multidisciplinary techniques of pain management promise to be an effective modality for the treatment of chronic pelvic pain.

  19. Intensity-Modulated Radiotherapy of Pelvic Lymph Nodes in Locally Advanced Prostate Cancer: Planning Procedures and Early Experiences

    SciTech Connect

    Muren, Ludvig Paul Wasbo, Ellen; Helle, Svein Inge; Hysing, Liv Bolstad; Karlsdottir, Asa; Odland, Odd Harald; Valen, Harald; Ekerold, Randi; Johannessen, Dag Clement

    2008-07-15

    Purpose: We present planning and early clinical outcomes of a study of intensity-modulated radiotherapy (IMRT) for locally advanced prostate cancer. Methods and Materials: A total of 43 patients initially treated with an IMRT plan delivering 50 Gy to the prostate, seminal vesicles, and pelvic lymph nodes, followed by a conformal radiotherapy (CRT) plan delivering 20 Gy to the prostate and seminal vesicles, were studied. Dose-volume histogram (DVH) data for the added plans were compared with dose-volume histogram data for the sum of two CRT plans for 15 cases. Gastrointestinal (GI) and genitourinary (GU) toxicity, based on the Radiation Therapy Oncology Group scoring system, was recorded weekly throughout treatment as well as 3 to 18 months after treatment and are presented. Results: Treatment with IMRT both reduced normal tissue doses and increased the minimum target doses. Intestine volumes receiving more than 40 and 50 Gy were significantly reduced (e.g., at 50 Gy, from 81 to 19 cm{sup 3}; p = 0.026), as were bladder volumes above 40, 50, and 60 Gy, rectum volumes above 30, 50, and 60 Gy, and hip joint muscle volumes above 20, 30, and 40 Gy. During treatment, Grade 2 GI toxicity was reported by 12 of 43 patients (28%), and Grade 2 to 4 GU toxicity was also observed among 12 patients (28%). With 6 to 18 months of follow-up, 2 patients (5%) experienced Grade 2 GI effects and 7 patients (16%) experienced Grade 2 GU effects. Conclusions: Use of IMRT for pelvic irradiation in prostate cancer reduces normal tissue doses, improves target coverage, and has a promising toxicity profile.

  20. Robotic and laparoscopic pelvic lymph node dissection for rectal cancer: short-term outcomes of 21 consecutive series

    PubMed Central

    Bae, Sung Uk; Saklani, Avanish P.; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young

    2014-01-01

    Purpose The aim of this study is to describe our initial experience and assess the feasibility and safety of robotic and laparoscopic lateral pelvic node dissection (LPND) in advanced rectal cancer. Methods Between November 2007 and November 2012, extended minimally invasive surgery for LPND was performed in 21 selected patients with advanced rectal cancer, including 11 patients who underwent robotic LPND and 10 who underwent laparoscopic LPND. Extended lymphadenectomy was performed when LPN metastasis was suspected on preoperative magnetic resonance imaging even after chemoradiation. Results All 21 procedures were technically successful without the need for conversion to open surgery. The median operation time was 396 minutes (range, 170-581 minutes) and estimated blood loss was 200 mL (range, 50-700 mL). The median length of stay was 10 days (range, 5-24 days) and time to removal of the urinary catheter was 3 days (range, 1-21 days). The median total number of lymph nodes harvested was 24 (range, 8-43), and total number of lateral pelvic lymph nodes was 7 (range, 2-23). Six patients (28.6%) developed postoperative complications; three with an anastomotic leakages, two with ileus and one patient with chyle leakage. Two patients (9.5%) developed urinary incontinence. There was no mortality within 30 days. During a median follow-up of 14 months, two patients developed lung metastasis and there was no local recurrence. Conclusion Robotic and laparoscopic LPND is technically feasible and safe. Minimally invasive techniques for LPND in selected patients can be an acceptable alternative to an open LPND. PMID:24761412

  1. TH-C-BRD-11: Robustness of Pencil Beam Scanning Proton Therapy for Pelvic Cancer Under Anatomical Changes

    SciTech Connect

    Dinges, E; Bhatia, S; Gross, B; McGuire, S; Wang, D

    2014-06-15

    Purpose: Pencil beam scanning (PBS) proton therapy provides excellent dosimetric benefits in pelvic cancer treatment, yet day-to-day anatomical variations in pelvic region tend to cause range uncertainties. This study evaluates the dosimetric robustness under anatomical changes for three PBS intensity-modulated proton therapy (IMPT), IMPT using worstcase robust optimization (thereafter ‘Robust IMPT’), and single-field uniform dose (SFUD), in cervical cancer treatment. Methods: IMPT, Robust IMPT, and SFUD plans using the same beam directions and the same prescription (Rx) were generated on computed tomography (CT) images acquired on the simulation day. The dose from each plan was then recomputed on CT images acquired in subsequent two to five weeks using the same protocol. The weekly CTs were registered to the planning CT based on bony anatomy. Target coverage was considered adequate on each weekly CT if dose to 99% of the internal target volume (D-ITV99%) reached at least 95% of the Rx dose. Statistical analysis was then performed on the 21 weekly CT images available for the 7 enrolled patients. Results: Statistically, IMPT was unable to maintain target coverage (mean D-ITV99% = 90.5% Rx, p = 0.004), and SFUD was able to maintain target coverage (mean D-ITV99% = 98.0% Rx, p = 0.0064), in the weeks following simulation. Robust IMPT was able to improve the robustness of IMPT significantly (p < 0.0001), though its maintenance of target coverage was not statistically significant by the 95% Rx criteria (mean D-ITV99% = 96.0%, p = 0.1677). Conclusion: During the multi-week treatment course with anatomical variations, SFUD is robust in terms of maintaining target coverage while IMPT is not. The worst-case optimized Robust IMPT, assuming ±3.5% range uncertainties, improves the robustness of IMPT under anatomical changes significantly, even though it was not designed to account for anatomical changes by mechanism.

  2. Prospective Study of Functional Bone Marrow-Sparing Intensity Modulated Radiation Therapy With Concurrent Chemotherapy for Pelvic Malignancies

    SciTech Connect

    Liang Yun; Bydder, Mark; Yashar, Catheryn M.; Rose, Brent S.; Cornell, Mariel; Hoh, Carl K.; Lawson, Joshua D.; Einck, John; Saenz, Cheryl; Fanta, Paul; Mundt, Arno J.; Bydder, Graeme M.; and others

    2013-02-01

    Purpose: To test the hypothesis that intensity modulated radiation therapy (IMRT) can reduce radiation dose to functional bone marrow (BM) in patients with pelvic malignancies (phase IA) and estimate the clinical feasibility and acute toxicity associated with this technique (phase IB). Methods and Materials: We enrolled 31 subjects (19 with gynecologic cancer and 12 with anal cancer) in an institutional review board-approved prospective trial (6 in the pilot study, 10 in phase IA, and 15 in phase IB). The mean age was 52 years; 8 of 31 patients (26%) were men. Twenty-one subjects completed {sup 18}F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) simulation and magnetic resonance imaging by use of quantitative IDEAL (IDEAL IQ; GE Healthcare, Waukesha, WI). The PET/CT and IDEAL IQ were registered, and BM subvolumes were segmented above the mean standardized uptake value and below the mean fat fraction within the pelvis and lumbar spine; their intersection was designated as functional BM for IMRT planning. Functional BM-sparing vs total BM-sparing IMRT plans were compared in 12 subjects; 10 were treated with functional BM-sparing pelvic IMRT per protocol. Results: In gynecologic cancer patients, the mean functional BM V{sub 10} (volume receiving {>=}10 Gy) and V{sub 20} (volume receiving {>=}20 Gy) were 85% vs 94% (P<.0001) and 70% vs 82% (P<.0001), respectively, for functional BM-sparing IMRT vs total BM-sparing IMRT. In anal cancer patients, the corresponding values were 75% vs 77% (P=.06) and 62% vs 67% (P=.002), respectively. Of 10 subjects treated with functional BM-sparing pelvic IMRT, 3 (30%) had acute grade 3 hematologic toxicity or greater. Conclusions: IMRT can reduce dose to BM subregions identified by {sup 18}F-fluorodeoxyglucose-PET/CT and IDEAL IQ. The efficacy of BM-sparing IMRT is being tested in a phase II trial.

  3. Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer

    PubMed Central

    Stabile, Cara; Gunn, Abigail; Sonoda, Yukio

    2015-01-01

    The surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, emotional well being, reproductive function, and overall quality of life (QoL). Fortunately, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae; however, these side effects of treatment are still prevalent. In this article, we provide an overview of the various standard-of-care pelvic surgeries and multimodality cancer treatments (chemotherapy and radiation therapy) by anatomic site and highlight the potential emotional and sexual consequences that can influence cancer survivorship and QoL. Potential screening tools that can be used in clinical practice to identify some of these concerns and treatment side effects and possible solutions are also provided. These screening tools include brief assessments that can be used in the clinical care setting to assist in the identification of problematic issues throughout the continuum of care. This optimizes quality of care, and ultimately, QoL in these women. Prospective clinical trials with gynecologic oncology populations should include patient-reported outcomes to identify subgroups at risk for difficulties during and following treatment for early intervention. PMID:26816823

  4. Comparison of Biochemical Recurrence–Free Survival Between Periprostatic and Pelvic Lymph Node Metastases of Prostate Cancer

    PubMed Central

    González-Roibón, Nilda; Han, Jeong S.; Lee, Stephen; Feng, Zhaoyong; Arslankoz, Sehbal; Smith, Nathaniel; Pierorazio, Philip M.; Humphreys, Elizabeth; Deweese, Theodore L.; Partin, Alan W.; Bivalacqua, Trinity J.; Han, Misop; Trock, Bruce; Netto, Georges J.

    2014-01-01

    Objective To assess the pathologic characteristics and prognostic significance of periprostatic lymph node (LN) metastasis of prostate cancer. The latter was performed by comparing biochemical recurrence (BCR)–free survival in cases of periprostatic LN metastasis versus matched patients showing pelvic LN metastasis Methods and Materials We identified 15 patients who underwent radical prostatectomy in our institution (1984–2011) showing positive periprostatic and negative pelvic LN with available follow-up information (group 1). These patients were matched 1:2 to patients with positive pelvic LN (group 2) for pertinent clinicopathologic parameters. Results Main locations of positive periprostatic LN were posterior base and mid posterolateral. Overall higher rate of positive margins, smaller LN, and metastasis size were encountered in group 1 compared with group 2. At 5 years postprostatectomy, 69% of patients in group 1 were free of BCR, whereas 26% of those in group 2 remained BCR free, suggesting that patients with periprostatic node metastasis appeared to have a lower risk of BCR. However, the difference was not statistically significant (P = .072). The same was true when adjusted for the effect of prostate-specific antigen, surgical margin status, size of LNs, size of metastasis, age, and year of surgery. Conclusion Patients with periprostatic node metastasis may have a lower risk of BCR compared with those with metastasis to pelvic LN. Future analysis of larger cohorts will help establish the biologic significance of prostate cancer metastasis to periprostatic LN. PMID:23564700

  5. [Clinical and microbiological study of acute pelvic inflammatory disease].

    PubMed

    Ovalle, A; Martínez, M A; Casals, A; Yuhaniak, R; Giglio, M S

    1993-01-01

    Upper genital tract infection was investigated in 46 women admitted to hospital with clinic diagnosis of acute pelvic inflammatory disease (PID) and 62 control women accepted to hospital for laparoscopy Fallopian tubes sterilization. Diagnosis was ratified by laparoscopy in mild and moderate salpingitis; culdocentesis and ultrasonography were performed in severe salpingitis and endometrial sample was made in endometritis. Microbiological specimens were taken from the cervix and abdomen. Antecedents and complete clinical studies were obtained. Patients were treated with antibiotic association sodic G penicillin, chloramphenicol and gentamicin. Risk factors to development PID were: single female (p < 0.05), multiple sexual partner (p < 0.01), previous PID (p < 0.05), infertility (p < 0.05), mean year of IUD use in severe salpingitis (p = 0.05) and mean years of age from women with sexually transmitted bacterias (STB) vs endogenous bacterias (EB) (p < 0.05). In the control group no abdomen bacterias were isolated. In patients with PID, C. trachomatis was detected by serology in 28.3%. N. gonorrhoeae was isolated from the cervix in 23.9% and from the abdomen 17.4%. Besides it was isolated from the abdomen: M. hominis 17.3% and E. coli 15.2%. STB were isolated in 54.3% and EB in 47.8% of the patients. Bacterial association was present on the 37%. Cervix isolation of G. vaginalis and Mycoplasma were not correlated with development of PID. Cervix microbiological samples were useful to know abdomen microbic etiology. They coincide with those in the 90.9%. EB were more frequently isolated from severe salpingitis (p = 0.05) and STB from mild and moderate salpingitis (p = 0.05). Antibiotic association cured all the mild and moderate salpingitis with independence of bacterial etiology. Failure occurred in 2 diffuse peritonitis and 13/14 tubo-ovarian abscesses. Surgery used in severe salpingitis and diffuse peritonitis, principally consisted in anexectomy, peritoneal toilet and

  6. Short-Course Accelerated Radiotherapy in Palliative Treatment of Advanced Pelvic Malignancies: A Phase I Study

    SciTech Connect

    Caravatta, Luciana; Padula, Gilbert D.A.; Macchia, Gabriella; Ferrandina, Gabriella; Bonomo, Pierluigi; Deodato, Francesco; Massaccesi, Mariangela; Mignogna, Samantha; Tambaro, Rosa; Rossi, Marco; Flocco, Mariano; Scapati, Andrea; and others

    2012-08-01

    Purpose: To define the maximum tolerated dose of a conformal short-course accelerated radiotherapy in patients with symptomatic advanced pelvic cancer. Methods and Materials: A phase I trial in 3 dose-escalation steps was designed: 14 Gy (3.5-Gy fractions), 16 Gy (4-Gy fractions), and 18 Gy (4.5-Gy fractions). The eligibility criteria included locally advanced and/or metastatic pelvic cancer and Eastern Cooperative Oncology Group performance status of {<=}3. Treatment was delivered in 2 days with twice-daily fractionation and at least an 8-hour interval. Patients were treated in cohorts of 6-12 to define the maximum tolerated dose. The dose-limiting toxicity was defined as any acute toxicity of grade 3 or greater, using the Radiation Therapy Oncology Group scale. Pain was recorded using a visual analog scale. The effect on quality of life was evaluated according to Cancer Linear Analog Scale (CLAS). Results: Of the 27 enrolled patients, 11 were male and 16 were female, with a median age of 72 years (range 47-86). The primary tumor sites were gynecologic (48%), colorectal (33.5%), and genitourinary (18.5%). The most frequent baseline symptoms were bleeding (48%) and pain (33%). Only grade 1-2 acute toxicities were recorded. No patients experienced dose-limiting toxicity. With a median follow-up time of 6 months (range 3-28), no late toxicities were observed. The overall (complete plus partial) symptom remission was 88.9% (95% confidence interval 66.0%-97.8%). Five patients (41.7%) had complete pain relief, and six (50%) showed >30% visual analog scale reduction. The overall response rate for pain was 91.67% (95% confidence interval 52.4%-99.9%). Conclusions: Conformal short course radiotherapy in twice-daily fractions for 2 consecutive days was well tolerated up to a total dose of 18 Gy. A phase II study is ongoing to confirm the efficacy on symptom control and quality of life indexes.

  7. Experimental studies on the human gait using a tethered pelvic assist device (T-PAD).

    PubMed

    Vashista, Vineet; Mustafa, S K; Agrawal, Sunil K

    2011-01-01

    This paper presents the prototype of a novel tethered pelvic assist device (T-PAD). This is a purely passive device, consisting of a set of elastic tethers with one end attached to a hip brace worn by a subject walking on a treadmill, and the other end attached to a fixed frame surrounding the subject. T-PAD offers the flexibility of varying the assistance required on the pelvis by changing the configuration of the tether attachment locations, number of tethers and tether elasticity. Experimental studies were conducted using a full and a partial pelvic constraint configuration of T-PAD, with varying tether elasticity. The studies were aimed at observing the effect of T-PAD on the human gait. Results show that T-PAD reduced the range-of-motion for the pelvic angles with increase of tether elasticity. However, it had mixed effects on the range-of-motion of the hip angles, but negligible effect on the knee and ankle joint angles. Overall, T-PAD shows potential as a low-cost pelvic support device with pelvic motion control capabilities, and can work in tandem with existing gait trainers.

  8. A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study.

    PubMed

    Karlsen, Mona Aarenstrup; Fagö-Olsen, Carsten; Høgdall, Estrid; Schnack, Tine Henrichsen; Christensen, Ib Jarle; Nedergaard, Lotte; Lundvall, Lene; Lydolph, Magnus Christian; Engelholm, Svend Aage; Høgdall, Claus

    2016-09-01

    The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0.688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary surgery (positive predictive value of 60 %), resulting in a negative predictive value of 87.5 %, sensitivity of 68.3 %, specificity of 83.5 %, and cutoff of 0.63 for the CONATS index. Non-invasive prediction of complete PDS is possible with the CONATS index. The CONATS index is meant as a supplement to the standard preoperative evaluation of each patient. Evaluation of the CONATS index combined with radiological and/or laparoscopic findings may improve the assessment of the optimal treatment strategy in patients with advanced epithelial ovarian cancer.

  9. Relative Importance of Hip and Sacral Pain Among Long-Term Gynecological Cancer Survivors Treated With Pelvic Radiotherapy and Their Relationships to Mean Absorbed Doses

    SciTech Connect

    Waldenstroem, Ann-Charlotte; Olsson, Caroline; Wilderaeng, Ulrica; Dunberger, Gail; Lind, Helena; Alevronta, Eleftheria; Al-Abany, Massoud; Tucker, Susan; Avall-Lundqvist, Elisabeth; Johansson, Karl-Axel; Steineck, Gunnar

    2012-10-01

    Purpose: To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs. Methods and Materials: We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors. Results: Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy. Conclusions: Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.

  10. Use of prolene mesh in surgical treatment of tissue defects after radical inguinal and pelvic lymph node dissection in vulvar cancer--a brief report.

    PubMed

    Olejek, A

    2006-01-01

    Surgery is still the procedure of choice in treatment of advanced vulvar cancer. Radical vulvar surgery is often associated with severe vulvar and inguinal skin and fat-tissue deficits resulting from wide "butterfly" shape resection. Primary closure of large vulvar and inguinal defects is hampered by lack of tissue. The study presents the case of using prolene mesh in filling up the tissue defects over femoral vein and artery after radical excision of enlarged inguinal superficial, femoral, and pelvic nodes to prevent vessels in hiatus saphenus. It is the first report describing the use of prolene mesh in such a procedure.

  11. Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis

    PubMed Central

    Kim, Soo Ah; Um, Mi Jung; Kim, Han Kyoung; Kim, Suk Jin; Moon, Seo Ju

    2016-01-01

    Objective To evaluate the effect of orally administered dienogest (DNG) for dysmenorrhea and pelvic pain associated with endometriosis. Methods For this study we recruited 89 patients with dysmenorrhea and pelvic pain associated with endometriosis diagnosed by laparoscopy. All patients complained of persistent dysmenorrhea and pelvic pain despite surgical treatment 6 months previously. After 6 months of DNG treatment, we used a 0 to 3 point verbal rating scale to measure the severity of disability in daily life due to dysmenorrhea and pelvic pain, and the use of analgesics. Weight gain, serum lipid and liver enzyme tests were performed before treatment and after 6 months of DNG treatment. Results Total dysmenorrhea scores assessed by the verbal rating scale significantly decreased by the end of treatment (P<0.001). The mean (±standard deviation) pain score for dysmenorrhea before and after treatment were 1.42±1.1 and 0.1±0.3, respectively. The mean non-menstrual pelvic pain scores before and after treatment were 0.52±0.6 and 0.18±0.3, respectively, showing a significant difference (P<0.001). The use of analgesics significantly decreased by the end of the treatment (P<0.001). The associated adverse effects were weight gains (in 56 of 89 patients, 63%) and uterine bleeding (in 28 of 89 patients, 31.5%). The weight gain (before treatment, 57.9±9.7; after treatment, 61.1±12.6) was statistically significant (P<0.040). Conclusion This study demonstrated that orally administered DNG could be used to effectively treat dysmenorrhea and pelvic pain associated with endometriosis although the side effects of weight gain and uterine bleeding should be considered. PMID:27896253

  12. Comparison of pelvic floor muscle strength evaluations in nulliparous and primiparous women: a prospective study

    PubMed Central

    Gameiro, Mônica Orsi; Sousa, Vanessa Oliveira; Gameiro, Luiz Felipe; Muchailh, Rosana Carneiro; Padovani, Carlos Roberto; Amaro, João Luiz

    2011-01-01

    OBJECTIVE: This study aimed to compare the pelvic floor muscle strength of nulliparous and primiparous women. METHODS: A total of 100 women were prospectively distributed into two groups: Group 1 (G1) (n = 50) included healthy nulliparous women, and Group 2 (G2) (n = 50) included healthy primiparous women. Pelvic floor muscle strength was subjectively evaluated using transvaginal digital palpation. Pelvic floor muscle strength was objectively assessed using a portable perineometer. All of the parameters were evaluated simultaneously in G1 and were evaluated in G2 during the 20th and 36th weeks of pregnancy and 45 days after delivery. RESULTS: In G2, 14 women were excluded because they left the study before the follow-up evaluation. The median age was 23 years in G1 and 22 years in G2; there was no significant difference between the groups. The average body mass index was 21.7 kg/m2 in G1 and 25.0 kg/m2 in G2; there was a significant difference between the groups (p = 0.0004). In G2, transvaginal digital palpation evaluation showed significant impairments of pelvic floor muscle strength at the 36th week of pregnancy (p = 0.0006) and 45 days after vaginal delivery (p = 0.0001) compared to G1. Objective evaluations of pelvic floor muscle strength in G2 revealed a significant decrease 45 days after vaginal delivery compared to nulliparous patients. CONCLUSION: Pregnancy and vaginal delivery may cause weakness of the pelvic floor muscles. PMID:21915489

  13. A study on difference and importance of sacral slope and pelvic sacral angle that affect lumbar curvature.

    PubMed

    Choi, Seyoung; Lee, Minsun; Kwon, Byongan

    2014-01-01

    Individual pelvic sacral angle was measured, compared and analyzed for the 6 male and female adults who were diagnosed with lumbar spinal stenosis, foraminal stenosis and mild spondylolisthesis in accordance with spinal parameters, pelvic parameters and occlusion state of sacroiliac joint presented by the author of this thesis based on the fact that the degree of lumbar excessive lordosis that was one of the causes for lumbar pain was determined by sacral slope. The measured values were compared with the standard values of the average normal range from 20 s to 40 s of normal Koreans stated in the study on the change in lumbar lordosis angle, lumbosacral angle and sacral slope in accordance with the age by Oh et al. [5] and sacral slope and pelvic sacral slope of each individual of the subjects for measurement were compared. Comparing the difference between the two tilt angles possessed by an individual is a comparison to determine how much the sacroiliac joint connecting pelvis and sacral vertebrae compensated and corrected the sacral vertebrae slope by pelvic tilt under the condition of synarthrodial joint.Under the condition that the location conforming to the line in which the sagittal line of gravity connects with pelvic ASIS and pubic pubic tuberele is the neutral location of pelvic tilt, sacral slope being greater than pelvic sacral slope means pelvic anterior tilting, whereas sacral slope being smaller than pelvic sacral slope means pelvic posterior tilting. On that account, male B, female A and female C had a pelvic posterior tilting of 16 degrees, 1 degree and 5 degrees respectively, whereas male A, male C and female B had a pelvic anterior tilting of 3 degrees, 9 degrees and 4 degrees respectively. In addition, the 6 patients the values of lumbar lordosis angle, lumbosacral angle and sacral slope that were almost twice as much as the normal standard values of Koreans. It is believed that this is because the pelvic sacral slope maintaining an angle that is

  14. Whole-Pelvic Nodal Radiation Therapy in the Context of Hypofractionation for High-Risk Prostate Cancer Patients: A Step Forward

    SciTech Connect

    Kaidar-Person, Orit; Roach, Mack; Créhange, Gilles

    2013-07-15

    Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer.

  15. Dosimetric Predictors of Radiation-Induced Vaginal Stenosis After Pelvic Radiation Therapy for Rectal and Anal Cancer

    SciTech Connect

    Son, Christina H.; Law, Ethel; Oh, Jung Hun; Apte, Aditya P.; Yang, T. Jonathan; Riedel, Elyn; Wu, Abraham J.; Deasy, Joseph O.; Goodman, Karyn A.

    2015-07-01

    Purpose: Although vaginal stenosis (VS) is a recognized toxicity in women who receive pelvic radiation therapy (RT), the relationship between RT dose and the volume and extent of toxicity has not been analyzed. We modeled this relationship to identify predictors of VS. Methods and Materials: We evaluated 54 women, aged 29 to 78 years, who underwent pelvic RT for rectal or anal cancer during 2008 to 2011 and were enrolled in a prospective study evaluating vaginal dilator use. Maximum dilator size was measured before RT (baseline) and 1 month and 12 months after RT. Dilator use was initiated at 1 month. The difference (D) in dilator size before and after RT was recorded. Those with D ≤−1 were classified as having VS (n=35); those with D ≥0 were classified as having no VS (n=19 at 1 month). Dose-volume parameters were extracted, and the generalized equivalent uniform dose (gEUD) was used to build a predictive model. Results: The mean vaginal doses were 50.0 Gy and 36.8 Gy for anal and rectal cancer patients, respectively. One month after RT, a gEUD model using a wide range of a values suggests that sparing of vaginal volume to a low dose may be important. When gEUD (a = −1) was <35 Gy and the mean vaginal dose was <43 Gy, severe VS was reduced (P=.02). A 1-year analysis suggests increasingly negative D values with increasing mean dose. However, patients with compliance <40% were more likely to have toxicity. Conclusions: Vaginal stenosis is influenced by multiple RT dose-volume characteristics. Mean dose and gEUD constraints together may reduce the risk of severe VS. Patients receiving higher mean vaginal doses should have greater compliance with dilator therapy to minimize risk of toxicity. Further validation with independent datasets is needed.

  16. Effect of Intensity-Modulated Pelvic Radiotherapy on Second Cancer Risk in the Postoperative Treatment of Endometrial and Cervical Cancer

    SciTech Connect

    Zwahlen, Daniel R. Ruben, Jeremy D.; Jones, Phillip; Gagliardi, Frank; Millar, Jeremy L.; Schneider, Uwe

    2009-06-01

    Purpose: To estimate and compare intensity-modulated radiotherapy (IMRT) with three-dimensional conformal radiotherapy (3DCRT) in terms of second cancer risk (SCR) for postoperative treatment of endometrial and cervical cancer. Methods and Materials: To estimate SCR, the organ equivalent dose concept with a linear-exponential, a plateau, and a linear dose-response model was applied to dose distributions, calculated in a planning computed tomography scan of a 68-year-old woman. Three plans were computed: four-field 18-MV 3DCRT and nine-field IMRT with 6- and 18-MV photons. SCR was estimated as a function of target dose (50.4 Gy/28 fractions) in organs of interest according to the International Commission on Radiological Protection Results: Cumulative SCR relative to 3DCRT was +6% (3% for a plateau model, -4% for a linear model) for 6-MV IMRT and +26% (25%, 4%) for the 18-MV IMRT plan. For an organ within the primary beam, SCR was +12% (0%, -12%) for 6-MV and +5% (-2%, -7%) for 18-MV IMRT. 18-MV IMRT increased SCR 6-7 times for organs away from the primary beam relative to 3DCRT and 6-MV IMRT. Skin SCR increased by 22-37% for 6-MV and 50-69% for 18-MV IMRT inasmuch as a larger volume of skin was exposed. Conclusion: Cancer risk after IMRT for cervical and endometrial cancer is dependent on treatment energy. 6-MV pelvic IMRT represents a safe alternative with respect to SCR relative to 3DCRT, independently of the dose-response model. 18-MV IMRT produces second neutrons that modestly increase the SCR.

  17. Three-dimensional study of pelvic asymmetry on anatomical specimens and its clinical perspectives

    PubMed Central

    Boulay, Christophe; Tardieu, Christine; Bénaim, Charles; Hecquet, Jérome; Marty, Catherine; Prat-Pradal, Dominique; Legaye, Jean; Duval-Beaupère, Ginette; Pélissier, Jacques

    2006-01-01

    The aim of this study was to assess pelvic asymmetry (i.e. to determine whether the right iliac bone and the right part of the sacrum are mirror images of the left), both quantitatively and qualitatively, using three-dimensional measurements. Pelvic symmetry was described osteologically using a common reference coordinate system for a large sample of pelvises. Landmarks were established on 12 anatomical specimens with an electromagnetic Fastrak system. Seventy-one paired variables were tested with a paired t-test and a non-parametric test (Wilcoxon). A Pearson correlation matrix between the right and left values of the same variable was applied exclusively to values that were significantly asymmetric in order to calculate a dimensionless asymmetry index, ABGi, for each variable. Fifteen variables were significantly asymmetric and correlated with the right vs. left sides for the following anatomical regions: sacrum, iliac blades, iliac width, acetabulum and the superior lunate surface of the acetabulum. ABGi values above a threshold of ± 4.8% were considered significantly asymmetric in seven variables of the pelvic area. Total asymmetry involving the right and the left pelvis seems to follow a spiral path in the pelvis; in the upper part, the iliac blades rotate clockwise, and in the lower part, the pubic symphysis rotates anticlockwise. Thus, pelvic asymmetry may be evaluated in clinical examinations by measuring iliac crest orientation. PMID:16420376

  18. Transperitoneal Robot-Assisted Radical Prostatectomy Should Be Considered in Prostate Cancer Patients with Pelvic Kidneys

    PubMed Central

    Plagakis, Sophie; Foreman, Darren; Sutherland, Peter

    2016-01-01

    Abstract We highlight two cases of transperitoneal robot-assisted radical prostatectomy (RARP) in patients with pelvic kidneys because of congenital development and renal transplant. These uncommon cases present a challenge to the surgeon contemplating surgery because of access and anomalous vascular and ureteral anatomy. We describe the technical considerations that are paramount in effectively completing transperitoneal RARP, and believe it should be considered as a treatment option in men with pelvic kidneys. PMID:27579412

  19. NR2F6 Expression Correlates with Pelvic Lymph Node Metastasis and Poor Prognosis in Early-Stage Cervical Cancer

    PubMed Central

    Niu, Chunhao; Sun, Xiaoying; Zhang, Weijing; Li, Han; Xu, Liqun; Li, Jun; Xu, Benke; Zhang, Yanna

    2016-01-01

    Background: There is an abnormal expression of nuclear receptor subfamily 2 group F member 6 (NR2F6) in human cancers such as breast cancer, colon cancer, and acute myelogenous leukemia. However, its clinical significance in cervical cancer has not been established. We explored NR2F6 expression and its clinicopathological significance in early-stage cervical cancer. Methods: NR2F6 expression in cervical cancer cell lines and cervical cancer tissues was determined by Western blotting, real-time PCR, and immunochemistry (IHC). NR2F6 expression in 189 human early-stage cervical cancer tissue samples was evaluated using IHC. The relevance between NR2F6 expression and early-stage cervical cancer prognosis and clinicopathological features was determined. Results: There was marked NR2F6 mRNA and protein overexpression in the cervical cancer cells and clinical tissues compared with an immortalized squamous cell line and adjacent noncancerous cervical tissues, respectively. In the 189 cervical cancer samples, NR2F6 expression was positively related to International Federation of Gynecology and Obstetrics (FIGO) stage (p = 0.006), squamous cell carcinoma antigen (p = 0.006), vital status (p < 0.001), tumor recurrence (p = 0.001), chemotherapy (p = 0.039), and lymph node metastasis (p < 0.001). Overall and disease-free survival was shorter in patients with early-stage cervical cancer and higher NR2F6 levels than in patients with lower levels of NR2F6. Univariate and multivariate analysis determined that NR2F6 was an independent prognostic factor of survival in early-stage cervical cancer. Conclusions: Taken together, our findings suggest that high NR2F6 expression predicts pelvic lymph node metastasis, tumor recurrence and poor prognosis in early-stage cervical cancer. NR2F6 might be a novel prognostic biomarker and potential therapeutic target of cervical cancer. PMID:27775588

  20. Sexual function in older women with pelvic floor symptoms: a cross-sectional study in general practice

    PubMed Central

    Panman, Chantal MCR; Wiegersma, Marian; Talsma, Marrit N; Kollen, Boudewijn J; Berger, Marjolein Y; Leeuwen, Yvonne Lisman-Van; Dekker, Janny H

    2014-01-01

    Background Pelvic floor symptoms are common and are negatively associated with sexual function which, in turn, is an important aspect of quality of life. The majority of older women with pelvic floor symptoms are treated in general practice but evidence from studies in general practice on the sexual functioning of these women is scarce. Aim This study examined predictors of sexual inactivity in older women with pelvic floor symptoms in general practice and of sexual functioning in those women who are sexually active. Design and setting Cross-sectional study in women (aged ≥55 years) from 20 general practices who screened positive on a pelvic floor symptom questionnaire. Method Logistic and linear regression analyses were used to determine predictors of sexual inactivity and sexual functioning (PISQ-12) by assessing their association with patient characteristics, symptoms (PFDI-20) and degree of prolapse (POP-Q). Results A total of 639 women were included (sexually active n = 393, sexually inactive n = 246). Predictors of sexual inactivity were increasing age (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10 to 1.17) and lower education (OR = 2.31; 95% CI = 1.50 to 3.54; Nagelkerke R2 = 0.208). In sexually active women, sexual functioning was associated with pelvic floor symptom distress (P<0.001) and pelvic floor surgery (P = 0.018; R2 = 0.138). Conclusion In older women with pelvic floor symptoms, increasing age and lower educational level are predictors of sexual inactivity. Many of these older women are sexually active and pelvic floor symptom distress is negatively associated with sexual functioning. These results may encourage GPs to ask about sexual problems in women with pelvic floor symptoms. PMID:24567653

  1. Unique patterns of pelvic fin evolution: a case study of balistoid fishes (Pisces: Tetraodontiformes) based on whole mitochondrial genome sequences.

    PubMed

    Yamanoue, Yusuke; Miya, Masaki; Matsuura, Keiichi; Sakai, Harumi; Katoh, Masaya; Nishida, Mutsumi

    2009-01-01

    Balistoid fishes have a unique and reduced pelvic fin structure, which does not exhibit paired structures. The pelvic complex exhibits reductive trends, but its rudimentary structure was retained among balistoids, and its unidirectional and parsimonious reduction in more derived lineages has been hypothesized based on morphology. We investigated the evolution of pelvic complex reduction in balistoids using whole mitochondrial genome (mitogenome) data from 33 species (27 newly determined during the study) that represent the entire morphological diversity of balistoids. Partitioned maximum likelihood and Bayesian analyses were conducted with two datasets that comprised concatenated nucleotide sequences from 13 protein-coding genes (all positions included; third codon positions converted into purine [R] and pyrimidine [Y] [RY-coding]) plus 22 transfer RNA and two ribosomal RNA genes. The resultant trees were well resolved and largely congruent, with most internal branches having high support values. The mitogenomic datasets strongly supported monophylies of both balistids and monacanthids, but rejected previous hypotheses on the intra-relationships in each family. The present tree topology revealed that highly reduced pelvic complexes had multiple origins, and optimization of the traits on the resultant tree strongly suggested the non-unidirectional and independent reduction of pelvic complexes in balistoids. The evolution of balistoid pelvic structure is very different among fishes that exhibit its reductive trends, and this uniqueness in pelvic evolution may be a link to their reproductive behaviors.

  2. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    SciTech Connect

    McGuire, S; Bhatia, S; Sun, W; Menda, Y; Ponto, L; Gross, B; Buatti, J

    2015-06-15

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced.

  3. Pelvic floor physical therapy for lifelong vaginismus: a retrospective chart review and interview study.

    PubMed

    Reissing, Elke D; Armstrong, Heather L; Allen, Caroline

    2013-01-01

    Pelvic floor physical therapy is used in the treatment of sexual pain disorders; however, women with lifelong vaginismus have not yet been included in treatment studies or have not been differentiated from women with acquired vaginismus and/or dyspareunia. This retrospective chart review and interview study was intended to obtain initial information on physical therapy interventions, course, and outcome in women who have never been able to experience vaginal intercourse. The files of 53 women, consecutively treated at one physical therapy clinic, were included in the chart review; 13 of these women volunteered to be interviewed. The chart review revealed significant pelvic floor pathology and an average treatment course of 29 sessions. Internal manual techniques were found to be most effective, followed by patient education, dilatation exercises, and home exercises. Although participants were very satisfied with the physical therapy, some symptoms, such as pain, anxiety/fear, and pelvic floor tension remained and scores on the Female Sexual Distress Scale and Female Sexual Function Index indicated clinical levels of sexual distress and impaired sexual function after treatment. Although there appears to be no linear relation between symptom reduction and healthy sexual function, this initial information suggests that physical therapy may be a promising treatment option for some women with lifelong vaginismus and merits further evaluation.

  4. Low Back Pain Response to Pelvic Tilt Position: An Observational Study of Chiropractic Patients

    PubMed Central

    Minicozzi, Salvatore J.; Russell, Brent S.; Ray, Kathryn J.; Struebing, Alessandria Y.; Owens, Edward F.

    2016-01-01

    Objective The aim of this study was to look for differences between patients with an increased pain response as compared with those with a decreased pain response. Methods Data were collected from consecutive new patients with lumbar or lumbopelvic pain in a chiropractic clinic. A pelvic tilt exercise was included in the initial examination, and pain response was noted. Analysis was made of pain and disability severity, as well as symptom location, chronicity, and other characteristics, before and after a course of chiropractic care. Results Patients with an increased pain response to pelvic tilt (n = 12) had higher levels of pain and disability at baseline than patients without (n = 34). There were no between-group differences in other aspects of their complaints; in age, sex, or body mass; or in the types of care they received (eg, manipulation, stretching, exercise instruction). On the average, both groups of patients showed improvement with chiropractic care, and there was no detectable difference in improvement between groups. Conclusions This study found that patients experiencing pain in response to a pelvic tilt maneuver may have a poorer precare status than patients with a decreased pain response. PMID:27069429

  5. Pelvic radiation disease management by hyperbaric oxygen therapy: prospective study of 44 patients.

    PubMed

    Ouaïssi, Mehdi; Tran, Stephanie; Mege, Diane; Latrasse, Vivien; Barthelemy, Alain; Pirro, Nicolas; Grandval, Philippe; Lassey, James; Sielezneff, Igor; Sastre, Bernard; Coulange, Mathieu

    2014-01-01

    Pelvic radiation disease (PRD) occurs in 2-11% of patients undergoing pelvic radiation for urologic and gynecologic malignancies. Hyperbaric oxygen therapy (HBOT) has previously been described as a noninvasive therapeutic option for the treatment of PRD. the purpose of study was to analyze prospectively the results of HBOT in 44 consecutive patients with PRD who were resistant to conventional oral or topical treatments. Material and Methods. The median age of the cohort was 65.7 years (39-85). Twenty-seven percent of patients required blood transfusion (n = 12). The median of delay between radiotherapy and HBOT was 26 months (3-175). We evaluated the results of HBOT, using SOMA-LENT Scale. Results. SOMA-LENT score was decreased in 59% of patient. The median of SOMA-LENT score before HBOT was significantly higher, being equal to 14 (0-36), than after HBOT with the SOMA-LENT score of 12 (0-38) (P = 0.003). Tenesmus (P = 0.02), bleeding (P = 0.0001), and ulceration (P = 0.001) significantly decreased after HBOT. Regarding patients with colostomy, 33% (n = 4) benefited from colostomies closure. HBOT was generally well tolerated. Only one patient stopped precociously due to transient myopia. Conclusion. This study is in favor of the interest of HBOT in pelvic radiation disease treatment (PRD).

  6. Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Radiologic and manometric studies in 41 patients.

    PubMed

    Siproudhis, L; Ropert, A; Lucas, J; Raoul, J L; Heresbach, D; Bretagne, J F; Gosselin, M

    1992-06-01

    A consecutive series of 41 patients with defecatory disorders was prospectively studied by anal manometry and evacuation proctography to determine the relationship between abnormalities and symptoms. The patients (29 female, 12 male, aged 41 +/- 2.3 years) all complained of difficulty in evacuation. All had normal colonoscopy and biochemistry. There was no evidence of megacolon or megarectum, and no symptoms had been previously treated by pelvic floor surgery. All subjects completed detailed questionnaires related to gastrointestinal symptoms with special reference to excessive straining and discomfort, digital manipulations during defecation, a sense of pelvic heaviness and incomplete evacuation. Each patient underwent clinical examination, anal manometry and defecography during a single outpatient visit. Rectocele (16 patients) was significantly associated with vaginal digitation, lower stool frequency, delayed rectal emptying and decreased rectal sensation to distension. Increased anal pressure on straining (14 patients) was also related to a poor rectal emptying in 13 patients. Neither perineal descent (24 patients) nor external rectal prolapse (12 patients) was related to objective obstruction. Nevertheless there was an association with pelvic heaviness and lower anal manometric recordings. Five among 16 patients with rectocele had manometric anismus. Forty percent of patients with intussusception also had a paradoxical sphincter response during defaecation. Furthermore, associated abnormalities were extremely common (34 of 41 patients), accurate interpretation of which was necessary for planning effective therapy.

  7. Animal model of simulated microgravity: a comparative study of hindlimb unloading via tail versus pelvic suspension.

    PubMed

    Chowdhury, Parimal; Long, Ashley; Harris, Gabrielle; Soulsby, Michael E; Dobretsov, Maxim

    2013-06-01

    The aim of this study was to compare physiological effects of hindlimb suspension (HLS) in tail- and pelvic-HLS rat models to determine if severe stretch in the tail-HLS rats lumbosacral skeleton may contribute to the changes traditionally attributed to simulated microgravity and musculoskeletal disuse in the tail-HLS model. Adult male Sprague-Dawley rats divided into suspended and control-nonsuspended groups were subjected to two separate methods of suspension and maintained with regular food and water for 2 weeks. Body weights, food and water consumption, soleus muscle weight, tibial bone mineral density, random plasma insulin, and hindlimb pain on pressure threshold (PPT) were measured. X-ray analysis demonstrated severe lordosis in tail- but not pelvic-HLS animals. However, growth retardation, food consumption, and soleus muscle weight and tibial bone density (decreased relative to control) did not differ between two HLS models. Furthermore, HLS rats developed similar levels of insulinopenia and mechanical hyperalgesia (decreased PPT) in both tail- and pelvic-HLS groups. In the rat-to-rat comparisons, the growth retardation and the decreased PPT observed in HLS-rats was most associated with insulinopenia. In conclusion, these data suggest that HLS results in mild prediabetic state with some signs of pressure hyperalgesia, but lumbosacral skeleton stretch plays little role, if any, in these pathological changes.

  8. Osteopathy for Endometriosis and Chronic Pelvic Pain – a Pilot Study

    PubMed Central

    Sillem, M.; Juhasz-Böss, I.; Klausmeier, I.; Mechsner, S.; Siedentopf, F.; Solomayer, E.

    2016-01-01

    Introduction: Pelvic pain is a common problem in gynaecological practice. It is often unclear whether definite causality exists between reported symptoms and objective clinical findings of the female genital tract, and medical or operative treatments do not always achieve long-term resolution of symptoms. Methods: This pilot study investigated 28 patients (age 20–65, median 36.5 years) from a gynaecology practice whose only clinical finding was painful pelvic floor muscle tightness. Following standardised gynaecological and physiotherapist examination, all patients received osteopathic treatment. Pain had been present for a median of 3 years (range 1 month to 20 years). 14 patients had previously confirmed endometriosis. Treatment success was evaluated on consultation with patients in person or in writing. Results: 22 of the 28 participants completed the treatment according to plan. Overall, 17 reported symptom improvement, while 10 of the 14 patients with endometriosis did. Conclusion: Osteopathy is well received by women with painful pelvic floor muscle tightness and appears to be an effective treatment option. PMID:27681520

  9. Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic over-view of the literature

    PubMed Central

    Rees, Thomas; Raison, Nicholas; Sheikh, Mohammed Iqbal; Jaffry, Zahra; Madaan, Sanjeev; Challacombe, Ben; Ahmed, Kamran; Dasgupta, Prokar

    2016-01-01

    Objective Pelvic lymph node dissection (PLND) is performed alongside radical prostatectomy as the most accurate method of staging prostate cancer. Yet the potential therapeutic benefits of lymphadenectomy are yet to be confirmed. Material and methods A PubMed database search was performed to identify all papers comparing techniques for PLND or none. The primary outcome measure was long term oncological outcomes. Studies looking at men with clinically localized prostate cancer at the time of radical prostatectomy who received no adjuvant treatment were included. Previous reviews and single case reports were excluded. The subsequent available papers were then systematically reviewed. Results Limited PLND provides no benefit in low risk prostate cancer and is unlikely to provide a therapeutic benefit in higher risk groups either when compared with no PLND. Extended PLND may provide some therapeutic benefit, particularly in patients with occult metastases; however, the evidence base for this is not particularly strong and may be down to statistical phenomena. Conclusion When performed in prostate cancer patients, PLND should be extended, as it is a more accurate staging tool and may provide therapeutic benefit to some patients. However, to properly assess this, randomised controlled studies need to be performed in this area. PMID:27909616

  10. Defining local nerve blocks for feline distal pelvic limb surgery: a cadaveric study.

    PubMed

    Enomoto, Masataka; Lascelles, B Duncan X; Gerard, Mathew P

    2017-02-01

    Objectives Anatomical and methodological detail is lacking regarding local anesthetic peripheral nerve block techniques for distal pelvic limb surgery in cats. The aim of this study was to develop, describe and test nerve block methods based on cadaveric dissections and dye injections. Methods Ten pairs of feline pelvic limbs (n = 20) were dissected and the tibial nerve (T n.), common fibular (peroneal) nerve (CF n., and its two branches, the superficial fibular [peroneal] nerve [SpF n.] and the deep fibular [peroneal] nerve [DpF n.]) and the saphenous nerve (Sa n.) were identified. Based on these dissections, a 'distal crus block' (selective blockade of the CF n., T n. and Sa n.) and a 'distal pes block' (selective blockade of the SpF n., DpF n., T n. and Sa n.) were developed for surgical procedures in two different regions of the distal pelvic limb. Techniques were tested using new methylene blue (NMB) dye injections in feline pelvic limbs (n = 12). Using a 25 G × 5/8 inch needle and 1 ml syringe, 0.1 ml/kg of NMB dye solution was injected at the site of the CF n., and 0.05 ml/kg was injected at the sites of the SpF n., DpF n., Sa n. and T n. The length and circumference (fully or partially stained) of each stained nerve were measured. Results Positive staining of nerves was observed in 12/12 limbs. The lengths stained for the CF n., DpF n., SpF n., Sa n. and T n. were 27.19 ± 7.13, 20.39 ± 5.57, 22.82 ± 7.13, 30.89 ± 6.99 and 25.16 ± 8.09 mm, respectively. The nerves were fully stained in 12, 12, 10, 11 and 11 out of 12 limbs, respectively. Conclusions and relevance These two, three-point injection methods may be an effective perioperative analgesia technique for feline distal pelvic limb procedures.

  11. Myofascial pelvic pain.

    PubMed

    Kotarinos, Rhonda

    2012-10-01

    Myofascial pelvic pain is fraught with many unknowns. Is it the organs of the pelvis, is it the muscles of the pelvis, or is the origin of the pelvic pain from an extrapelvic muscle? Is there a single source or multiple? In this state of confusion what is the best way to manage the many symptoms that can be associated with myofascial pelvic pain. This article reviews current studies that attempt to answer some of these questions. More questions seem to develop as each study presents its findings.

  12. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    PubMed

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis.

  13. The potential for dose dumping in normal tissues with IMRT for pelvic and H&N cancers.

    PubMed

    Reddy, Nandanuri M S; Mazur, Andrzej K; Sampath, Seshadri; Osian, Adrian; Sood, Brij M; Ravi, Akkamma; Nori, Dattatreyudu

    2008-01-01

    The purpose of this study is to understand the potential for dose dumping in normal tissues (>85% of prescription dose) and to analyze effectiveness of techniques used in reducing dose dumping during IMRT. Two hundred sixty-five intensity modulated radiation therapy (IMRT) plans for 55 patients with prostate, head-and-neck (H&N), and cervix cancers with 6-MV photon beams and >5 fields were reviewed to analyze why dose dumping occurred, and the techniques used to reduce dose dumping. Various factors including gantry angles, depth of beams (100-SSD), duration of optimization, severity of dose-volume constraints (DVC) on normal structures, and spatial location of planning treatment volumes (PTV) were reviewed in relation to dose dumping. In addition, the effect of partial contouring of rectum in beam's path on dose dumping in rectum was studied. Dose dumping occurred at d(max) in 17 pelvic cases (85% to 129%). This was related to (1) depth of beams (100 SSD [source-to-skin distance]), (2) PTV located between normal structures with DVC, and (3) relative lack of rectum and bladder in beam's path. Dose dumping could be reduced to 85% by changing beam angles and/or DVC for normal structures in 5 cases and by creating "phantom structures" in 12 cases. Decreasing the iterations (duration of optimization) also reduced dose dumping and monitor units (MUs). Part of uncontoured rectum, if present in the field, received a higher dose than the contoured rectum with DVC, indicating that complete delineation of normal structures and DVC is necessary to prevent dose dumping. In H&N, when PTV extends inadvertently into air beyond the body even by a few millimeters, dose dumping occurred in beam's path (220% for 5-field and 170%, 7-field plans). Keeping PTV margins within body contour reduced this type of dose dumping. Beamlet optimization, duration of optimization, spatial location of PTV, and DVC on PTV and normal structures has the potential to cause dose dumping. However, these

  14. The Potential for Dose Dumping in Normal Tissues with IMRT for Pelvic and H and N Cancers

    SciTech Connect

    Reddy, Nandanuri; Mazur, Andrzej K.; Sampath, Seshadri; Osian, Adrian; Sood, Brij M.; Ravi, Akkamma; Nori, Dattatreyudu

    2008-04-01

    The purpose of this study is to understand the potential for dose dumping in normal tissues (>85% of prescription dose) and to analyze effectiveness of techniques used in reducing dose dumping during IMRT. Two hundred sixty-five intensity modulated radiation therapy (IMRT) plans for 55 patients with prostate, head-and-neck (H and N), and cervix cancers with 6-MV photon beams and >5 fields were reviewed to analyze why dose dumping occurred, and the techniques used to reduce dose dumping. Various factors including gantry angles, depth of beams (100 - SSD), duration of optimization, severity of dose-volume constraints (DVC) on normal structures, and spatial location of planning treatment volumes (PTV) were reviewed in relation to dose dumping. In addition, the effect of partial contouring of rectum in beam's path on dose dumping in rectum was studied. Dose dumping occurred at d{sub max} in 17 pelvic cases (85% to 129%). This was related to (1) depth of beams (100 SSD [source-to-skin distance]), (2) PTV located between normal structures with DVC, and (3) relative lack of rectum and bladder in beam's path. Dose dumping could be reduced to 85% by changing beam angles and/or DVC for normal structures in 5 cases and by creating 'phantom structures' in 12 cases. Decreasing the iterations (duration of optimization) also reduced dose dumping and monitor units (MUs). Part of uncontoured rectum, if present in the field, received a higher dose than the contoured rectum with DVC, indicating that complete delineation of normal structures and DVC is necessary to prevent dose dumping. In H and N, when PTV extends inadvertently into air beyond the body even by a few millimeters, dose dumping occurred in beam's path (220% for 5-field and 170%, 7-field plans). Keeping PTV margins within body contour reduced this type of dose dumping. Beamlet optimization, duration of optimization, spatial location of PTV, and DVC on PTV and normal structures has the potential to cause dose dumping

  15. Pelvic incidentalomas

    PubMed Central

    Newmark, G.M.; Thakrar, K.H.; Mehta, U.K.; Berlin, J.W.

    2010-01-01

    Abstract Recent advances in multi-detector computed tomography, magnetic resonance imaging, and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal abnormalities in both the oncology and non-oncology patient population that in the past remained undiscovered. These incidental pelvic lesions have created a management dilemma for both clinicians and radiologists. Depending on the clinical setting, these lesions may require no further evaluation, additional immediate or serial follow-up imaging, or surgical intervention. In this review, guidelines concerning the diagnosis and management of some of the more common pelvic incidentalomas are presented. PMID:20880789

  16. Primary sources of pelvic serous cancer in patients with endometrial intraepithelial carcinoma.

    PubMed

    Jia, Lin; Yuan, Zeng; Wang, Yiying; Cragun, Janiel M; Kong, Beihua; Zheng, Wenxin

    2015-01-01

    Serous endometrial intraepithelial carcinoma is often associated with extrauterine disease. It is currently unclear where does the extrauterine disease come from. This study addressed this issue. A total of 135 samples from 21 serous endometrial intraepithelial carcinoma patients were studied. Cellular lineage relationships between intrauterine and extrauterine serous carcinomas were determined by TP53-mutation analysis and correlated to the clinicopathologic features. There were three conditions contributing the extrauterine disease: metastasis from serous endometrial intraepithelial carcinoma (n=10) showed identical TP53 mutation between intrauterine lesions and extrauterine disease, cases of adnexal origin (n=5) had discordant TP53 mutations, and the mixed cellular origin cases (n=6) with both identical and discordant mutation status. Patients with extrauterine disease from serous endometrial intraepithelial carcinoma metastasis typically had small tumor masses (<2 cm) in extrauterine sites and without finding of serous tubal intraepithelial carcinoma, while extrauterine disease with adnexal or tubal origin commonly had larger tumor masses in extrauterine sites including ovary and omentum and serous tubal intraepithelial carcinoma. The majority of extrauterine diseases associated with serous endometrial intraepithelial carcinoma are metastasized from the endometrium. Serous endometrial intraepithelial carcinoma is frequently associated with serous cancers of adnexal or tubal origin, indicating that endometrial and adnexal or tubal serous cancers may share similar etiologies. TP53-mutation analysis provides a strong linkage for cellular lineage analysis. Tumor size in extrauterine disease and presence of serous tubal intraepithelial carcinoma or not are useful clinicopathologic features to determine primary cancer site, which helps in clinical management.

  17. Category III chronic prostatitis/chronic pelvic pain syndrome: insights from the National Institutes of Health Chronic Prostatitis Collaborative Research Network studies.

    PubMed

    Nickel, J Curtis; Alexander, Richard B; Anderson, Rodney; Berger, Richard; Comiter, Craig V; Datta, Nand S; Fowler, Jackson E; Krieger, John N; Landis, J Richard; Litwin, Mark S; McNaughton-Collins, Mary; O'Leary, Michael P; Pontari, Michel A; Schaeffer, Anthony J; Shoskes, Daniel A; White, Paige; Kusek, John; Nyberg, Leroy

    2008-07-01

    Chronic prostatitis/chronic pelvic pain syndrome remains an enigmatic medical condition. Creation of the National Institutes of Health-funded Chronic Prostatitis Collaborative Research Network (CPCRN) has stimulated a renewed interest in research on and clinical aspects of chronic prostatitis/chronic pelvic pain syndrome. Landmark publications of the CPCRN document a decade of progress. Insights from these CPCRN studies have improved our management of chronic prostatitis/chronic pelvic pain syndrome and offer hope for continued progress.

  18. Pelvic nerve innervation of the external sphincter of urethra as suggested by urodynamic and horse-radish peroxidase studies.

    PubMed

    Morita, T; Nishizawa, O; Noto, H; Tsuchida, S

    1984-03-01

    In view of the fact that the detrusor vesicae and external urethral sphincter perform closely synergic functions in micturition, experiments were conducted to explore the action of the pelvic efferent neurons on the external urethral sphincter. The pelvic efferent neurons are generally recognized, by urodynamic assessments and histochemical study with the technique of retrograde axonal transport of horse-radish peroxidase, to innervate the vesical detrusor. In 7 of 15 adult dogs studied, the external urethral sphincter continued to show a normal synergic electromyogram pattern with enhanced electrical activity on vesical distention and disappearance of discharges on vesical contraction even after bilateral transection of the pudendal nerves. The electrical discharges ceased in the sphincter only after subsequent bilateral pelvic neurotomy. Horse-radish peroxidase-positive cells were demonstrated in the intermediolateral and intermediomedial nuclei and in the Onuf nucleus of the sacral cord in approximately half the dogs whose pelvic nerve was injected with the plant peroxidase. The results suggest that the pelvic nerve may contain somatic fibers innervating the external urethral sphincter.

  19. Chronic pelvic floor dysfunction.

    PubMed

    Hartmann, Dee; Sarton, Julie

    2014-10-01

    The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management.

  20. Pelvic radiotherapy and sexual function in women

    PubMed Central

    Froeding, Ligita Paskeviciute

    2015-01-01

    Background During the past decade there has been considerable progress in developing new radiation methods for cancer treatment. Pelvic radiotherapy constitutes the primary or (neo) adjuvant treatment of many pelvic cancers e.g., locally advanced cervical and rectal cancer. There is an increasing focus on late effects and an increasing awareness that patient reported outcomes (PROs) i.e., patient assessment of physical, social, psychological, and sexual functioning provides the most valid information on the effects of cancer treatment. Following cure of cancer allow survivors focus on quality of life (QOL) issues; sexual functioning has proved to be one of the most important aspects of concern in long-term survivors. Methods An updated literature search in PubMed was performed on pelvic radiotherapy and female sexual functioning/dysfunction. Studies on gynaecological, urological and gastrointestinal cancers were included. The focus was on the period from 2010 to 2014, on studies using PROs, on potential randomized controlled trials (RCTs) where female sexual dysfunction (FSD) at least constituted a secondary outcome, and on studies reporting from modern radiotherapy modalities. Results The literature search revealed a few RCTs with FSD evaluated as a PRO and being a secondary outcome measure in endometrial and in rectal cancer patients. Very limited information could be extracted regarding FSD in bladder, vulva, and anal cancer patients. The literature before and after 2010 confirms that pelvic radiotherapy, independent on modality, increases the risk significantly for FSD both compared to data from age-matched healthy control women and compared to data on patients treated by surgery only. There was only very limited data available on modern radiotherapy modalities. These are awaited during the next five years. Several newer studies confirm that health care professionals are still reluctant to discuss treatment induced sexual dysfunction with patients. Conclusions

  1. Variation in the Definition of Clinical Target Volumes for Pelvic Nodal Conformal Radiation Therapy for Prostate Cancer

    SciTech Connect

    Lawton, Colleen A.F. Michalski, Jeff; El-Naqa, Issam; Kuban, Deborah; Lee, W. Robert; Rosenthal, Seth A.; Zietman, Anthony; Sandler, Howard; Shipley, William; Ritter, Mark; Valicenti, Richard; Catton, Charles; Roach, Mack; Pisansky, Thomas M.; Seider, Michael

    2009-06-01

    Purpose: We conducted a comparative study of clinical target volume (CTV) definition of pelvic lymph nodes by multiple genitourinary (GU) radiation oncologists looking at the levels of discrepancies amongst this group. Methods and Materials: Pelvic computed tomography (CT) scans from 2 men were distributed to 14 Radiation Therapy Oncology Group GU radiation oncologists with instructions to define CTVs for the iliac and presacral lymph nodes. The CT data with contours were then returned for analysis. In addition, a questionnaire was completed that described the physicians' method for target volume definition. Results: Significant variation in the definition of the iliac and presacral CTVs was seen among the physicians. The minimum, maximum, mean (SD) iliac volumes (mL) were 81.8, 876.6, 337.6 {+-} 203 for case 1 and 60.3, 627.7, 251.8 {+-} 159.3 for case 2. The volume of 100% agreement was 30.6 and 17.4 for case 1 and 2 and the volume of the union of all contours was 1,012.0 and 807.4 for case 1 and 2, respectively. The overall agreement was judged to be moderate in both cases (kappa = 0.53 (p < 0.0001) and kappa = 0.48 (p < 0.0001). There was no volume of 100% agreement for either of the two presacral volumes. These variations were confirmed in the responses to the associated questionnaire. Conclusions: Significant disagreement exists in the definition of the CTV for pelvic nodal radiation therapy among GU radiation oncology specialists. A consensus needs to be developed so as to accurately assess the merit and safety of such treatment.

  2. Auricular Acupuncture as a Treatment for Pregnant Women Suffering from Low Back and Posterior Pelvic Pain: A Pilot Study

    PubMed Central

    Wang, Shu-Ming; Dizinno, Peggy; Lin, Eric C.; Lin, Haiqun; Yue, James J.; Berman, Michael R.; Braveman, Ferne; Kain, Zeev N.

    2009-01-01

    Objective The primary aim of this study was to examine whether one week of continuous auricular acupuncture could reduce low back and posterior pelvic pain associated with pregnancy. Study Design A randomized controlled trial was conducted on pregnant women suffering from lower back and posterior pelvic pain. These women were randomized into an acupuncture group, a sham acupuncture group, or a waiting list control group. All participants were followed for 2 weeks. Results Baseline and Day 7 showed significant group differences in pain [F= 15, P<0.0001] and in the disability rating index score [F=7, p<0.0001]. The participants in the acupuncture group reported a significant reduction of pain and improvement of functional status as compared to those in the sham acupuncture and control groups. Conclusion One week of continuous auricular acupuncture decreases the pain and disability experienced by women with pregnancy related low back and posterior pelvic pain. PMID:19560110

  3. Use of CT simulation for treatment of cervical cancer to assess the adequacy of lymph node coverage of conventional pelvic fields based on bony landmarks

    SciTech Connect

    Finlay, Marisa H.; Ackerman, Ida . E-mail: Ida.Ackerman@sw.ca; Tirona, Romeo G. B.Sc.; Hamilton, Paul; Barbera, Lisa; Thomas, Gillian

    2006-01-01

    Purpose: To assess the adequacy of nodal coverage of 'conventional' pelvic radiation fields for carcinoma of the cervix, with contoured pelvic vessels on simulation computed tomography (CT) as surrogates for lymph node location. Methods and Materials: Pelvic arteries were contoured on non-contrast-enhanced CT simulation images of 43 patients with cervix cancer, FIGO Stages I-III. Vessel contours were hidden, and conventional pelvic fields were outlined: (1) anterior/posterior fields (AP): superior border, L5-S1 interspace; inferior border, obturator foramina; lateral border, 2 centimeters lateral to pelvic brim. (2) Lateral fields (LAT): Anterior border, symphysis pubis; posterior border, S2-S3 interspace. Distances were measured between the following: (1) bifurcation of the common iliac artery and superior border (2) external iliac artery and lateral border of the AP field, and (3) external iliac artery and anterior border of the LAT field. The distances were considered as 'inadequate' if <15 mm, 'adequate' if 15-20 mm, and 'generous' if >20 mm. Results: Superiorly, 34 patients (79.1%) had inadequate coverage. On the AP, margins were generous in 19 (44.2%), but inadequate in 9 (20.9%). On the LAT, margins were inadequate in 30 (69.8%) patients. Overall, 41 (95.4%, CI, 84.2%-99.4%) patients had at least 1 inadequate margin, the majority located superiorly. Twenty-four (55.8%; CI, 39.9%-70.9%) patients had at least 1 generous margin, the majority located laterally on the AP field. Conclusion: Conventional pelvic fields based on bony landmarks do not provide optimal lymph node coverage in a substantial proportion of patients and may include excess normal tissue in some. CT simulation with vessel contouring as a surrogate for lymph node localization provides more precise and individualized field delineation.

  4. Chronic Pelvic Pain

    MedlinePlus

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  5. Urinary incontinence and other pelvic floor dysfunctions in female athletes in Brazil: A cross-sectional study.

    PubMed

    Almeida, M B A; Barra, A A; Saltiel, F; Silva-Filho, A L; Fonseca, A M R M; Figueiredo, E M

    2016-09-01

    The pelvic floor (PF) provides support to all pelvic organs, as well as appropriately closure/opening mechanism of the urethra, vagina, and anus. Therefore, it is likely that female athletes involved in high-impact and in strong-effort activities are at risk for the occurrence of urinary incontinence (UI). This study aimed to investigate the occurrence of UI and other PF dysfunctions (PFD) [anal incontinence (AI), symptoms of constipation, dyspareunia, vaginal laxity, and pelvic organ prolapse] in 67 amateur athletes (AT) compared with a group 96 of nonathletes (NAT). An ad hoc survey based on questions from reliable and valid instruments was developed to investigate the occurrence of PFD symptoms. The risk of UI was higher in AT group (odds ratio: 2.90; 95% CI: 1.50-5.61), mostly among artistic gymnastics and trampoline, followed by swimming and judo athletes. Whereas, AT group reported less straining to evacuate (OR: 0.46; 95% CI: 0.22-0.96), manual assistance to defecate (OR: 0.24; 95% CI: 0.05-1.12), and a higher stool frequency (OR: 0.29; 95% CI: 0.13-0.64) than NAT group. The occurrence of loss of gas and sexual symptoms was high for both groups when compared with literature, although with no statistical difference between them. Pelvic organ prolapse was only reported by nonathletes. Athletes are at higher risk to develop UI, loss of gas, and sexual dysfunctions, either practicing high-impact or strong-effort activities. Thus, pelvic floor must be considered as an entity and addressed as well. Also, women involved in long-term high-impact and strengthening sports should be advised of the impact of such activities on pelvic floor function and offered preventive PFD strategies as well.

  6. Reproducibility of Dynamic MR Imaging Pelvic Measurements: A Multi-institutional Study

    PubMed Central

    Lockhart, Mark E.; Fielding, Julia R.; Richter, Holly E.; Brubaker, Linda; Salomon, Caryl G.; Ye, Wen; Hakim, Christiane M.; Wai, Clifford Y.; Stolpen, Alan H.; Weber, Anne M.

    2008-01-01

    Purpose: To assess the reproducibility of bone and soft-tissue pelvimetry measurements obtained from dynamic magnetic resonance (MR) imaging studies in primiparous women across multiple centers. Materials and Methods: All subjects prospectively gave consent for participation in this institutional review board–approved, HIPAA-compliant study. At six clinical sites, standardized dynamic pelvic 1.5-T multiplanar T2-weighted MR imaging was performed in three groups of primiparous women at 6–12 months after birth: Group 1, vaginal delivery with anal sphincter tear (n = 93); group 2, vaginal delivery without anal sphincter tear (n = 79); and group 3, cesarean delivery without labor (n = 26). After standardized central training, blinded readers at separate clinical sites and a blinded expert central reader measured nine bone and 10 soft-tissue pelvimetry parameters. Subsequently, three readers underwent additional standardized training, and reread 20 MR imaging studies. Measurement variability was assessed by using intraclass correlation for agreement between the clinical site and central readers. Acceptable agreement was defined as an intraclass correlation coefficient (ICC) of at least 0.7. Results: There was acceptable agreement (ICC range, 0.71–0.93) for eight of 19 MR imaging parameters at initial readings of 198 subjects. The remaining parameters had an ICC range of 0.13–0.66. Additional training reduced measurement variability: Twelve of 19 parameters had acceptable agreement (ICC range, 0.70–0.92). Correlations were greater for bone (ICC, ≥0.70 in five [initial readings] and eight of nine [rereadings] variables) than for soft-tissue measurements (ICC, ≥0.70 in three [initial readings] of 10 and four [rereadings] of 10 readings, respectively). Conclusion: Despite standardized central training, there is high variability of pelvic MR imaging measurements among readers, particularly for soft-tissue structures. Although slightly improved with additional

  7. Radiation dose reduction in thoracic and abdomen-pelvic CT using tube current modulation: a phantom study.

    PubMed

    Sabarudin, Akmal; Mustafa, Zakira; Nassir, Khadijah Mohd; Hamid, Hamzaini Abdul; Sun, Zhonghua

    2015-01-01

    This phantom study was designed to compare the radiation dose in thoracic and abdomen-pelvic CT scans with and without use of tube current modulation (TCM). Effective dose (ED) and size-specific dose estimation (SSDE) were calculated with the absorbed doses measured at selective radiosensitive organs using a thermoluminescence dosimeter-100 (TLD-100). When compared to protocols without TCM, the ED and SSDE were reduced significantly with use of TCM for both the thoracic and abdomen-pelvic CT. With use of TCM, the ED was 6.50±0.29 mSv for thoracic and 6.01±0.20 mSv for the abdomen-pelvic CT protocols. However without use of TCM, the ED was 20.07±0.24 mSv and 17.30±0.41 mSv for the thoracic and abdomen-pelvic CT protocols, respectively. The corresponding SSDE was 10.18±0.48 mGy and 11.96±0.27 mGy for the thoracic and abdomen-pelvic CT protocols with TCM, and 31.56±0.43 mGy and 33.23±0.05 mGy for thoracic and abdomen-pelvic CT protocols without TCM, respectively. The highest absorbed dose was measured at the breast with 8.58±0.12 mGy in the TCM protocols and 51.52±14.72 mGy in the protocols without TCM during thoracic CT. In the abdomen-pelvic CT, the absorbed dose was highest at the skin with 9.30±1.28 mGy and 29.99±2.23 mGy in protocols with and without use of TCM, respectively. In conclusion, the TCM technique results in significant dose reduction; thus it is to be highly recommended in routine thoracic and abdomen-pelvic CT. PACS numbers: 87.57.Q-, 87.57.qp, 87.53.Bn.

  8. Radiation dose reduction in thoracic and abdomen-pelvic CT using tube current modulation: a phantom study.

    PubMed

    Sabarudin, Akmal; Mustafa, Zakira; Nassir, Khadijah Mohd; Hamid, Hamzaini Abdul; Sun, Zhonghua

    2014-01-08

    This phantom study was designed to compare the radiation dose in thoracic and abdomen-pelvic CT scans with and without use of tube current modulation (TCM). Effective dose (ED) and size-specific dose estimation (SSDE) were calculated with the absorbed doses measured at selective radiosensitive organs using a thermoluminescence dosimeter-100 (TLD-100). When compared to protocols without TCM, the ED and SSDE were reduced significantly with use of TCM for both the thoracic and abdomen-pelvic CT. With use of TCM, the ED was 6.50 ± 0.29 mSv for thoracic and 6.01 ± 0.20 mSv for the abdomen-pelvic CT protocols. However without use of TCM, the ED was 20.07 ± 0.24 mSv and 17.30 ± 0.41 mSv for the thoracic and abdomen-pelvic CT protocols, respectively. The corresponding SSDE was 10.18 ± 0.48 mGy and 11.96 ± 0.27 mGy for the thoracic and abdomen-pelvic CT protocols with TCM, and 31.56 ± 0.43 mGy and 33.23 ± 0.05 mGy for thoracic and abdomen-pelvic CT protocols without TCM, respectively. The highest absorbed dose was measured at the breast with 8.58 ± 0.12 mGy in the TCM protocols and 51.52 ± 14.72 mGy in the protocols without TCM during thoracic CT. In the abdomen-pelvic CT, the absorbed dose was highest at the skin with 9.30 ± 1.28mGy and 29.99 ± 2.23 mGy in protocols with and without use of TCM, respectively. In conclusion, the TCM technique results in significant dose reduction; thus it is to be highly recommended in routine thoracic and abdomen-pelvic CT.

  9. Possible linkages between lignite aquifers, pathogenic microbes, and renal pelvic cancer in northwestern Louisiana, USA

    USGS Publications Warehouse

    Bunnell, J.E.; Tatu, C.A.; Bushon, R.N.; Stoeckel, D.M.; Brady, A.M.G.; Beck, M.; Lerch, H.E.; McGee, B.; Hanson, B.C.; Shi, R.; Orem, W.H.

    2006-01-01

    In May and September, 2002, 14 private residential drinking water wells, one dewatering well at a lignite mine, eight surface water sites, and lignite from an active coal mine were sampled in five Parishes of northwestern Louisiana, USA. Using a geographic information system (GIS), wells were selected that were likely to draw water that had been in contact with lignite; control wells were located in areas devoid of lignite deposits. Well water samples were analyzed for pH, conductivity, organic compounds, and nutrient and anion concentrations. All samples were further tested for presence of fungi (cultures maintained for up to 28 days and colonies counted and identified microscopically) and for metal and trace element concentration by inductively-coupled plasma mass spectrometry and atomic emission spectrometry. Surface water samples were tested for dissolved oxygen and presence of pathogenic leptospiral bacteria. The Spearman correlation method was used to assess the association between the endpoints for these field/laboratory analyses and incidence of cancer of the renal pelvis (RPC) based on data obtained from the Louisiana Tumor Registry for the five Parishes included in the study. Significant associations were revealed between the cancer rate and the presence in drinking water of organic compounds, the fungi Zygomycetes, the nutrients PO4 and NH3, and 13 chemical elements. Presence of human pathogenic leptospires was detected in four out of eight (50%) of the surface water sites sampled. The present study of a stable rural population examined possible linkages between aquifers containing chemically reactive lignite deposits, hydrologic conditions favorable to the leaching and transport of toxic organic compounds from the lignite into the groundwater, possible microbial contamination, and RPC risk. ?? Springer Science+Business Media B.V. 2006.

  10. Intra and inter-rater reliability study of pelvic floor muscle dynamometric measurements

    PubMed Central

    Martinho, Natalia M.; Marques, Joseane; Silva, Valéria R.; Silva, Silvia L. A.; Carvalho, Leonardo C.; Botelho, Simone

    2015-01-01

    OBJECTIVE: The aim of this study was to evaluate the intra and inter-rater reliability of pelvic floor muscle (PFM) dynamometric measurements for maximum and average strengths, as well as endurance. METHOD: A convenience sample of 18 nulliparous women, without any urogynecological complaints, aged between 19 and 31 (mean age of 25.4±3.9) participated in this study. They were evaluated using a pelvic floor dynamometer based on load cell technology. The dynamometric evaluations were repeated in three successive sessions: two on the same day with a rest period of 30 minutes between them, and the third on the following day. All participants were evaluated twice in each session; first by examiner 1 followed by examiner 2. The vaginal dynamometry data were analyzed using three parameters: maximum strength, average strength, and endurance. The Intraclass Correlation Coefficient (ICC) was applied to estimate the PFM dynamometric measurement reliability, considering a good level as being above 0.75. RESULTS: The intra and inter-raters' analyses showed good reliability for maximum strength (ICCintra-rater1=0.96, ICCintra-rater2=0.95, and ICCinter-rater=0.96), average strength (ICCintra-rater1=0.96, ICCintra-rater2=0.94, and ICCinter-rater=0.97), and endurance (ICCintra-rater1=0.88, ICCintra-rater2=0.86, and ICCinter-rater=0.92) dynamometric measurements. CONCLUSIONS: The PFM dynamometric measurements showed good intra- and inter-rater reliability for maximum strength, average strength and endurance, which demonstrates that this is a reliable device that can be used in clinical practice. PMID:25993624

  11. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  12. [Guidelines for delineation of pelvic lymph nodes in anal cancer treatment].

    PubMed

    Vendrely, V; Galland-Girodet, S; Orré, M; Maire, J-P

    2013-10-01

    Squamous cell anal cancer is a rare malignancy, its incidence increases due to higher exposure of the young adults to risk factors. The current management is based on chemoradiotherapy, which is highly effective and achieves locoregional control but causes important morbidity. Improvement of radiation technique such as intensity modulated radiation therapy has led to reduce acute toxicities, but also requires an accurate delineation of the target volumes in order not to underestimate potential and pathological sites resulting in an increase of the locoregional failures. PET scanner has an important place in the pretreatment work-up for staging and targeting the delineation of the volumes, allowing to select patients with localized disease, avoid geographic miss and appropriately boost nodal disease. The study of recurrences sites has not yet provided a real mapping of the recurrences depending on the treatment volumes. Different radiation oncologist cooperative groups have published guidelines and tools for delineation, in order to provide homogeneity but also customize the management of anal carcinoma.

  13. Radiation-Related Predictors of Hematologic Toxicity After Concurrent Chemoradiation for Cervical Cancer and Implications for Bone Marrow-Sparing Pelvic IMRT

    SciTech Connect

    Albuquerque, Kevin; Giangreco, David; Morrison, Courtney; Siddiqui, Mohammed; Sinacore, Jim; Potkul, Ronald; Roeske, John

    2011-03-15

    Purpose: To determine factors predictive for hematologic toxicity (HT) associated with concurrent chemoradiation for Stage II through IV cervical cancer. Methods and Materials: The medical records of 40 women receiving concurrent chemoradiation for cervical cancer were reviewed. Hematologic toxicity was defined by use of Common Terminology Criteria for Adverse Events (version 3.0). Variables predicting for HT including age, body mass index, transfusions, and bone marrow volumes irradiated were included in the data analysis. Results: Of the patients, 13 (32.5%) had Grade 0 or 1 HT and 27 (67.5%) had Grade 2 through 4 HT (HT2+). Multiple logistic regression analysis of potential predictors showed that only the volume of bone receiving 20 Gy (V20) for whole pelvic bone tended toward significance for predicting HT2+. A strong correlation was noted between HT2+ and V20 (r = 0.8, p < 0.0001). A partitioning analysis to predict HT2+ showed a cutoff value of 79.42% (approximately 80%) for V20 of whole pelvic bone. That is, if the V20 of the whole pelvis exceeds 80%, the risk of HT2+ developing increases by a factor (odds ratio) of 4.5 (95%, confidence interval, 1.08-18.69) (p < 0.05). Conclusions: We have shown a correlation between bone marrow volume radiated and development of HT. This has implications for use of pelvic intensity-modulated radiation therapy, which can potentially decrease the volume of bone marrow radiated.

  14. Assessment of Long-Term Rectal Function in Patients Who Received Pelvic Radiotherapy: A Pooled North Central Cancer Treatment Group Trial Analysis, N09C1

    PubMed Central

    Brown, Lindsay C.; Atherton, Pamela J.; Neben-Wittich, Michelle A.; Wender, Donald B.; Behrens, Robert J.; Kozelsky, Timothy F.; Loprinzi, Charles L.; Haddock, Michael G.; Martenson, James A.

    2013-01-01

    Purpose Pelvic radiotherapy (PRT) is known to adversely affect bowel function (BF) and patient well-being. This study characterized long-term BF and evaluated quality of life (QOL) in patients receiving PRT. Methods Data from 252 patients were compiled from 2 North Central Cancer Treatment Group prospective studies, which included assessment of BF and QOL by the BF questionnaire (BFQ) and Uniscale QOL at baseline and 12 and 24 months after completion of radiotherapy. BFQ scores (sum of symptoms), Uniscale results, adverse-event incidence, and baseline demographic data were compared via t test, χ2, Fisher exact, Wilcoxon, and correlation methodologies. Results The total BFQ score was higher than baseline at 12 and 24 months (P<.001). More patients had 5 or more symptoms at 12 months (13%) and 24 months (10%) than at baseline (2%). Symptoms occurring in greater than 20% of patients at 12 and 24 months were clustering, stool-gas confusion, and urgency. Factors associated with worse BF were female sex, rectal or gynecologic primary tumors, prior anterior resection of the rectum, and 5-fluorouracil chemotherapy. Patients experiencing grade 2 or higher acute toxicity had worse 24-month BF (P values, <.001-.02). Uniscale QOL was not significantly different from baseline at 12 or 24 months, despite worse BFQ scores. Conclusions PRT was associated with worse long-term BF. Worse BFQ score was not associated with poorer QOL. Further research to characterize the subset of patients at risk of significant decline in BF is warranted. PMID:23748483

  15. Comparative anatomical study on the relationships between the vestigial pelvic bones and the surrounding structures of finless porpoises (Neophocaena phocaenoides).

    PubMed

    Tajima, Yuko; Hayashi, Yoshihiro; Yamada, Tadasu K

    2004-07-01

    Morphology of the modern cetaceans represents the results of adaptation of the ancestral terrestrial mammals to aquatic life through their evolutional processes. Some of the primitive fossil cetaceans are known to have both fore and hind limbs, whereas the pelvic bones of modern cetaceans are, in general, a pair of slender rod-like structures within the abdominal wall muscles just anterior to the anus with no articulations to the axial skeleton in both sexes. It is interesting and important to consider the causes and processes of how the hind limbs were lost and how the pelvis was reduced during the process of adaptation. In the present study, we tried to evaluate the topography and function of rudimentary pelvic bones of the finless porpoise (Neophocaena phocaenoides), one of the members of the odontocete cetaceans, with special references to the structures around the pelvic bones. Some soft tissues such as M. ischiocavernosus relating to the pelvic bone are transformed following the drastic reduction of the pelvis. This transformation tells us that the cetaceans adapted to the aquatic life during evolutional processes chose the tail flukes driven by the powerful trunk muscles for locomotion, instead of modifying the hind limbs into hind flippers as seen in pinnipeds. On the other hand, it is evident that a function of the pelvic bones of the male finless porpoise was supporting the penis as those of terrestrial mammals. It is noteworthy that the morphological features of the ancestral terrestrial mammals can be traced when they are carefully compared with those of the finless porpoise.

  16. Automatic Segmentation of Pelvic Structures From Magnetic Resonance Images for Prostate Cancer Radiotherapy

    SciTech Connect

    Pasquier, David . E-mail: d-pasquier@o-lambret.fr; Lacornerie, Thomas; Vermandel, Maximilien; Rousseau, Jean; Lartigau, Eric; Betrouni, Nacim

    2007-06-01

    Purpose: Target-volume and organ-at-risk delineation is a time-consuming task in radiotherapy planning. The development of automated segmentation tools remains problematic, because of pelvic organ shape variability. We evaluate a three-dimensional (3D), deformable-model approach and a seeded region-growing algorithm for automatic delineation of the prostate and organs-at-risk on magnetic resonance images. Methods and Materials: Manual and automatic delineation were compared in 24 patients using a sagittal T2-weighted (T2-w) turbo spin echo (TSE) sequence and an axial T1-weighted (T1-w) 3D fast-field echo (FFE) or TSE sequence. For automatic prostate delineation, an organ model-based method was used. Prostates without seminal vesicles were delineated as the clinical target volume (CTV). For automatic bladder and rectum delineation, a seeded region-growing method was used. Manual contouring was considered the reference method. The following parameters were measured: volume ratio (Vr) (automatic/manual), volume overlap (Vo) (ratio of the volume of intersection to the volume of union; optimal value = 1), and correctly delineated volume (Vc) (percent ratio of the volume of intersection to the manually defined volume; optimal value 100). Results: For the CTV, the Vr, Vo, and Vc were 1.13 ({+-}0.1 SD), 0.78 ({+-}0.05 SD), and 94.75 ({+-}3.3 SD), respectively. For the rectum, the Vr, Vo, and Vc were 0.97 ({+-}0.1 SD), 0.78 ({+-}0.06 SD), and 86.52 ({+-}5 SD), respectively. For the bladder, the Vr, Vo, and Vc were 0.95 ({+-}0.03 SD), 0.88 ({+-}0.03 SD), and 91.29 ({+-}3.1 SD), respectively. Conclusions: Our results show that the organ-model method is robust, and results in reproducible prostate segmentation with minor interactive corrections. For automatic bladder and rectum delineation, magnetic resonance imaging soft-tissue contrast enables the use of region-growing methods.

  17. Hyperbaric Oxygen Therapy in Treating Long-Term Gastrointestinal Adverse Effects Caused by Radiation Therapy in Patients With Pelvic Cancer

    ClinicalTrials.gov

    2011-07-14

    Bladder Cancer; Cervical Cancer; Colorectal Cancer; Endometrial Cancer; Gastrointestinal Complications; Long-term Effects Secondary to Cancer Therapy in Adults; Ovarian Cancer; Prostate Cancer; Radiation Toxicity; Sarcoma; Testicular Germ Cell Tumor; Vaginal Cancer

  18. Defining the “Hostile Pelvis” for Intensity Modulated Radiation Therapy: The Impact of Anatomic Variations in Pelvic Dimensions on Dose Delivered to Target Volumes and Organs at Risk in Patients With High-Risk Prostate Cancer Treated With Whole Pelvic Radiation Therapy

    SciTech Connect

    Yirmibeşoğlu Erkal, Eda; Karabey, Sinan; Karabey, Ayşegül; Hayran, Mutlu; Erkal, Haldun Şükrü

    2015-07-15

    Purpose: The aim of this study was to evaluate the impact of variations in pelvic dimensions on the dose delivered to the target volumes and the organs at risk (OARs) in patients with high-risk prostate cancer (PCa) to be treated with whole pelvic radiation therapy (WPRT) in an attempt to define the hostile pelvis in terms of intensity modulated radiation therapy (IMRT). Methods and Materials: In 45 men with high-risk PCa to be treated with WPRT, the target volumes and the OARs were delineated, the dose constraints for the OARs were defined, and treatment plans were generated according to the Radiation Therapy Oncology Group 0924 protocol. Six dimensions to reflect the depth, width, and height of the bony pelvis were measured, and 2 indexes were calculated from the planning computed tomographic scans. The minimum dose (D{sub min}), maximum dose (D{sub max}), and mean dose (D{sub mean}) for the target volumes and OARs and the partial volumes of each of these structures receiving a specified dose (V{sub D}) were calculated from the dose-volume histograms (DVHs). The data from the DVHs were correlated with the pelvic dimensions and indexes. Results: According to an overall hostility score (OHS) calculation, 25 patients were grouped as having a hospitable pelvis and 20 as having a hostile pelvis. Regarding the OHS grouping, the DVHs for the bladder, bowel bag, left femoral head, and right femoral head differed in favor of the hospitable pelvis group, and the DVHs for the rectum differed for a range of lower doses in favor of the hospitable pelvis group. Conclusions: Pelvimetry might be used as a guide to define the challenging anatomy or the hostile pelvis in terms of treatment planning for IMRT in patients with high-risk PCa to be treated with WPRT.

  19. Acupuncture and Immune Function in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Randomized, Controlled Study

    PubMed Central

    Lee, Shaun Wen Huey; Liong, Men Long; Yuen, Kah Hay; Krieger, John N

    2014-01-01

    Objective The immune system has been implicated as one mechanism underlying the benefits of acupuncture therapy. Evidence suggests that acupuncture can ameliorate symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), but the association between clinical response and the immune system has not been investigated. Design/Setting We investigated 12 CP/CPPS patients participating in a prospective randomized clinical trial comparing acupuncture versus sham acupuncture for effects on cellular immunity. Blood samples were taken before the first needling and after the last of 20 treatment sessions (week 10). Patients also completed questionnaires examining their CP/CPPS symptoms and mood status at the baseline and end of study visits. Results At the end of study 8 of 12 participants (67%) were classified as treatment responders, 4 participants each from the acupuncture and sham groups. The acupuncture group averaged a 5% increase in natural killer cell levels compared to corresponding sham (-13%; p=0.03). Similarly, patients randomized to acupuncture reported a reduction in other white blood cell parameters examined, supporting the possibility that immunity might be important in the pathophysiology of CP/CPPS. Conclusions The specific effect of acupuncture on CP/CPPS remains unclear. Further research is warranted to examine the mechanisms by which acupuncture therapy may improve clinical symptoms in patients with CP/CPPS. PMID:25453515

  20. Preliminary structural MRI based brain classification of chronic pelvic pain: A MAPP network study.

    PubMed

    Bagarinao, Epifanio; Johnson, Kevin A; Martucci, Katherine T; Ichesco, Eric; Farmer, Melissa A; Labus, Jennifer; Ness, Timothy J; Harris, Richard; Deutsch, Georg; Apkarian, A Vania; Mayer, Emeran A; Clauw, Daniel J; Mackey, Sean

    2014-12-01

    Neuroimaging studies have shown that changes in brain morphology often accompany chronic pain conditions. However, brain biomarkers that are sensitive and specific to chronic pelvic pain (CPP) have not yet been adequately identified. Using data from the Trans-MAPP Research Network, we examined the changes in brain morphology associated with CPP. We used a multivariate pattern classification approach to detect these changes and to identify patterns that could be used to distinguish participants with CPP from age-matched healthy controls. In particular, we used a linear support vector machine (SVM) algorithm to differentiate gray matter images from the 2 groups. Regions of positive SVM weight included several regions within the primary somatosensory cortex, pre-supplementary motor area, hippocampus, and amygdala were identified as important drivers of the classification with 73% overall accuracy. Thus, we have identified a preliminary classifier based on brain structure that is able to predict the presence of CPP with a good degree of predictive power. Our regional findings suggest that in individuals with CPP, greater gray matter density may be found in the identified distributed brain regions, which are consistent with some previous investigations in visceral pain syndromes. Future studies are needed to improve upon our identified preliminary classifier with integration of additional variables and to assess whether the observed differences in brain structure are unique to CPP or generalizable to other chronic pain conditions.

  1. Postural changes in women with chronic pelvic pain: a case control study

    PubMed Central

    Montenegro, Mary LLS; Mateus-Vasconcelos, Elaine CL; Rosa e Silva, Júlio C; dos Reis, Francisco J Candido; Nogueira, Antonio A; Poli-Neto, Omero B

    2009-01-01

    Background Chronic pelvic pain (CPP) is a lower abdominal pain lasting at least 6 months, occurring continuously or intermittently and not associated exclusively with menstruation or intercourse. Although the musculoskeletal system has been found to be involved in CPP, few studies have assessed the contribution of posture in women with CPP. We aimed to determine if the frequency of postural changes was higher in women with CPP than healthy subjects. Methods A case-control study included 108 women with CPP of more than 6 months' duration (CPP group) who consecutively attended at the Hospital of the University of São Paulo and 48 healthy female volunteers (control group). Postural assessment was noninvasive and performed in the standing position, with the reference points of Kendall used as normal parameters. Factors associated with CPP were assessed by logistic regression analysis. Results Logistic regression showed that the independent factors associated with CPP were postural changes in the cervical spine (OR 4.1; 95% CI 1.6–10.7; p < 0.01) and scapulae (OR 2.9; 95% CI 1.1–7.6; p < 0.05). Conclusion Musculoskeletal changes were associated with CPP in 34% of women. These findings suggest that a more detailed assessment of women with CPP is necessary for better diagnosis and for more effective treatment. PMID:19583850

  2. Pelvic Floor Disorders

    MedlinePlus

    ... NICHD Research Information Clinical Trials Resources and Publications Pelvic Floor Disorders: Condition Information Skip sharing on social media links Share this: Page Content What is the pelvic floor? The term "pelvic floor" refers to the group ...

  3. Pelvic Organ Prolapse

    MedlinePlus

    ... occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs resulting in ... organ prolapse. Supporting muscles and tissue of the pelvic floor may become torn or stretched because of labor ...

  4. Constriction of the levator hiatus during instruction of pelvic floor or transversus abdominis contraction: a 4D ultrasound study.

    PubMed

    Bø, Kari; Braekken, Ingeborg H; Majida, Memona; Engh, Marie E

    2009-01-01

    A new theory claims that the pelvic floor muscles (PFM) can be trained via the transversus abdominis (TrA). The aim of the present study was to compare the effect of instruction of PFM and TrA contraction on constriction of the levator hiatus, using 4D perineal ultrasonography. Thirteen women with pelvic organ prolapse participated in the study. Perineal ultrasound in standing position was used to assess constriction of the levator hiatus. Analyses were conducted off-line with measurements in the axial plane of minimal hiatal dimensions. The reduction of all the hiatal dimensions was significantly greater during PFM than TrA contraction. All patients had a reduction of the levator hiatus area during PFM contraction (mean reduction 24.0%; range 6.1-49.2%). In two patients, there was an increase of the levator hiatus area during TrA contraction. Instruction of PFM contraction is more effective than TrA contraction.

  5. [Extra peritoneal anterior pelvic exenteration with total urethrectomy and vaginectomy for bladder and urethra cancer - clinical case and review of literature].

    PubMed

    Kovachev, S; Dragiev, D

    2013-01-01

    The anterior pelvic exenteration is technically demanding surgical intervention carried out in advanced malignant genito-urethral process origin. It is characterized by a high percentage of intra and postoperative complications. They can be reduced through new surgical techniques, such as extra peritoneal approach to perform this operation. We present a clinical case of 56 years old patient with adenocarcinoma of the urethra/bladder established histologically by TUR (Transurethral) - biopsy. Of the clinical and imaging studies - data for the invasion to the anterior vaginal wall. The patient is after Total Hysterectomy with bilateral salpingo oophorectomy on the occasion of the fibroids in the uterus. After a routine preoperative preparation, we did: extra peritoneal anterior pelvic exenteration with total urethrectomy and vaginectomy. Bilateral extra peritoneal ureterocutaneostomy with "JJ" stents. Bilateral extra peritoneal pelvic lymph dissection. Our clinical case, proves the thesis of many authors about the benefits of extra peritoneal approach for anterior pelvic exenteration. Reduce significantly the intra/post-operative complications, hospital stay and a time to follow postoperative therapy. We consider that the extra peritoneal approach for radical surgery should be applied whenever possible in the interest of the health of the patient.

  6. RapidArc radiotherapy for whole pelvic lymph node in cervical cancer with 6 and 15 MV: a treatment planning comparison with fixed field IMRT

    PubMed Central

    Zhai, De-Yin; Yin, Yong; Gong, Guan-Zhong; Liu, Tong-Hai; Chen, Jin-Hu; Ma, Chang-Sheng; Lu, Jie

    2013-01-01

    Dosimetric differences were investigated among single and dual arc RapidArc and fixed-field intensity-modulated radiotherapy (f-IMRT) treatment plans for whole pelvic irradiation of lymph nodes. A total of 12 patients who had undergone radical surgery for cervical cancer and who had demonstrated multiple pelvic lymph node metastases were treated with radiotherapy. For all 12 cases, 7-field IMRT, single-arc RapidArc and dual-arc RapidArc were applied with 6 MV and 15 MV X-ray energies. The radiation dosimetric parameters for the different plans were compared with one another. All the plans met the clinical requirements. The homogeneity, conformity and external volume indices of f-IMRT and dual-arc RapidArc were better than for single-arc RapidArc (P < 0.05), while the differences between f-IMRT and dual-arc RapidArc were not significant. There were no significant differences in the radiation dose to organs at risk, except for the small bowel receiving >40 Gy (f-IMRT and dual-arc < single-arc, P < 0.05). The differences in dose distributions between the two applied X-ray energies for each of the modality plans were not significant. RapidArc plans resulted in fewer monitor units than the corresponding f-IMRT plans. Also, there were no differences between the two photon energies, except for a reduction in the number of MUs for 15 MV (P > 0.05). Compared to f-IMRT, no significant dosimetric benefits were found using RapidArc for whole pelvic lymph node irradiation. However, RapidArc has been associated with shorter treatment time and fewer monitor units, supporting the case for its safety and efficacy for pelvic irradiation. PMID:23283869

  7. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

    PubMed Central

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan

    2017-01-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications. PMID:28344966

  8. Routine pelvic examinations: A descriptive cross-sectional survey of women's attitudes and beliefs after new guidelines.

    PubMed

    Kling, Juliana M; Vegunta, Suneela; Al-Badri, Mina; Faubion, Stephanie S; Fields, Heather E; Shah, Amit A; Wallace, Mark R; Ruddy, Barbara E; Bryan, Michael J; Temkit, M'hamed; MacLaughlin, Kathy L

    2017-01-01

    Routine pelvic examinations have been a fundamental part of the annual female examination. The 2014 American College of Physicians (ACP) guideline recommends against routine pelvic examinations in asymptomatic, nonpregnant, average-risk women. Our aim was to evaluate women's attitudes and beliefs about pelvic examinations and how knowledge of the new guidelines contributes to attitudes and beliefs. A descriptive cross-sectional study was performed using a self-administered written survey developed through literature review and pretested and revised on the basis of staff suggestions. Nonpregnant women age≥21years presenting to outpatient clinics at Mayo Clinic in Arizona or Mayo Clinic in Rochester, Minnesota, received the survey. After being asked about pelvic examination practices and beliefs, participants were informed of the ACP guideline, to determine effect on attitudes and beliefs. Demographic characteristics and pertinent medical history questions were collected from participants. In total, 671 women who were predominantly white, married, and educated completed surveys. Participants described pelvic examinations as reassuring, and a majority believed the examinations were useful in detecting ovarian cancer (74.6%), necessary for screening for sexually transmitted infections (STIs) (71.0%), or necessary before initiating contraception (67.0%). After reading the 2014 ACP guideline, significantly fewer women planned to continue yearly pelvic examinations (P<0.001). Despite evidence to the contrary, women believed pelvic examinations were necessary for STI screening, contraception initiation, and ovarian cancer detection. After education on the ACP screening guideline, fewer women planned to continue yearly pelvic examinations.

  9. Prostate-specific antigen kinetics after stereotactic body radiotherapy as monotherapy or boost after whole pelvic radiotherapy for localized prostate cancer

    PubMed Central

    Kim, Hun Jung; Phak, Jung Hoon; Kim, Woo Chul

    2015-01-01

    Purpose Stereotactic body radiotherapy (SBRT) has emerged as an effective treatment for localized prostate cancer. However, prostate-specific antigen (PSA) kinetics after SBRT has not been well characterized. The purpose of the current study is to assess the kinetics of PSA for low- and intermediate-risk prostate cancer patients treated with SBRT using Cyberknife as both monotherapy and boost after whole pelvic radiotherapy (WPRT) in the absence of androgen deprivation therapy. Methods A total of 61 patients with low- and intermediated-risk prostate cancer treated with SBRT as monotherapy (36.25 Gy in 5 fractions in 32 patients) and SBRT (21 Gy in 3 fractions in 29 patients) boost combined with WPRT (45 Gy in 25 fractions). Patients were excluded if they failed therapy by the Phoenix definition or had androgen deprivation therapy. PSA nadir and rate of change in PSA over time (slope) were calculated and compared. Results With a median follow-up of 52.4 months (range, 14–74 months), for SBRT monotherapy, the median PSA nadir was 0.31 ng/mL (range, 0.04–1.15 ng/mL) and slopes were –0.41 ng/mL/mo, –0.17 ng/mL/mo, –0.12 ng/mL/mo, and –0.09 ng/mL/mo, respectively, for durations of 1 year, 2 years, 3 years, and 4 years postradiotherapy. Similarly, for SBRT boost after WPRT, the median PSA nadir was 0.34 ng/mL (range, 0.04–1.44 ng/mL) and slopes were –0.53 ng/mL/mo, –0.25 ng/mL/mo, –0.14 ng/mL/mo, and –0.09 ng/mL/mo, respectively. The median nadir and slopes of SBRT monotherapy did not differ significantly from those of SBRT boost after WPRT. Benign PSA bounces were common in 30.4% of all cohorts, and the median time to PSA bounce was 12 months (range, 6–25 months). Conclusions In this report of low- and intermediate-risk prostate cancer patients, an initial period of rapid PSA decline was followed by a slow decline, which resulted in a lower PSA nadir. The PSA kinetics of SBRT monotherapy appears to be comparable to those achieved

  10. External Pelvic and Vaginal Irradiation Versus Vaginal Irradiation Alone as Postoperative Therapy in Medium-Risk Endometrial Carcinoma-A Prospective Randomized Study

    SciTech Connect

    Sorbe, Bengt; Horvath, Gyoergy; Andersson, Hakan; Boman, Karin; Lundgren, Caroline; Pettersson, Birgitta

    2012-03-01

    Purpose: To evaluate the value of adjuvant external beam pelvic radiotherapy as adjunct to vaginal brachytherapy (VBT) in medium-risk endometrial carcinoma, with regard to locoregional tumor control, recurrences, survival, and toxicity. Methods and Materials: Consecutive series of 527 evaluable patients were included in this randomized trial. Median follow-up for patients alive was 62 months. The primary study endpoints were locoregional recurrences and overall survival. Secondary endpoints were recurrence-free survival, recurrence-free interval, cancer-specific survival, and toxicity. Results: Five-year locoregional relapse rates were 1.5% after external beam radiotherapy (EBRT) plus VBT and 5% after vaginal irradiation alone (p = 0.013), and 5-year overall survival rates were 89% and 90%, respectively (p = 0.548). Endometrial cancer-related death rates were 3.8% after EBRT plus VBT and 6.8% after VBT (p = 0.118). Pelvic recurrences (exclusively vaginal recurrence) were reduced by 93% by the addition of EBRT to VBT. Deep myometrial infiltration was a significant prognostic factor in this medium-risk group of endometrioid carcinomas but not International Federation of Gynecology and Obstetrics grade or DNA ploidy. Combined radiotherapy was well tolerated, with serious (Grade 3) late side effects of less than 2%. However, there was a significant difference in favor of VBT alone. Conclusions: Despite a significant locoregional control benefit with combined radiotherapy, no survival improvement was recorded, but increased late toxicity was noted in the intestine, bladder, and vagina. Combined RT should probably be reserved for high-risk cases with two or more high-risk factors. VBT alone should be the adjuvant treatment option for purely medium-risk cases.

  11. Intermittent androgen ablation in patients with biochemical failure after pelvic radiotherapy for localized prostate cancer

    SciTech Connect

    Cury, Fabio L.B.; Souhami, Luis . E-mail: luis.souhami@muhc.mcgill.ca; Rajan, Raghu; Tanguay, Simon; Gagnon, Bruno; Duclos, Marie; Shenouda, George; Faria, Sergio L.; David, Marc; Freeman, Carolyn R.

    2006-03-01

    Purpose: To assess the efficacy of intermittent androgen ablation (IAA) in patients with biochemical failure after radiotherapy for prostate cancer. Methods and Materials: Thirty-nine patients received a luteinizing hormone-releasing hormone analog every 2 months for a total of 4 doses. IAA was then discontinued if serum prostate-specific antigen (PSA) fell to a normal level with a castrate level of testosterone. Therapy was restarted when the serum PSA level reached {>=}10 ng/mL and was discontinued if hormone resistance or unacceptable toxicity occurred. Results: Median PSA was 9.1 ng/mL at the time of first IAA. The median time between the first and the second cycles was 20.1 months, decreasing to 15.5 months between the third and fourth cycles. Two patients discontinued the treatment because of severe hot flushes. Four patients developed hormone resistance. With a median follow-up of 56.4 months, 5-year survival is 92.3%. Three patients died of unrelated causes. The incidence of distant metastasis is 6.8%. Conclusions: The use of IAA seems to be a safe and effective treatment for patients with biochemical failure post radiotherapy and no evidence of metastatic disease. The use of IAA limits hormone-related side effects and health care costs without an apparent increase in the risk for the development of metastatic disease.

  12. The interplay of dyadic and individual planning of pelvic-floor exercise in prostate-cancer patients following radical prostatectomy.

    PubMed

    Burkert, Silke; Knoll, Nina; Luszczynska, Aleksandra; Gralla, Oliver

    2012-06-01

    This study broadens the current understanding of the role of planning by focusing on the interplay between individual and dyadic planning (i.e. making plans about the target person's behaviour together with a partner). Self-report data from N=141 prostatectomy-patients and their partners were assessed at three times within 1 year post-surgery. Direct and indirect effects of dyadic and individual planning on patients' pelvic-floor exercise (PFE) were tested. Proposed mediators were social support, social control, and action control. Cross-sectionally, the dyadic planning-PFE relationship was mediated by patients' received support and partners' provided social control. Longitudinally, mediators of dyadic planning were partners' provided social control and support. Effects of individual planning on PFE were mediated by action control at baseline only. Also, at lower levels of individual planning, patients' dyadic planning was more strongly associated with receipt of social control. Results underscore the importance of social factors in the planning process and its mechanisms in health-behaviour change.

  13. Physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery: a protocol for a mixed-methods prospective cohort study

    PubMed Central

    Nygaard, Ingrid E; Clark, Erin; Clark, Lauren; Egger, Marlene J; Hitchcock, Robert; Hsu, Yvonne; Norton, Peggy; Sanchez-Birkhead, Ana; Shaw, Janet; Sheng, Xiaoming; Varner, Michael

    2017-01-01

    Introduction Pelvic floor disorders (PFDs), including pelvic organ prolapse (POP), stress and urgency urinary incontinence, and faecal incontinence, are common and arise from loss of pelvic support. Although severe disease often does not occur until women become older, pregnancy and childbirth are major risk factors for PFDs, especially POP. We understand little about modifiable factors that impact pelvic floor function recovery after vaginal birth. This National Institutes of Health (NIH)-funded Program Project, ‘Bridging physical and cultural determinants of postpartum pelvic floor support and symptoms following vaginal delivery’, uses mixed-methods research to study the influences of intra-abdominal pressure, physical activity, body habitus and muscle fitness on pelvic floor support and symptoms as well as the cultural context in which women experience those changes. Methods and analysis Using quantitative methods, we will evaluate whether pelvic floor support and symptoms 1 year after the first vaginal delivery are affected by biologically plausible factors that may impact muscle, nerve and connective tissue healing during recovery (first 8 weeks postpartum) and strengthening (remainder of the first postpartum year). Using qualitative methods, we will examine cultural aspects of perceptions, explanations of changes in pelvic floor support, and actions taken by Mexican-American and Euro-American primipara, emphasising early changes after childbirth. We will summarise project results in a resource toolkit that will enhance opportunities for dialogue between women, their families and providers, and across lay and medical discourses. We anticipate enrolling up to 1530 nulliparous women into the prospective cohort study during the third trimester, following those who deliver vaginally 1 year postpartum. Participants will be drawn from this cohort to meet the project's aims. Ethics and dissemination The University of Utah and Intermountain Healthcare

  14. FDG PET/CT images demonstrating Fournier gangrene with bilateral pelvic muscle extension in a patient with recurrent rectosigmoid cancer.

    PubMed

    Hsu, Chia-Tien; Kao, Pan-Fu; Huang, Chi-Chou; Huang, Hsin-Hui; Lee, Jong-Kang

    2014-01-01

    A 71-year-old male patient with Parkinsonism was referred for an F-FDG PET/CT scan for suspicious recurrence of rectosigmoid adenocarcinoma. The FDG PET/CT scan revealed increased FDG uptakes in the lower pelvic region around the wall of the rectal stump, with extension to the bilateral pelvic sidewalls and the right gluteous minimus muscle. In addition, multiple small air bubbles were noted in the lesions on the attenuation CT images. Fournier gangrene was diagnosed. After treatment with intravenous antibiotics and debridement with sigmoidoscopic irrigation, the patient was discharged and remained uneventful during clinical follow-up for 50 days.

  15. Clinical Response of Pelvic and Para-aortic Lymphadenopathy to a Radiation Boost in the Definitive Management of Locally Advanced Cervical Cancer

    SciTech Connect

    Rash, Dominique L.; Lee, Yongsook C.; Kashefi, Amir; Durbin-Johnson, Blythe; Mathai, Mathew; Valicenti, Richard; Mayadev, Jyoti S.

    2013-10-01

    Purpose: Optimal treatment with radiation for metastatic lymphadenopathy in locally advanced cervical cancer remains controversial. We investigated the clinical dose response threshold for pelvic and para-aortic lymph node boost using radiographic imaging and clinical outcomes. Methods and Materials: Between 2007 and 2011, 68 patients were treated for locally advanced cervical cancer; 40 patients had clinically involved pelvic and/or para-aortic lymph nodes. Computed tomography (CT) or 18F-labeled fluorodeoxyglucose-positron emission tomography scans obtained pre- and postchemoradiation for 18 patients were reviewed to assess therapeutic radiographic response of individual lymph nodes. External beam boost doses to involved nodes were compared to treatment response, assessed by change in size of lymph nodes by short axis and change in standard uptake value (SUV). Patterns of failure, time to recurrence, overall survival (OS), and disease-free survival (DFS) were determined. Results: Sixty-four lymph nodes suspicious for metastatic involvement were identified. Radiation boost doses ranged from 0 to 15 Gy, with a mean total dose of 52.3 Gy. Pelvic lymph nodes were treated with a slightly higher dose than para-aortic lymph nodes: mean 55.3 Gy versus 51.7 Gy, respectively. There was no correlation between dose delivered and change in size of lymph nodes along the short axis. All lymph nodes underwent a decrease in SUV with a complete resolution of abnormal uptake observed in 68%. Decrease in SUV was significantly greater for lymph nodes treated with ≥54 Gy compared to those treated with <54 Gy (P=.006). Median follow-up was 18.7 months. At 2 years, OS and DFS for the entire cohort were 78% and 50%, respectively. Locoregional control at 2 years was 84%. Conclusions: A biologic response, as measured by the change in SUV for metastatic lymph nodes, was observed at a dose threshold of 54 Gy. We recommend that involved lymph nodes be treated to this minimum dose.

  16. Incidence and Risk Factors of De novo Stress Urinary Incontinence after Pelvic Floor Reconstruction: A Nested Case-control Study

    PubMed Central

    Wang, Shi-Yan; Cao, Ting-Ting; Wang, Run-Zhi; Yang, Xin; Sun, Xiu-Li; Wang, Jian-Liu

    2017-01-01

    Background: Some patients with pelvic organ prolapse may suffer from lower urinary tract symptoms (LUTS), especially stress urinary incontinence (SUI) named de novo SUI after pelvic floor reconstruction. This study aimed to investigate the incidence and risk factors of de novo SUI. Methods: This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse (POP) at the Department of Gynecology in Peking University People's Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% (101 patients lost to follow-up). There were 75 patients with de novo SUI postoperatively. According to the ratio of 1:3, we ensured the number of control group (n = 225). The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results: The incidence of de novo SUI was 25% (75/300). Univariate analysis showed that the ratio of lower urinary tract obstruction (LUTO) before surgery in de novo SUI group was significantly higher than the control group (odds ratio [OR] = 2.1, 95% confidence interval [CI] [1.1–4.0], P = 0.022). The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher (OR = 2.1, 95% CI [1.0–3.7], P = 0.045). After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery (OR = 2.3, 95% CI [1.2–4.6], P = 0.013). Conclusions: Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder

  17. Omental transposition for low pelvic anastomoses.

    PubMed

    Topor, B; Acland, R D; Kolodko, V; Galandiuk, S

    2001-11-01

    Surgeons' opinions differ regarding the role of the omentum in low pelvic intestinal anastomoses. This study was undertaken to define the anatomy and surgical technique of omental transposition to the pelvis. We studied 45 cadavers to elucidate surgical aspects of omental mobilization, lengthening, and transposition into the pelvic cavity. In addition, intraoperative studies of omental transposition to the pelvis were performed in 20 patients with chronic ulcerative colitis, familial adenomatous polyposis, and rectal cancer who were undergoing ileal J-pouch anal anastomosis or low anterior resection. The most important anatomic variables for omental transposition are three variants of arterial blood supply: (1) In 56% of patients, there is one right, one (or two) middle, and one left omental artery. (2) In 26% of patients, the middle omental artery is absent. (3) In the remaining 18% of patients, the gastroepiploic artery is continued as a left omental artery but with various smaller connections to the right or middle omental artery. The first stage of omental lengthening is detachment of the omentum from the transverse colon mesentery. This must be performed carefully, as the omentum is closely adherent to the right transverse mesocolon. The second stage is the actual lengthening of the omentum. The third stage is placement of the omental flap into the pelvis. Creation of an omental pedicle is a simple surgical procedure. This procedure can be performed quickly, does not involve significant blood loss, and may reduce the frequency of complications after low pelvic anastomoses.

  18. Pelvic radiation disease: Updates on treatment options

    PubMed Central

    Frazzoni, Leonardo; La Marca, Marina; Guido, Alessandra; Morganti, Alessio Giuseppe; Bazzoli, Franco; Fuccio, Lorenzo

    2015-01-01

    Pelvic cancers are among the most frequently diagnosed neoplasms and radiotherapy represents one of the main treatment options. The irradiation field usually encompasses healthy intestinal tissue, especially of distal large bowel, thus inducing gastrointestinal (GI) radiation-induced toxicity. Indeed, up to half of radiation-treated patients say that their quality of life is affected by GI symptoms (e.g., rectal bleeding, diarrhoea). The constellation of GI symptoms - from transient to long-term, from mild to very severe - experienced by patients who underwent radiation treatment for a pelvic tumor have been comprised in the definition of pelvic radiation disease (PRD). A correct and evidence-based therapeutic approach of patients experiencing GI radiation-induced toxicity is mandatory. Therapeutic non-surgical strategies for PRD can be summarized in two broad categories, i.e., medical and endoscopic. Of note, most of the studies have investigated the management of radiation-induced rectal bleeding. Patients with clinically significant bleeding (i.e., causing chronic anemia) should firstly be considered for medical management (i.e., sucralfate enemas, metronidazole and hyperbaric oxygen); in case of failure, endoscopic treatment should be implemented. This latter should be considered the first choice in case of acute, transfusion requiring, bleeding. More well-performed, high quality studies should be performed, especially the role of medical treatments should be better investigated as well as the comparative studies between endoscopic and hyperbaric oxygen treatments. PMID:26677440

  19. The Risser sign for forensic age estimation in living individuals: a study of 643 pelvic radiographs.

    PubMed

    Wittschieber, Daniel; Schmeling, Andreas; Schmidt, Sven; Heindel, Walter; Pfeiffer, Heidi; Vieth, Volker

    2013-03-01

    Due to increasing international migratory movements, forensic age estimations of living individuals in criminal proceedings are gaining increasing significance for forensic physicians and radiologists involved in delivering expert opinions. The present study examines the suitability of the radiologically well-known Risser sign grading as a possible new criterion in forensic age diagnostics. For this purpose, anteroposterior pelvic radiographs of 643 patients aged between 10 and 30 years were retrospectively evaluated by means of two different Risser sign grading systems (US and French), each with 5 stages. The left and right sides of the pelvis were assessed separately. The data was analyzed with separation of the sexes. Reliable Risser sign determination was possible in 566 cases. In both sexes, stage 4 of both the US and the French grading systems was predominantly first noted at age 14 years. In the US grading system, stage 5 was also first achieved at age 14 years in the majority of both sexes. In the French grading system, females manifested stage 5 at a minimum of 16 years, whereas in males it was first observed at 17 years. As to the nature of iliac crest maturation, interesting deviations were observed at stages 1 and 5, raising doubts about Risser's ossification process. To conclude, both Risser sign grading systems are suitable for forensic age diagnostics, especially to determine whether the 14th year of life has been completed or not. The French Risser sign system additionally allows for statements as to the completion of the 16th year of age.

  20. Toll-like Receptor 4 and Comorbid Pain in Interstitial Cystitis/Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Study

    PubMed Central

    Schrepf, Andrew; Bradley, Catherine S.; O'Donnell, Michael; Luo, Yi; Harte, Steven E.; Kreder, Karl; Lutgendorf, Susan

    2015-01-01

    Background Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a condition characterized by pelvic pain and urinary symptoms. Some IC/BPS patients have pain confined to the pelvic region, while others suffer widespread pain. Inflammatory processes have previously been linked to pelvic pain in IC/BPS, but their association with widespread pain in IC/BPS has not been characterized. Methods Sixty-six women meeting criteria for IC/BPS completed self-report measures of pain as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP), collected 3 days of saliva for cortisol assays, and provided blood samples. Peripheral blood mononuclear cells (PBMCs) were stimulated with Toll-Like Receptor (TLR) 2 and 4 agonists and cytokines were measured in supernatant; IL-6 was also measured in plasma. Associations between inflammatory variables and the likelihood of endorsing extra-pelvic pain, or the presence of a comorbid syndrome, were tested by logistic regression and General Linear Models, respectively. A subset of patients (n=32) completed Quantitative Sensory Testing. Results A one standard deviation increase in TLR-4 inflammatory response was associated with a 1.59 greater likelihood of endorsing extra-pelvic pain (p = .019). Participants with comorbid syndromes also had higher inflammatory responses to TLR-4 stimulation in PBMCs (p = .016). Lower pressure pain thresholds were marginally associated with higher TLR-4 inflammatory responses (p = .062), and significantly associated with higher IL-6 in plasma (p = .031). Conclusions TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain. PMID:25771510

  1. The Role of Transcatheter Arterial Embolization in Traumatic Pelvic Hemorrhage: Not Only Pelvic Fracture

    PubMed Central

    Zatelli, Marianna; Haglmuller, Thomas; Bonatti, Giampietro

    2016-01-01

    Purpose: The most common life-threatening complication of pelvic trauma is bleeding. Arterial bleedings frequently require active management, preferably with transcatheter arterial embolization (TAE). Hemodynamic instability and/or contrast extravasation at computer tomography (CT) examination are reliable indicators of arterial injury. Unstable pelvic fractures are much more hemorrhagic than stable fractures. Nevertheless, an absent or isolated pelvic fracture does not exclude pelvic hemorrhage. Materials and Methods: A retrospective study was conducted on our institutional database by collecting data of patients who underwent pelvic angiography and/or embolization due to pelvic blunt trauma in the period between August 2010 and August 2015. Results: In a period of five years, 39 patients with traumatic pelvic bleeding underwent angiography at our institution. Thirty-six of the 39 (92%) patients did show CT signs of active pelvic bleeding. Nineteen of 39 (49%) patients were hemodynamically unstable at presentation. Three of the 39 patients did not require embolization. Technical success was 35/36 (97%), and overall mortality was 3/39 (8%). Notably, 5/39 (13%) patients did not have any pelvic fracture at presentation, and 18/39 (46%) had only isolated or stable pelvic ring fracture. Conclusions: TAE is an effective technique to treat arterial pelvic bleeding after trauma. The absence of a major pelvic fracture does not exclude the risk of active bleeding requiring prompt treatment. PMID:27625908

  2. Dose–volume analysis of predictors for chronic gastrointestinal complications in patients with cervical cancer treated with postoperative concurrent chemotherapy and whole-pelvic radiation therapy

    PubMed Central

    Isohashi, Fumiaki; Mabuchi, Seiji; Akino, Yuichi; Yoshioka, Yasuo; Seo, Yuji; Suzuki, Osamu; Tamari, Keisuke; Yoshino, Kiyoshi; Sawada, Kenjiro; Ueda, Yutaka; Kobayashi, Eiji; Sumida, Iori; Mizuno, Hirokazu; Okubo, Hirofumi; Kimura, Tadashi; Ogawa, Kazuhiko

    2016-01-01

    The purpose of this study is to evaluate dose–volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in patients with cervical cancer who have undergone postoperative concurrent chemotherapy and whole-pelvic radiation therapy (WPRT). The subjects were 135 patients who had undergone postoperative WPRT with concurrent nedaplatin-based chemotherapy between 2000 and 2014. Associations between selected DVH parameters and the incidence of chronic GI complications of G3 or higher were evaluated. Chronic GI complications of severity G3 occurred in 18 (13%) patients. Patients with GI complications had significantly greater V5–V45, mean dose and the generalized equivalent uniform dose (gEUD) of the small bowel loops, compared with those without GI complications. V30–V45, mean dose and gEUD of the bowel bag also showed significant differences between patients with and without GI complications. In contrast, no parameter for the large bowel loop was correlated with GI complications. Receiver operating characteristics curve analysis indicated that V30–V45 of the small bowel loops were better predictors than these respective parameters for the bowel bag. Next, patients were divided into four groups based on the median V15 and V40 of the small bowel loops. The group with both a high V15 and a high V40 showed a significantly higher probability of chronic GI complications. In conclusion, the small bowel loops are better predictors of chronic GI complications compared with the bowel bag, and a relatively high-dose volume (e.g. V40) of the small bowel loops is a useful predictor of chronic GI complications. PMID:27342839

  3. Haemoglobin levels may predict toxicities in patients on pelvic chemoradiation for carcinoma of the cervix—experience of a regional cancer centre

    PubMed Central

    Gangopadhyay, Aparna; Das, Joydeep; Nath, Partha; Biswas, Jaydip

    2014-01-01

    Background Haemoglobin levels and tissue oxygenation influence tumour outcome in carcinoma cervix radiotherapy. The clinical impact of haemoglobin levels on acute normal tissue toxicity during radiation and interaction with chemotherapy in carcinoma of the cervix is underexplored. This paper aims to explore this issue. Methods Treatment toxicity among 227 patients with squamous cell carcinoma of the cervix stages II B–IV A, receiving pelvic radiotherapy or chemoradiation at our institute, were studied prospectively. The baseline and weekly haemoglobin levels during treatment were recorded. Acute toxicities were recorded using Radiation Therapy Oncology Group (RTOG) acute toxicity and Common Terminology Criteria for Adverse Events (CTCAE) criteria, version 4. For the analysis, patients were divided into two groups, depending on nadir haemoglobin levels. A cut-off value for anaemia was selected at 12 gm/dL. Toxicity was compared between anaemic and non-anaemic groups. Results Patients on chemoradiation and having haemoglobin levels >12 gm/dL suffered significantly higher dermatitis (two-tailed p value = 0.0288) and vaginal mucositis (two-tailed p value = 0.0187) of at least RTOG acute toxicity grade 2, compared with the anaemic group. In contrast patients receiving radiotherapy alone did not experience any significantly greater mucocutaneous toxicity if haemoglobin was >12 gm/dL. Anaemia had significantly greater impact on malaise and neutropenia (two-tailed p value <0.0001) of CTCAE grade 1 and above among chemoradiation patients, as opposed to those receiving radiotherapy alone (two-tailed p values = 0.0012 for neutropenia and 0.0422 for malaise). Conclusion Haemoglobin values >12 gm/dL significantly worsen acute mucocutaneous toxicity in locally advanced cervical cancer patients receiving chemoradiation. Similar effects are not observed in the absence of chemotherapy. PMID:24963348

  4. Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy in Postoperative Treatment of Endometrial and Cervical Cancer

    SciTech Connect

    Small, William Mell, Loren K.; Anderson, Penny; Creutzberg, Carien; De Los Santos, Jennifer; Gaffney, David; Jhingran, Anuja; Portelance, Lorraine; Schefter, Tracey; Iyer, Revathy; Varia, Mahesh; Winter, Kathryn M.S.; Mundt, Arno J.

    2008-06-01

    Purpose: To develop an atlas of the clinical target volume (CTV) definitions for postoperative radiotherapy of endometrial and cervical cancer to be used for planning pelvic intensity-modulated radiotherapy. Methods and Materials: The Radiation Therapy Oncology Group led an international collaberation of cooperative groups in the development of the atlas. The groups included the Radiation Therapy Oncology Group, Gynecologic Oncology Group, National Cancer Institute of Canada, European Society of Therapeutic Radiology and Oncology, and American College of Radiology Imaging Network. The members of the group were asked by questionnaire to define the areas that were to be included in the CTV and to outline theses areas on individual computed tomography images. The initial formulation of the group began in late 2004 and culminated with a formal consensus conference in June 2005. Results: The committee achieved a consensus CTV definition for postoperative therapy for endometrial and cervical cancer. The CTV should include the common, external, and internal iliac lymph node regions. The upper 3.0 cm of the vagina and paravaginal soft tissue lateral to the vagina should also be included. For patients with cervical cancer, or endometrial cancer with cervical stromal invasion, it is also recommended that the CTV include the presacral lymph node region. Conclusion: This report serves as an international template for the definition of the CTV for postoperative intensity-modulated radiotherapy for endometrial and cervical cancer.

  5. Presence of Mental Imagery Associated with Chronic Pelvic Pain: A Pilot Study

    PubMed Central

    Berna, Chantal; Vincent, Katy; Moore, Jane; Tracey, Irene; Goodwin, Guy M; Holmes, Emily A

    2011-01-01

    Objective To ascertain whether a small sample of patients with chronic pelvic pain experienced any pain-related cognitions in the form of mental images. Patients Ten women with chronic pelvic pain consecutively referred from a tertiary referral center by the physicians in charge of their treatment. Outcome measures An interview was used to determine the presence, emotional valence, content, and impact of cognitions about pain in the form of mental images and verbal thoughts. The Brief Pain Inventory (BPI), Pain Catastrophizing Scale (PCS), Spontaneous Use of Imagery Scale (SUIS), and Hospital Anxiety and Depression Scale (HADS) were completed. Results In a population of patients with a prolonged duration of pain and high distress, all patients reported experiencing cognitions about pain in the form of mental images. For each patient, the most significant image was both negative in valence and intrusive. The associated emotional-behavioral pattern could be described within a cognitive behavioral therapy framework. Eight patients also reported coping imagery. Conclusion Negative pain-related cognitions in the form of intrusive mental imagery were reported by women with chronic pelvic pain. Targeting such imagery has led to interesting treatment innovation in the emotional disorders. Thus, imagery, hitherto neglected in pain phenomenology, could provide a novel target for cognitive behavioral therapy in chronic pain. These exciting yet preliminary results require replication and extension in a broader population of patients with chronic pain. PMID:21668746

  6. Less Invasive Endometrial Cancer Surgery with Extraperitoneal Pelvic and Para-aortic Lymphadenectomy via a Small Midline Abdominal Incision and the Retroperitoneal Approach.

    PubMed

    Komiyama, Shinichi; Takeya, Chiaki; Takahashi, Rena; Nagasaki, Sumito; Kubushiro, Kaneyuki

    2016-01-01

    [Objective] To achieve less invasive lymphadenectomy in endometrial cancer patients, we performed extraperitoneal pelvic and para-aortic lymphadenectomy via a small midline abdominal incision with retroperitoneal approach. The feasibility and safety of this method were investigated. [Methods] Inclusion criteria were 1) endometrioid adenocarcinoma diagnosed by preoperative biopsy, 2) myometrial invasion by magnetic resonance imaging, and 3) no peritoneal dissemination or distant metastasis by computed tomography. Systematic extraperitoneal dissection of pelvic and para-aortic lymph nodes was performed via an approximately 12-cm midline lower abdominal incision, after which hysterectomy and bilateral salpingo-oophorectomy were done (extraperitoneal group). The historical control group was patients who underwent standard transperitoneal lymphadenectomy followed by hysterectomy and bilateral salpingo-oophorectomy. The two groups were compared for demographic characteristics, perioperative factors, and complications. [Results] A total of 62 patients were enrolled. Demographic and clinicopathological factors showed no differences between the extraperitoneal group (n = 34) and the historical control group (n = 28). The median number of pelvic (30 vs. 28) and para-aortic (14 vs. 17) nodes dissected was also similar. However, median intraoperative blood loss was significantly smaller in the extraperitoneal group than the control group (220 vs. 573 g). Median operating time (265 vs. 323.5 min), median laparotomy time (60 vs. 295 min), and median initial flatus time (8 vs. 32 hours) were all significantly shorter in the extraperitoneal group, while complications and severe postoperative pain were significantly less frequent. [Conclusions] Our new technique was feasible, safe, and less invasive than standard laparotomy. It is an alternative to laparoscope-assisted or robotic procedures.

  7. Less Invasive Endometrial Cancer Surgery with Extraperitoneal Pelvic and Para-aortic Lymphadenectomy via a Small Midline Abdominal Incision and the Retroperitoneal Approach

    PubMed Central

    Komiyama, Shinichi; Takeya, Chiaki; Takahashi, Rena; Nagasaki, Sumito; Kubushiro, Kaneyuki

    2016-01-01

    [Objective] To achieve less invasive lymphadenectomy in endometrial cancer patients, we performed extraperitoneal pelvic and para-aortic lymphadenectomy via a small midline abdominal incision with retroperitoneal approach. The feasibility and safety of this method were investigated. [Methods] Inclusion criteria were 1) endometrioid adenocarcinoma diagnosed by preoperative biopsy, 2) myometrial invasion by magnetic resonance imaging, and 3) no peritoneal dissemination or distant metastasis by computed tomography. Systematic extraperitoneal dissection of pelvic and para-aortic lymph nodes was performed via an approximately 12-cm midline lower abdominal incision, after which hysterectomy and bilateral salpingo-oophorectomy were done (extraperitoneal group). The historical control group was patients who underwent standard transperitoneal lymphadenectomy followed by hysterectomy and bilateral salpingo-oophorectomy. The two groups were compared for demographic characteristics, perioperative factors, and complications. [Results] A total of 62 patients were enrolled. Demographic and clinicopathological factors showed no differences between the extraperitoneal group (n = 34) and the historical control group (n = 28). The median number of pelvic (30 vs. 28) and para-aortic (14 vs. 17) nodes dissected was also similar. However, median intraoperative blood loss was significantly smaller in the extraperitoneal group than the control group (220 vs. 573 g). Median operating time (265 vs. 323.5 min), median laparotomy time (60 vs. 295 min), and median initial flatus time (8 vs. 32 hours) were all significantly shorter in the extraperitoneal group, while complications and severe postoperative pain were significantly less frequent. [Conclusions] Our new technique was feasible, safe, and less invasive than standard laparotomy. It is an alternative to laparoscope-assisted or robotic procedures. PMID:27313778

  8. Treatment of Unstable Posterior Pelvic Ring Fracture with Pedicle Screw-Rod Fixator Versus Locking Compression Plate: A Comparative Study

    PubMed Central

    Bi, Chun; Wang, Qiugen; Nagelli, Christopher; Wu, Jianhong; Wang, Qian; Wang, Jiandong

    2016-01-01

    Background The aim of this study was to assess the clinical results of treatment for unstable posterior pelvic fractures using a pedicle screw-rod fixator compared to use of a locking compression plate. Material/Methods A retrospective study was performed between June 2010 and May 2014 and the data were collected from 46 patients with unstable posterior pelvic ring fractures. All patients were treated using either a pedicle screw-rod fixator (study group, 24 patients) or locking compression plate (control group, 22 patients). In these patients, causes of injury included traffic accidents (n=27), fall from height (n=12), and crushing accidents (n=7). The quality of reduction and radiological grading were assessed. Clinical assessments included the operation time, times of X-ray exposures, bleeding volume during operation, incision length, and Majeed postoperative functional evaluation. Results No iatrogenic neurovascular injuries occurred during the operations in these 2 groups. The average follow-up time was 24.5 months. All fractures were healed. The significant differences (P<0.05) between the 2 groups were operation duration, size of incision, and intraoperative bleeding volume. Statistically significant differences in the Majeed postoperative functional evaluation and times of X-ray exposures were not found between the 2 groups. Conclusions Similar clinical effects were achieved in treating the posterior pelvic ring fractures using the pedicle screw-rod fixator and the locking compression plate. However, the pedicle screw-rod fixator has the advantages of smaller incision, shorter duration of the operation, and less bleeding volume compared to using the locking compression plate. PMID:27748355

  9. Palliation of advanced pelvic malignant disease with large fraction pelvic radiation and misonidazole: final report of RTOG phase I/II study

    SciTech Connect

    Spanos, W.J. Jr.; Wasserman, T.; Meoz, R.; Sala, J.; Kong, J.; Stetz, J.

    1987-10-01

    Between October 1979 and June 1982 forty-six patients were entered on a non-randomized Phase I-II protocol for the evaluation of Misonidazole combined with high dose per fraction radiation for the treatment of advanced pelvic malignancies. Pelvic radiation consisted of 1000 cGy in one fraction repeated at 4-week intervals for a total of three treatments. Oral Misonidazole at a dose of 4 gm/m2 was administered 4-6 hr prior to radiation (total dose 12 g/m2). The distribution of histology consisted of 20 gynecologic, 24 bowel, and 2 prostate malignancies. Of the thirty-seven patients completing the three treatments; there were 6 complete responses (14% CR), 10 partial responses (27% PR) 19 minimal or no response (32% NR), and 4 unevaluable. One patient remains NED 5.5 years following radiation. Toxicity directly related to Misonidazole was minimal and consisted primarily of transcient Grade 1, 2 peripheral neuropathy (20% Grade 1, 4% Grade 2) and Grade 2 ototoxicity (4%). Radiation toxicity was significant for late bowel damage. There were 4 (11%) Grade 3 and 7 (19%) Grade 4 gastro-intestinal (GI) toxicities. Kaplan-Meier plot of GI toxicity showed a progressive increase in incidence with time for projected rate of 49% Grade 3, 4 by 12-month. GI toxicity (Grade 3, 4) was also related to tumor response. The complication rate was 80% (4/6) for CR, 30% (3/10) for PR and 26% (5/19) for NR or progression. Because of the GI complication rate, this protocol for palliation of advanced pelvic malignancies has been replaced by a protocol that uses 4 fractions over 2 days (b.i.d.) of 370 cGy per fraction repeated at 3-week intervals for a total of 3 courses.

  10. Pelvic floor muscle strength in primiparous women according to the delivery type: cross-sectional study 1

    PubMed Central

    Mendes, Edilaine de Paula Batista; de Oliveira, Sonia Maria Junqueira Vasconcellos; Caroci, Adriana de Souza; Francisco, Adriana Amorim; Oliveira, Sheyla Guimaraes; da Silva, Renata Luana

    2016-01-01

    ABSTRACT Objectives: to compare the pelvic floor muscle strength in primiparous women after normal birth and cesarean section, related to the socio-demographic characteristics, nutritional status, dyspareunia, urinary incontinence, perineal exercise in pregnancy, perineal condition and weight of the newborn. Methods: this was a cross-sectional study conducted after 50 - 70 postpartum days, with 24 primiparous women who underwent cesarean delivery and 72 who had a normal birth. The 9301 PeritronTM was used for analysis of muscle strength. The mean muscle strength was compared between the groups by two-way analysis of variance. Results: the pelvic floor muscle strength was 24.0 cmH2O (±16.2) and 25.4 cmH2O (±14.7) in postpartum primiparous women after normal birth and cesarean section, respectively, with no significant difference. The muscular strength was greater in postpartum women with ≥ 12 years of study (42.0 ±26.3 versus 14.6 ±7.7 cmH2O; p= 0.036) and in those who performed perineal exercises (42.6±25.4 11.8±4.9 vs. cmH2O; p = 0.010), compared to caesarean. There was no difference in muscle strength according to delivery type regarding nutritional status, dyspareunia, urinary incontinence, perineal condition or newborn weight. Conclusion: pelvic floor muscle strength does not differ between primiparous women based on the type of delivery. Postpartum women with normal births, with higher education who performed perineal exercise during pregnancy showed greater muscle strength. PMID:27533267

  11. Ectopic Pelvic Kidney Mimicking Sacral Metastasis on Post-Therapy Iodine-131 Scan of a Thyroid Cancer Patient

    PubMed Central

    Soyluoğlu Demir, Selin; Ege Aktaş, Gül; Polat, Ahmet; Sarıkaya, Ali

    2017-01-01

    A 25-year-old woman had total thyroidectomy and iodine-131 ablation therapy for papillary thyroid carcinoma. Whole body imaging on the 7th day of therapeutic activity demonstrated radioiodine uptake in the remnant tissue and intense heterogeneous uptake at the sacral region prominently in the posterior image. Initial interpretation was suspicious for sacral metastasis. Technetium-99m-methylene diphosphonate bone scan demonstrated normal bone uptake and the absence of left kidney. On blood-pool phase of bone scan, the absence of left renal activity and an extra area of uptake in the sacral region suggestive of pelvic kidney were noticed. Magnetic resonance imaging scan confirmed the ectopic pelvic kidney overlying the sacrum. PMID:28291010

  12. Pelvic congestion syndrome and pelvic varicosities.

    PubMed

    Koo, Sonya; Fan, Chieh-Min

    2014-06-01

    Pelvic venous insufficiency (PVI), defined as retrograde flow in the gonadal and internal iliac veins, is the underlying cause of pelvic congestion syndrome (PCS), a common cause of disabling chronic pelvic pain in women of child-bearing age. PCS is a chronic pain syndrome characterized by positional pelvic pain that is worse in the upright position and is associated with pelvic and vulvar varicosities as well as symptoms of dyspareunia and postcoital pain. Through collaterals to the lower extremity venous system, PVI may also contribute to varicose vein formation and recurrence in the lower extremities. Endovascular embolization of the ovarian and internal iliac veins has become the treatment of choice for PVI and PCS. This article reviews the pelvic retroperitoneal venous anatomy, pathophysiology of PCS, treatment options and techniques, and clinical outcomes of embolotherapy for PCS.

  13. Development of a European Organization for Research and Treatment of Cancer Module to Assess the Quality of Life of Patients With Proctitis After Pelvic Radiotherapy for Malignancy

    SciTech Connect

    Spry, Nigel; Halkett, Georgia Aoun, Samar; Spry, Jane; Yeoh, Eric

    2008-10-01

    Purpose: To describe the development of a proctitis-specific quality-of-life module to supplement the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Methods and Materials: The module was developed according to EORTC guidelines, which consisted of an extensive literature review to identify previously described issues and interviews conducted with seven health professionals and 10 patients to rationalize the item list for construction into a provisional module. The module developed was then pretested with 28 patients and five health professionals. Results: The final module contains 21-items that are suitable to obtain information about the patients' quality of life after high-dose pelvic irradiation. The questionnaire has now been translated into four languages and commenced field testing in late 2007. Conclusions: The EORTC QLQ-C30, supplemented by EORTC QLQ-PRT21, will enable health professionals to more accurately monitor the side effects that patients experience after pelvic irradiation.

  14. A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women's Stress Urinary Incontinence: Three- Month Follow- Up

    PubMed Central

    Farzinmehr, Azizeh; Moezy, Azar; Koohpayehzadeh, Jalil; Kashanian, Maryam

    2015-01-01

    Objective: To determine whether Whole Body Vibration Training (WBVT) is effective at improving pelvic floor muscles strength in women with Stress Urinary Incontinence (SUI). Materials and methods: The study was designed as a randomized clinical trial. 43 women with SUI were randomly assigned in two groups; WBVT and Pelvic Floor Muscle Training (PFMT) and received interventions for four weeks. Pelvic floor muscle (PFM) strength, quality of life and incontinence intensity were evaluated. All measurements were conducted pre and post intervention and also after 3 months in all participants. The ANOVA and the independent sample t test were applied respectively to determine the differences in each group and between the groups. Results: This study showed the WBVT protocol in this study was effective in pelvic floor muscles strength similar to PFMT, and also in reducing the severity of incontinence and increasing I-QOL questionnaire score. We found significant differences in each group pre and post intervention (p = 0.0001); but no significant difference in comparison of two groups' outcomes. Also after three-month follow up, there was no significant difference between groups. Conclusion: The findings of this study showed the beneficial effects of WBVT in improving pelvic floor muscles strength and quality of life in patients with urinary incontinence in four-week treatment period and after three months follow up. PMID:27047560

  15. Bone Health and Pelvic Radiotherapy.

    PubMed

    Higham, C E; Faithfull, S

    2015-11-01

    Survivors who have received pelvic radiotherapy make up many of the long-term cancer population, with therapies for gynaecological, bowel, bladder and prostate malignancies. Individuals who receive radiotherapy to the pelvis as part of their cancer treatment are at risk of insufficiency fractures. Symptoms of insufficiency fractures include pelvic and back pain and immobility, which can affect substantially quality of life. This constellation of symptoms can occur within 2 months of radiotherapy up to 63 months post-treatment, with a median incidence of 6-20 months. As a condition it is under reported and evidence is poor as to the contributing risk factors, causation and best management to improve the patient's bone health and mobility. As radiotherapy advances, chronic symptoms, such as insufficiency fractures, as a consequence of treatment need to be better understood and reviewed. This overview explores the current evidence for the effect of radiotherapy on bone health and insufficiency fractures and identifies what we know and where gaps in our knowledge lie. The overview concludes with the need to take seriously complaints of pelvic pain from patients after pelvic radiotherapy and to investigate and manage these symptoms more effectively. There is a clear need for definitive research in this field to provide the evidence-based guidance much needed in practice.

  16. Preliminary report of a new treatment strategy for advanced pelvic malignancy: surgical resection and radiation therapy using afterloading catheters plus an inflatable displacement prosthesis in the treatment of advanced primary and recurrent rectal cancer

    SciTech Connect

    Edington, H.D.; Hancock, S.; Coe, F.L.; Sugarbaker, P.H.

    1986-09-01

    An unsolved problem in colon and rectal surgery involves the treatment of locally invasive primary and recurrent rectal cancer. An approach is described that uses intracavitary iridium-192 sources in combination with a pelvic displacement prosthesis to augment external beam radiation doses to sites of residual disease identified at surgery. This approach should permit administration of tumoricidal doses of radiation to positive surgical margins minimizing radiation toxicity to the small bowel. The radiation source and all prosthetic materials are removed at the bedside within 2 weeks of surgery, ensuring accurate radiation dosimetry, minimizing infectious complications, and sparing the patient the need for full high-dose pelvic irradiation.

  17. Pelvic inflammatory disease

    PubMed Central

    2008-01-01

    Introduction Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common gynaecological reason for admission to hospital in the USA and is diagnosed in almost 2% of women aged 16 to 45 years consulting their GP in England and Wales. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of empirical treatment compared with treatment delayed until the results of microbiological investigations are known? How do different antimicrobial regimens compare? What are the effects of routine antibiotic prophylaxis to prevent pelvic inflammatory disease before intrauterine contraceptive device (IUD) insertion? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found nine systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, parenteral, empirical treatment, treatment guided by test results, different durations, outpatient, inpatient), and routine antibiotic prophylaxis (before intrauterine device insertion in women at high risk or low risk). PMID:19450319

  18. Cancers Selected for Study - TCGA

    Cancer.gov

    The Cancer Genome Atlas researchers are mapping the genetic changes in 33 cancers. Find out which cancers have been selected for study, the criteria for selection and the scientific questions being asked about each cancer.

  19. Pelvic Support Problems

    MedlinePlus

    The pelvic floor is a group of muscles and other tissues that form a sling or hammock across the pelvis. ... place so that they can work properly. The pelvic floor can become weak or be injured. The main ...

  20. Pelvic Organ Prolapse

    MedlinePlus

    ... and layers of connective tissue, which are called fascia, become weakened, stretched, or are torn the pelvic ... delivery) can cause injury to the muscles or fascia of the pelvic floor. The increased pressure of ...

  1. Optical Strategies for Studying Metastatic Mechanisms, Tumor Cell Detection and Treatment of Prostate Cancer

    DTIC Science & Technology

    2006-10-01

    study we have used 2 prostate cancer cell lines. The LNCaP human prostate cancer cells initially isolated from a lymph node biopsy are useful for...cell line is fast growing, poorly differentiated, and metastatic to the lungs and lymph nodes. To determine if this subcurative PDT- induced decrease in...5 – PDT increases the fraction of animals with lymph node metastases. At the time of sacrifice the lungs, pelvic lymph nodes, liver and spines

  2. Hematologic Toxicity in RTOG 0418: A Phase 2 Study of Postoperative IMRT for Gynecologic Cancer

    SciTech Connect

    Klopp, Ann H.; Moughan, Jennifer; Portelance, Lorraine; Miller, Brigitte E.; Salehpour, Mohammad R.; Hildebrandt, Evangeline; Nuanjing, Jenny; D'Souza, David; Souhami, Luis; Small, William; Gaur, Rakesh; Jhingran, Anuja

    2013-05-01

    Purpose: Intensity modulated radiation therapy (IMRT), compared with conventional 4-field treatment, can reduce the volume of bone marrow irradiated. Pelvic bone marrow sparing has produced a clinically significant reduction in hematologic toxicity (HT). This analysis investigated HT in Radiation Therapy Oncology Group (RTOG) 0418, a prospective study to test the feasibility of delivering postoperative IMRT for cervical and endometrial cancer in a multiinstitutional setting. Methods and Materials: Patients in the RTOG 0418 study were treated with postoperative IMRT to 50.4 Gy to the pelvic lymphatics and vagina. Endometrial cancer patients received IMRT alone, whereas patients with cervical cancer received IMRT and weekly cisplatin (40 mg/m{sup 2}). Pelvic bone marrow was defined within the treatment field by using a computed tomography density-based autocontouring algorithm. The volume of bone marrow receiving 10, 20, 30, and 40 Gy and the median dose to bone marrow were correlated with HT, graded by Common Terminology Criteria for Adverse Events, version 3.0, criteria. Results: Eighty-three patients were eligible for analysis (43 with endometrial cancer and 40 with cervical cancer). Patients with cervical cancer treated with weekly cisplatin and pelvic IMRT had grades 1-5 HT (23%, 33%, 25%, 0%, and 0% of patients, respectively). Among patients with cervical cancer, 83% received 5 or more cycles of cisplatin, and 90% received at least 4 cycles of cisplatin. The median percentage volume of bone marrow receiving 10, 20, 30, and 40 Gy in all 83 patients, respectively, was 96%, 84%, 61%, and 37%. Among cervical cancer patients with a V40 >37%, 75% had grade 2 or higher HT compared with 40% of patients with a V40 less than or equal to 37% (P =.025). Cervical cancer patients with a median bone marrow dose of >34.2 Gy also had higher rates of grade ≥2 HT than did those with a dose of ≤34.2 Gy (74% vs 43%, P=.049). Conclusions: Pelvic IMRT with weekly cisplatin is

  3. A retrospective study of the effects of pelvic irradiation for carcinoma of the cervix on gastrointestinal function

    SciTech Connect

    Yeoh, E.; Ahmad, A.; Horowitz, M.; Russo, A.; Muecke, T.; Chatterton, B. ); Robb, T. )

    1993-03-20

    The purpose of the study was to evaluate the prevalence of disordered gastrointestinal function following therapeutic irradiation. Gastrointestinal function was evaluated in 30 randomly selected patients who had received pelvic irradiation for treatment of carcinoma of the cervix between 1 and 6 years previously. Each patient underwent evaluations of (a) gastrointestinal symptoms (b) absorption of bile acid, vitamin B12, lactose and fat (c) gastrointestinal transit: gastric emptying, small intestinal transit and whole gut transit and (d) intestinal permeability. Results were compared with those obtained in 18 normal volunteers. Stool frequency was above the control range in five patients and had increased (p < 0.001) since radiotherapy treatment. Bile acid (p<0.001) vitamin B12(p<0.01) and lactose (p<0.01) absorption were less in the patients when compared with the control subjects. Bile acid adsorption was below the control range in 14 of the 30 patients. Dietary calcium intake was lower (p<0.05) in those patients with lactose malabsorption. Gastric emptying (p<0.01) and small intestinal transit (p<0.01) were more rapid in the patients. Both small intestinal (r=-0.39, p<0.05) and whole gut (r=-0.45) transit were inversely related to stool frequency. Either bowel frequency, bile acid adsorption, vitamin B12 absorption was outside the control range in 19 of the 30 patients. Abnormal gastrointestinal function is essentially an inevitable long-term sequel of pelvic irradiation. 41 refs., 4 figs., 3 tabs.

  4. Prospective study of /sup 123/I-labeled monoclonal antibody imaging in ovarian cancer

    SciTech Connect

    Granowska, M.; Britton, K.E.; Shepherd, J.H.; Nimmon, C.C.; Mather, S.; Ward, B.; Osborne, R.J.; Slevin, M.L.

    1986-05-01

    Thirty patients presenting with a pelvic mass were entered into a prospective study on the use of radioimmunoscintigraphy with the /sup 123/I-labeled monoclonal antibody HMFG2. The imaging data was obtained without knowledge of the clinical data and compared with subsequent surgical findings. A false-positive diagnosis of ovarian cancer was made in five of ten patients subsequently shown not to have ovarian cancer; thus the technique cannot be used as a screening test. A true-positive diagnosis was made in 19 out of 20 patients shown subsequently to have ovarian cancer. In 18 of these patients the distribution of uptake closely fitted the surgical findings. Methods of improving these results are described. In conclusion, radioimmunoscintigraphy is of no use in determining whether a pelvic mass is due to ovarian cancer, but has benefit in the evaluation of chemotherapy and may, in the future, prevent the need for second-look operations in some circumstances.

  5. Pelvic Inflammatory Disease (PID)

    MedlinePlus

    Pelvic Inflammatory Disease (PID) - CDC Fact Sheet Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a ... tubal blockage; •• Ectopic pregnancy (pregnancy outside the womb); •• Infertility (inability to get pregnant); •• Long-term pelvic/abdominal ...

  6. Multimodal nociceptive mechanisms underlying chronic pelvic pain

    PubMed Central

    HELLMAN, Kevin M.; PATANWALA, Insiyyah Y.; POZOLO, Kristen E.; TU, Frank F.

    2015-01-01

    Objective To evaluate candidate mechanisms underlying the pelvic floor dysfunction in women with chronic pelvic pain and/or painful bladder syndrome/interstitial cystitis. Notably, prior studies have not consistently controlled for potential confounding by psychological or anatomical factors. Study Design As part of a larger study on pelvic floor pain dysfunction and bladder pain sensitivity, we compared a measure of mechanical pain sensitivity, pressure pain thresholds, between women with pelvic pain and pain-free controls. We also assessed a novel pain measure using degree and duration of post-exam pain aftersensation, and conducted structural and functional assessments of the pelvic floor to account for any potential confounding. Phenotypic specificity of pelvic floor measures was assessed with receiver-operator characteristic curves adjusted for prevalence. Results A total of 23 women with chronic pelvic pain, 23 painful bladder syndrome, and 42 pain-free controls completed the study. Women with chronic pelvic pain or painful bladder syndrome exhibited enhanced pain sensitivity with lower pressure pain thresholds (1.18 [interquartile range: 0.87–1.41] kg/cm2) than pain-free participants (1.48 [1.11–1.76] kg/cm2; p<0.001) and prolonged pain aftersensation (3.5 [0–9] vs 0 [0–1] minutes; p< 0.001). Although genital hiatus (p<0.01) was wider in women with chronic pelvic pain there were no consistently observed group differences in pelvic floor anatomy, muscle tone or strength. The combination of pressure pain thresholds and aftersensation duration correlated with severity of pelvic floor tenderness (R2 =41–51, p’s< 0.01). Even after adjustment for prevalence, the combined metrics discriminated pain-free controls from women with chronic pelvic pain or painful bladder syndrome (area under the curve=0.87). Conclusion Both experimental assessment of pelvic floor pain thresholds and measurement of sustained pain are independently associated with pelvic pain

  7. The pathophysiology of pelvic floor disorders: evidence from a histomorphologic study of the perineum and a mouse model of rectal prolapse

    PubMed Central

    YIOU, RENÉ; DELMAS, VINCENT; CARMELIET, PETER; GHERARDI, ROMAIN K.; BARLOVATZ-MEIMON, GEORGIA; CHOPIN, DOMINIQUE K.; ABBOU, CLÉMENT-CLAUDE; LEFAUCHEUR, JEAN-PASCAL

    2001-01-01

    The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA−/−) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice. Histochemical analysis of the pelvic floor muscles revealed a majority of type IIA fibres. Rectal prolapses were observed only in male uPA−/− mice. The most obvious finding was an irreducible evagination of the rectal mucosa and a swelling of the entire perineal region corresponding to an irreducible hernia of the seminal vesicles through the pelvic outlet. The hernia caused stretching and thinning of the ISC, BC and LA. Myopathic damage, with degenerated and centronucleated myofibres, were observed in these muscles. The PC, ILC, SPA and SPU were not affected. This study provides an original description of a model of pelvic floor disorder and illustrates the differences existing between the perineum of humans and that of a quadruped species. In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA−/− mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury. This should be taken into account in the evaluation of pelvic floor disorders. PMID:11760891

  8. Intranodal signal suppression in pelvic MR lymphography of prostate cancer patients: a quantitative comparison of ferumoxtran-10 and ferumoxytol

    PubMed Central

    Fortuin, Ansje S.; Meijer, Hanneke J.M.; Hambrock, Thomas; Litjens, Geert J.S.; Barentsz, Jelle O.; Huisman, Henkjan J.

    2016-01-01

    Objectives The key to MR lymphography is suppression of T2* MR signal in normal lymph nodes, while retaining high signal in metastatic nodes. Our objective is to quantitatively compare the ability of ferumoxtran-10 and ferumoxytol to suppress the MR signal in normal pelvic lymph nodes. Methods In 2010, a set of consecutive patients who underwent intravenous MR Lymphography (MRL) were included. Signal suppression in normal lymph nodes in T2*-weighted images due to uptake of USPIO (Ultra-Small Superparamagnetic Particles of Iron Oxide) was quantified. Signal suppression by two USPIO contrast agents, ferumoxtran-10 and ferumoxytol was compared using Wilcoxon’s signed rank test. Results Forty-four patients were included, of which all 44 had a ferumoxtran-10 MRL and 4 had additionally a ferumoxytol MRL. A total of 684 lymph nodes were identified in the images, of which 174 had been diagnosed as metastatic. USPIO-induced signal suppression in normal lymph nodes was significantly stronger in ferumoxtran-10 MRL than in ferumoxytol MRL (p < 0.005). Conclusions T2* signal suppression in normal pelvic lymph nodes is significantly stronger with ferumoxtran-10 than with ferumoxytol, which may affect diagnostic accuracy. PMID:27781154

  9. Determinants of pelvic organ prolapse among gynecologic patients in Bahir Dar, North West Ethiopia: a case–control study

    PubMed Central

    Asresie, Ayalnesh; Admassu, Eleni; Setegn, Tesfaye

    2016-01-01

    Introduction Pelvic organ prolapse (POP) is a significant public health problem in developing countries including Ethiopia. However, less has been documented on risk factors of POP. Therefore, the aim of this study was to identify the determinants factors of POP. Methods An unmatched case–control study was conducted among gynecologic patients in Bahir Dar city, North West Ethiopia, from July to October 2014. A total of 370 women (selected from outpatient departments) were included in the study. Cases (clients with stage III or IV POP) and controls (who declared free of any stages of POP) were identified by physicians using the Pelvic Organ Prolapse Quantitative Examination tool. Data analysis was carried out by SPSS version 20.0. Descriptive, bivariate, and multivariable logistic regression analyses were performed. Statistical differences were considered at P<0.05, and the strength of association was assessed by odds ratio (OR) and respective confidence intervals (CIs). Results This study revealed that determinants such as age of women (>40 years) (adjusted OR [AOR] =3.0 [95% CI: 1.59–5.89]), sphincter damage (AOR =8.1 [95% CI: 1.67–39.7]), family history of POP (AOR =4.9 [95% CI: 1.94–12.63]), parity (≥4) (AOR =4.5 [95% CI: 2.26–9.10]), nonattendance of formal education (AOR =4.3 [95% CI: 1.25–14.8]), carrying heavy objects (AOR =3.1 [95% CI: 1.56–6.30]), body mass index (BMI) <18.5 kg/m2 (AOR =3.1 [95% CI: 1.22–7.82]), and delivery assisted by nonhealth professionals (AOR =2.6 [95% CI: 1.24–5.56]) were significantly associated with POP. Conclusion In our study, sphincter damage, family history of POP, being uneducated, having ≥4 vaginal deliveries, carrying heavy objects, BMI <18.5 kg/m2, age ≥40 years, and having delivery assisted by nonhealth professional were the independent determinants of POP. Therefore, skilled delivery, further promoting family planning and girls’ education, early pelvic floor assessment, and counseling on

  10. Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women.

    PubMed

    Kato, Masao; Matsubara, Akio; Murakami, Gen; Abe, Shin-Ichi; Ide, Yoshinobu; Sato, Iwao; Usui, Tsuguru

    2008-12-01

    To describe the architecture and topohistology of the female perineal structures, especially the perineal membrane (PM), we examined frontal sections (one side) and horizontal or transverse sections (another side) of 15 bisectioned pelvic floors. The PM, notably comprising elastic fibers, extended mediolaterally or transversely on the immediately inferior side of the rhabdosphincter area. More posteriorly, the elastic fibers more tilted along the long axis of the vagina and became lining the lateral vaginal wall as a fibrous skeleton. The compressor urethrae and urethrovaginal sphincter were embedded in and interdigitated with the PM. The elastic fiber architecture of the PM was similar to the rectovaginal septum. We hypothesize that the PM plays a role of a shock-absorber at the interface between the levator ani and distalmost vagina. A standard diagram of the female perineal structures is necessary to be revised.

  11. Functional anatomy of pelvic floor.

    PubMed

    Rocca Rossetti, Salvatore

    2016-03-31

    Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.

  12. Utilization of surgical procedures for pelvic organ prolapse: a population-based study in Olmsted County, Minnesota, 1965-2002.

    PubMed

    Babalola, Ebenezer O; Bharucha, Adil E; Melton, L Joseph; Schleck, Cathy D; Zinsmeister, Alan R; Klingele, Christopher J; Gebhart, John B

    2008-09-01

    To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P < 0.001) and 32% (P = 0.02), respectively. In both groups, utilization decreased in all age groups over time except in women aged 80 years and older undergoing hysterectomy plus PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.

  13. Which sexually active young female students are most at risk of pelvic inflammatory disease? A prospective study

    PubMed Central

    Hay, Phillip E; Kerry, Sarah R; Normansell, Rebecca; Horner, Paddy J; Reid, Fiona; Kerry, Sally M; Prime, Katia; Williams, Elizabeth; Simms, Ian; Aghaizu, Adamma; Jensen, Jorgen; Oakeshott, Pippa

    2016-01-01

    Objective To identify risk factors for pelvic inflammatory disease (PID) in female students. Methods We performed a prospective study set in 11 universities and 9 further education colleges in London. In 2004–2006, 2529 sexually experienced, multiethnic, female students, mean age 20.8 years, provided self-taken vaginal samples and completed questionnaires at recruitment to the Prevention of Pelvic Infection chlamydia screening trial. After 12 months, they were followed up by questionnaire backed by medical record search and assessed for PID by blinded genitourinary medicine physicians. Results Of 2004 (79%) participants who reported numbers of sexual partners during follow-up, 32 (1.6%, 95% CI 1.1% to 2.2%) were diagnosed with PID. The strongest predictor of PID was baseline Chlamydia trachomatis (relative risk (RR) 5.7, 95% CI 2.6 to 15.6). After adjustment for baseline C. trachomatis, significant predictors of PID were ≥2 sexual partners or a new sexual partner during follow-up (RR 4.0, 95% CI 1.8 to 8.5; RR 2.8, 95% CI 1.3 to 6.3), age <20 years (RR 3.3, 95% CI 1.5 to 7.0), recruitment from a further education college rather than a university (RR 2.6,  95% CI 1.3 to 5.3) and history at baseline of vaginal discharge (RR 2.7, 95% CI 1.2 to 5.8) or pelvic pain (RR 4.1, 95% CI 2.0 to 8.3) in the previous six months. Bacterial vaginosis and Mycoplasma genitalium infection were no longer significantly associated with PID after adjustment for baseline C. trachomatis. Conclusions Multiple or new partners in the last 12 months, age <20 years and attending a further education college rather than a university were risk factors for PID after adjustment for baseline C. trachomatis infection. Sexual health education and screening programmes could be targeted at these high-risk groups. Trial registration number (ClinicalTrials.gov NCT00115388). PMID:26082320

  14. Genetic Variants of NPAT-ATM and AURKA are Associated With an Early Adverse Reaction in the Gastrointestinal Tract of Patients With Cervical Cancer Treated With Pelvic Radiation Therapy

    SciTech Connect

    Ishikawa, Atsuko; Suga, Tomo; Shoji, Yoshimi; Kato, Shingo; Ohno, Tatsuya; Ishikawa, Hitoshi; Yoshinaga, Shinji; Ohara, Kiyoshi; Ariga, Hisanori; Nomura, Kuninori; Shibamoto, Yuta; Ishikawa, Ken-Ichi; Moritake, Takashi; Michikawa, Yuichi; Iwakawa, Mayumi; Imai, Takashi

    2011-11-15

    Purpose: This study sought to associate polymorphisms in genes related to cell cycle regulation or genome maintenance with radiotherapy (RT)-induced an early adverse reaction (EAR) in patients with cervical cancer. Methods and Materials: This study enrolled 243 cervical cancer patients who were treated with pelvic RT. An early gastrointestinal reaction was graded using the National Cancer Institute Common Toxicity Criteria, version 2. Clinical factors of the enrolled patients were analyzed, and 208 patients were grouped for genetic analysis according to their EAR (Grade {<=}1, n = 150; Grade {>=}2, n = 58). Genomic DNA was genotyped, and association with the risk of EAR for 44 functional single-nucleotide polymorphisms (SNPs) of 19 candidate genes was assessed by single-locus, haplotype, and multilocus analyses. Results: Our analysis revealed two haplotypes to be associated with an increased risk of EAR. The first, comprising rs625120C, rs189037T, rs228589A, and rs183460G, is located between the 5' ends of NPAT and ATM (OR = 1.86; 95% CI, 1.21-2.87), whereas the second is located in the AURKA gene and comprises rs2273535A and rs1047972G (OR = 1.75; 95% CI, 1.10-2.78). A third haplotype, rs2273535T and rs1047972A in AURKA, was associated with a reduced EAR risk (OR = 0.42; 95% CI, 0.20-0.89). The risk of EAR was significantly higher among patients with both risk diplotypes than in those possessing the other diplotypes (OR = 3.24; 95% CI, 1.52-6.92). Conclusions: Individual radiosensitivity of intestine may be determined by haplotypes in the NPAT-ATM and AURKA genes. These variants should be explored in larger association studies in cervical cancer patients.

  15. Detection of sexually transmitted pathogens in patients with chronic prostatitis/chronic pelvic pain: a prospective clinical study.

    PubMed

    Papeš, Dino; Pasini, Miram; Jerončić, Ana; Vargović, Martina; Kotarski, Viktor; Markotić, Alemka; Škerk, Višnja

    2017-01-01

    In <10% of patients with prostatitis syndrome, a causative uropathogenic organism can be detected. It has been shown that certain organisms that cause sexually transmitted infections can also cause chronic bacterial prostatitis, which can be hard to diagnose and treat appropriately because prostatic samples obtained by prostatic massage are not routinely tested to detect them. We conducted a clinical study to determine the prevalence of Chlamydia, mycoplasma, and trichomonas infection in 254 patients that were previously diagnosed and treated for chronic prostatitis/chronic pelvic pain syndrome due to negative urethral swab, urine, and prostate samples. Urethral swabs and standard Meares-Stamey four-glass tests were done. Detailed microbiological analysis was conducted to detect the above organisms. Thirty-five (13.8%) patients had positive expressed prostatic secretions/VB3 samples, of which 22 (10.1%) were sexually transmitted organisms that were not detected on previous tests.

  16. [Patients with hemodynamic unstable pelvic fractures in extremis: pelvic packing or angiography?].

    PubMed

    Liñán-Padilla, A; Giráldez-Sánchez, M Á; Serrano-Toledano, D; Lázaro-Gonzálvez, A; Cano-Luís, P

    2013-01-01

    The multidisciplinary management of patients with pelvic trauma has improved prognosis, but mortality is still very high. The appropriate treatment strategy remains controversial, especially regarding the control of bleeding in patients whose clinical situation is extreme by using angiography or pelvic packing. We propose using a tool of evidence-based medicine (CAT) the benefit of the completion of pelvic packing in relation to a specific clinical question from a specific situation. What is best for the management of bleeding, extraperitoneal pelvic packing or angiography, in patients with hemodynamically unstable pelvic fracture in extremis? From this study we can conclude that angiography may improve control of bleeding in patients with arterial bleeding and hemodynamically stable but the packing has priority in patients with pelvic fractures and hemodynamic instability.

  17. Phase II clinical trial using californium 252 fast neutron brachytherapy, external pelvic radiation, and extrafascial hysterectomy in the treatment of bulky, barrel-shaped stage IB cervical cancer.

    PubMed

    van Nagell, J R; Maruyama, Y; Donaldson, E S; Hanson, M B; Gallion, H H; Yoneda, J; Powell, D E; Kryscio, R J; Beach, J L

    1986-05-15

    From June 1977 to June 1983, 32 patients with bulky (greater than 4 cm diameter), barrel-shaped Stage IB cervical cancer were treated at the University of Kentucky Medical Center by a combination of outpatient neutron brachytherapy using californium 252 (252Cf) and external pelvic radiation followed by extrafascial hysterectomy. Nineteen patients had cervical tumors 4 to 6 cm in diameter, and 13 patients had lesions in excess of 6 cm in diameter. A dose of 4500 rad external photon therapy was given from a linear accelerator, and one or two 6-hour 252Cf implants were given during or immediately after external radiation. Extrafascial hysterectomy with bilateral salpingo-oophorectomy was performed 6 weeks after completion of radiation therapy. Complications during and after radiation were minimal and included vaginal stenosis (three) and proctitis (two). Tumor clearance in the hysterectomy specimen was complete in 23 patients (72%) and residual cervical tumor was present in 9 patients (28%). Two patients developed tumor recurrence and died of disease 15 and 27 months after therapy, respectively. Thirty patients remain free of disease 26 to 96 months (median, 52 months) after treatment, and none have been lost to follow-up. The actuarial survival of these patients is 97% at 2 years and 94% at 5 years. Intracavitary neutron therapy is well tolerated and is effective when combined with external radiation and hysterectomy in the treatment of bulky, barrel-shaped Stage IB cervical cancer.

  18. Clinical Outcome in Posthysterectomy Cervical Cancer Patients Treated With Concurrent Cisplatin and Intensity-Modulated Pelvic Radiotherapy: Comparison With Conventional Radiotherapy

    SciTech Connect

    Chen, M.-F.; Tseng, C.-J.; Tseng, C.-C.; Kuo, Y.-C.; Yu, C.-Y.; Chen, W.-C. . E-mail: rto_chen@yahoo.com.tw

    2007-04-01

    Purpose: To assess local control and acute and chronic toxicity with intensity-modulated radiation therapy (IMRT) as adjuvant treatment of cervical cancer. Methods and Materials: Between April 2002 and February 2006, 68 patients at high risk of cervical cancer after hysterectomy were treated with adjuvant pelvic radiotherapy and concurrent chemotherapy. Adjuvant chemotherapy consisted of cisplatin (50 mg/m{sup 2}) for six cycles every week. Thirty-three patients received adjuvant radiotherapy by IMRT. Before the IMRT series was initiated, 35 other patients underwent conventional four-field radiotherapy (Box-RT). The two groups did not differ significantly in respect of clinicopathologic and treatment factors. Results: IMRT provided compatible local tumor control compared with Box-RT. The actuarial 1-year locoregional control for patients in the IMRT and Box-RT groups was 93% and 94%, respectively. IMRT was well tolerated, with significant reduction in acute gastrointestinal (GI) and genitourinary (GU) toxicities compared with the Box-RT group (GI 36 vs. 80%, p = 0.00012; GU 30 vs. 60%, p = 0.022). Furthermore, the IMRT group had lower rates of chronic GI and GU toxicities than the Box-RT patients (GI 6 vs. 34%, p = 0.002; GU 9 vs. 23%, p = 0.231). Conclusion: Our results suggest that IMRT significantly improved the tolerance to adjuvant chemoradiotherapy with compatible locoregional control compared with conventional Box-RT. However, longer follow-up and more patients are needed to confirm the benefits of IMRT.

  19. Preclinical animal study and human clinical trial data of co-electrospun poly(l-lactide-co-caprolactone) and fibrinogen mesh for anterior pelvic floor reconstruction

    PubMed Central

    Wu, Xujun; Wang, Yuru; Zhu, Cancan; Tong, Xiaowen; Yang, Ming; Yang, Li; Liu, Zhang; Huang, Weihong; Wu, Feng; Zong, Honghai; Li, Huaifang; He, Hongbing

    2016-01-01

    Synthetic and biological materials are commonly used for pelvic floor reconstruction. In this study, host tissue response and biomechanical properties of mesh fabricated from co-electrospun poly(l-lactide-co-caprolactone) (PLCL) and fibrinogen (Fg) were compared with those of polypropylene mesh (PPM) in a canine abdominal defect model. Macroscopic, microscopic, histological, and biomechanical evaluations were performed over a 24-week period. The results showed that PLCL/Fg mesh had similar host tissue responses but better initial vascularization and graft site tissue organization than PPM. The efficacy of the PLCL/Fg mesh was further examined in human pelvic floor reconstruction. Operation time, intraoperative blood loss, and pelvic organ prolapse quantification during 6-month follow-up were compared for patients receiving PLCL/Fg mesh versus PPM. According to the pelvic organ prolapse quantification scores, the anterior vaginal wall 3 cm proximal to the hymen point (Aa point), most distal edge of the cervix or vaginal cuff scar point (C point), and posterior fornix point (D point) showed significant improvement (P<0.01) at 1, 3, and 6 months for both groups compared with preoperatively. At 6 months, improvements at the Aa point in the PLCL/Fg group were significantly more (P<0.005) than the PPM group, indicating that, while both materials improve the patient symptoms, PLCL/Fg mesh resulted in more obvious improvement. PMID:26893556

  20. A Dosimetric Comparison of Tomotherapy and Volumetric Modulated Arc Therapy in the Treatment of High-Risk Prostate Cancer With Pelvic Nodal Radiation Therapy

    SciTech Connect

    Pasquier, David; Cavillon, Fabrice; Lacornerie, Thomas; Touzeau, Claire; Tresch, Emmanuelle; Lartigau, Eric

    2013-02-01

    Purpose: To compare the dosimetric results of volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy. Methods and Materials: Plans were generated for 10 consecutive patients treated for high-risk prostate cancer with prophylactic whole pelvic radiation therapy (WPRT) using VMAT and HT. After WPRT, a sequential boost was delivered to the prostate. Plan quality was assessed according to the criteria of the International Commission on Radiation Units and Measurements 83 report: the near-minimal (D98%), near-maximal (D2%), and median (D50%) doses; the homogeneity index (HI); and the Dice similarity coefficient (DSC). Beam-on time, integral dose, and several organs at risk (OAR) dosimetric indexes were also compared. Results: For WPRT, HT was able to provide a higher D98% than VMAT (44.3 {+-} 0.3 Gy and 43.9 {+-} 0.5 Gy, respectively; P=.032) and a lower D2% than VMAT (47.3 {+-} 0.3 Gy and 49.1 {+-} 0.7 Gy, respectively; P=.005), leading to a better HI. The DSC was better for WPRT with HT (0.89 {+-} 0.009) than with VMAT (0.80 {+-} 0.02; P=.002). The dosimetric indexes for the prostate boost did not differ significantly. VMAT provided better rectum wall sparing at higher doses (V70, V75, D2%). Conversely, HT provided better bladder wall sparing (V50, V60, V70), except at lower doses (V20). The beam-on times for WPRT and prostate boost were shorter with VMAT than with HT (3.1 {+-} 0.1 vs 7.4 {+-} 0.6 min, respectively; P=.002, and 1.5 {+-} 0.05 vs 3.7 {+-} 0.3 min, respectively; P=.002). The integral dose was slightly lower for VMAT. Conclusion: VMAT and HT provided very similar and highly conformal plans that complied well with OAR dose-volume constraints. Although some dosimetric differences were statistically significant, they remained small. HT provided a more homogeneous dose distribution, whereas VMAT enabled a shorter delivery time.

  1. Quality of Life After Whole Pelvic Versus Prostate-Only External Beam Radiotherapy for Prostate Cancer: A Matched-Pair Comparison

    SciTech Connect

    Pinkawa, Michael; Piroth, Marc D.; Holy, Richard; Fischedick, Karin; Klotz, Jens; Szekely-Orban, Dalma; Eble, Michael J.

    2011-09-01

    Purpose: Comparison of health-related quality of life after whole pelvic (WPRT) and prostate-only (PORT) external beam radiotherapy for prostate cancer. Methods and Materials: A group of 120 patients (60 in each group) was surveyed prospectively before radiation therapy (RT) (time A), at the last day of RT (time B), at a median time of 2 months (time C) and >1 year after RT (time D) using a validated questionnaire (Expanded Prostate Cancer Index Composite). All patients were treated with 1.8- to 2.0-Gy fractions up to 70.2 to 72.0 Gy with or without WPRT up to 45 to 46 Gy. Pairs were matched according to the following criteria: age {+-} 5years, planning target volume {+-} 10 cc (considering planning target volume without pelvic nodes for WPRT patients), urinary/bowel/sexual function score before RT {+-} 10, and use of antiandrogens. Results: With the exception of prognostic risk factors, both groups were well balanced with respect to baseline characteristics. No significant differences were found with regard to urinary and sexual score changes. Mean bladder function scores reached baseline levels in both patient subgroups after RT. However, bowel function scores decreased significantly more for patients after WPRT than in those receiving PORT at all times (p < 0.01, respectively). Significant differences were found for most items in the bowel domain in the acute phase. At time D, patients after WPRT reported rectal urgency (>once a day in 15% vs. 3%; p = 0.03), bloody stools ({>=}half the time in 7% vs. 0%; p = 0.04) and frequent bowel movements (>two on a typical day in 32% vs. 7%; p < 0.01) more often than did patients after PORT. Conclusion: In comparison to PORT, WPRT (larger bladder and rectum volumes in medium dose levels, but similar volumes in high dose levels) was associated with decreased bowel quality of life in the acute and chronic phases after treatment but remained without adverse long-term urinary effects.

  2. The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

    PubMed Central

    Lei, Jianyin; Zhang, Yue; Wu, Guiying; Wang, Zhihua; Cai, Xianhua

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated. PMID:26495033

  3. Myofascial pelvic pain.

    PubMed

    Spitznagle, Theresa Monaco; Robinson, Caitlin McCurdy

    2014-09-01

    Individuals with pelvic pain commonly present with complaints of pain located anywhere below the umbilicus radiating to the top of their thighs or genital region. The somatovisceral convergence that occurs within the pelvic region exemplifies why examination of not only the organs but also the muscles, connective tissues (fascia), and neurologic input to the region should be performed for women with pelvic pain. The susceptibility of the pelvic floor musculature to the development of myofascial pain has been attributed to unique functional demands of this muscle. Conservative interventions should be considered to address the impairments found on physical examination.

  4. Pelvic Organ Prolapse--Surgery

    MedlinePlus

    ... That Answers to FAQs Learn the Terms Glossary Pelvic Floor Dialogues Printable PDFs on PFDs Patient Fact Sheets ... treatments have failed. The goal of all reconstructive pelvic floor procedures is to restore normal pelvic floor anatomy ...

  5. Chronic Pelvic Pain in Women

    MedlinePlus

    Chronic pelvic pain in women Overview By Mayo Clinic Staff Chronic pelvic pain is pain in the area below your bellybutton ... your hips that lasts six months or longer. Chronic pelvic pain can have multiple causes. It can be a ...

  6. Relationship between lower limb position and pelvic floor muscle surface electromyography activity in menopausal women: a prospective observational study

    PubMed Central

    Halski, Tomasz; Ptaszkowski, Kuba; Słupska, Lucyna; Dymarek, Robert; Paprocka-Borowicz, Małgorzata

    2017-01-01

    Objectives In physiotherapeutic practice, special attention is being given to the reciprocal anatomical, physiological, and biomechanical relationship of the pelvis and the structures connected to it. However, the scientific literature shows mainly the theoretical information about their mutual connections. The lack of information about these relations from a practical aspect coupled with the paucity of scientific papers on the impact of posture changes on the pelvic floor led the authors to conduct this study. The primary aim of this study was to compare the resting and functional bioelectrical activities of pelvic floor muscles (PFMs) depending on three different positions of the lower limbs (positions A, B, and C) in the supine position. Materials and methods This was a prospective observational study evaluating resting and functional activities of the PFM depending on the position of the lower limbs. The study was carried out at the Department and Clinic of Urology, University Hospital in Wroclaw, Poland and the target group were women in the menopausal period. Bioelectrical activity of PFM was recorded using a surface electromyographic instrument in the supine position. Results of the values obtained in A, B, and C positions were compared using a one-way analysis of variance. Results In position A, the average resting surface electromyography (sEMG) activity of PFM was 6.9±2.6 µV; in position B, the result was 6.9±2.5 µV and in position C, the resting sEMG activity was 5.7±1.8 µV (P=0.0102). The results of the functional bioelectrical activity of PFM were as follows: position A – 20.3±11.8 µV, position B – 19.9±10.6 µV, and position C – 25.3±10.9 µV (P=0.0104). Conclusion The results showed that in the supine position, the PFM achieved the lowest resting activity and the highest functional activity. Therefore, the supine position can be recommended for the diagnosis and therapy of weakened PFM. PMID:28115836

  7. Southeastern Cancer Study Group: breast cancer studies

    SciTech Connect

    Smalley, R.V.; Bartolucci, A.A.; Moore, M.

    1983-12-01

    During the past 10 years, the Southeastern Cancer Study Group (SECSG) has been engaged in one major adjuvant study and three major advanced disease studies for patients with adenocarcinoma of the breast. The adjuvant study is demonstrating that six months of adjuvant CMF is the therapeutic equivalent of 12 months and that post-operative irradiation is of no added therapeutic benefit. In patients with advanced disease, a low dose 5 drug combination of CMFVP induces more objective responses than single agent 5FU, but improves survival only for those patients with liver metastases when compared to the sequential use of the same 5 single agents. The three drug combination, CAF, utilizing doxorubicin, induces more objective responses than low dose CMFVP, but it does not improve overall survival. The addition of a phase active combination, CAMELEON, (i.e., sequentially alternating therapy) of CAF has not improved the duration of disease control and survival for patients with liver metastases, lymphangitic and nodular lung metastases compared to CAF. Aggressive combination chemotherapeutic approaches to patients with advanced disease provide better and longer disease and tumor control but only marginal improvements in overall survival. Adding additional agents to a maximally tolerable regimen has not improved the therapeutic outcome.

  8. Pelvic Floor Disorders 6 Months after Attempted Operative Vaginal Delivery According to the Fetal Head Station: A Prospective Cohort Study

    PubMed Central

    Ducarme, Guillaume; Hamel, Jean-François; Brun, Stéphanie; Madar, Hugo; Merlot, Benjamin; Sentilhes, Loïc

    2016-01-01

    Objective To evaluate the effect of the fetal head station at attempted operative vaginal delivery (aOVD), and specifically midpelvic or low aOVD, on urinary incontinence (UI), anal incontinence (AI), and perineal pain at 6 months. Design Prospective cohort study. Setting 1941 women with singleton term fetuses in vertex presentation with midpelvic or low aOVD between 2008 and 2013 in a tertiary care university hospital. Methods Symptoms of urinary incontinence (UI) using the Bristol Female Lower Urinary Tract Symptoms questionnaire, and symptoms of anal incontinence (AI) severity using Fecal Incontinence Severity Index (FISI) were assessed 6 months after aOVD. We measured the association between midpelvic or low aOVD and symptoms of UI, AI, and perineal pain at 6 months using multiple regression and adjusting for demographics, and risk factors of UI and AI, with adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Results The study included 907 women (46.7%) who responded to the questionnaire; 18.4% (167/907) had midpelvic aOVD, and 81.6% (740/907) low; and none of women with symptoms of UI (26.6%, and 22.4%, respectively; p = 0.31), AI (15.9%, and 21.8%; p = 0.09), the FISI score, and perineal pain (17.2%, and 12.7%; p = 0.14) differed significantly between groups. The same was true for stress, urge, and mixed-type UI, severe UI and difficulty voiding. Compared with low pelvic aOVD, the aORs for symptoms of UI in midpelvic aOVD were 0.70 (0.46–1.05) and AI 1.42 (0.85–2.39). Third- and fourth-degree tears were a major risk factor of symptoms of UI (aOR 3.08, 95% CI 1.35–7.00) and AI (aOR 3.47, 95% CI 1.43–8.39). Conclusion Neither symptoms of urinary nor anal incontinence differed at 6 months among women who had midpelvic and low pelvic aOVD. These findings are reassuring and need further studies at long-term to confirm these short-term data. PMID:27992558

  9. Pelvic Inflammatory Disease

    MedlinePlus

    ... Weström, L., Joesoef, R., Reynolds, G., Hagdu, A., Thompson, S.E. (1992). Pelvic inflammatory disease and fertility. A ... Weström, L., Joesoef, R., Reynolds, G., Hagdu, A., Thompson, S.E. (1992). Pelvic inflammatory disease and fertility. A ...

  10. Pelvic Nodal Dosing With Registration to the Prostate: Implications for High-Risk Prostate Cancer Patients Receiving Stereotactic Body Radiation Therapy

    SciTech Connect

    Kishan, Amar U. Lamb, James M.; Jani, Shyam S.; Kang, Jung J.; Steinberg, Michael L.; King, Christopher R.

    2015-03-15

    Purpose: To determine whether image guidance with rigid registration (RR) to intraprostatic markers (IPMs) yields acceptable coverage of the pelvic lymph nodes in the context of a stereotactic body radiation therapy (SBRT) regimen. Methods and Materials: Four to seven kilovoltage cone-beam CTs (CBCTs) from 12 patients with high-risk prostate cancer were analyzed, allowing approximation of an SBRT regimen. The nodal clinical target volume (CTV{sub N}) and bladder were contoured on all kilovoltage CBCTs. The V{sub 100} CTV{sub N}, expressed as a ratio to the same parameter on the initial plan, and the magnitude of translational shift between RR to the IPMs versus RR to the pelvic bones, were computed. The ability of a multimodality bladder filling protocol to minimize bladder height variation was assessed in a separate cohort of 4 patients. Results: Sixty-five CBCTs were assessed. The average V{sub 100} CTV{sub N} was 92.6%, but for a subset of 3 patients the average was 80.0%, compared with 97.8% for the others (P<.0001). The average overall and superior–inferior axis magnitudes of the bony-to-fiducial translations were significantly larger in the subgroup with suboptimal nodal coverage (8.1 vs 3.9 mm and 5.8 vs 2.4 mm, respectively; P<.0001). Relative bladder height changes were also significantly larger in the subgroup with suboptimal nodal coverage (42.9% vs 18.5%; P<.05). Use of a multimodality bladder-filling protocol minimized bladder height variation (P<.001). Conclusion: A majority of patients had acceptable nodal coverage after RR to IPMs, even when approximating SBRT. However, a subset of patients had suboptimal nodal coverage. These patients had large bony-to-fiducial translations and large variations in bladder height. Nodal coverage should be excellent if the superior–inferior axis bony-to-fiducial translation and the relative bladder height change (both easily measured on CBCT) are kept to a minimum. Implementation of a strict bladder filling

  11. An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain

    PubMed Central

    Whitaker, Lucy H. R.; Reid, Jen; Choa, Alex; McFee, Stuart; Seretny, Marta; Wilson, John; Elton, Rob A.; Vincent, Katy; Horne, Andrew W.

    2016-01-01

    Chronic pelvic pain (CPP) affects 5.7–26.6% women worldwide. 55% have no obvious pathology and 40% have associated endometriosis. Neuropathic pain (NeP) is pain arising as a consequence of a lesion/disease affecting the somatosensory system. The prevalence of NeP in women with CPP is not known. The diagnosis of NeP is challenging because there is no gold-standard assessment. Questionnaires have been used in the clinical setting to diagnose NeP in other chronic pain conditions and quantitative sensory testing (QST) has been used in a research setting to identify abnormal sensory function. We aimed to determine if women with chronic pelvic pain (CPP) have a neuropathic pain (NeP) component to their painful symptoms and how this is best assessed. We performed an exploratory prospective cohort study of 72 pre-menopausal women with a diagnosis of CPP. They underwent a clinician completed questionnaire (DN4) and completed the S-LANSS and PainDETECT™ questionnaires. Additionally QST testing was performed by a clinician. They also completed a patient acceptability questionnaire. Clinical features of NeP were identified by both questionnaires and QST. Of the women who were NeP positive, 56%, 35% and 26% were identified by the S-LANSS, DN4 and PainDETECT™ respectively. When NeP was identified by questionnaire, the associated laparoscopy findings were similar irrespective of which questionnaire was used. No subject had entirely unchanged QST parameters. There were distinct loss and gain subgroups, as well as mixed alteration in function, but this was not necessarily clinically significant in all patients. 80% of patients were confident that questionnaires could diagnose NeP, and 90% found them easy to complete. Early identification of NeP in women with CPP with a simple questionnaire could facilitate targeted therapy with neuromodulators, which are cheap, readily available, and have good safety profiles. This approach could prevent unnecessary or fertility

  12. Chronic Prostatitis/Chronic Pelvic Pain Syndrome is associated with Irritable Bowel Syndrome: A Population-based Study.

    PubMed

    Liao, Chun-Hou; Lin, Herng-Ching; Huang, Chao-Yuan

    2016-05-26

    This study aimed to examine this association by comparing the risk of prior irritable bowel syndrome (IBS) between patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and matched controls in Taiwan. Data were retrieved from the Longitudinal Health Insurance Database 2005. This study included 4870 cases with CP/CPPS and 4870 age-matched controls. Conditional logistic regressions were conducted to examine associations of CP/CPPS with previously diagnosed IBS. We found that a total of 753 (7.7%) of the 9740 sampled patients had IBS prior to the index date; IBS was found in 497 (10.2%) cases and in 256 (5.3%) controls. Conditional logistic regression revealed a higher odds ratio (OR) of prior IBS (OR 2.05, 95% CI = 1.75-2.40) for cases than controls. Furthermore, after adjusting for the patients' monthly income, geographical location, urbanization level, and hypertension and coronary heart disease, the conditional logistic regression analysis indicated that cases were more likely than controls to have prior IBS (OR = 1.96, 95% CI = 1.67-2.29). Furthermore, we found that CP/CPPS was consistently and significantly associated with prior IBS regardless of age group. We concluded that the diagnosis of CP/CPPS was associated with previously diagnosed IBS. Urologists should be aware of the association between CP/CPPS and IBS when treating patients.

  13. Depression and Somatic Symptoms May Influence on Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Preliminary Study

    PubMed Central

    Koh, Jun Sung; Ko, Hyo Jung; Wang, Sheng-Min; Cho, Kang Joon; Kim, Joon Chul; Lee, Soo-Jung

    2014-01-01

    The present study is the first one to investigate the impacts of depression and somatization on the disease severity and quality of life (QoL) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The Korean version of National Institutes of Health (NIH)- Chronic Prostatitis Symptom Index (CPSI) for severity of CP/CPPS. Korean version of Patient Health Questionnaire-9 (PHQ-9) for depression, Korean version of Patient Health Questionnaire-15 (PHQ-15) for somatization, and Korean version of EuroQol Questionnaire-5 Dimensions (EQ-5D)- [(EQ-5D utility index and visual analog scale (EQ-5D VAS)] for QoL, were administered. Eighty patients were enrolled. The NIH-CPSI total scores were significantly higher in those with depression (25.3%, p=0.01) or somatization (23.2%, p=0.03) than in those without. These trends toward significantly negative influence of depression and somatic symptoms on QoL were also observed. Our preliminary results indicate that depression and somatization may have negative influence on the symptom severity and QoL in patients with CP/CPPS. However, adequately-powered and more well-designed studies are mandatory to prove our results. PMID:25395984

  14. Chronic Prostatitis/Chronic Pelvic Pain Syndrome is associated with Irritable Bowel Syndrome: A Population-based Study

    PubMed Central

    Liao, Chun-Hou; Lin, Herng-Ching; Huang, Chao-Yuan

    2016-01-01

    This study aimed to examine this association by comparing the risk of prior irritable bowel syndrome (IBS) between patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and matched controls in Taiwan. Data were retrieved from the Longitudinal Health Insurance Database 2005. This study included 4870 cases with CP/CPPS and 4870 age-matched controls. Conditional logistic regressions were conducted to examine associations of CP/CPPS with previously diagnosed IBS. We found that a total of 753 (7.7%) of the 9740 sampled patients had IBS prior to the index date; IBS was found in 497 (10.2%) cases and in 256 (5.3%) controls. Conditional logistic regression revealed a higher odds ratio (OR) of prior IBS (OR 2.05, 95% CI = 1.75–2.40) for cases than controls. Furthermore, after adjusting for the patients’ monthly income, geographical location, urbanization level, and hypertension and coronary heart disease, the conditional logistic regression analysis indicated that cases were more likely than controls to have prior IBS (OR = 1.96, 95% CI = 1.67–2.29). Furthermore, we found that CP/CPPS was consistently and significantly associated with prior IBS regardless of age group. We concluded that the diagnosis of CP/CPPS was associated with previously diagnosed IBS. Urologists should be aware of the association between CP/CPPS and IBS when treating patients. PMID:27225866

  15. Metabolomic Study on the Preventive Effect of Patrinia scabiosaefolia Fisch on Multipathogen Induced Pelvic Inflammatory Disease in Rats

    PubMed Central

    Zou, Wei; Wen, Xiaoke; Zheng, Yi; Xiao, Zuoqi; Luo, Jieying; Chen, Shuqiong; Wang, Yichao; Cheng, Zeneng; Xiang, Daxiong; Nie, Yichu

    2015-01-01

    Patrinia scabiosaefolia Fisch (PSF), a well-known traditional Chinese medicine (TCM), has been used as a “heat-clearing and detoxifying” agent. The present study was to illustrate the preventive effect of PSF on pelvic inflammatory disease (PID) in rats. The PID model was constructed by multipathogen infection of the upper genital tract with reference to the method previously reported. Urine metabolomic analysis was conducted with a GC-MS coupled with derivatization method. In this study, PID rats showed obvious infiltration of inflammatory cells and elevated expression of cytokines (IL-1β and IL-6) in upper genital tract, compared with control rats. Sixteen differentiating metabolites contributed to the alteration of metabolic profile in PID rats, including two amino acids, three fat acids, nine organic acids, and two types of sugars. The rats, infected by multipathogen and administered with PSF, showed decreased infiltration of inflammatory cells and lowered expression of cytokines in upper genital tract, compared with PID rats. Meanwhile, PSF intervened in the PID-associated alterations in TCA cycle, sugar metabolism, amino acid metabolism, and other uncertain metabolic pathways. These results indicate that PSF has preventive effect on multipathogen induced PID and holistic interventional effect on disease-associated metabolomic change. PMID:26175792

  16. [Recommendations for Releasing the Pelvic Binder After a Non-Invasive Pelvic Stabilisation Procedure Under Emergency Room Conditions].

    PubMed

    Schweigkofler, U; Wohlrath, B; Paffrath, T; Flohé, S; Wincheringer, D; Hoffmann, R; Trentzsch, H

    2016-10-01

    Severe brain, thoracic and intrapelvic injuries, as well as heavy bleeding, are the main causes of death in patients with major trauma. Unstable pelvic ring fractures can cause this bleeding and the so-called "C problem". This is usually due to haemorrhagic shock caused by the loss of large volumes of blood from the presacral venous plexus, iliac vessels and the fracture surfaces. Many clinical studies have shown that, in the preclinical setting, unstable pelvic ring injuries are often underestimated. The application of a non-invasive external pelvic ring stabilisation (pelvic binder) is therefore recommended if a pelvic fracture is possible. Several circumferential pelvic binders have been developed and their prehospital use is increasing. Clinical and biomechanical studies have demonstrated that there is a favourable haemodynamic effect in unstable fractures, due to rapid closure of the pelvic ring. It is unclear whether the pelvic binder can be safely removed in a presumably haemodynamically stable patient. A correctly placed pelvic binder leads to anatomical closure of the pelvic ring. Therefore unstable pelvic ring fractures may be clinically and radiologically overlooked. This is a particular problem in unconscious patients. Furthermore, the real severity of the injury may then be underestimated in the diagnostic evaluation. Unconsidered opening of the pelvic binder can thus provoke renewed deterioration of the circulatory situation, especially if the injury was adequately treated by the binder and the C problem was controlled. The aim of this article is to describe procedures for handling pelvic binders, particularly as to how to deal with an already applied pelvic binder and how to "clear the pelvic region" while reducing the risk of haemodynamic instability. A detailed analysis of the literature and a Delphi-like discussion among several experts were performed. The following points were raised: 1) Assessment of the clinical situation, including trauma

  17. Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat?

    PubMed

    Westesson, Karin E; Shoskes, Daniel A

    2010-07-01

    National Institutes of Health category III prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome, is a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several approaches to therapy including biofeedback, acupuncture, and myofascial release physical therapy. However, the only multicenter study of pelvic floor physical therapy for pelvic floor spasm in men failed to show an advantage over conventional Western massage. We have proposed a clinical phenotyping system called UPOINT to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy. Here, we review the current approach to category III prostatitis and describe how clinical phenotyping with UPOINT may improve therapy outcomes.

  18. Pelvic floor muscle activity, quality of life, and sexual function in peri- and recently postmenopausal women with and without dyspareunia: a cross-sectional study.

    PubMed

    Schvartzman, Renata; Bertotto, Adriane; Schvartzman, Luiza; Wender, Maria Celeste Osório

    2014-01-01

    Pelvic floor alterations during menopausal years, resulting from aging and hormonal decline, may lead to several forms of sexual dysfunction. Dyspareunia-pain during sexual intercourse-is among the most frequent. Nevertheless, few studies so far have evaluated pelvic floor muscle function in postmenopausal women with dyspareunia. The authors thus carried out a cross-sectional study to assess myoelectric activity in pelvic floor muscles in peri- and postmenopausal women with and without dyspareunia receiving routine care at an outpatient clinic. In addition, sexual function (using the Female Sexual Function Index) and quality of life (using the Cervantes Scale) were assessed. Fifty-one peri- and postmenopausal women between 45 to 60 years of age (M = 52.1, SD = 4.9) were evaluated, 27 with and 24 without dyspareunia. There were no statistically significant differences in resting muscle activity, maximal voluntary contraction, and sustained contraction between women with and without dyspareunia. There were statistically significant between-group differences on the Cervantes Scale (p =.009) and in all Female Sexual Function Index domains except desire and satisfaction (arousal, p =.019; lubrication, p =.030; orgasm, p =.032; pain, p <.001; desire, p =.061; satisfaction, p =.081), indicating that women with dyspareunia experience worse quality of life and less satisfactory sexual function as compared with women without dyspareunia.

  19. Ertapenem Once a Day Versus Piperacillin–Tazobactam Every 6 Hours for Treatment of Acute Pelvic Infections: A Prospective, Multicenter, Randomized, Double-Blind Study

    PubMed Central

    Roy, Subir; Higareda, Iliana; Angel-Muller, Edith; Ismail, Mahmoud; Hague, Caren; Adeyi, Ben; Teppler, Hedy

    2003-01-01

    Objective: To compare ertapenem therapy with piperacillin–tazobactam therapy for the management of acute pelvic infections. Methods: In a multicenter, double-blind study, 412 women with acute pelvic infection were assigned to one of two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then randomized to ertapenem, 1 g once a day, or piperacillin–tazobactam, 3.375 g every 6 hours, both administered intravenously. Results: In total, 163 patients in the ertapenem group and 153 patients in the piperacillin–tazobactam group were clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common single pathogen was Escherichia coli . At the primary efficacy endpoint 2–4 weeks post therapy, 93.9% of patients who received ertapenem and 91.5% of those who received piperacillin–tazobactam were cured (95% confidence interval for the difference, adjusting for strata, –4% to 8.8%), indicating that cure rates for both treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by stratum and severity of infection. The frequency and severity of drug-related adverse events were generally similar in both groups. Conclusions: In this study, ertapenem was as effective as piperacillin–tazobactam for the treatment of acute pelvic infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin–tazobactam. PMID:12839630

  20. Haemodynamically Unstable Pelvic Fractures

    DTIC Science & Technology

    2009-01-01

    patients with pelvic fractures. Ann Surg 2001;233:843–50. 12. Blackmore CC, Cummings P, Jurkovich GJ , et al. Predicting major hemorrhage in patients...with pelvic fracture. J Trauma 2006;61:346–52. 13. Blackmore CC, Jurkovich GJ , Linnau KF, et al. Assessment of volume of hemorrhage and outcome from...outcome of blunt trauma patients sustaining pelvic fractures. Injury 2000;31:677–82. 55. Haidukewych GJ , Kumar S, Prpa B. Placement of half-pins for

  1. The Early Result of Whole Pelvic Radiotherapy and Stereotactic Body Radiotherapy Boost for High-Risk Localized Prostate Cancer

    PubMed Central

    Lin, Yu-Wei; Lin, Li-Ching; Lin, Kuei-Li

    2014-01-01

    Purpose: The rationale for hypofractionated radiotherapy in the treatment of prostate cancer is based on the modern understanding of radiobiology and advances in stereotactic body radiotherapy (SBRT) techniques. Whole-pelvis irradiation combined with SBRT boost for high-risk prostate cancer might escalate biologically effective dose without increasing toxicity. Here, we report our 4-year results of SBRT boost for high-risk localized prostate cancer. Methods and Materials: From October 2009 to August 2012, 41 patients newly diagnosed, high-risk or very high-risk (NCCN definition) localized prostate cancer were treated with whole-pelvis irradiation and SBRT boost. The whole pelvis dose was 45 Gy (25 fractions of 1.8 Gy). The SBRT boost dose was 21 Gy (three fractions of 7 Gy). Ninety percent of these patients received hormone therapy. The toxicities of gastrointestinal (GI) and genitourinary (GU) tracts were scored by Common Toxicity Criteria Adverse Effect (CTCAE v3.0). Biochemical failure was defined by Phoenix definition. Results: Median follow-up was 42 months. Mean PSA before treatment was 44.18 ng/ml. Mean PSA level at 3, 6, 12, 18, and 24 months was 0.94, 0.44, 0.13, 0.12, and 0.05 ng/ml, respectively. The estimated 4-year biochemical failure-free survival was 91.9%. Three biochemical failures were observed. GI and GU tract toxicities were minimal. No grade 3 acute GU or GI toxicity was noted. During radiation therapy, 27% of the patient had grade 2 acute GU toxicity and 12% had grade 2 acute GI toxicity. At 3 months, most toxicity scores had returned to baseline. At the last follow-up, there was no grade 3 late GU or GI toxicity. Conclusions: Whole-pelvis irradiation combined with SBRT boost for high-risk localized prostate cancer is feasible with minimal toxicity and encouraging biochemical failure-free survival. Continued accrual and follow-up would be necessary to confirm the biochemical control rate and the toxicity profiles. PMID

  2. Qualitative estimation of pelvic organ interactions and their consequences on prostate motion: Study on a deceased person

    SciTech Connect

    Keros, Laurent; Bernier, Valerie; Aletti, Pierre; Marchesi, Vincent; Wolf, Didier; Noel, Alain

    2006-06-15

    In an attempt to have better targeting of the prostate during radiotherapy it is necessary to understand the mechanical interactions between bladder, rectum, and prostate and estimate their consequences on prostate motion. For this, the volumes of bladder, rectum, and lungs were modified concomitantly on a deceased person. A CT acquisition was performed for each of these different pelvic configurations (36 acquisitions). An increase in the volume of the bladder or lungs induces a compression of tissues of the pelvic area from its supero-anterior (S-A) to infero-posterior (I-P) side. Conversely, an increase of rectum volume induces a compression from the I-P to the S-A side of the pelvic region. These compressive actions can be added or subtracted from each other, depending on their amplitudes and directions. Prostate motion occurs when a movement of the rectum is observed (this movement depends, itself, on lungs and bladder volume). The maximum movement of prostate is 9 mm considering maximal bladder or rectal action, and 11 mm considering maximum lung action. In some other cases, opposition of compressive effects can lead to stasis of the prostate. Based on the volumes of bladder, rectum, and lungs, it is possible to qualitatively estimate the movement of organs of the pelvic area. The best way to reduce prostate movement is to recommend the patient to have an empty rectum, with either full bladder and/or full lungs.

  3. Pelvic Inflammatory Disease

    MedlinePlus

    Pelvic inflammatory disease (PID) is an infection and inflammation of the uterus, ovaries, and other female reproductive organs. It causes scarring ... United States. Gonorrhea and chlamydia, two sexually transmitted diseases, are the most common causes of PID. Other ...

  4. Pelvic laparoscopy - slideshow

    MedlinePlus

    ... ency/presentations/100131.htm Pelvic laparoscopy - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  5. 42 CFR 410.56 - Screening pelvic examinations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... screening pelvic examination (including a clinical breast examination) if it is performed by a doctor of... of her medical history or other findings) of developing cervical cancer or vaginal cancer, as determined in accordance with the following risk factors: (i) High risk factors for cervical cancer:...

  6. 42 CFR 410.56 - Screening pelvic examinations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... screening pelvic examination (including a clinical breast examination) if it is performed by a doctor of... of her medical history or other findings) of developing cervical cancer or vaginal cancer, as determined in accordance with the following risk factors: (i) High risk factors for cervical cancer:...

  7. 42 CFR 410.56 - Screening pelvic examinations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... screening pelvic examination (including a clinical breast examination) if it is performed by a doctor of... of her medical history or other findings) of developing cervical cancer or vaginal cancer, as determined in accordance with the following risk factors: (i) High risk factors for cervical cancer:...

  8. Case report: pelvic actinomycosis.

    PubMed

    Maxová, K; Menzlová, E; Kolařík, D; Dundr, P; Halaška, M

    2012-01-01

    A case of pelvic actinomycosis is presented. The patient is 42-year-old female with a 5 weeks history of pelvic pain. An intrauterine device (IUD) was taken out 3 weeks ago. There is a lump length 9 cm between rectus muscles. Ultrasound, magnetic resonance imaging (MRI) and histology are used to make the diagnosis. Actinomycosis can mimic the tumour disease. The definitive diagnosis requires positive anaerobic culture or histological identification of actinomyces granulas. A long lasting antibiotic therapy is performed.

  9. Chronic pelvic pain, psychiatric disorders and early emotional traumas: Results of a cross sectional case-control study

    PubMed Central

    Osório, Flávia L; Carvalho, Ana Carolina F; Donadon, Mariana F; Moreno, André L; Polli-Neto, Omero

    2016-01-01

    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 socio-economic 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 associated with 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. PMID:27679773

  10. Pelvic organ prolapse.

    PubMed

    Jelovsek, J Eric; Maher, Christopher; Barber, Matthew D

    2007-03-24

    Pelvic organ prolapse is downward descent of female pelvic organs, including the bladder, uterus or post-hysterectomy vaginal cuff, and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development is multifactorial, with vaginal child birth, advancing age, and increasing body-mass index as the most consistent risk factors. Vaginal delivery, hysterectomy, chronic straining, normal ageing, and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching, or dysfunction of the levator ani complex, connective-tissue attachments of the vagina, or both, resulting in prolapse. Patients generally present with several complaints, including bladder, bowel, and pelvic symptoms; however, with the exception of vaginal bulging, none is specific to prolapse. Women with symptoms suggestive of prolapse should undergo a pelvic examination and medical history check. Radiographic assessment is usually unnecessary. Many women with pelvic organ prolapse are asymptomatic and do not need treatment. When prolapse is symptomatic, options include observation, pessary use, and surgery. Surgical strategies for prolapse can be categorised broadly by reconstructive and obliterative techniques. Reconstructive procedures can be done by either an abdominal or vaginal approach. Although no effective prevention strategy for prolapse has been identified, considerations include weight loss, reduction of heavy lifting, treatment of constipation, modification or reduction of obstetric risk factors, and pelvic-floor physical therapy.

  11. [Pelvic floor and pregnancy].

    PubMed

    Fritel, X

    2010-05-01

    Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.

  12. Pelvic Organ Prolapse: New Concepts in Pelvic Floor Anatomy.

    PubMed

    Maldonado, Pedro A; Wai, Clifford Y

    2016-03-01

    As the field of reconstructive pelvic surgery continues to evolve, with descriptions of new procedures to repair pelvic organ prolapse, it remains imperative to maintain a functional understanding of pelvic floor anatomy and support. The goal of this review was to provide a focused, conceptual approach to differentiating anatomic defects contributing to prolapse in the various compartments of the vagina. Rather than provide exhaustive descriptions of pelvic floor anatomy, basic pelvic floor anatomy is reviewed, new and historical concepts of pelvic floor support are discussed, and relevance to the surgical management of specific anatomic defects is addressed.

  13. A pilot study on the use of acupuncture or pelvic floor muscle training for mixed urinary incontinence

    PubMed Central

    Solberg, Mona; Alræk, Terje; Mdala, Ibrahimu; Klovning, Atle

    2016-01-01

    Objectives To determine the feasibility and acceptability of traditional Chinese medicine (TCM) acupuncture and pelvic floor muscle training (PFMT) in reducing symptoms and bothersomeness in women with mixed urinary incontinence (MUI); and to estimate the sample size for a full scale trial. Methods Thirty-four women with MUI were randomly assigned to either 12 sessions of TCM acupuncture, 12 sessions of PFMT, or to a waiting list control group. Outcome measures included an assessment of interest to participate in the trial, identification of successful recruitment strategies, the appropriateness of eligibility criteria, and compliance with treatment. Clinical outcomes were assessed at baseline and 12 weeks, and included the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI SF), expectations of treatment effect, and adverse events. Results Recruitment was feasible and randomisation worked adequately by means of SurveyMonkey. SurveyMonkey does not permit stratification by ICIQ-UI SF baseline score. Fourteen of 22 women found the treatment options acceptable. The dropout rate was high, especially in the control group (6/12). Outcome forms were completed by 20 of 34 women. The median (IQR) changes of the ICIQ-UI SF scores in the acupuncture, physiotherapy, and waiting list group were 5.5 (2.3 to 6.8), 1.0 (−3.0 to 4.5), and 1.5 (−1.5 to 3.0), respectively, suggesting the need for a full scale trial. Conclusions Women with MUI were willing to participate in this study. There is a need for adjusting eligibility criteria. A sample size of 129 women, 43 in three arms, is required. No major adverse events occurred. PMID:26362793

  14. Non-surgical interventions for pelvic organ prolapse in rural Nepal: a prospective monitoring and evaluation study

    PubMed Central

    Fitchett, Joseph R; Bhatta, Surya; Sherpa, Tenzing Y; Malla, Bishwo S; A Fitchett, Elizabeth J; Samen, Arlene

    2015-01-01

    Objectives Pelvic organ prolapse (POP) is a major cause of morbidity in Nepal, particularly affecting women in the rural communities. Women with POP in Nepal may suffer from symptoms for decades. At present, the Government of Nepal advocates surgical intervention but access to surgical care is inadequate. This report evaluated the feasibility of a non-surgical public health programme in rural Nepal, and describes risk factors associated with POP in this setting. Design Prospective monitoring and evaluation study of a new public health programme. Setting Baglung district, rural Nepal. Participants Women with gynaecological symptoms of POP. Main outcome measures Risk factors for disease progression were assessed using Fisher’s exact test, Pearson’s χ2-test and logistic regression analysis. Results Of the 74 women included in this analysis, 70.8% were diagnosed with stage 2 POP or greater. The majority of women did not have any further children following the onset of POP symptoms (63.5%). Duration of symptoms ranged from 2 months to 60 years, with 73.4% of women suffering for over 5 years and 28.4% suffering for over 20 years. Univariate analyses identified age at screening, age at onset of symptoms, the duration of symptoms and an associated rectocele as factors associated with increasing POP severity (p < 0.05). Kegel exercises were taught to 25 (33.8%) women with POP and ring pessaries were offered to 47 (63.5%) women with POP. Conclusions Non-surgical interventions may provide an opportunity to address the significant burden of POP in rural Nepal. PMID:26664731

  15. Pelvic muscles during rest: responses to pelvic muscle exercise.

    PubMed

    Griffin, C; Dougherty, M C; Yarandi, H

    1994-01-01

    The purpose of the research was to study pelvic muscle changes in the resting phase between voluntary contractions (during pelvic muscle assessment) and in response to pelvic muscle exercise (PME) through secondary analysis of data. The sample consisted of healthy women (N = 38) aged 35 to 54. Analysis of variance showed a significant difference in resting pressure within each assessment (F = 2.92, p < .04). A significant difference in resting pressures within subjects was found (F = 3.54, p < .02). Within-subject variance suggests exercises performed without a warmup may result in incomplete relaxation prior to contraction. Significant change between baseline and Level 1 of the graded PME program suggests slow relaxation of untrained muscles. Increases in resting pressure at Levels 3 and 4 may be a more accurate reflection of muscle hypertrophy. The results of this research indicate that care should be taken in establishing the point from which changes during contractions are measured. It is recommended that the resting pressure be used. Exercise continued for more than 3 or 4 weeks accounts for nearly all strength gains and explains the increases in resting pressure at PME Levels 3 and 4.

  16. Pelvic Fractures in Children Results from the German Pelvic Trauma Registry

    PubMed Central

    Zwingmann, Jörn; Aghayev, Emin; Südkamp, Norbert P.; Neumann, Mirjam; Bode, Gerrit; Stuby, Fabian; Schmal, Hagen

    2015-01-01

    Abstract As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries. Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed. We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ≤14 years and compared these 2 groups. The 2 groups’ Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults’ 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P = 0.041) and ARDS and MOF (P = 0.006). This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults. PMID:26705223

  17. Evaluation of embolization for periuterine varices involving chronic pelvic pain secondary to pelvic congestion syndrome

    PubMed Central

    Siqueira, Flavio Meirelles; Monsignore, Lucas Moretti; Rosa-e-Silva, Julio Cesar; Poli-Neto, Omero Benedicto; de Castro-Afonso, Luis Henrique; Nakiri, Guilherme Seizem; Muglia, Valdair Francisco; Abud, Daniel Giansante

    2016-01-01

    OBJECTIVES: To evaluate the clinical response and success rate after periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome and to report the safety of endovascular treatment and its rate of complications. METHODS: Retrospective cohort of patients undergoing endovascular treatment of pelvic congestion syndrome in our department from January 2012 to November 2015. Data were analyzed based on patient background, imaging findings, embolized veins, rate of complications, and clinical response as indicated by the visual analog pain scale. RESULTS: We performed periuterine varices embolization in 22 patients during the study, four of which required a second embolization. Seventeen patients reported a reduction in pelvic pain after the first embolization and three patients reported a reduction in pelvic pain after the second embolization. Minor complications were observed in our patients, such as postural hypotension, postoperative pain, and venous perforation during the procedure, without clinical repercussion. CONCLUSION: Periuterine varices embolization in patients with chronic pelvic pain secondary to pelvic congestion syndrome appears to be an effective and safe technique. PMID:28076514

  18. Psychosocial aspects of chronic pelvic pain, with special reference to sexual abuse. A study of 164 women.

    PubMed Central

    Fry, R. P.; Crisp, A. H.; Beard, R. W.; McGuigan, S.

    1993-01-01

    Patients with chronic pelvic pain attending a tertiary referral centre show certain social, developmental and psychological characteristics. Specifically, they appear to have fewer children and to report more paternal overprotection, and a trend towards low maternal care compared to normals. They also show more depression, free-floating anxiety and somatic anxiety than such populations. The levels are similar to those found in other outpatient populations presenting with migraine or irritable bowel syndrome. Hostility levels are greater than those in normal subjects. Overall the present patient population reports the same degree of childhood sexual abuse as do many other female clinic and community sample populations. Sexual abuse is unlikely to be a specific aetiological factor in the development of chronic pelvic pain though it may yet be found to be important in subsets of the population. PMID:8415346

  19. Resident education outcomes and perception of a seminar format to teach female pelvic anatomy and procedures to correct pelvic prolapse.

    PubMed

    Teichman, Joel M.H.; Cespedes, R. Duane; Littlefield, John H.

    1998-12-01

    Urologic residents need to learn basic and applied knowledge of female pelvic anatomy, a subject rarely taught beyond preclinical undergraduate medical education. This study tests the hypothesis that urologic resident knowledge of female pelvic anatomy and prolapse may be enhanced with a seminar. Twenty residents attended a one day seminar combining didactics and a cadaveric dissection related to female pelvic anatomy and female pelvic prolapse conditions. Resident knowledge was measured with a multiple choice test administered in a pretest-posttest experimental design. Resident attitudes toward the seminar were assessed by a 20 item survey using a strongly disagree to strongly agree scale. Pretest and posttest mean scores were 55% and 71% respectively, p=.0007 (Kuder-Richardson 20 coefficients were 0.7). Questionnaire responses indicated positive opinions regarding the educational value of the seminar. Urologic resident knowledge of female pelvic anatomy and pelvic prolapse conditions may be enhanced by conducting a one day teaching seminar.

  20. Benefit of Adjuvant Chemotherapy and Pelvic Lymph Node Dissection in pT3 and Node Positive Bladder Cancer Patients Treated with Radical Cystectomy

    PubMed Central

    Boström, Peter J.; Mirtti, Tuomas; van Rhijn, Bas; Fleshner, Neil E.; Finelli, Antonio; Laato, Matti; Jewett, Michael A.; Moore, Malcom J.; Sridhar, Srikala; Nurmi, Martti; Tannock, Ian F.; Zlotta, Alexandre R.

    2016-01-01

    Background: Benefits of adjuvant chemotherapy (AC) and extent of pelvic lymph node dissection (PLND) in radical cystectomy (RC) are debated. Results from randomized trials are still expected. Objective: To analyze the effects of AC and PLND in two academic centers with opposite policies regarding their use. Methods: 581 bladder cancer patients who underwent RC without neoadjuvant chemotherapy, from Toronto (University Health Network), Canada, and Turku University Hospital, Finland were included. Disease specific survival (DSS) and failure patterns were assessed. Results: Centers differed in PLND rate (93% and 36% in Toronto and Turku respectively, p <  0.001), PLND extent (≥10 removed nodes, 58% vs. 8%, p <  0.001) and AC rate (21% vs. 2%, p <  0.001). Survival between centers among pT≤1 or pT4 patients was similar. pT3 patients in Toronto had an improved 10 year DSS (43% vs. 22%, p = 0.025). Distant failures were less common after AC (HR 0.56, 95%  CI 0.33–0.98, p <  0.042). In node positive (N+) patients, mortality was significantly higher in Turku (HR 2.19, 95%  CI 1.44–3.34, p <  0.001) and lower in patients receiving AC (HR 0.60, 95%  CI 0.37–0.99, p = 0.044). 41% DSS at 10 years was observed in N+ Toronto patients. Limitations included the non-randomized retrospective design and absence of propensity score analysis. Conclusion: Combining AC and PLND to RC is associated with improved survival in pT3 and N+ patients. PLND did not affect survival independently but helps in selecting patients for AC. Our data adds to the growing body of evidence supporting the usefulness of AC in addition to PLND in high risk patients operated by cystectomy. PMID:27376145

  1. Gum chewing reduces the time to first defaecation after pelvic surgery: A randomised controlled study.

    PubMed

    Tazegül Pekin, A; Kerimoğlu, O Seçilmiş; Doğan, N U; Yılmaz, S A; Kebapcılar, A G; Gençoğlu Bakbak, B B; Çelik, Ç

    2015-01-01

    Post-operative ileus is a major complication that increases the morbidity in patients who had abdominal surgery. Several different procedures have been used to manage bowel function, including adequate pain control, prokinetic drugs and supportive strategies. The present study aimed to assess the effect of chewing gum on bowel recovery in patients undergoing gynaecologic abdominal surgeries. A total of 137 patients were randomised into gum-chewing and control groups. Patients in the gum-chewing group began chewing gum at post-operative 3rd h and chewed gum thereafter every 4 h daily, for 30 min each time. All patients received the same post-operative treatment. Primary outcome measures were the time to first passage of flatus and time to first passage of stool. The secondary outcome measures included the first hearing of normal bowel sounds, nausea and the time until discharge from the hospital. Compared with the control group, the time interval between operation and first flatus was shorter in the gum-chewing group (median, 33 h vs 30 h). However, the difference was not significant (p = 0.381). The first defaecation time was significantly shorter in the gum-chewing group. The median time to first defaecation was 67 (20-105) h in the control group and 45 (12-97) h in the gum-chewing group (p < 0.01). Gum chewing is safe, well tolerated and it allows early defaecation after gynaecologic abdominal surgery.

  2. Inherited pelvic organ prolapse in the mouse: preliminary evaluation of a new murine model

    PubMed Central

    MCNANLEY, Anna R.; JOHNSON, Aimee M.; FLYNN, Michael K.; WOOD, Ronald W.; KENNEDY, Scott D.; REEDER, Jay E.

    2013-01-01

    Objectives/Introduction To report the initial anatomic, radiographic, and genetic evaluations of a novel form of spontaneous pelvic organ prolapse (S-POP) in mice. Methods We observed S-POP in a colony of UPII-SV40T transgenic mice developed for studies on bladder cancer. We utilized magnetic resonance imaging and necropsy to characterize this finding. We have established a breeding colony to identify inheritance patterns and for future studies. Results Selective breeding isolated the S-POP phenotype from the transgene. In contrast to other animal models, the S-POP mouse does not require an obligatory antecedent event to manifest pelvic organ prolapse. Necropsy and imaging demonstrate significant displacement of the pelvic organs distal to the pelvic floor in both sexes. The appearance of the POP is similar to that seen in the human female phenotype. Preliminary breeding studies indicate an autosomal dominant inheritance pattern. Conclusions This mouse may be an effective animal model for the study of POP in humans. PMID:18802654

  3. The Role of Pretreatment FDG-PET in Treating Cervical Cancer Patients With Enlarged Pelvic Lymph Node(s) Shown on MRI: A Phase 3 Randomized Trial With Long-Term Follow-Up

    SciTech Connect

    Lin, Shinn-Yn; Tsai, Chien-Sheng; Chang, Yu-Chen; Ng, Koon-Kwan; Chang, Ting-Chang; Kao, Wei-Heng; Lai, Chyong-Huey; Hong, Ji-Hong

    2015-07-01

    Purpose: This report is the second analysis of a prospective randomized trial to investigate the impact of {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG-PET) on cervical cancer patients with enlarged pelvic lymph nodes identified by magnetic resonance imaging. Methods and Materials: Patients with newly diagnosed cervical cancer with enlarged pelvic lymph nodes but free of enlarged para-aortic lymph nodes (PALN) were eligible. Patients were randomized to receive either pretreatment FDG-PET (PET arm) or not (control arm). The whole pelvis was the standard irradiation field for all patients except those with FDG-avid extrapelvic findings. Results: In all, 129 patients were enrolled. Pretreatment PET detected extrapelvic metastases in 7 patients. No new patient experienced treatment failure during the additional 4-year follow-up period. There were no significant differences between the PET arm and the control arm regarding overall survival, disease-free survival, and freedom from extrapelvic metastasis. In the control arm, 8 of 10 patients with PALN relapse had limited extrapelvic nodal failures; their 5-year disease-specific survival was 34.3%. By contrast, only 1 of 5 patients with PALN relapse in the PET arm experienced such limited failures; their 5-year survival rate was 0%. Conclusions: Although the pretreatment detection of PALN did not translate into survival benefit, it indeed decreased the need for extended-field concurrent chemoradiation therapy.

  4. A pilot study on acupuncture for lower urinary tract symptoms related to chronic prostatitis/chronic pelvic pain

    PubMed Central

    Capodice, Jillian L; Jin, Zhezhen; Bemis, Debra L; Samadi, David; Stone, Brian A; Kapan, Steven; Katz, Aaron E

    2007-01-01

    Background The etiology and treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) remain poorly understood. Pain, lower urinary tract voiding symptoms and negative impact on quality of life (QOL) are the most common complaints. Acupuncture, which has been widely used to treat painful and chronic conditions, may be a potential treatment to alleviate the constellation of symptoms experienced by men with CP/CPPS. The purpose of our study was to assess the impact of standardized full body and auricular acupuncture in men refractory to conventional therapies and collect pilot data to warrant further randomized trials. Methods Ten men diagnosed with category IIIA or IIIB CP/CPPS >6 months, refractory to at least 1 conventional therapy (antibiotics, anti-inflammatory agents, 5-α reductase inhibitors, α-1 blockers) and scoring >4 on the pain subset of the NIH-CPSI were prospectively analyzed in an Institutional Review Board (IRB) approved, single-center clinical trial (Columbia University Medical Center IRB#AAAA-7460). Standardized full body and auricular acupuncture treatment was given twice weekly for 6 weeks. The primary endpoints were total score of the NIH-CPSI and assessment of serious adverse events. The secondary endpoints were individual scores of the NIH-CPSI and QOL questionnaire scores of the short-form 36 (SF-36). Results The median age of the subjects was 36 years (range 29–63). Decreases in total NIH-CPSI scores (mean ± SD) after 3 and 6 weeks from baseline (25.1 ± 6.6) were 17.6 ± 5.7 (P < 0.006) and 8.8 ± 6.2 (P < 0.006) respectively and remained significant after an additional 6 weeks of follow-up (P < 0.006). Symptom and QOL/NIH-CPSI sub-scores were also significant (P < 0.002 and P < 0.002 respectively). Significance in 6 of 8 categories of the SF-36 including bodily pain (P < 0.002) was achieved. One regression in the SF-36 vitality category was observed after follow-up. There were no adverse events. Conclusion The preliminary

  5. Glycoprotein and Glycan in Tissue and Blood Samples of Patients With Stage IB-IVA Cervical Cancer Undergoing Surgery to Remove Pelvic and Abdominal Lymph Nodes

    ClinicalTrials.gov

    2016-10-26

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma, Not Otherwise Specified; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  6. Early Clinical Outcomes and Toxicity of Intensity Modulated Versus Conventional Pelvic Radiation Therapy for Locally Advanced Cervix Carcinoma: A Prospective Randomized Study

    SciTech Connect

    Gandhi, Ajeet Kumar; Sharma, Daya Nand; Rath, Goura Kisor; Julka, Pramod Kumar; Subramani, Vellaiyan; Sharma, Seema; Manigandan, Durai; Laviraj, M.A.; Kumar, Sunesh; Thulkar, Sanjay

    2013-11-01

    Purpose: To evaluate the toxicity and clinical outcome in patients with locally advanced cervical cancer (LACC) treated with whole pelvic conventional radiation therapy (WP-CRT) versus intensity modulated radiation therapy (WP-IMRT). Methods and Materials: Between January 2010 and January 2012, 44 patients with International Federation of Gynecology and Obstetrics (FIGO 2009) stage IIB-IIIB squamous cell carcinoma of the cervix were randomized to receive 50.4 Gy in 28 fractions delivered via either WP-CRT or WP-IMRT with concurrent weekly cisplatin 40 mg/m{sup 2}. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events, version 3.0, and late toxicity was graded according to the Radiation Therapy Oncology Group system. The primary and secondary endpoints were acute gastrointestinal toxicity and disease-free survival, respectively. Results: Of 44 patients, 22 patients received WP-CRT and 22 received WP-IMRT. In the WP-CRT arm, 13 patients had stage IIB disease and 9 had stage IIIB disease; in the IMRT arm, 12 patients had stage IIB disease and 10 had stage IIIB disease. The median follow-up time in the WP-CRT arm was 21.7 months (range, 10.7-37.4 months), and in the WP-IMRT arm it was 21.6 months (range, 7.7-34.4 months). At 27 months, disease-free survival was 79.4% in the WP-CRT group versus 60% in the WP-IMRT group (P=.651), and overall survival was 76% in the WP-CRT group versus 85.7% in the WP-IMRT group (P=.645). Patients in the WP-IMRT arm experienced significantly fewer grade ≥2 acute gastrointestinal toxicities (31.8% vs 63.6%, P=.034) and grade ≥3 gastrointestinal toxicities (4.5% vs 27.3%, P=.047) than did patients receiving WP-CRT and had less chronic gastrointestinal toxicity (13.6% vs 50%, P=.011). Conclusion: WP-IMRT is associated with significantly less toxicity compared with WP-CRT and has a comparable clinical outcome. Further studies with larger sample sizes and longer follow-up times are warranted to justify

  7. Transgenic Mice Expressing MCP-1 by the Urothelium Demonstrate Bladder Hypersensitivity, Pelvic Pain and Voiding Dysfunction: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network Animal Model Study

    PubMed Central

    Wang, Yaoqin; Lutgendorf, Susan; Bradley, Catherine; Schrepf, Andrew; Kreder, Karl; O'Donnell, Michael; Luo, Yi

    2016-01-01

    Monocyte chemoattractant protein-1 (MCP-1) is one of the key chemokines that play important roles in diverse inflammatory and chronic pain conditions. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating inflammatory condition of the urinary bladder characterized by the hallmark symptoms of pelvic pain and voiding dysfunction. To facilitate IC/BPS research, we used transgenic technology to develop a novel urothelial MCP-1 secretion mouse model (URO-MCP-1). A transgene consisting of the uroplakin II gene promoter and the mouse MCP-1 coding sequence with a secretory element was constructed and microinjected. URO-MCP-1 mice were found to express MCP-1 mRNA in the bladder epithelium and MCP-1 protein in the urine, and developed bladder inflammation 24 hours after intravesical administration of a single sub-noxious dose of lipopolysaccharide (LPS). The inflamed bladders of URO-MCP-1 mice exhibited elevated mRNAs for interleukin (IL)-1ß, IL-6, substance P precursor, and nerve growth factor as well as increased macrophage infiltration. In parallel with these phenotypic changes, URO-MCP-1 mice manifested significant functional changes at days 1 and 3 after cystitis induction. These functional changes included pelvic pain as measured by von Frey filament stimulation and voiding dysfunction (increased urinary frequency, reduced average volume voided per micturition, and reduced maximum volume voided per micturition) as measured by micturition cages. Micturition changes remained evident at day 7 after cystitis induction, although these changes were not statistically significant. Control wild-type C57BL/6 mice manifested no clear changes in histological, biochemical and behavioral features after similar cystitis induction with LPS. Taken together, our results indicate that URO-MCP-1 mice are hypersensitive to bladder irritants such as LPS and develop pelvic pain and voiding dysfunction upon cystitis induction, providing a novel model for IC

  8. The “Pelvic Harness”: a skeletonized mesh implant for safe pelvic floor reconstruction

    PubMed Central

    Natalia, Sumerova; Menahem, Neuman; Haim, Krissi; Dmitri, Pushkar

    2016-01-01

    ABSTRACT Objectives To evaluate the feasibility, safety and surgical results of skeletonized mesh implants to form a pelvic harness for pelvic floor reconstruction surgery. Study design Patients with advanced pelvic floor prolapse were enrolled to this study. Study model was a kit mesh, reduced to 75% of the original surface area by cutting out mesh material from the central mesh body. Patients were evaluated at the end of the 1st and 6th post-operative months and interviewed at the study conclusion. Results Ninety-five women with advanced pelvic floor prolapse had this implant. Mean follow-up duration was 9 months (6-12 months). The POP-Q point’s measurements showed marked and statistically significant improvements. Bladder over-activity symptoms, fecal incontinence, pelvic pain and constipation rates were all reduced as well. No adverse effects related to the dissection or mesh implantation were marked. The first and sixth post-operative month follow-up records as well as the study conclusion interview findings were satisfactory in terms of subjective and objective cure and adverse effects occurrence. Conclusion This study data proposes that skeletonizing meshes might be safely and successfully implanted for potentially improved pelvic floor reconstruction. PMID:27286114

  9. A comparative study of pelvic floor muscle training in women with multiple sclerosis: its impact on lower urinary tract symptoms and quality of life

    PubMed Central

    Lúcio, Adélia Correia; Perissinoto, Maria Carolina; Natalin, Ricardo Aydar; Prudente, Alessandro; Damasceno, Benito Pereira; D'ancona, Carlos Arturo Levi

    2011-01-01

    OBJECTIVE: To compare pelvic floor muscle training and a sham procedure for the treatment of lower urinary tract symptoms and quality of life in women with multiple sclerosis. METHODS: Thirty-five female patients with multiple sclerosis were randomized into two groups: a treatment group (n = 18) and a sham group (n = 17). The evaluation included use of the Overactive Bladder Questionnaire, Medical Outcomes Study Short Form 36, International Consultation on Incontinence Questionnaire Short Form, and Qualiveen questionnaire. The intervention was performed twice per week for 12 weeks in both groups. The treatment group underwent pelvic floor muscle training with assistance from a vaginal perineometer and instructions to practice the exercises daily at home. The sham group received a treatment consisting of introducing a perineometer inside the vagina with no exercises required. Pre- and post-intervention data were recorded. RESULTS: The evaluation results of the two groups were similar at baseline. At the end of the treatment, the treatment group reported fewer storage and voiding symptoms than the sham group. Furthermore, the differences found between the groups were significant improvements in the following scores in the treatment group: Overactive Bladder Questionnaire, International Consultation on Incontinence Questionnaire Short Form, and the General Quality of Life, and Specific Impact of Urinary Problems domains of the Qualiveen questionnaire. CONCLUSIONS: The improvement of lower urinary tract symptoms had a positive effect on the quality of life of women with multiple sclerosis who underwent pelvic floor muscle training, as the disease-specific of quality of life questionnaires demonstrated. This study reinforces the importance of assessing quality of life to judge the effectiveness of a treatment intervention. PMID:22179160

  10. Proteomics studies of pancreatic cancer

    PubMed Central

    Chen, Ru; Pan, Sheng; Aebersold, Ruedi; Brentnall, Teresa A.

    2008-01-01

    Pancreatic cancer is the fourth leading cause of cancer death in the United States, with 4% survival 5 years after diagnosis. Biomarkers are desperately needed to improve earlier, more curable cancer diagnosis and to develop new effective therapeutic targets. The development of quantitative proteomics technologies in recent years offers great promise for understanding the complex molecular events of tumorigenesis at the protein level, and has stimulated great interest in applying the technology for pancreatic cancer studies. Proteomic studies of pancreatic tissues, juice, serum/plasma, and cell lines have recently attempted to identify differentially expressed proteins in pancreatic cancer to dissect the abnormal signaling pathways underlying oncogenesis, and to detect new biomarkers. It can be expected that the continuing evolution of proteomics technology with better resolution and sensitivity will greatly enhance our capability in combating pancreatic cancer. PMID:18633454

  11. Persistent pelvic pain and pelvic joint instability.

    PubMed

    Saugstad, L F

    1991-10-08

    As accepted as the condition of pelvic pain and pelvic joint instability (PPPJI) is in pregnancy, as controversial and doubted is the same diagnosis in non-pregnant women. Women suffering severe incapacitating PPPJI for years following parturition have recently founded an association. This offers a unique opportunity to investigate their characteristics. 153 of the 215 members answered a questionnaire. The majority (110) suffered PPPJI in first pregnancy with onset preceding 20 weeks gestation in 84 women. Onset was significantly earlier in users of oral contraceptives than in non-users (16.3 weeks and 20.5 weeks, respectively). The 153 women did not differ from the controls with regard to life-style, diseases prior to reproduction or reproduction. Their 358 deliveries were characterized by a marked excess of post-term deliveries, a raised proportion of infants of 4000 g or more, an extremely low sex-ratio of offspring (0.84) with 54.5% female births, and a significantly raised congenital hip dysplasia rate, consistent with elevated oestrogen and relaxin levels.

  12. Physical activity and the pelvic floor.

    PubMed

    Nygaard, Ingrid E; Shaw, Janet M

    2016-02-01

    Pelvic floor disorders are common, with 1 in 4 US women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse, or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review was to summarize studies reporting the association between physical activity and pelvic floor disorders. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include that urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high-intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this examination finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for

  13. Making sense of urodynamic studies for women with urinary incontinence and pelvic organ prolapse: a urogynecology perspective.

    PubMed

    Whiteside, James L

    2012-08-01

    The support for routine urodynamic testing in the management of women with urinary incontinence or pelvic organ prolapse is eroding. The reasons for this change largely reflect the growing evidence that urodynamic testing in this context renders little additional information over basic office assessment. The clinical features of urodynamic testing and its diagnostic and prognostic precision and accuracy are all problematic. As our understanding of female lower urinary tract dysfunction improves, the inadequacy of urodynamic testing to meaningfully improve patient and clinician decision making has become more apparent.

  14. Pelvic inflammatory disease

    PubMed Central

    2013-01-01

    Introduction Pelvic inflammatory disease is caused by infection of the upper female genital tract and is often asymptomatic. Pelvic inflammatory disease is the most common gynaecological reason for admission to hospital in the US, and is diagnosed in approximately 1% of women aged 16 to 45 years consulting their GP in England and Wales. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: How do different antimicrobial regimens compare when treating women with confirmed pelvic inflammatory disease? What are the effects of routine antibiotic prophylaxis to prevent pelvic inflammatory disease before intrauterine contraceptive device (IUD) insertion? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up to date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 RCTs or systematic reviews of RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: antibiotics (oral, parenteral, different durations, different regimens) and routine antibiotic prophylaxis (before intrauterine device insertion in women at high risk or low risk). PMID:24330771

  15. Pelvic ultrasound - abdominal

    MedlinePlus

    ... pelvic ultrasound. In: Lumb P, Karakitsos D, eds. Critical Care Ultrasound. Philadelphia, PA: Elsevier Saunders; 2015:chap 43. Review Date 3/4/2016 Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, ...

  16. Pelvic Pain: Other FAQs

    MedlinePlus

    ... Publications Pelvic Pain: Other FAQs Skip sharing on social media links Share this: Page Content Basic information for topics, such as “What is it?” and “How many people are affected?” is available in the Condition Information ...

  17. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study.

    PubMed

    Smith, A R; Hosker, G L; Warrell, D W

    1989-01-01

    Single-fibre electromyography of the pubococcygeus muscle of the pelvic floor was performed in 69 asymptomatic women and 105 women with stress incontinence of urine or genitourinary prolapse or both. The results suggest that partial denervation of the pelvic floor with subsequent reinnervation is a normal accompaniment of ageing and is increased by childbirth. Women with stress incontinence of urine or genitourinary prolapse or both have a significant increase in denervation of the pelvic floor compared with asymptomatic women.

  18. [Pelvic floor muscle training and pelvic floor disorders in women].

    PubMed

    Thubert, T; Bakker, E; Fritel, X

    2015-05-01

    Our goal is to provide an update on the results of pelvic floor rehabilitation in the treatment of urinary incontinence and genital prolapse symptoms. Pelvic floor muscle training allows a reduction of urinary incontinence symptoms. Pelvic floor muscle contractions supervised by a healthcare professional allow cure in half cases of stress urinary incontinence. Viewing this contraction through biofeedback improves outcomes, but this effect could also be due by a more intensive and prolonged program with the physiotherapist. The place of electrostimulation remains unclear. The results obtained with vaginal cones are similar to pelvic floor muscle training with or without biofeedback or electrostimulation. It is not known whether pelvic floor muscle training has an effect after one year. In case of stress urinary incontinence, supervised pelvic floor muscle training avoids surgery in half of the cases at 1-year follow-up. Pelvic floor muscle training is the first-line treatment of post-partum urinary incontinence. Its preventive effect is uncertain. Pelvic floor muscle training may reduce the symptoms associated with genital prolapse. In conclusion, pelvic floor rehabilitation supervised by a physiotherapist is an effective short-term treatment to reduce the symptoms of urinary incontinence or pelvic organ prolapse.

  19. Clinical assessment of the impact of pelvic pain on women.

    PubMed

    Chalmers, K Jane; Catley, Mark J; Evans, Susan F; Moseley, G Lorimer

    2017-03-01

    We aimed to develop a questionnaire that assesses the impact of pelvic pain on women, regardless of diagnosis, that has high utility, sound psychometric performance, easy scoring, and high reliability. Two studies, with 3 separate cohorts, were undertaken. Both studies were completed online. Studies included women with self-reported pelvic pain. Women were eligible to participate regardless of whether their pelvic pain was undiagnosed, self-diagnosed, or diagnosed by a clinician. Study 1 used a 3-round "patient-as-expert" Delphi technique. These rounds defined the 10 aspects of life with the self-reported greatest impact on the lives of women with pelvic pain, which formed the questionnaire. Study 2 used Rasch analysis to assess the psychometric properties of the resultant 10-item questionnaire. To assess its reliability, a subgroup completed the questionnaire 3 times over a 3-week period. In study 1, 443 women with pelvic pain participated. The resultant 10-item questionnaire consisted of 8 Likert questions and 2 supplemental, nonscored questions. In study 2, 1203 women with pelvic pain completed the questionnaire. Rasch analysis showed that the questionnaire targeted the pelvic pain population well, had appropriate Likert categories, constituted a unidimensional scale, and showed internal consistency. Twenty-seven women with pelvic pain completed the reliability trial. Test-retest reliability was high (intraclass correlation coefficient 0.91, P < 0.001). The resultant Pelvic Pain Impact Questionnaire assesses the life impact of pelvic pain. It uses patient-generated language, is easily administered and scored, has very strong psychometric properties, and it is suitable for research and clinical settings across primary, secondary, and tertiary care.

  20. A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders

    PubMed Central

    Kanter, Gregg; Rogers, Rebecca G; Pauls, Rachel N; Kammerer-Doak, Dorothy; Thakar, Ranee

    2015-01-01

    Introduction and Hypothesis We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders. Methods This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the US and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical exams included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone per ICS guidelines. Results The cohort of 585 women was middle aged (mean age 54.9 +/−12.1) with 395 (67.5%) reporting sexual activity. Women with a strong pelvic floor (n=275) were more likely to report sexual activity than women with weak strength (n=280) (75.3 vs. 61.8%, p<0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs. 60.2%, normal vs. hypoactive, p=0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18–3.03, p<0.01). Among sexually active women (n=370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (Parameter Estimate 0.20+/−0.09, P=0.04), and FSFI orgasm domain (PE 0.51+/−0.17, P=0.004). Conclusion A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and orgasm domain of the FSFI. PMID:25994625

  1. Pelvic architectural distortion is associated with pelvic organ prolapse.

    PubMed

    Huebner, Markus; Margulies, Rebecca U; DeLancey, John O L

    2008-06-01

    The aim of this study was to determine whether there is an association between architectural distortion seen on magnetic resonance (MR) scans (lateral "spill" of the vagina and posterior extension of the space of Retzius) and pelvic organ prolapse. Secondary analysis of MR imaging scans from a case-control study of women with prolapse (maximum point > or = + 1 cm; N = 144) and normal controls (maximum point < or = -1 cm; N= 126) was done. Two independent investigators, blinded to prolapse status and previously established levator-defect scores, determined the presence of architectural distortion on axial MR scans. Women were categorized into three groups based on levator defects and architectural distortion. Among the three groups, women with levator defects and architectural distortion have the highest proportion of prolapse (78%; p < 0.001). Among women with levator defects, those with prolapse had an odds ratio of 2.2 for the presence of architectural distortion (95% CI = 1.1-4.6). Pelvic organ prolapse is associated with the presence of visible architectural distortion on MR scans.

  2. Pelvic Floor and Urinary Distress in Women with Fibromyalgia.

    PubMed

    Jones, Kim Dupree; Maxwell, Charlene; Mist, Scott D; King, Virginia; Denman, Mary Anna; Gregory, W Thomas

    2015-12-01

    Fibromyalgia (FM) patients were recently found to have more symptom burden from bothersome pelvic pain syndromes that women seeking care for pelvic floor disease at a urogynecology clinic. We sought to further characterize pelvic floor symptoms in a larger sample of FM patients using of validated questionnaires. Female listserv members of the Fibromyalgia Information Foundation completed an online survey of three validated questionnaires: the Pelvic Floor Distress Inventory 20 (PFDI-20), the Pelvic Pain, Urgency and Frequency Questionnaire (PUF), and the Revised Fibromyalgia Impact Questionnaire (FIQR). Scores were characterized using descriptive statistics. Patients (n = 204 with complete data on 177) were on average 52.3 ± 11.4 years with a mean parity of 2.5 ± 1.9. FM severity based on FIQR score (57.2 ± 14.9) positively correlated with PFDI-20 total 159.08 ± 55.2 (r = .34, p < .001) and PUF total 16.54 ± 7 (r = .36, p < .001). Women with FM report significantly bothersome pelvic floor and urinary symptoms. Fibromyalgia management should include evaluation and treatment of pelvic floor disorders recognizing that pelvic distress and urinary symptoms are associated with more severe FM symptoms. Validated questionnaires, like the ones used in this study, are easily incorporated into clinical practice.

  3. Effect of pelvic floor muscle exercises on pulmonary function

    PubMed Central

    Han, DongWook; Ha, Misook

    2015-01-01

    [Purpose] This study aimed to determine the correlation between pelvic floor muscle strength and pulmonary function. In particular, we examined whether pelvic floor muscle exercises can improve pulmonary function. [Subjects] Thirty female college students aged 19–21 with no history of nervous or musculoskeletal system injury were randomly divided into experimental and control groups. [Methods] For the pulmonary function test, spirometry items included forced vital capacity and maximal voluntary ventilation. Pelvic floor muscle exercises consisted of Kegel exercises performed three times daily for 4 weeks. [Results] Kegel exercises performed in the experimental group significantly improved forced vital capacity, forced expiratory volume in 1 second, PER, FEF 25–75%, IC, and maximum voluntary ventilation compared to no improvement in the control group. [Conclusion] Kegel exercises significantly improved pulmonary function. When abdominal pressure increased, pelvic floor muscles performed contraction at the same time. Therefore, we recommend that the use of pelvic floor muscle exercises be considered for improving pulmonary function. PMID:26644681

  4. PHYSICAL ACTIVITY AND THE PELVIC FLOOR

    PubMed Central

    Nygaard, Ingrid E.; Shaw, Janet M.

    2015-01-01

    Pelvic floor disorders (PFDs) are common, with one in four U.S. women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review is to summarize studies reporting the association between physical activity and PFDs. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include: Urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this exam finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for women. However

  5. Pelvic girdle shape predicts locomotion and phylogeny in batoids.

    PubMed

    Ekstrom, Laura J; Kajiura, Stephen M

    2014-01-01

    In terrestrial vertebrates, the pelvic girdle can reliably predict locomotor mode. Because of the diminished gravitational effects on positively buoyant bony fish, the same relationship does not appear to exist. However, within the negatively buoyant elasmobranch fishes, benthic batoids employ pelvic fin bottom-walking and punting as primary or supplementary forms of locomotion. Therefore, in this study, we employed geometric and linear morphometrics to investigate if their pelvic girdles exhibit shape characteristics similar to those of sprawling terrestrial vertebrates. We tested for correlates of pelvic girdle shape with 1) Order, 2) Family, 3) Swim Mode, and/or 4) Punt Mode. Landmarks and semilandmarks were placed along outlines of dorsal views of 61 batoid pelvic girdles (3/3 orders, 10/13 families, 35/72 genera). The first three relative warps explained 88.45% of the variation among individuals (P < 0.01%). Only Order and Punt Mode contained groups that were all significantly different from each other (P < 0.01%). Discriminant function analyses indicated that the majority of variation within each category was due to differences in extension of lateral and prepelvic processes and puboischiac bar angle. Over 60% of the original specimens and 55% of the cross-validated specimens were correctly classified. The neutral angle of the propterygium, which articulates with the pelvic girdle, was significantly different among punt modes, whereas only pectoral fin oscillators had differently shaped pelvic girdles when compared with batoids that perform other swimming modes (P < 0.01). Pelvic girdles of batoids vary greatly, and therefore, likely function in ways not previously described in teleost fishes. This study illustrates that pelvic girdle shape is a good predictor of punt mode, some forms of swimming mode, and a species' Order. Such correlation between locomotor style and pelvic girdle shape provides evidence for the convergent evolution of

  6. Metabolic Response of Lymph Nodes Immediately After RT Is Related With Survival Outcome of Patients With Pelvic Node-Positive Cervical Cancer Using Consecutive [{sup 18}F]fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

    SciTech Connect

    Yoon, Mee Sun; Ahn, Sung-Ja; Nah, Byung-Sik; Chung, Woong-Ki; Song, Ho-Chun; Yoo, Su Woong; Song, Ju-Young; Jeong, Jae-Uk; Nam, Taek-Keun

    2012-11-15

    Purpose: To evaluate the metabolic response of uterine cervix and pelvic lymph nodes (LNs) using consecutive {sup 18}F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) immediately after RT and to correlate survival outcome with the metabolic response. Methods and Materials: We retrospectively reviewed 48 patients with cervical cancer who had positive pelvic LNs by preradiation therapy (pre-RT) PET/CT. All patients underwent PET/CT scans immediately after RT (inter-RT PET/CT) after median 63 Gy to the gross LNs. The metabolic response of the LNs was assessed quantitatively and semiquantitatively by measurement of the maximal standardized uptake value (SUV{sub max}). Results: Classifying the metabolic response of all nodal lesions, 37 patients (77%) had LNs with complete metabolic response on the inter-RT PET/CT (LNCMRi), and 11 patients had a non-LNCMRi, including 4 patients with progressive metabolic disease. The overall 3-year survival rates were 83% for the patients with LNCMRi and 73% for the non-LNCMRi group (P=.038). The disease-free survival for patients with LNCMRi were significantly better than that for the non-LNCMRi group (71% vs 18%, respectively, P<.001). The 3-year distant metastasis-free survival rates were 79% for the patients with LNCMRi and 27% for the non-LNCMRi group (P<.001). There were no statistically significant differences in overall survival (76% vs 86%, respectively, P=.954) and disease-free survival rates (58% vs 61%, respectively, P=.818) between the CMR of primary cervical tumor and the non-CMR groups. Conclusions: The results showed a significant correlation between survival outcome and the interim metabolic response of pelvic LNs. CMR of nodal lesion on inter-RT PET/CT had excellent overall survival, disease-free survival and distant metastasis-free survival rates. This suggested that PET/CT immediately after RT can be a useful tool for the evaluation of the interim response of the LNs and identify a subset

  7. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study

    PubMed Central

    Scaldazza, Carlo Vecchioli; Morosetti, Carolina; Giampieretti, Rosita; Lorenzetti, Rossana; Baroni, Marinella

    2017-01-01

    ABSTRACT Introduction This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS. PMID:28124534

  8. Open Pelvic Fractures: Review of 30 Cases

    PubMed Central

    Giordano, Vincenzo; Koch, Hilton Augusto; Gasparini, Savino; Serrão de Souza, Felipe; Labronici, Pedro José; do Amaral, Ney Pecegueiro

    2016-01-01

    Background: Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval. Patients and Methods: In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%. Results: Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the

  9. The morphogenesis of the arteries of the pelvic extremity. A comparative study of mammals with special reference to the tree shrew Tupaia belangeri (Tupaiidae, Scandentia, Mammalia).

    PubMed

    Funke, C; Kuhn, H J

    1998-01-01

    The ontogeny of the arteries of the pelvic extremity of Tupaia belangeri was investigated by light microscopy on the basis of serial sections of 30 embryos, dating from day 17 to day 42 post-copulation. In Tupaia, the gestational period takes approximately 43 days. Additionally, a 3-D reconstruction of the pelvic region and the right leg of a 22-day embryo was prepared. The arteries of an adult Tupaia were studied on the basis of a corrosion cast. The results were compared with the ontogeny of the arterial system of other mammals. In the 17-day embryo, the anlage of the pelvic extremity is penetrated by a capillary plexus. In the 18-day embryo, the a. ischiadica reaches the pelvic limb bud, representing the primary axial artery. On day 19, its r. perforans tarsi extends from the plantar to the dorsal aspect of the foot plate. The a. ischiadica is the main artery of the leg until the stage of the 22-day embryo. Afterwards, the peripheral arteries supplied by it are taken over by the a. iliaca externa and its extension, the a. femoralis. The a. iliaca externa springs from the a. iliaca communis in the 19-day embryo. From day 21 to day 22, the capillary plexus, which is nourished by the a. femoralis, closely approaches the a. ischiadica, and finally, a connecting branch joins the a. ischiadica. The a. ischiadica is then reduced to the a. glutea caudalis, and the aa. femoralis, poplitea profunda (at the cranial aspect of the m. popliteus), and interossea become the main arteries of the pelvic extremity. The a. poplitea superficialis, lying at the caudal aspect of the m. popliteus, and its continuation in the crural region, the a. peronea, develop until the 25-day embryo. The a. peronea gives rise to an r. perforans which penetrates the membrana interossea towards the dorsum of the foot. As a result of a shift of the origin of the a. iliaca externa in the proximal direction, the length of the a. iliaca communis gradually decreases until, on day 24, the a. iliaca externa

  10. Musculoskeletal etiologies of pelvic pain.

    PubMed

    Prather, Heidi; Camacho-Soto, Alejandra

    2014-09-01

    Several musculoskeletal diagnoses are frequently concomitant with pelvic floor pathology and pain. The definition of pelvic pain itself often depends on the medical specialist evaluating the patient. Because there is variability among disorders associated with pelvic pain, patients may seek treatment for extended periods as various treatment options are attempted. Further, health care providers should recognize that there may not be a single source of dysfunction. This article discusses the musculoskeletal disorders of the pelvic girdle (structures within the bony pelvis) and their association with lumbar spine and hip disorders.

  11. Detroit Research on Cancer Survivors Study

    Cancer.gov

    An NCI press release about the launch of the Detroit Research on Cancer Survivors (ROCS) study, which will look at factors affecting cancer progression, recurrence, mortality, and quality of life among African-American cancer survivors.

  12. Can I prevent Pelvic Organ Prolapse

    MedlinePlus

    ... That Answers to FAQs Learn the Terms Glossary Pelvic Floor Dialogues Printable PDFs on PFDs Patient Fact Sheets ... or retrain the nerves and muscles of the pelvic floor. Regular daily exercising of the pelvic muscles can ...

  13. Impact of conventional fractionated RT to pelvic lymph nodes and dose-escalated hypofractionated RT to prostate gland using IMRT treatment delivery in high-risk prostate cancer

    NASA Astrophysics Data System (ADS)

    Pervez, Nadeem

    Prostate cancer is the most common cancer among Canadian men. The standard treatment in high-risk category is radical radiation, with androgen suppression treatment (AST). Significant disease progression is reported despite this approach. Radiation dose escalation has been shown to improve disease-free survival; however, it results in higher toxicities. Hypofractionated radiation schedules (larger dose each fraction in shorter overall treatment time) are expected to deliver higher biological doses. A hypofractionated scheme was used in this study to escalate radiation doses with AST. Treatment was well tolerated acutely. Early results of self-administered quality of life reported by patients shows a decrease in QOL which is comparable to other treatment schedules. Significant positional variation of the prostate was observed during treatment. Therefore, we suggest daily target verification to avoid a target miss. Initial late effects are reasonable and early treatment outcomes are promising. Longer follow-up is required for full outcomes assessments.

  14. The extent and serial pattern of interfractional variation in patients with whole pelvic irradiation: a study using a kilovoltage orthogonal on-board imager.

    PubMed

    Yoon, Won Sup; Yang, Dae Sik; Lee, Jung Ae; Lee, Suk; Park, Young Je; Kim, Chul Yong

    2012-03-08

    The purpose of this study is to assess the extent and serial pattern of setup error of conventional fractionated whole pelvic irradiation using a kilovoltage on-board imager. The daily on-board images of 69 patients were matched with the digitally reconstructed radiographs of simulation on the basis of pelvic bony structure. The shifts along x- (lateral), y- (longitudinal), and z- (vertical) axes, and the 3D vector, were measured. The shift between an origin of the first fraction and each fraction (Δshift(1st)) and the shift between an isocenter of simulation and each fraction (Δshift(Sim)) were calculated. To evaluate serial changes, the shifts of each fraction were classified into four consecutive sessions, and an ANOVA and chi-square test were used. The systematic error of the Δshift(Sim) and Δshift(1st) were 2.72 and 1.43 mm along the x-axis, 2.98 and 1.28 mm along the y-axis, and 4.26 and 2.39 mm along the z-axis, respectively. The Δshift(Sim) and Δshift(1st) ≥ 5 mm of the 3D vector occurred in 54.3% and 23.1%, respectively. The recommended margins to cover setup error in case of using Δshift(1st) were 3.81, 3.54, and 6.01 mm along x-, y-, and z-axes, whereas those using Δshift(Sim) were 6.39, 6.95, and 9.95 mm, respectively. With the passage of time, the Δshift(1st) ≥ 5 mm of 3D vector and along any axis in supine setup increased from 14.1% for first session to 22.5% for fourth session (p=0.027) and from 10.8% to 18.5% (p = 0.034), respectively. In prone setup, first session was better than others in the Δshift(1st) ≥ 5 mm of 3D vector and along any axis. It is expected that the correction using the on-board images on the first fraction improves geometrical uncertainties and reduces the margin for target coverage. Daily continuous OBI follow-up during conventional fractionated pelvic irradiation can increase the reproducibility and be more effective in the late period.

  15. The effects of selective breeding on the architectural properties of the pelvic limb in broiler chickens: a comparative study across modern and ancestral populations

    PubMed Central

    Paxton, Heather; Anthony, Nicolas B; Corr, Sandra A; Hutchinson, John R

    2010-01-01

    Intensive artificial selection has led to the production of the modern broiler chicken, which over the last few decades has undergone a dramatic increase in growth rate and noticeable changes in body conformation. Unfortunately, this has been associated with musculoskeletal abnormalities which have altered the walking ability of these birds, raising obvious welfare concerns, as well as causing economic losses. Here we present a comparative study of ancestral and derived muscle anatomy in chickens to begin to tease apart how evolutionary alterations of muscle form in chickens have influenced their locomotor function and perhaps contributed to lameness. We measured the muscle architectural properties of the right pelvic limb in 50 birds, including the Giant Junglefowl, a commercial strain broiler and four pureline commercial broiler breeder lines (from which the broiler populations are derived) to identify which features of the broiler’s architectural design have diverged the most from the ancestral condition. We report a decline in pelvic limb muscle mass in the commercial line birds that may compromise their locomotor abilities because they carry a larger body mass. This greater demand on the pelvic limb muscles has mostly led to changes in support at the hip joint, revealing significantly larger abductors and additionally much larger medial rotators in the broiler population. Differences were seen within the commercial line bird populations, which are likely attributed to different selection pressures and may reflect differences in the walking ability of these birds. In addition, Junglefowl seem to have both greater force-generating capabilities and longer, presumably faster contracting muscles, indicative of superior musculoskeletal/locomotor function. We have provided baseline data for generating hypotheses to investigate in greater depth the specific biomechanical constraints that compromise the modern broiler’s walking ability and propose that these

  16. [The role of ultrasound in the exploration of pelvic floor disorders].

    PubMed

    Lapray, J-F; Costa, P; Delmas, V; Haab, F

    2009-12-01

    Dynamic ultrasound, especially perineal and introital, allows the appreciation of the prolapses (cystoptosis, bladder neck and urethral mobility,enterocele, rectocele). It remains, however, clearly more limited in the precise study of posterior colpoceles, and especially in anorectal disorders, than colpocystodefecography or dynamic MRI. Endoanal ultrasound is the first line morphological examination of the anal sphincter. Perineal and introital ultrasound examinations are useful to appreciate certain complications with suburethral tape and pelvic mesh. For an appreciaton of the morphology of the pelvis and post-mictional residual, the ultrasound remains the first line examination. Pelvic and endovaginal ultrasounds should be systematic, in the absence of MRI, in the presurgical assessment of a prolapse: checks for an ovarian lesion or endrometrial cancer (obesity being a risk factor in the menopaused woman), evaluation of uterine volume in the younger woman.

  17. [Pelvic hydatid yst: apropos of 8 cases].

    PubMed

    Laghzaoui Boukaidi, M; Bouhya, S; Soummani, A; Hermas, S; Bennan, O; Sefrioui, O; Aderdour, M

    2001-05-01

    The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.

  18. Testing of the Anorectal and Pelvic Floor Area

    MedlinePlus

    ... minutes and is well tolerated by most people. Balloon capacity and compliance A balloon capacity and compliance ... while measurements of volume and pressure are recorded. Balloon evacuation study A balloon evacuation study tests pelvic ...

  19. Study of penile circulation before and after radiation in patients with prostate cancer and its effect on impotence

    SciTech Connect

    Mittal, B.

    1985-06-01

    Decrease in penile blood flow has been implicated as the cause of erectile impotence in patients receiving pelvic irradiation. To determine any changes in the penile circulation secondary to pelvic irradiation, the authors measured the penile blood flow before and 6-9 months following completion of irradiation in six patients with prostate cancer. None of these patients had hormonal manipulation. The non-invasive techniques of Penile Brachial Index (PBI) and Penile Flow Index (PFI) were used to study penile circulation. Two patients developed impotence 2 to 4 1/2 months following completion of irradiation. There was no significant change in penile blood flow following irradiation in any of the six patients studied. The etiology of post-irradiation impotence is probably multifactorial and it may be an oversimplification to attribute it to a single organic cause.

  20. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality.

    PubMed

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty.

  1. Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

    PubMed Central

    Zhou, Xiaoxiao; Wang, Qi; Zhang, Xianlong; Chen, Yunsu; Peng, Xiaochun; Mao, Yuanqing; Yang, Yang; Fu, Beigang; Wang, Xiuhui; Tang, Tingting

    2015-01-01

    Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty. PMID:26673427

  2. Knowledge of the pelvic floor in nulliparous women

    PubMed Central

    Neels, Hedwig; Wyndaele, Jean-Jacques; Tjalma, Wiebren A. A.; De Wachter, Stefan; Wyndaele, Michel; Vermandel, Alexandra

    2016-01-01

    [Purpose] Proper pelvic floor function is important to avoid serious dysfunctions including incontinence, prolapse, and sexual problems. The current study evaluated the knowledge of young nulliparous women about their pelvic floor and identified what additional information they wanted. [Subjects and Methods] In this cross-sectional survey, a validated, 36 item questionnaire was distributed to 212 nulliparous women. The questionnaire addressed demography, pelvic floor muscles, pelvic floor dysfunction, and possible information sources. Descriptive statistics were generated for all variables. Stability and validity testing were performed using Kappa statistics and intra class correlation coefficients to define agreement for each question. The study was approved by the ethics Committee (B300201318334). [Results] Using a VAS scale (0 to 10), the women rated their knowledge about the pelvic floor as a mean of 2.4 (SD 2.01). A total of 93% of the women were insufficiently informed and requested more information; 25% had concerns about developing urinary incontinence, and 14% about fecal incontinence. Many of the women were unaware what pelvic floor training meant. [Conclusion] There was a significant lack of knowledge about pelvic floor function among nulliparous women. The majority of nulliparous women expressed a need for education, which might offer a way to reduce dysfunction. PMID:27313364

  3. Knowledge of the pelvic floor in nulliparous women.

    PubMed

    Neels, Hedwig; Wyndaele, Jean-Jacques; Tjalma, Wiebren A A; De Wachter, Stefan; Wyndaele, Michel; Vermandel, Alexandra

    2016-05-01

    [Purpose] Proper pelvic floor function is important to avoid serious dysfunctions including incontinence, prolapse, and sexual problems. The current study evaluated the knowledge of young nulliparous women about their pelvic floor and identified what additional information they wanted. [Subjects and Methods] In this cross-sectional survey, a validated, 36 item questionnaire was distributed to 212 nulliparous women. The questionnaire addressed demography, pelvic floor muscles, pelvic floor dysfunction, and possible information sources. Descriptive statistics were generated for all variables. Stability and validity testing were performed using Kappa statistics and intra class correlation coefficients to define agreement for each question. The study was approved by the ethics Committee (B300201318334). [Results] Using a VAS scale (0 to 10), the women rated their knowledge about the pelvic floor as a mean of 2.4 (SD 2.01). A total of 93% of the women were insufficiently informed and requested more information; 25% had concerns about developing urinary incontinence, and 14% about fecal incontinence. Many of the women were unaware what pelvic floor training meant. [Conclusion] There was a significant lack of knowledge about pelvic floor function among nulliparous women. The majority of nulliparous women expressed a need for education, which might offer a way to reduce dysfunction.

  4. Sexual selection targets cetacean pelvic bones

    PubMed Central

    Dines, J. P.; Otárola-Castillo, E.; Ralph, P.; Alas, J.; Daley, T.; Smith, A. D.; Dean, M. D.

    2014-01-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis which seems to serve no other function except to anchor muscles that maneuver the penis. Here we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: 1) males from species with relatively intense sexual selection (inferred by relative testes size) have evolved relatively large penises and pelvic bones compared to their body size, and 2) pelvic bone shape diverges more quickly in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time. PMID:25186496

  5. Sexual selection targets cetacean pelvic bones.

    PubMed

    Dines, James P; Otárola-Castillo, Erik; Ralph, Peter; Alas, Jesse; Daley, Timothy; Smith, Andrew D; Dean, Matthew D

    2014-11-01

    Male genitalia evolve rapidly, probably as a result of sexual selection. Whether this pattern extends to the internal infrastructure that influences genital movements remains unknown. Cetaceans (whales and dolphins) offer a unique opportunity to test this hypothesis: since evolving from land-dwelling ancestors, they lost external hind limbs and evolved a highly reduced pelvis that seems to serve no other function except to anchor muscles that maneuver the penis. Here, we create a novel morphometric pipeline to analyze the size and shape evolution of pelvic bones from 130 individuals (29 species) in the context of inferred mating system. We present two main findings: (1) males from species with relatively intense sexual selection (inferred by relative testes size) tend to evolve larger penises and pelvic bones compared to their body length, and (2) pelvic bone shape has diverged more in species pairs that have diverged in inferred mating system. Neither pattern was observed in the anterior-most pair of vertebral ribs, which served as a negative control. This study provides evidence that sexual selection can affect internal anatomy that controls male genitalia. These important functions may explain why cetacean pelvic bones have not been lost through evolutionary time.

  6. Laparoscopy for pelvic floor disorders.

    PubMed

    Van Geluwe, B; Wolthuis, A; D'Hoore, A

    2014-02-01

    Surgical treatment of pelvic floor disorders has significantly evolved during the last decade, with increasing understanding of anatomy, pathophysiology and the minimally-invasive 'revolution' of laparoscopic surgery. Laparoscopic pelvic floor repair requires a thorough knowledge of pelvic floor anatomy and its supportive components before repair of defective anatomy is possible. Several surgical procedures have been introduced and applied to treat rectal prolapse syndromes. Transabdominal procedures include a variety of rectopexies with the use of sutures or prosthesis and with or without resection of redundant sigmoid colon. Unfortunately there is lack of one generally accepted standard treatment technique. This article will focus on recent advances in the management of pelvic floor disorders affecting defecation, with a brief overview of contemporary concepts in pelvic floor anatomy and different laparoscopic treatment options.

  7. Pelvic skeleton reduction and Pitx1 expression in threespine stickleback populations.

    PubMed

    Bell, Michael A; Ellis, Kaitlyn E; Sirotkin, Howard I

    2007-01-01

    The pelvic skeleton of threespine stickleback fish contributes to defence against predatory vertebrates, but rare populations exhibit vestigial pelvic phenotypes. Low ionic strength water and absence of predatory fishes are associated with reduction of the pelvic skeleton, and lack of Pitx1 expression in the pelvic region is evidently the genetic basis for pelvic reduction in several populations. Pelvic vestiges in most populations are larger on the left (left-biased), apparently because Pitx2 is expressed only on that side. We used whole-mount in situ hybridization to study Pitx1 expression in 19 populations of Gasterosteus aculeatus from lakes around Cook Inlet, Alaska, USA. As expected, specimens from six populations with full pelvic structures usually expressed Pitx1 in the limb bud; those from eight populations with left-biased pelvic reduction usually did not express it. Specimens from one of three populations with right-biased or unbiased pelvic reduction sometimes expressed Pitx1. One of two populations in which the pelvic spines (but not the girdle) are usually absent often expressed Pitx1. In terms of Jacob's 1977 'tinkering' metaphor, Pitx1 was the spare part with which natural selection usually tinkered for stickleback pelvic reduction, but it also tinkered with other genes that have smaller effects.

  8. Adjuvant Chemotherapy With or Without Pelvic Radiotherapy After Simultaneous Surgical Resection of Rectal Cancer With Liver Metastases: Analysis of Prognosis and Patterns of Recurrence

    SciTech Connect

    An, Ho Jung; Yu, Chang Sik; Yun, Sung-Cheol; Kang, Byung Woog; Hong, Yong Sang; Lee, Jae-Lyun; Ryu, Min-Hee; Chang, Heung Moon; Park, Jin Hong; Kim, Jong Hoon; Kang, Yoon-Koo; Kim, Jin Cheon; Kim, Tae Won

    2012-09-01

    Purpose: To investigate the outcomes of adjuvant chemotherapy (CT) or chemoradiotherapy (CRT) after simultaneous surgical resection in rectal cancer patients with liver metastases (LM). Materials and Methods: One hundred and eight patients receiving total mesorectal excision for rectal cancer and surgical resection for LM were reviewed. Forty-eight patients received adjuvant CRT, and 60 were administered CT alone. Recurrence patterns and prognosis were analyzed. Disease-free survival (DFS) and overall survival (OS) rates were compared between the CRT and CT groups. The inverse probability of the treatment-weighted (IPTW) method based on the propensity score was used to adjust for selection bias between the two groups. Results: At a median follow-up period of 47.7 months, 77 (71.3%) patients had developed recurrences. The majority of recurrences (68.8%) occurred in distant organs. By contrast, the local recurrence rate was only 4.7%. Median DFS and OS were not significantly different between the CRT and CT groups. After applying the IPTW method, we observed no significant differences in terms of DFS (hazard ratio [HR], 1.347; 95% confidence interval [CI], 0.759-2.392; p = 0.309) and OS (HR, 1.413; CI, 0.752-2.653; p = 0.282). Multivariate analyses showed that unilobar distribution of LM and normal preoperative carcinoembryonic antigen level (<6 mg/mL) were significantly associated with longer DFS and OS. Conclusions: The local recurrence rate after simultaneous resection of rectal cancer with LM was relatively low. DFS and OS rates were not different between the adjuvant CRT and CT groups. Adjuvant CRT may have a limited role in this setting. Further prospective randomized studies are required to evaluate optimal adjuvant treatment in these patients.

  9. Study on the influence of the fetus head molding on the biomechanical behavior of the pelvic floor muscles, during vaginal delivery.

    PubMed

    Silva, M E T; Oliveira, D A; Roza, T H; Brandão, S; Parente, M P L; Mascarenhas, T; Natal Jorge, R M

    2015-06-25

    Pelvic floor injuries during vaginal delivery are considered a significant risk factor to develop pelvic floor dysfunction. The molding of the fetus head during vaginal delivery facilitates the labor progress, since it adjusts to the birth canal geometry. In this work, a finite element model was used to represent the effects induced by the passage of the fetus head on the pelvic floor. The numerical model used for this simulation included the pelvic floor muscles attached to the bones, and a fetus body. The model of the fetus head included the skin and soft tissues, the skull with sutures and fontanelles, and the brain. The fetus head movements during birth in vertex position were simulated: descent, internal rotation and extension. Two models of the fetus head were compared: a rigid and a deformable one, with the inclusion of the cranial sutures. The influence of the fetus head molding on the pelvic floor muscles was analyzed by evaluating their reaction forces, stretch, and stress and strain fields. Additionally, anatomical indices for the molding of the fetal skull were obtained and compared with clinical data. The passage of the deformable fetus head through the birth canal leads to a reduction of 17.3% on the reaction forces on the pelvic floor muscles when compared to the ones of a rigid head. Furthermore, the fetus head molding implies inferior resistance to rotation resulting in a reduction of 1.86% in muscle stretching. Quantitative evaluation of the fetus head molding showed good agreement with clinical experiments.

  10. Evaluation of stereotactic body radiotherapy (SBRT) boost in the management of endometrial cancer.

    PubMed

    Demiral, S; Beyzadeoglu, M; Uysal, B; Oysul, K; Kahya, Y Elcim; Sager, O; Dincoglan, F; Gamsiz, H; Dirican, B; Surenkok, S

    2013-01-01

    The purpose of this study is to evaluate the use of linear accelerator (LINAC)-based stereotactic body radiotherapy (SBRT) boost with multileaf collimator technique after pelvic radiotherapy (RT) in patients with endometrial cancer. Consecutive patients with endometrial cancer treated using LINAC-based SBRT boost after pelvic RT were enrolled in the study. All patients had undergone surgery including total abdominal hysterectomy and bilateral salpingo-oophorectomy ± pelvic/paraortic lymphadenectomy before RT. Prescribed external pelvic RT dose was 45 Gray (Gy) in 1.8 Gy daily fractions. All patients were treated with SBRT boost after pelvic RT. The prescribed SBRT boost dose to the upper two thirds of the vagina including the vaginal vault was 18 Gy delivered in 3 fractions with 1-week intervals. Gastrointestinal and genitourinary toxicity was assessed using the Common Terminology Criteria for Adverse Events version 3 (CTCAE v3).Between April 2010 and May 2011, 18 patients with stage I-III endometrial cancer were treated with LINAC-based SBRT boost after pelvic RT. At a median follow-up of 24 (8-26) months with magnetic resonance imaging (MRI) and gynecological examination, local control rate of the study group was 100 % with negligible acute and late toxicity.LINAC-based SBRT boost to the vaginal cuff is a feasible gynecological cancer treatment modality with excellent local control and minimal toxicity that may replace traditional brachytherapy boost in the management of endometrial cancer.

  11. Locally vascularized pelvic accessory spleen.

    PubMed

    Iorio, F; Frantellizzi, V; Drudi, Francesco M; Maghella, F; Liberatore, M

    2016-01-01

    Polysplenism and accessory spleen are congenital, usually asymptomatic anomalies. A rare case of polysplenism with ectopic spleen in pelvis of a 67-year-old, Caucasian female is reported here. A transvaginal ultrasound found a soft well-defined homogeneous and vascularized mass in the left pelvis. Patient underwent MRI evaluation and contrast-CT abdominal scan: images with parenchymal aspect, similar to spleen were obtained. Abdominal scintigraphy with 99mTc-albumin nanocolloid was performed and pelvic region was studied with planar scans and SPECT. The results showed the presence of an uptake area of the radiopharmaceutical in the pelvis, while the spleen was normally visualized. These findings confirmed the presence of an accessory spleen with an artery originated from the aorta and a vein that joined with the superior mesenteric vein. To our knowledge, in the literature, there is just only one case of a true ectopic, locally vascularized spleen in the pelvis.

  12. Consensus Guidelines for Delineation of Clinical Target Volume for Intensity-Modulated Pelvic Radiotherapy for the Definitive Treatment of Cervix Cancer

    SciTech Connect

    Lim, Karen; Portelance, Lorraine; Creutzberg, Carien; Juergenliemk-Schulz, Ina M.; Mundt, Arno; Mell, Loren K.; Mayr, Nina; Viswanathan, Akila; Jhingran, Anuja; Erickson, Beth; De Los Santos, Jennifer; Gaffney, David; Yashar, Catheryn; Beriwal, Sushil; Wolfson, Aaron

    2011-02-01

    Purpose: Accurate target definition is vitally important for definitive treatment of cervix cancer with intensity-modulated radiotherapy (IMRT), yet a definition of clinical target volume (CTV) remains variable within the literature. The aim of this study was to develop a consensus CTV definition in preparation for a Phase 2 clinical trial being planned by the Radiation Therapy Oncology Group. Methods and Materials: A guidelines consensus working group meeting was convened in June 2008 for the purposes of developing target definition guidelines for IMRT for the intact cervix. A draft document of recommendations for CTV definition was created and used to aid in contouring a clinical case. The clinical case was then analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with kappa statistics as a measure of agreement between participants. Results: Nineteen experts in gynecological radiation oncology generated contours on axial magnetic resonance images of the pelvis. Substantial STAPLE agreement sensitivity and specificity values were seen for gross tumor volume (GTV) delineation (0.84 and 0.96, respectively) with a kappa statistic of 0.68 (p < 0.0001). Agreement for delineation of cervix, uterus, vagina, and parametria was moderate. Conclusions: This report provides guidelines for CTV definition in the definitive cervix cancer setting for the purposes of IMRT, building on previously published guidelines for IMRT in the postoperative setting.

  13. Delayed complication of pelvic lymphocele: Ileal conduit obstruction.

    PubMed

    Bankar, Sanket S; Bakshi, Ganesh K; Prakash, Gagan; Sable, Nilesh P

    2015-01-01

    Radical cystectomy is the standard treatment for muscle invasive bladder cancer. Lymphocele is a common sequalae of pelvic lymphadenectomy. We report an unusual presentation of pelvic lymphocele developing after radical cystectomy reconstructed with an ileal conduit where the patient developed obstruction of the ileal conduit loop due to external pressure of the lymphocele. Catheter drainage of the conduit relieved the symptoms and a computerized tomography scan showed a large lymphocele causing acute angulation and resultant obstruction of the ileal conduit. The patient was treated with percutaneous drainage of the lymphocele and remains symptom-free on follow-up at 1 year.

  14. Pelvic Floor Ultrasound: A Review.

    PubMed

    Dietz, Hans Peter

    2017-03-01

    Female pelvic floor dysfunction encompasses a number of prevalent conditions and includes pelvic organ prolapse, urinary and fecal incontinence, obstructed defecation, and sexual dysfunction. In most cases neither etiology nor pathophysiology are well understood. Imaging has great potential to enhance both research and clinical management capabilities, and to date this potential is underutilized. Of the available techniques such as x-ray, computed tomography, magnetic resonance imaging, and ultrasound, the latter is generally superior for pelvic floor imaging, especially in the form of perineal or translabial imaging. The technique is safe, simple, cheap, easily accessible and provides high spatial and temporal resolutions.

  15. Loneliness May Sabotage Breast Cancer Survival: Study

    MedlinePlus

    ... gov/news/fullstory_162498.html Loneliness May Sabotage Breast Cancer Survival: Study Weak social ties linked to higher ... 2016 (HealthDay News) -- Loneliness may impede long-term breast cancer survival, a new study suggests. In the years ...

  16. Outcome after Surgery for Metastases to the Pelvic Bone: A Single Institutional Experience

    PubMed Central

    Krishnan, Chandra Kumar; Kim, Han-Soo

    2017-01-01

    Background The pelvic bone is the most common site of bone metastases following the axial skeleton. Surgery on the pelvic bone is a demanding procedure. Few studies have been published on the surgical outcomes of metastasis to the pelvic bone with only small numbers of patients involved. This study sought to analyze the complications, local progression and survival after surgery for metastasis to the pelvic bone on a larger cohort of patients. Methods We analyzed 83 patients who underwent surgery for metastases to the pelvic bone between the years 2000 and 2015. There were 41 men and 42 women with a mean age of 55 years. Possible factors that might be associated with complications, local progression and survival were investigated with regard to patient demographics and disease-related and treatment-related variables. Results The overall complication rate was 16% (13/83). Advanced age (> 55 years, p = 0.034) and low preoperative serum albumin levels (≤ 39 g/L, p = 0.001) were associated with increased complication rates. In patients with periacetabular disease, the complication rate was higher in those who underwent total hip replacement arthroplasty (THR) than those who did not (p = 0.030). Local progression rate was 46% (37/83). The overall median time to local progression was 26 ± 14.3 months. The median time from local progression to death was 13 months (range, 0 to 81 months). The local progression-free survival was 52.6% ± 6.4% at 2 years and 36.4%± 7.6% at 5 years, respectively. Presence of skip lesions (p = 0.017) and presence of visceral metastasis (p = 0.027) were found to be significantly associated with local progression. The median survival of all patients was 24 months. The 2-year and 3-year survival rates were 52.5% ± 5.9% and 35.6% ± 6%, respectively. Metastasis from the kidney, breast, or thyroid or of hematolymphoid origin (p = 0.014), absence of visceral metastasis (p = 0.017) and higher preoperative serum albumin levels (p = 0.009) were

  17. Body Image and Sexuality in Women with Pelvic Organ Prolapse

    PubMed Central

    Zielinski, Ruth; Low, Lisa Kane; Tumbarello, Julie; Miller, Janis M.

    2010-01-01

    Body image, including how a woman views her genitals, has been shown to impact sexuality. Currently, there are no valid and reliable questionnaires to assess body image specific to women with genital changes from pelvic organ prolapse. The purpose of this study was to assess implementation of a body image questionnaire in women with pelvic organ prolapse. The Vaginal Changes Sexual and Body Esteem Scale showed utility and potential for demonstrating change in body image after prolapse surgery. PMID:19718939

  18. Reduction of irradiated small bowel volume with Trendelenburg position in gynecologic pelvic radiotherapy.

    PubMed

    Dirier, A; Adli, M; Andic, F; Cifci, S; Ors, Y; Kuzhan, A

    2010-04-01

    The aim of this study was to assess the effect of Trendelenburg position in comparison to prone position on small bowel volume and treatment dose in gynecologic pelvic external beam radiotherapy using three-dimensional conformal treatment plans. Eight patients with gynecologic cancers, treated with definitive or postoperative pelvic radiotherapy were investigated. Pelvic computerized tomography (CT) scans for treatment planning were performed in prone and 25 degree Trendelenburg positions for each patient. The dose-volume histograms of small bowel within the treatment fields were obtained and compared for both positions. The clinical target volume (CTV) and the planning target volume (PTV) were also defined and evaluated in the subjects. Treatment dose was 5040 cGy to PTV with 180 cGy daily fraction doses in both techniques for all patients. The average irradiated small bowel volume was 726 cc for prone position and 458 cc for the Trendelenburg position. The average irradiated small bowel volume reduction in the Trendelenburg position was 38.0% (95% CI 19.5 +/- 38%) compared with the prone position. The average small bowel percent dose was 25.4% (1280 cGy) for Trendelenburg position and 39.9% (2010 cGy) for prone position. PTV doses were similar in both techniques. The results of this dosimetric study suggest that gynecologic pelvic radiotherapy in the Trendelenburg position decreases the volume of irradiated small bowel compared to prone position and may decrease treatment related small bowel morbidity. Clinical benefit of this position should be evaluated in further clinical studies.

  19. LUCIS: lung cancer imaging studies.

    PubMed

    Harders, Stefan Walbom

    2012-11-01

    Pulmonary nodules are of high clinical importance, as they may prove to be an early manifestation of lung cancer. Pulmonary nodules are small, focal opacities that may be solitary or multiple. A solitary pulmonary nodule (SPN) is a single, small (= 30 mm in diameter) radiographic opacity. Larger opacities are called masses and are often malignant. As imaging techniques improve and more nodules are detected, the optimal management of SPNs remains unclear. Current strategies include tissue sampling or CT follow-up. The aim of this PhD was to examine current non-invasive methods used to characterise pulmonary nodules and masses in patients with suspected lung cancer and to stage NSCLC. In doing so, this PhD helps to validate the existing methods used to diagnose and stage lung cancer correctly and, hopefully, aids in the development of new methods. In the first study, 213 participants with pulmonary nodules on CT were examined with an additional HRCT. In this study, it was concluded that HRCT of a solitary pulmonary nodule, assessed using attenuation and morphological criteria is a fast, widely available and effective method for diagnosing lung cancer correctly, and especially for ruling out cancer. In the second study, 168 patients with pulmonary lesions on CT were examined with an additional F-18-FDG PET/CT. It was concluded that when used early in the work-up of the lesions, CT raised the prevalence of lung cancer in the population to the point at which further diagnostic imaging examination could be considered redundant. Standard contrast-enhanced CT seems better suited to identify patients with lung cancer than to rule out cancer. Finally, the overall diagnostic accuracy as well as the classification probabilities and predictive values of the two modalities were not significantly different. The reproducibility of the above results was substantial. In the third study, 59 patients with pulmonary nodules or masses on chest radiography were examined with an

  20. Preoperative Capecitabine and Pelvic Radiation in Locally Advanced Rectal Cancer-Is it Equivalent to 5-FU Infusion Plus Leucovorin and Radiotherapy?

    SciTech Connect

    Chan, Alexander K.; Wong, Alfred O.; Jenken, Daryl A.

    2010-04-15

    Purpose: The aim of this retrospective case-matching study was to compare the treatment outcomes and acute toxicity of preoperative radiotherapy (RT) with capecitabine vs. preoperative RT with intermittent 5-fluorouracil (5-FU) infusion, leucovorin, and mitomycin C in rectal cancer. Methods and Materials: We matched 34 patients who were treated with preoperative concurrent capecitabine and 50 Gy of RT by their clinical T stage (T3 or T4) and the tumor location (<=7 cm or >7 cm from the anal verge) with another 68 patients who were treated with preoperative intermittent 5-FU infusion, leucovorin, mitomycin C, and 50 Gy of RT for a comparison of the pathologic tumor response, local control, distant failure, and survival rates. Results: The pathologic complete response rate was 21% with capecitabine and 18% with 5-FU and leucovorin (p = 0.72). The rate of T downstaging after chemoradiation was 59% for both groups. The rate of sphincter-sparing resection was 38% after capecitabine plus RT and 43% after 5-FU plus RT (p = 0.67). At 3 years, there was no significant difference in the local control rate (93% for capecitabine and 92% for 5-FU and leucovorin), relapse-free rate (74% for capecitabine and 73% for 5-FU and leucovorin), or disease-specific survival rate (86% for capecitabine and 77% for 5-FU and leucovorin). The acute toxicity profile was comparable, with little Grade 3 and 4 toxicity. Conclusions: When administered with concurrent preoperative RT, both capecitabine and intermittent 5-FU infusion with leucovorin modulation provided comparable pathologic tumor response, local control, relapse-free survival, and disease-specific survival rates in rectal cancer.

  1. Classification of pelvic ring fractures in skeletonized human remains.

    PubMed

    Báez-Molgado, Socorro; Bartelink, Eric J; Jellema, Lyman M; Spurlock, Linda; Sholts, Sabrina B

    2015-01-01

    Pelvic ring fractures are associated with high rates of mortality and thus can provide key information about circumstances surrounding death. These injuries can be particularly informative in skeletonized remains, yet difficult to diagnose and interpret. This study adapted a clinical system of classifying pelvic ring fractures according to their resultant degree of pelvic stability for application to gross human skeletal remains. The modified Tile criteria were applied to the skeletal remains of 22 individuals from the Cleveland Museum of Natural History and Universidad Nacional Autónoma de México that displayed evidence of pelvic injury. Because these categories are tied directly to clinical assessments concerning the severity and treatment of injuries, this approach can aid in the identification of manner and cause of death, as well as interpretations of possible mechanisms of injury, such as those typical in car-to-pedestrian and motor vehicle accidents.

  2. Animal models of female pelvic organ prolapse: lessons learned

    PubMed Central

    Couri, Bruna M; Lenis, Andrew T; Borazjani, Ali; Paraiso, Marie Fidela R; Damaser, Margot S

    2012-01-01

    Pelvic organ prolapse is a vaginal protrusion of female pelvic organs. It has high prevalence worldwide and represents a great burden to the economy. The pathophysiology of pelvic organ prolapse is multifactorial and includes genetic predisposition, aberrant connective tissue, obesity, advancing age, vaginal delivery and other risk factors. Owing to the long course prior to patients becoming symptomatic and ethical questions surrounding human studies, animal models are necessary and useful. These models can mimic different human characteristics – histological, anatomical or hormonal, but none present all of the characteristics at the same time. Major animal models include knockout mice, rats, sheep, rabbits and nonhuman primates. In this article we discuss different animal models and their utility for investigating the natural progression of pelvic organ prolapse pathophysiology and novel treatment approaches. PMID:22707980

  3. Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

    SciTech Connect

    Lopez, Anthony James

    2015-08-15

    Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequate randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.

  4. [Quality of life in women after anterior pelvic exenteration].

    PubMed

    Loran, O B; Veliev, E I; Seregin, A V; Khachatryan, A L; Guspanov, R I; Seregin, I V

    2016-04-01

    60 women, who underwent anterior pelvic exenteration with different types of urine derivation since 2004 till 2014 years in urology department, RMAPO, S.P. Botkin city hospital, were included in retrospective investigation. Middle age of patients was 53,2+/-3 (32-68). 38 women with bladder cancer and 22 women with urinary injuries after radiation therapy underwent anterior pelvic exenteration. Aim of this work is to perform quality of life comparison of patients after anterior pelvic exenteration with different types of urine derivation. Patients were divided in 3 groups: 1-st group 39 (65%) women, who underwent Brickers operation, 2-nd group 19 (31,66% ) women, who had Studers operation and 3-rd group - 2 (3,34%), patients who underwent continent urine derivation with formation of catheterizing urinary reservoir. Questionnaire (SF-36) was used to evaluate quality of life. Observation period was from 2 to 10 years. Postsurgical lethality was 3%, 5-years survival rate was 60,9+/-15,8% and 5-years recurrence-free survival rate was 55,4+/-12,6%. We established that quality of life in women who underwent orthotopic urine derivation was higher than in patients who underwent incontinent ileoconduit formation. Better quality of life was demonstrated by women, who had catheterizing urinary reservoir, but it is difficult to compare this group with the others, because of small number of patients with heterotopic catheterizing reservoir. Regarding the results of our investigation we made next conclusions: In spite of difficult technique, high risk of postoperative complications and lethality, anterior pelvic exenteration provide 5-years survival rate for 70% of patients In locally advanced tumors of pelvic organs anterior pelvic exenteration is salvational operation and keep satisfactory quality of life Orthotopic intestinal urine derivation is better to provide satisfactory quality of life for patients with invasive bladder cancer. For women with urinary injuries after

  5. Can Ovarian Cancer Be Found Early?

    MedlinePlus

    ... Ovarian Cancer Early Detection, Diagnosis, and Staging Can Ovarian Cancer Be Found Early? About 20% of ovarian cancers ... cancer in its earliest stage. Ways to find ovarian cancer early Regular women's health exams During a pelvic ...

  6. Pelvic floor muscle training exercises

    MedlinePlus

    ... nlm.nih.gov/pubmed/22258946 . Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, ... nlm.nih.gov/pubmed/20091581 . Herderschee R, Hay-Smith EJC, Herbison GP, Roovers JP, Heineman MJ. Feedback ...

  7. Social Determinants of Chronic Prostatitis/Chronic Pelvic Pain Syndrome Related Lifestyle and Behaviors among Urban Men in China: A Case-Control Study

    PubMed Central

    Chen, Chen; Chen, Liang; Han, Qingrong; Ye, Huarong

    2016-01-01

    Purpose. In order to find key risk factors of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among urban men in China, an age-matched case-control study was performed from September 2012 to May 2013 in Yichang, Hubei Province, China. Methodology. A total of 279 patients and 558 controls were recruited in this study. Data were collected by a self-administered questionnaire, including demographics, diet and lifestyle, psychological status, and a physical exam. Conditional logistic regression model was used to analyze collected data. Results. Chemical factors exposure, night shift, severity of mood, and poor self-health cognition were entered into the regression model, and result displayed that these four factors had odds ratios of 1.929 (95% CI, 1.321–2.819), 1.456 (95% CI, 1.087–1.949), 1.619 (95% CI, 1.280–2.046), and 1.304 (95% CI, 1.094–1.555), respectively, which suggested that these four factors could significantly affect CP/CPPS. Conclusion. These results suggest that many factors affect CP/CPPS, including biological, social, and psychological factors. PMID:27579305

  8. Social Determinants of Chronic Prostatitis/Chronic Pelvic Pain Syndrome Related Lifestyle and Behaviors among Urban Men in China: A Case-Control Study.

    PubMed

    Wang, Yan; Chen, Chen; Zhu, Changcai; Chen, Liang; Han, Qingrong; Ye, Huarong

    2016-01-01

    Purpose. In order to find key risk factors of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among urban men in China, an age-matched case-control study was performed from September 2012 to May 2013 in Yichang, Hubei Province, China. Methodology. A total of 279 patients and 558 controls were recruited in this study. Data were collected by a self-administered questionnaire, including demographics, diet and lifestyle, psychological status, and a physical exam. Conditional logistic regression model was used to analyze collected data. Results. Chemical factors exposure, night shift, severity of mood, and poor self-health cognition were entered into the regression model, and result displayed that these four factors had odds ratios of 1.929 (95% CI, 1.321-2.819), 1.456 (95% CI, 1.087-1.949), 1.619 (95% CI, 1.280-2.046), and 1.304 (95% CI, 1.094-1.555), respectively, which suggested that these four factors could significantly affect CP/CPPS. Conclusion. These results suggest that many factors affect CP/CPPS, including biological, social, and psychological factors.

  9. Irradiation of the prostate and pelvic lymph nodes with an adaptive algorithm

    SciTech Connect

    Hwang, A. B.; Chen, J.; Nguyen, T. B.; Gottschalk, A. G.; Roach, M. R. III; Pouliot, J.

    2012-02-15

    Purpose: The simultaneous treatment of pelvic lymph nodes and the prostate in radiotherapy for prostate cancer is complicated by the independent motion of these two target volumes. In this work, the authors study a method to adapt intensity modulated radiation therapy (IMRT) treatment plans so as to compensate for this motion by adaptively morphing the multileaf collimator apertures and adjusting the segment weights. Methods: The study used CT images, tumor volumes, and normal tissue contours from patients treated in our institution. An IMRT treatment plan was then created using direct aperture optimization to deliver 45 Gy to the pelvic lymph nodes and 50 Gy to the prostate and seminal vesicles. The prostate target volume was then shifted in either the anterior-posterior direction or in the superior-inferior direction. The treatment plan was adapted by adjusting the aperture shapes with or without re-optimizing the segment weighting. The dose to the target volumes was then determined for the adapted plan. Results: Without compensation for prostate motion, 1 cm shifts of the prostate resulted in an average decrease of 14% in D-95%. If the isocenter is simply shifted to match the prostate motion, the prostate receives the correct dose but the pelvic lymph nodes are underdosed by 14% {+-} 6%. The use of adaptive morphing (with or without segment weight optimization) reduces the average change in D-95% to less than 5% for both the pelvic lymph nodes and the prostate. Conclusions: Adaptive morphing with and without segment weight optimization can be used to compensate for the independent motion of the prostate and lymph nodes when combined with daily imaging or other methods to track the prostate motion. This method allows the delivery of the correct dose to both the prostate and lymph nodes with only small changes to the dose delivered to the target volumes.

  10. The Impact of Pelvic Floor Disorders and Pelvic Surgery on Women's Sexual Satisfaction and Function.

    PubMed

    Yount, Susan M

    2013-01-01

    Pelvic floor disorders have a significant impact on women's daily lives. Sexual health, which includes sexual satisfaction and function, can be altered by pelvic floor disorders and pelvic surgery. This article reviews common pelvic floor disorders (pelvic organ prolapse, urinary and fecal incontinence) and the effect they have on sexual satisfaction and function. Associations between sexual function and pelvic floor disorders are described, as are the relationships between sexual function and pelvic surgery. Women of all ages need to know their options and understand the impact pelvic surgery can have on sexual satisfaction, function, and activity.

  11. Lumbar-pelvic coordination in the sitting position.

    PubMed

    Kasahara, Satoshi; Miyamoto, Kenji; Takahashi, Mitsuhiko; Yamanaka, Masanori; Takeda, Naoki

    2008-08-01

    This study assessed the relationship of each movement direction on the lumbar spine and on the pelvis in regards to lumbar-pelvic coordination in the sitting position. Lumbar and pelvic motions were recorded using a flexible electrogoniometer in 12 healthy subjects during two different tasks in the sitting position. The coordination of the lumbar spine and pelvis was evaluated using the ratio of lumbar and pelvic angles (L/P ratio hereafter) in three motion phases. There were significant differences in the L/P ratio values between during the "forward bending" and "rising from a forward flexed position" phases (P<0.01). The L/P ratio value ( approximately -0.7) was consistent during the movement from an erect to a slumped sitting position as the lumbar spine and pelvis moved in opposing directions. This study shows that lumbar-pelvic coordination occurs in the sitting position. Lumbar-pelvic coordination is confirmed even if the movement tasks are different in the sitting position, and these findings show that aspects of a particular movement are dependent on the given movement task. These findings may provide greater insight into the kinematic changes involved in lumber-pelvic coordination, and help clinicians implement sitting exercises conducive to the independence of the patient.

  12. Patients with pelvic fracture: what factors are associated with mortality?

    PubMed Central

    Goh, Hsin K.; Tay, Seow Y.; Phua, Dong H.

    2010-01-01

    Background Pelvic fracture is one of the major injuries that lead to death in patients who sustain high-impact injuries such as road traffic accidents and falls from height. Aims This study aims to look at the epidemiology and the significant predictors of mortality in victims with pelvic fracture presenting to the emergency department (ED) of an urban Asian city. Methods This was a retrospective data analysis of all trauma patients with pelvic fracture who were treated at the ED of an urban adult hospital in Singapore from April 2001 to December 2004. Student’s t-test and χ2 test were used in statistical analysis where appropriate. Results The study included 179 consecutive patients. Sixty-four percent of patients were males, and 71% of patients were in the 20–49-year-old age group. Road traffic accidents and falls from height were the two most common mechanisms of injury. Mortality rate was 37%. Pelvic fracture severity, shock and coma at presentation, and the presence of concurrent head and chest injuries were associated with increased mortality. Gender, other mechanisms of injury and other concomitant injuries were not associated with increased mortality. Conclusions The mortality rate of trauma patients with pelvic fracture continues to be high. In such patients, predictors of mortality are the severity of the pelvic fracture, the presence of coma, shock, and head and chest injuries. PMID:21373296

  13. Pelvic radiation therapy: Between delight and disaster

    PubMed Central

    Morris, Kirsten AL; Haboubi, Najib Y

    2015-01-01

    In the last few decades radiotherapy was established as one of the best and most widely used treatment modalities for certain tumours. Unfortunately that came with a price. As more people with cancer survive longer an ever increasing number of patients are living with the complications of radiotherapy and have become, in certain cases, difficult to manage. Pelvic radiation disease (PRD) can result from ionising radiation-induced damage to surrounding non-cancerous tissues resulting in disruption of normal physiological functions and symptoms such as diarrhoea, tenesmus, incontinence and rectal bleeding. The burden of PRD-related symptoms, which impact on a patient’s quality of life, has been under appreciated and sub-optimally managed. This article serves to promote awareness of PRD and the vast potential there is to improve current service provision and research activities. PMID:26649150

  14. Pelvic exenteration – reconsidering the procedure

    PubMed Central

    Bacalbasa, N; Balescu, I

    2015-01-01

    Pelvic exenteration remains one of the most destructive surgical procedures in gynecologic oncology, performed in patients with locally advanced malignancies who were considered for a long time as unresectable. However, for these patients, an aggressive surgical approach seems to be the only potential curative solution. This is a literature review of the most important studies, which analyzes the benefits and the secondary risks of this demanding procedure. PMID:25866569

  15. Effect of depression and anxiety on the success of pelvic floor muscle training for pelvic floor dysfunction.

    PubMed

    Khan, Z A; Whittal, C; Mansol, S; Osborne, Lisa A; Reed, P; Emery, S

    2013-10-01

    The objective of this study was to determine the impact of the psychiatric symptoms of anxiety and depression, as assessed by validated questionnaires on the success of pelvic floor muscle training (PFMT). A prospective observational study was carried out by the Uro-gynaecological Physiotherapy Department at the Singleton Hospital, Swansea. A total of 108 consecutive women with pelvic floor dysfunction were referred for physiotherapy and admitted to the 6-month physiotherapy programme. They underwent subjective and objective assessments of their pelvic floor and psychological health at the beginning and end of the programme. A strong correlation was noted between the severity of anxiety and depression symptoms and the severity of their pelvic floor dysfunction. Following physiotherapy, apart from sexual function, all domains of pelvic floor dysfunction showed significant improvement. Based on the severity of their anxiety/depression symptoms, the patients were stratified into three groups. The group of patients that benefitted most had either no or only mild anxiety/depression. This study raises the question of whether a targeted approach should be undertaken for managing patients who, in addition to their pelvic floor dysfunction, demonstrate psychiatric symptoms.

  16. CANCER INCIDENCE IN THE AGRICULTURAL HEALTH STUDY

    EPA Science Inventory

    Despite low mortality and cancer incidence rates overall, farmers may experience excess risk of several cancers. These excesses have been observed in some, but not all, retrospective epidemiological studies of agricultural workers in several countries. Excess risk has been ob...

  17. The effect of parity on pelvic floor muscle strength and quality of life in women with urinary incontinence: a cross sectional study

    PubMed Central

    Özdemır, Özlem Çınar; Bakar, Yesim; Özengın, Nuriye; Duran, Bülent

    2015-01-01

    [Purpose] The purpose of this study was to analyze the pelvic floor muscle (PFM) activity after vaginal birth, and the effect of parity on PFM strength and quality of life (QoL) in women with urinary incontinence. [Subjects and Methods] Patients (n=241) who gave birth vaginally and experienced urinary incontinence were divided into three groups: group 1 consisted of women having 1–3 children, group 2 consisted of women having 4–6 children, and group 3 consisted of women having more than 6 children. All patients underwent detailed examination of the PFM. The Turkish version of the self-administered Incontinence Quality of Life Instrument (I-QoL) questionnaire was used to evaluate the effects of stress urinary incontinence on participants’ QoL. [Results] Comparison of PFM strengths showed a significant intergroup difference. Group 1 showed significantly higher PFM strength scores than those of groups 2 and 3. I-QoL scores related to stress incontinence showed a significant intergroup difference. As number of deliveries increased, quality of life decreased. Comparison of PFM strengths and I-QoL scores related to stress incontinence showed a significant intergroup difference. [Conclusion] Increasing the awareness of PFM training in women will reduce potential postpartum incontinence due to a weak PFM strength; and will increase quality of life. PMID:26311939

  18. Pelvic Vein Embolisation in the Management of Varicose Veins

    SciTech Connect

    Ratnam, Lakshmi A.; Marsh, Petra; Holdstock, Judy M.; Harrison, Charmaine S.; Hussain, Fuad F.; Whiteley, Mark S.; Lopez, Anthony

    2008-11-15

    Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

  19. Managing chronic pelvic pain following reconstructive pelvic surgery with transvaginal mesh.

    PubMed

    Gyang, Anthony N; Feranec, Jessica B; Patel, Rakesh C; Lamvu, Georgine M

    2014-03-01

    In 2001, the US Food and Drug Administration (FDA) approved the first transvaginal mesh kit to treat pelvic organ prolapse (POP). Since the introduction of vaginal mesh kits, some vaginal meshes have been associated with chronic pelvic pain after reconstructive pelvic floor surgery. Pelvic pain results in between 0 % and 30 % of patients following transvaginal mesh placement. Common causes of chronic pelvic pain include pelvic floor muscle spasm, pudendal neuralgia, and infection. Paucity of data exists on the effective management of chronic pelvic pain after pelvic reconstructive surgery with mesh. We outline the management of chronic pelvic pain after transvaginal mesh placement for reconstructive pelvic floor repair based on our clinical experience and adaptation of data used in other aspects of managing chronic pelvic pain conditions.

  20. Pelvic Belt Effects on Pelvic Morphometry, Muscle Activity and Body Balance in Patients with Sacroiliac Joint Dysfunction

    PubMed Central

    Soisson, Odette; Lube, Juliane; Germano, Andresa; Hammer, Karl-Heinz; Josten, Christoph; Sichting, Freddy; Winkler, Dirk; Milani, Thomas L.; Hammer, Niels

    2015-01-01

    Introduction The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. Methods Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. Results Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. Discussion Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest. PMID:25781325

  1. Late gastrointestinal effects of pelvic radiation: a nurse-led service.

    PubMed

    Ludlow, Helen; Green, John; Turner, Jeff

    2017-02-23

    There are currently at least 2 million people in the UK living with and following a cancer diagnosis. Typically four out of every ten people with cancer will receive radiotherapy, but a large proportion of people who have pelvic radiotherapy may go on to develop gastrointestinal (GI) symptoms. This includes rectal bleeding and faecal incontinence, which can have a huge impact on quality of life. These problems often go under-reported by patients and are also under-recognised or under-treated by health professionals. Cancer survivorship is a growing topic that is likely to have a major impact on the NHS, with increasing numbers of patients presenting. A late GI effects of pelvic radiotherapy clinic was set up to address these growing needs of patients with GI symptoms following radiotherapy. This article also shares insights from a doctoral study that is underway looking at people's experiences of living with symptoms following their treatment, in order to improve awareness of the major impact that this can have.

  2. The pelvic floor in health and disease.

    PubMed Central

    Shelton, A A; Welton, M L

    1997-01-01

    Normal pelvic floor function involves a set of learned and reflex responses that are essential for the normal control and evacuation of stool. A variety of functional disturbances of the pelvic floor, including incontinence and constipation, are not life threatening, but can cause significant distress to affected patients. Understanding the normal anatomy and physiology of the pelvic floor is essential to understanding and treating these disorders of defecation. This article describes the normal function of the pelvic floor, the diagnostic tools available to investigate pelvic floor dysfunction, and the etiology, diagnosis, and management of the functional pelvic floor disorders that lead to incontinence and constipation. Images Figure 1. PMID:9291746

  3. Acupuncture for pelvic and back pain in pregnancy: a systematic review.

    PubMed

    Ee, Carolyn C; Manheimer, Eric; Pirotta, Marie V; White, Adrian R

    2008-03-01

    The objective of our study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported. We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.

  4. A Phase II study of acute toxicity for Celebrex{sup TM} (celecoxib) and chemoradiation in patients with locally advanced cervical cancer: Primary endpoint analysis of RTOG 0128

    SciTech Connect

    Gaffney, David K. . E-mail: david.gaffney@hci.utah.edu; Winter, Kathryn M.S.; Dicker, Adam P.; Miller, Brigitte; Eifel, Patricia J.; Ryu, Janice; Avizonis, Vilija; Fromm, Mitch; Greven, Kathryn

    2007-01-01

    Purpose: To determine treatment-related acute toxicity rates in patients with locally advanced cervical cancer treated by oral celecoxib, i.v. cisplatin and 5-FU, and concurrent pelvic radiation therapy. Methods and Materials: Eligible patients on this RTOG Phase I-II study for advanced cervix cancer included FIGO Stage IIB-IVA or patients with FIGO Stage IB through IIA with biopsy proven pelvic node metastases or tumor size {>=}5 cm. Patients were treated with pelvic radiotherapy and brachytherapy. Celecoxib was prescribed at 400 mg twice daily beginning on day 1 for 1 year. Cisplatin (75 mg/m2) and 5-FU (1g/m2 for 4 days) were administered every 3 weeks times 3. The primary end point of the study was treatment related toxicity. Results: Between August 2001 and March 2004, 84 patients were accrued to the study and 77 patients were evaluable for toxicity. Regarding the primary end point, toxicities were observed in the following areas: blood/bone marrow (16), gastrointestinal (14), pain (7), renal/genitourinary (6), cardiovascular (3), hemorrhage (1), and neurologic (1). For the first 75 evaluable patients, a toxicity failure was identified in 36 patients for a rate of 48%. Conclusions: Celecoxib at 400 mg twice daily together with concurrent cisplatin and 5-FU and pelvic radiotherapy has a high incidence of acute toxicities. The most frequent toxicities were hematologic. Albeit, the toxicity was deemed excessive in this trial, the rate of toxicities was not too different compared to other recent experiences with concurrent chemoradiation for advanced cervix cancer.

  5. Relationship between Pelvic Alignment and Weight-bearing Asymmetry in Community-dwelling Chronic Stroke Survivors

    PubMed Central

    Karthikbabu, Suruliraj; Chakrapani, Mahabala; Ganesan, Sailakshmi; Ellajosyula, Ratnavalli

    2016-01-01

    Background and Purpose: Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors. Materials and Methods: This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA. Results: Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P < 0.001) than anterior pelvic tilt (r = 0.44; P < 0.001). Conclusion: Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors. PMID:28163501

  6. Hormonal contraception and pelvic inflammatory disease.

    PubMed

    Henry-Suchet, J

    1997-12-01

    Estrogen-progestogen contraception (OC) is significantly associated with a high prevalence of Chlamydia trachomatis in the lower genital tracts of young women. In contrast, pelvic inflammatory disease is less frequent and is associated with milder pelvic lesions in OC users than in non-users. A recent study suggests that OC use can be associated with silent endometritis and salpingitis. The usual clinical, biological and laparoscopic signs of acute and chronic pelvic inflammatory disease are described. As shown tby several cost-benefit analyses, C. trachomatis detection in family planning centers is cost-effective and the eradication of bacteria is obtained in 90% of cases by a new treatment: azithromycin (1 g for 1 day). Although the data clearly show that C. trachomatis screening is cost-effective, selection of the diagnostic laboratory tests used in such screening programs should be carefully evaluated relative to cost, feasibility, specificity and sensitivity, and should be adapted to the presumed prevalence in screened populations. A systematic screening is indicated in populations susceptible to a prevalence of 5% or more.

  7. Pelvic inflammatory disease (PID)

    MedlinePlus

    ... for cancer) Getting an intrauterine device (IUD) Miscarriage Abortion In the United States, nearly 1 million women ... ncbi.nlm.nih.gov/pubmed/26042815 . Read More Abortion - surgical Chlamydia Ectopic pregnancy Ectropion Endometrial biopsy Endometritis ...

  8. Abdominal and Pelvic CT

    MedlinePlus Videos and Cool Tools

    ... as ulcerative colitis or Crohn's disease , pancreatitis or liver cirrhosis. cancers of the liver, kidneys, pancreas, ovaries and bladder as well as ... injuries to abdominal organs such as the spleen, liver, kidneys or other internal organs in cases of ...

  9. Erectile Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Outcomes from a Multi-Center Study and Risk Factor Analysis in a Single Center

    PubMed Central

    Chen, Xin; Wang, Zhu; Chen, Shengfu; Yang, Qiyun; Wan, Zi; Han, Dayu; Xiao, Haipeng; Sun, Xiangzhou; Deng, Chunhua

    2016-01-01

    The aim of this study was to investigate the prevalence of erectile dysfunction (ED) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and explore the influence of UPOINT domains, National Institutes of Health-CP symptom index (NIH-CPSI) and other factors on ED prevalence. This was a prospective study of consecutive patients with CP/CPPS seen at 11 tertiary hospitals during January–July 2014. ED was diagnosed as a score of<21 on the International Index of Erectile Function (IIEF-5). Patients from one center were evaluated by the UPOINT system and NIH-CPSI. Each patient was assessed using clinical examination, asocio-demographic questionnaire, the Patient Health Questionnaire (PHQ), the Pain Catastrophizing Scale (PCS), NIH-CPSI and IIEF-5.1406 patients from 11 centers (mean age, 32.18 years; range 18–60 years) were enrolled. ED was found in 638/1406 patients (45.4%), and was categorized as mild in 291(45.6%), moderate in 297(46.6%) and severe in50(7.7%). 192 patients from one center(mean age,31.3 years; range 18–57 years) were further studied.IIEF-5 score correlated negatively with NIH-CPSI(r = 0.251), PHQ (r = 0.355) and PCS (r = 0.322)scores (P<0.001).PHQ score correlated positively with NIH-CPSI (r = 0.586) and PCS(r = 0.662) scores (P<0.001).NIH-CPSI, PHQ, PCS and IIEF-5 scores did not differ significantly between class IIIA and IIIB CP/CPPS. Multivariate logistic regression showed that UPOINT psychological (P) domain and NIH-CPSI symptom severity were independent risk factors for ED in CP/CPPS. It is concluded that psychological factors and symptom severity are independent risk factors for ED in CP/CPPS. PMID:27120096

  10. Erectile Dysfunction in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Outcomes from a Multi-Center Study and Risk Factor Analysis in a Single Center.

    PubMed

    Zhang, Yadong; Zheng, Tao; Tu, Xiang'an; Chen, Xin; Wang, Zhu; Chen, Shengfu; Yang, Qiyun; Wan, Zi; Han, Dayu; Xiao, Haipeng; Sun, Xiangzhou; Deng, Chunhua

    2016-01-01

    The aim of this study was to investigate the prevalence of erectile dysfunction (ED) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and explore the influence of UPOINT domains, National Institutes of Health-CP symptom index (NIH-CPSI) and other factors on ED prevalence. This was a prospective study of consecutive patients with CP/CPPS seen at 11 tertiary hospitals during January-July 2014. ED was diagnosed as a score of<21 on the International Index of Erectile Function (IIEF-5). Patients from one center were evaluated by the UPOINT system and NIH-CPSI. Each patient was assessed using clinical examination, asocio-demographic questionnaire, the Patient Health Questionnaire (PHQ), the Pain Catastrophizing Scale (PCS), NIH-CPSI and IIEF-5.1406 patients from 11 centers (mean age, 32.18 years; range 18-60 years) were enrolled. ED was found in 638/1406 patients (45.4%), and was categorized as mild in 291(45.6%), moderate in 297(46.6%) and severe in50(7.7%). 192 patients from one center(mean age,31.3 years; range 18-57 years) were further studied.IIEF-5 score correlated negatively with NIH-CPSI(r = 0.251), PHQ (r = 0.355) and PCS (r = 0.322)scores (P<0.001).PHQ score correlated positively with NIH-CPSI (r = 0.586) and PCS(r = 0.662) scores (P<0.001).NIH-CPSI, PHQ, PCS and IIEF-5 scores did not differ significantly between class IIIA and IIIB CP/CPPS. Multivariate logistic regression showed that UPOINT psychological (P) domain and NIH-CPSI symptom severity were independent risk factors for ED in CP/CPPS. It is concluded that psychological factors and symptom severity are independent risk factors for ED in CP/CPPS.

  11. Side impact: influence of impact conditions and bone mechanical properties on pelvic response using a fracturable pelvis model.

    PubMed

    Song, Eric; Trosseille, Xavier; Guillemot, Hevé

    2006-11-01

    This study aimed at determining the influence of impact conditions and occupant mechanical properties on pelvic response in side impact. First, a fracturable pelvis model was developed and validated against dynamic tests on isolated pelvic bones and on whole cadavers. By coupling a fixed cortical bone section thickness within a single subject's pelvis and across the population with a parametric material law for the pelvic bone, this model reproduced the pelvic response and tolerance variation among individuals. Three material laws were also identified to represent fragile, medium and strong pelvic bones for the 50th percentile male. With this model, the influence of impact mass, velocity and surface shape on pelvic response was examined. Results indicated that the shape difference between four main impactors reported in the literature has little effect on the pelvic response. Under iso-energy conditions, the relationship of pelvic loading between different combinations of impact mass and velocity was also determined. Based on this relationship, existing data from different impactor tests were scaled and combined to establish a pelvic response corridor in terms of pelvis loading versus impact energy. The relationship between bone mechanical properties and pelvic response and tolerance was also investigated with this model. Results indicated that changes in the mechanical properties due to ageing affected the pelvic tolerance more than the pelvic mechanical response. Assuming that the ultimate stress of the pelvic bone decreases 0.4% per year from 25 to 80 years old, the pelvic tolerance should be scaled by 0.4% per year while the pelvic loading response should be scaled only by 0.1% per year. Finally, it is to be noted that the model developed in this paper is a "global" model, not a "descriptive" model. Therefore, while it may be a useful tool for the analysis presented in this paper (e.g., overall fracture tolerance, overall effects of age, etc.), it cannot be

  12. Long-term experience with (laterally) extended endopelvic resection (LEER) in relapsed pelvic malignancies.

    PubMed

    Höckel, Michael

    2015-03-01

    Gynecologic cancers recurring in the pelvis are generally advanced in malignant progression limiting curative treatment approaches. The cancer field theory links cancer progression to reversed morphogenesis and allows the exact anatomical delineation of the cancer field, i.e., the tissue compartment of potential tumor infiltration related to the tumor's ontogenetic stage. Cancer surgery is redefined with the resection of ontogenetic stage-related cancer fields instead of the mere removal of the malignant tumor with an uninvolved tissue margin. Most gynecologic pelvic malignancies recurring in the pelvis represent ontogenetic stages 3 and 4. (Laterally) extended endopelvic resection ((L)EER) has been designed to resect the cancer fields of gynecologic tumors in these advanced ontogenetic stages. This paper reports long-term experience with (L)EER for relapsed pelvic malignancies strongly supporting the cancer field theory and the principle and practice of cancer field resection.

  13. Application of a pelvic phantom in brachytherapy dosimetry for high-dose-rate (HDR) 192Ir source based on Monte Carlo simulations

    NASA Astrophysics Data System (ADS)

    Ahn, Woo Sang; Choi, Wonsik; Shin, Seong Soo; Jung, Jinhong

    2014-08-01

    In this study, we evaluate how the radial dose function is influenced by the source position as well as the phantom size and shape. A pelvic water phantom similar to the pelvic shape of a human body was designed by averaging dimensions obtained from computed tomography (CT) images of patients treated with brachytherapy for cervical cancer. Furthermore, for the study of the effects of source position on the dose distribution, the position of the source in the water phantom was determined by using the center of mass of the gross target volume (GTV) in the CT images. To obtain the dosimetric parameter of a high-dose-rate (HDR) 192Ir source, we performed Monte Carlo simulations by using the Monte Carlo n-particle extended code (MCNPX). The radial dose functions obtained using the pelvic water phantom were compared with those of spherical phantom with different sizes, including the Monte Carlo (MC) results of Williamson and Li. Differences between the radial dose functions from this study and the data in the literature increased with the radial distances. The largest differences appeared for spherical phantom with the smallest size. In contrast to the published MC results, the radial dose function of the pelvic water phantom significantly decreased with radial distance in the vertical direction because full scattering was not possible. When the source was located in posterior position 2 cm from the center in the pelvic water phantom, the differences between the radial dose functions rapidly decreased with the radial distance in the lower vertical direction. If the International Commission on Radiation Units and Measurements bladder and rectum points are considered, doses to these reference points could be underestimated by up to 1%-2% at a distance of 3 to 6 cm. Our simulation results provide a valid clinical reference data and can used to improve the accuracy of the doses delivered during brachytherapy applied to patients with cervical cancer.

  14. Bowel Obstruction in Elderly Ovarian Cancer Patients: A Population-Based Study

    PubMed Central

    Mooney, Stephen J.; Winner, Megan; Hershman, Dawn L.; Wright, Jason D.; Feingold, Daniel L.; Allendorf, John D.; Neugut, Alfred I.

    2013-01-01

    PURPOSE Bowel obstruction is a common pre-terminal event in abdominal/pelvic cancer that has mainly been described in small single-institution studies. We used a large, population-based database to investigate the incidence, management, and outcomes of obstruction in ovarian cancer patients. PATIENTS AND METHODS We identified patients with stages IC-IV ovarian cancer, aged 65 years or older, in the Surveillance, Epidemiology and End Results (SEER)-Medicare database diagnosed between January 1, 1991 and December 31, 2005. We modeled predictors of inpatient hospitalization for bowel obstruction after cancer diagnosis, categorized management of obstruction, and analyzed the associations between treatment for obstruction and outcomes. RESULTS Of 8607 women with ovarian cancer, 1518 (17.6%) were hospitalized for obstruction subsequent to cancer diagnosis. Obstruction at cancer diagnosis (HR=2.17, 95% CI: 1.86–2.52) and mucinous tumor histology (HR=1.45, 95% CI: 1.15–1.83) were associated with increased risk of subsequent obstruction. Surgical management of obstruction was associated with lower 30-day mortality (13.4% in women managed surgically vs. 20.2% in women managed non-surgically), but equivalent survival after 30 days and equivalent rates of post-obstruction chemotherapy. Median post-obstruction survival was 382 days in women with obstructions of adhesive origin and 93 days in others. CONCLUSION In this large-scale, population-based assessment of patients with advanced ovarian cancer, nearly 20% of women developed bowel obstruction after cancer diagnosis. While obstruction due to adhesions did not signal the end of life, all other obstructions were pre-terminal events for the majority of patients regardless of treatment. PMID:23274561

  15. Pelvic Inflammatory Disease (PID) Treatment and Care

    MedlinePlus

    ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ...

  16. How Are Pelvic Floor Disorders Diagnosed?

    MedlinePlus

    ... Information Clinical Trials Resources and Publications How are pelvic floor disorders diagnosed? Skip sharing on social media links ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  17. Pelvic Inflammatory Disease (PID) Fact Sheet

    MedlinePlus

    ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ... Pelvic Inflammatory Disease (PID) STDs & Infertility STDs & Pregnancy Syphilis Trichomoniasis Other STDs See Also Pregnancy Reproductive Health ...

  18. Cured of Primary Bone Cancer, But at What Cost: A Qualitative Study of Functional Impairment and Lost Opportunities

    PubMed Central

    Fauske, Lena; Bruland, Oyvind S.; Grov, Ellen Karine; Bondevik, Hilde

    2015-01-01

    Purpose. Our study aims to explore how former cancer patients experience physical and psychosocial late effects 3–7 years after they underwent treatment for primary bone sarcoma in the hip/pelvic region. A qualitative, phenomenological, and hermeneutic design was applied. Methods. Sarcoma survivors (n = 10) previously treated at Oslo University Hospital, Norwegian Radium Hospital were selected to participate. In-depth and semistructured interviews were conducted. The interviews were analysed using inductive thematic analysis. Results. The participants reported that the late effects had three core spheres of impact: “their current daily life,” “their future opportunities,” and “their identity.” They expressed negative changes in activity, increased dependence on others, and exclusion from participation in different areas. Their daily life, work, sports activities, and social life were all affected. Several of their experiences are similar to those described by people with functional impairment or disability. Conclusion. Patients cured of bone cancer in the hip/pelvic region pay a significant price in terms of functional impairment, practical challenges, exclusion from important aspects of life, and loss of previous identity. It is important to appreciate this in order to help bone cancer survivors who struggle to reorient their life and build a secure new identity. PMID:25949211

  19. Influence of pelvic asymmetry and idiopathic scoliosis in adolescents on postural balance during sitting.

    PubMed

    Jung, Ji-Yong; Cha, Eun-Jong; Kim, Kyung-Ah; Won, Yonggwan; Bok, Soo-Kyung; Kim, Bong-Ok; Kim, Jung-Ja

    2015-01-01

    The effects of pelvic asymmetry and idiopathic scoliosis on postural balance during sitting were studied by measuring inclination angles, pressure distribution, and electromyography. Participants were classified into a control group, pelvic asymmetry group, scoliosis group, and scoliosis with pelvic asymmetry and then performed anterior, posterior, left, and right pelvic tilting while sitting on the unstable board for 5 seconds to assess their postural balance. Inclination and obliquity angles between the groups were measured by an accelerometer located on the unstable board. Pressure distribution (maximum force and peak pressure) was analyzed using a capacitive seat sensor. In addition, surface electrodes were attached to the abdominal and erector spinae muscles of each participant. Inclination and obliquity angles increased more asymmetrically in participants with both pelvic asymmetry and scoliosis than with pelvic asymmetry or scoliosis alone. Maximum forces and peak pressures of each group showed an asymmetrical pressure distribution caused by the difference in height between the left and right pelvis and curve type of the patients' spines when performing anterior, posterior, left, and right pelvic tilting while sitting. Muscle contraction patterns of external oblique, thoracic erector spinae, lumbar erector spinae, and lumbar multifidus muscles may be influenced by spine curve type and region of idiopathic scoliosis. Asymmetrical muscle activities were observed on the convex side of scoliotic patients and these muscle activity patterns were changed by the pelvic asymmetry. From these results, it was confirmed that pelvic asymmetry and idiopathic scoliosis cause postural asymmetry, unequal weight distribution, and muscular imbalance during sitting.

  20. Migraine in women with chronic pelvic pain with and without endometriosis

    PubMed Central

    Karp, Barbara Illowsky; Sinaii, Ninet; Nieman, Lynnette K.; Silberstein, Stephen D.; Stratton, Pamela

    2012-01-01

    Objective To examine the prevalence of migraine in women with chronic pelvic pain with and without endometriosis. Design Prospective study of headache, pelvic pain, and quality of life before laparoscopic surgery for pelvic pain. Endometriosis was diagnosed pathologically. Headaches were classified as migraine or non-migraine using International Headache Society criteria. Setting Clinical research hospital. Patient(s) 108 women in a clinical trial for chronic pelvic pain (NCT00001848). Intervention(s) Laparoscopy to diagnose endometriosis, assessment by neurologist to assess headaches. Main Outcome Measure(s) Prevalence of migraine and other headaches in women with chronic pelvic pain with or without endometriosis. Headache frequency, severity and relationship to pelvic pain and endometriosis. Result(s) Lifetime prevalence of definite or possible migraine was 67% of women with chronic pelvic pain. An additional 8% met criteria for possible migraine. Migraine was no more likely in women with endometriosis than those without. Women with the most severe headaches had a lower quality of life compared with those with pelvic pain alone. Conclusion(s) Migraine headache is common in women with chronic pelvic pain, regardless of endometriosis, and contributes to disability in those with both conditions. The strong association suggests a common pathophysiology. PMID:21145540

  1. Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs.

    PubMed

    Gutke, Annelie; Hansson, Eva Roos; Zetherström, Gunilla; Ostgaard, Hans Christian

    2009-07-01

    The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

  2. Weakness of the Pelvic Floor Muscle and Bladder Neck Is Predicted by a Slight Rise in Abdominal Pressure During Bladder Filling: A Video Urodynamic Study in Children

    PubMed Central

    2016-01-01

    Purpose: To investigate the significance of slowly rising abdominal pressure (SRAP), which is often observed in nonneurogenic children during bladder filling in video urodynamic studies (VUDSs). Methods: The records of patients who underwent VUDS from July 2011 to June 2013 were reviewed. SRAP was defined as a rising curve over 5 cm H2O from the baseline abdominal pressure during the filling phase in VUDS. Bladder descent was defined when the base of the bladder was below the upper line of the pubic symphysis. An open bladder neck was defined as the opening of the bladder neck during the filling phase. Results: Of the 488 patients, 285 were male patients. The mean age at VUDS was 3.7 years (range, 0.2–17.6 years). The VUDS findings were as follows: SRAP, 20.7% (101 of 488); descending bladder, 14.8% (72 of 488); and bladder neck opening, 4.3% (21 of 488). Of the 72 patients with a descending bladder, 84.7% had SRAP. A significant difference in the presence of SRAP was found between the descending bladder and the normal bladder (P<0.001). Of the 101 patients with SRAP, 40 (39.6%) did not have a descending bladder. Of the 40 patients, 14 (35.0%) had a bladder neck opening, which was a high incidence compared with the 4.3% in all subjects (P<0.001). Conclusions: SRAP was associated with a descending bladder or a bladder neck opening, suggesting that SRAP is a compensatory response to urinary incontinence. SRAP may also predict decreased function of the bladder neck or pelvic floor muscle. PMID:27032558

  3. More effects of extracorporeal magnetic innervation and terazosin therapy than terazosin therapy alone for non-inflammatory chronic pelvic pain syndrome: a pilot study.

    PubMed

    Paick, J-S; Lee, S C; Ku, J H

    2006-01-01

    The objective of this study was to evaluate whether extracorporeal magnetic innervation (ExMI) combined with alpha-blocker therapy is more effective than alpha-blocker monotherapy for patients with non-inflammatory chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS), category IIIB. Patients were randomized to either terazosin monotherapy (group 1, n=21) or terazosin combined with ExMI therapy (group 2, n=19). Patients in group 2 had 12 treatment sessions of ExMI twice a week during 6 weeks. None of the patients experienced any side effects from treatment. The changes in each domain of the National Institutes of Health (NIH)-Chronic Prostatitis Symptom Index (CPSI) measured on week 6 were not significantly different between the groups. However, the difference (median, 25-75th percentiles) between the two groups in total NIH-CPSI scores was -4 (-11.5, -2) for group 1 and -12 (-17.3, -2.3) for group 2, respectively (P=0.047). At 6 weeks, 47.6% (10 of 21) of group 1 had a >25% decrease in total NIH-CPSI compared with 78.9% (15 of 19) of group 2 (P=0.041). Also, more patients in group 2 (78.9%) were rated as responders with a 6-point decrease in NIH-CPSI compared with group 1 (47.6%) (P=0.041). The early results suggest that ExMI combined with alpha-blocker therapy has better effect than alpha-blocker monotherapy for the treatment of CP/CPPS.

  4. Gynecological pelvic pain as emergency pathology.

    PubMed

    Rivera Domínguez, A; Mora Jurado, A; García de la Oliva, A; de Araujo Martins-Romeo, D; Cueto Álvarez, L

    Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management.

  5. [Micronized purified flavonoid fraction in treatment of pelvic varicose veins].

    PubMed

    Gavrilov, S G; Karalkin, A V; Moskalenko, E P; Beliaeva, E S; Ianina, A M; Kirienko, A I

    2012-01-01

    Presented herein are the results of studying efficacy of micronized purified flavonoid fraction (MPFF) in treatment of pelvic varicose veins (PVV) using reference ray-tracing methods of study. We examined a total of 85 patients with PVV. Of these, 65 subjects were found to have isolated dilatation of pelvic venous plexuses (study group), and 20 were diagnosed as having combined dilation of gonadal veins and venous plexuses of the pelvis (control group). Besides clinical examination, the patients were subjected to ultrasonographic angioscanning (USAS) and emission computed tomography (ECT) of pelvic veins before treatment and 2, 6, 12, 24, 36 and 60 months after the beginning of phlebotrophic therapy. Based on the findings of the clinical and instrumental studies, it was determined that MPFF was most efficient in patients with isolated dilatation of uterine and parametrial veins. In this group of patients, pelvic pain and other symptoms of the disease disappeared completely and the clinical effect persisted for a long time (up to 6-9 months). In the control group, venotonic therapy had a positive effect which was less pronounced as compared to the control group, and pelvic pain reappeared in the nearest time (up to 3 weeks) after withdrawal of MPFF.

  6. On pelvic reference lines and the MR evaluation of genital prolapse: a proposal for standardization using the Pelvic Inclination Correction System.

    PubMed

    Betschart, C; Chen, L; Ashton-Miller, J A; Delancey, J O L

    2013-09-01

    Five midsagittal pelvic reference lines have been employed to quantify prolapse using MRI. However, the lack of standardization makes study results difficult to compare. Using MRI scans from 149 women, we demonstrate how use of existing reference lines can systematically affect measurements in three distinct ways: in oblique line systems, distances measured to the reference line vary with antero-posterior location; soft issue-based reference lines can underestimate organ movement relative to the pelvic bones; and systems defined relative to the MR scanner are affected by intra- and interindividual differences in the pelvic inclination angle at rest and strain. Thus, we propose a standardized approach called the Pelvic Inclination Correction System (PICS). Based on bony structures and the body axis, the PICS system corrects for variation in pelvic inclination, at rest of straining, and allows for the standardized measurement of organ displacement in the direction of prolapse.

  7. [Actinomycotic tubo-ovarian abscess. Contribution of pelvic angioscanner].

    PubMed

    Bazot, M; Davenne, C; Benzakine, Y; Boudghène, F; Bigot, J M

    1997-07-01

    Pelvic actinomycosis is uncommon and usually responsible for tubo-ovarian abscesses which are similar in aspect with nonactinomycotic abscesses. They are usually a complication of an intra-uterine device (IUD) that can be absent as in this case. The differential diagnosis is ovarian cancer. The role of the dynamic CT scan for differential diagnosis in this case is presented. Preoperative diagnosis in this affection is important because of the excellent response to Penicillin.

  8. Clinical Outcomes of Intensity-Modulated Pelvic Radiation Therapy for Carcinoma of the Cervix

    SciTech Connect

    Hasselle, Michael D.; Rose, Brent S.; Kochanski, Joel D.; Nath, Sameer K.; Bafana, Rounak; Yashar, Catheryn M.; Hasan, Yasmin; Roeske, John C.; Mundt, Arno J.; Mell, Loren K.

    2011-08-01

    Purpose: To evaluate disease outcomes and toxicity in cervical cancer patients treated with pelvic intensity-modulated radiation therapy (IMRT). Methods and Materials: We included all patients with Stage I-IVA cervical carcinoma treated with IMRT at three different institutions from 2000-2007. Patients treated with extended field or conventional techniques were excluded. Intensity-modulated radiation therapy plans were designed to deliver 45 Gy in 1.8-Gy daily fractions to the planning target volume while minimizing dose to the bowel, bladder, and rectum. Toxicity was graded according to the Radiation Therapy Oncology Group system. Overall survival and disease-free survival were estimated by use of the Kaplan-Meier method. Pelvic failure, distant failure, and late toxicity were estimated by use of cumulative incidence functions. Results: The study included 111 patients. Of these, 22 were treated with postoperative IMRT, 8 with IMRT followed by intracavitary brachytherapy and adjuvant hysterectomy, and 81 with IMRT followed by planned intracavitary brachytherapy. Of the patients, 63 had Stage I-IIA disease and 48 had Stage IIB-IVA disease. The median follow-up time was 27 months. The 3-year overall survival rate and the disease-free survival rate were 78% (95% confidence interval [CI], 68-88%) and 69% (95% CI, 59-81%), respectively. The 3-year pelvic failure rate and the distant failure rate were 14% (95% CI, 6-22%) and 17% (95% CI, 8-25%), respectively. Estimates of acute and late Grade 3 toxicity or higher were 2% (95% CI, 0-7%) and 7% (95% CI, 2-13%), respectively. Conclusions: Intensity-modulated radiation therapy is associated with low toxicity and favorable outcomes, supporting its safety and efficacy for cervical cancer. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT vs. conventional techniques.

  9. Magnetic resonance-based female pelvic anatomy as relevant for maternal childbirth injury simulations.

    PubMed

    Hoyte, Lennox; Damaser, Margot S

    2007-04-01

    The objectives of the study are to review the female pelvic floor anatomy relevant to childbirth simulations, to discuss available methods for clinical evaluation of female pelvic floor function, and to review the variation in pelvic floor changes after vaginal childbirth. A high-resolution magnetic resonance (MR) data set from an asymptomatic nullipara was used to illustrate the MR anatomy of the female pelvic floor. Manual segmentation was performed and three-dimensional reconstructions of the pelvic floor structures were generated, which were used to illustrate the 3D anatomy of the pelvic floor. Variation in the post partum appearance of the levator ani muscles is illustrated using other 2D MR data sets, which depict unilateral and bilateral disruptions in the puborectalis portion of levator ani, as well as shape variations, which may be seen in the post partum levator. The clinical evaluation of the pelvic floor is then reviewed. The female pelvis is composed of a bony scaffold, from which the pelvic floor muscles (obturator internus, levator ani) are suspended. The rectum fits in a midline groove in the levator ani. The vagina is suspended across the midline, attaching bilaterally to the obturator and levator ani. The vagina supports the bladder and urethra. MR studies have demonstrated disruptions in levator ani attachments after vaginal childbirth. Such disruptions are rare in women who have not given birth vaginally. Changes to the neuromuscular apparatus of the pelvic floor can also be demonstrated after vaginal delivery. The combination of childbirth-related anatomic and neurological injury to the pelvic floor may be associated with pelvic floor dysfunction (PFD). These changes are difficult to study in vivo but may be studied through simulations. Appropriate consideration of clinical anatomy is important in these simulations.

  10. Whole-Pelvis Radiotherapy in Combination With Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High-Risk Prostate Cancer?

    SciTech Connect

    Bittner, Nathan; Wallner, Kent E.; Butler, Wayne M.; Galbreath, Robert; Adamovich, Edward

    2010-03-15

    Purpose: To compare biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) rates among high-risk prostate cancer patients treated with brachytherapy and supplemental external beam radiation (EBRT) using either a mini-pelvis (MP) or a whole-pelvis (WP) field. Methods and Materials: From May 1995 to October 2005, 186 high-risk prostate cancer patients were treated with brachytherapy and EBRT with or without androgen-deprivation therapy (ADT). High-risk prostate cancer was defined as a Gleason score of >=8 and/or a prostate-specific antigen (PSA) concentration of >=20 ng/ml. Results: With a median follow-up of 6.7 years, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 91.7% vs. 84.4% (p = 0.126), 95.5% vs. 92.6% (p = 0.515), and 79.5% vs. 67.1% (p = 0.721), respectively. Among those patients who received ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 93.6% vs. 90.1% (p = 0.413), 94.2% vs. 96.0% (p = 0.927), and 73.7% vs. 70.2% (p = 0.030), respectively. Among those patients who did not receive ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 82.4% vs. 75.0% (p = 0.639), 100% vs. 88% (p = 0.198), and 87.5% vs. 58.8% (p = 0.030), respectively. Based on multivariate analysis, none of the evaluated parameters predicted for CSS, while bPFS was best predicted by ADT and percent positive biopsy results. OS was best predicted by age and percent positive biopsy results. Conclusions: For high-risk prostate cancer patients receiving brachytherapy, there is a nonsignificant trend toward improved bPFS, CSS, and OS rates when brachytherapy is given with WPRT. This trend is most apparent among ADT-naive patients, for whom a significant improvement in OS was observed.

  11. Clinical study of duloxetine hydrochloride combined with doxazosin for the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome: An observational study.

    PubMed

    Zhang, Mingxin; Li, Hanzhong; Ji, Zhigang; Dong, Dexin; Yan, Su

    2017-03-01

    To explore the safety and efficacy of the selective 5-serotonin and norepinephrine reuptake inhibitor duloxetine hydrochloride and alpha-adrenergic receptor blocker (alpha-blocker) doxazosin mesylate-controlled tablets in the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).In all, 150 patients were enrolled and 126 patients completed the study (41 patients in the doxazosin group, 41 patients in the sertraline group, and 44 patients in the duloxetine group). This was an open randomized 6-month study. CP/CPPS patients who met the diagnostic criteria were randomized into 3 groups. The patients in the duloxetine group received doxazosin 4 mg + duloxetine 30 mg once a day, and the dosage of duloxetine was increased to 60 mg after a week. The patients in the doxazosin group received doxazosin 4 mg once a day. The patients in the sertraline group received doxazosin 4 mg + sertraline 50 mg once a day. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, the short-form McGill Pain questionnaire (SF-MPQ), and the hospital anxiety and depression scale (HAD) were applied for evaluations during follow-up of 1, 3, and 6 months after treatment.There were slight positive significant correlations between NIH-CPSI scores and HAD scores, moderate positive significant correlations between the quality of life (QOL) and SF-MPQ, and slight positive significant correlations between HAD and QOL. The effective rate in the doxazosin group was 4.88%, 19.51%, and 56.10% after 1, 3, and 6 months, respectively (P < 0.05). The SF-MPQ score in the doxazosin group decreased to 1.80 ± 1.29, 2.66 ± 1.57, and 3.24 ± 1.67 after 1, 3, and 6 months, respectively (P < 0.05). The HAD score in the doxazosin group decreased to 2.24 ± 2.17, 4 ± 2.11, and 4.90 ± 2.62 after 1, 3, and 6 months, respectively (P < 0.05). The effective rate in the sertraline group was 9.76%, 36.59%, and 63

  12. PELVIC INJURY IN CHILDHOOD: WHAT IS ITS CURRENT IMPORTANCE?

    PubMed Central

    GUERRA, MARÍA ROXANA VIAMONT; BRAGA, SUSANA REIS; AKKARI, MIGUEL; SANTILI, CLAUDIO

    2016-01-01

    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. PMID:27217818

  13. Pelvic floor muscle rehabilitation using biofeedback.

    PubMed

    Newman, Diane K

    2014-01-01

    Pelvic floor muscle exercises have been recommended for urinary incontinence since first described by obstetrician gynecologist Dr. Arnold Kegel more than six decades ago. These exercises are performed to strengthen pelvic floor muscles, provide urethral support to prevent urine leakage, and suppress urgency. In clinical urology practice, expert clinicians also teach patients how to relax the muscle to improve bladder emptying and relieve pelvic pain caused by muscle spasm. When treating lower urinary tract symptoms, an exercise training program combined with biofeedback therapy has been recommended as first-line treatment. This article provides clinical application of pelvic floor muscle rehabilitation using biofeedback as a technique to enhance pelvic floor muscle training.

  14. Ultrasound Imaging of the Pelvic Floor.

    PubMed

    Stone, Daniel E; Quiroz, Lieschen H

    2016-03-01

    This article discusses the background and appraisal of endoluminal ultrasound of the pelvic floor. It provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variability and pathology, such as prolapse, fecal incontinence, urinary incontinence, vaginal wall cysts, synthetic implanted material, and pelvic pain, are easily assessed with endoluminal vaginal ultrasound. With pelvic organ prolapse in particular, not only is the prolapse itself seen but the underlying cause related to the anatomic and functional abnormalities of the pelvic floor muscle structures are also visualized.

  15. Chronic Pelvic Pain in Women.

    PubMed

    Speer, Linda M; Mushkbar, Saudia; Erbele, Tara

    2016-03-01

    Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.

  16. Liver cell cancer--intervention studies.

    PubMed

    Linsell, C A

    1981-01-01

    The field studies leading to possible intervention procedures are reviewed. Currently the most promising form of intervention is the prevention of aflatoxin contamination of foodstuffs. It is essential that these are monitored and their efficacy in lowering the incidence of liver cancer measured. The association of liver cancer with hepatitis B infection may be a confounding factor and the impact of this on the study population must also be considered. The imminent production of vaccines for hepatitis B infection may provide an alternative or additional mode of intervention. The possibilities for intervention in liver cell cancer appear one of the brighter prospects for primary prevention of a cancer.

  17. Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

    PubMed Central

    Pandian, Rajadoss Muthukrishna; John, Nirmal Thampi; Eapen, Anu; Antonisamy, B.; Devasia, Antony; Kekre, Nitin

    2017-01-01

    ABSTRACT Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU. PMID:28124535

  18. [Complex pelvic injury in childhood].

    PubMed

    Schmal, H; Klemt, C; Haag, C; Bonnaire, F

    2002-08-01

    Pelvic disruptions are rare in children caused by the flexible anchoring of bony parts associated with a high elasticity of the skeleton. Portion of pelvic fractures in infants is lower than 5% even when reviewing cases of specialized centers. The part of complex pelvic injuries and multiple injured patients in infants is higher when compared to adults, a fact caused by the more intense forces that are necessary to lead to pelvic disruption in children. Combination of a rare injury and the capability of children to compensate blood loss for a long time may implicate a wrong security and prolong diagnostic and therapeutic procedures--a problem that definitely should be avoided. Three cases were analyzed and established algorithms for treatment of patients matching these special injury-features demonstrated. A good outcome may only be achieved when all components of injury pattern get recognized and treatment is organized following the hierarchy of necessity. Therefore in the time table first life-saving steps have to be taken and then accompanying injuries can be treated that often decisively influence life quality. As seen in our cases unstable and dislocated fractures require open reduction and internal fixation ensuring nerval decompression, stop of hemorrhage and realizing the prerequisite for effective treatment of soft tissue damage. The acute hemorrhagic shock is one of the leading causes of death following severe pelvic injuries. After stabilization of fracture, surgical treatment of soft tissue injuries and intraabdominal bleeding sources the immediate diagnostic angiography possibly in combination with a therapeutic selective embolization is a well established part of the treatment. The aim of complete restitution can only be accomplished by cooperation of several different specialists and consultants in a trauma center.

  19. Use of the UPOINT phenotype system in treating Chinese patients with chronic prostatitis/chronic pelvic pain syndrome: a prospective study

    PubMed Central

    Guan, Xiao; Zhao, Cheng; Ou, Zhen-Yu; Wang, Long; Zeng, Feng; Qi, Lin; Tang, Zheng-Yan; Dun, Jin-Geng; Liu, Long-Fei

    2015-01-01

    The urinary, psychosocial, organ-specific, infection, neurological/systemic and tenderness (UPOINT) phenotype system has been validated to be an effective phenotype system in classifying patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in western populations. To validate the utility of the UPOINT system and evaluate the effect of multimodal therapy based on the UPOINT system in Chinese patients with CP/CPPS, we performed this study. Chinese patients with CP/CPPS were prospectively offered multimodal therapy using the UPOINT system and re-examined after 6 months. A minimum 6-point drop in National Institutes of Health-Chronic Prostatitis Symptoms Index (NIH-CPSI) was set to be the primary endpoint. Finally, 140 patients were enrolled in the study. The percentage of patients with each domain was 59.3%, 45.0%, 49.3%, 22.1%, 37.9%, and 56.4% for the UPOINT, respectively. The number of positive domains significantly correlated with symptom severity, which is measured by total NIH-CPSI scores (r = 0.796, P < 0.001). Symptom duration was associated with a greater number of positive domains (r = 0.589, P < 0.001). With 6 months follow-up at least, 75.0% (105/140) had at least a 6-point improvement in NIH-CPSI after taking the therapy. All NIH-CPSI scores were significantly improved from original ones: pain 10.14 ± 4.26 to 6.60 ± 3.39, urinary 6.29 ± 2.42 to 3.63 ± 1.52, quality of life 6.56 ± 2.44 to 4.06 ± 1.98, and total 22.99 ± 7.28 to 14.29 ± 5.70 (all P < 0.0001). Our study indicates that the UPOINT system is clinically feasible in classifying Chinese patients with CP/CPPS and directing therapy. PMID:25248659

  20. Sexual Abuse and Sexual Functioning in a Chronic Pelvic Pain Sample

    ERIC Educational Resources Information Center

    Randolph, Mary E.; Reddy, Diane M.

    2006-01-01

    Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index…

  1. Current technique and results for extended pelvic lymph node dissection during robot-assisted radical prostatectomy

    PubMed Central

    Li, Roger; Petros, Firas G.; Kukreja, Janet B.; Williams, Stephen B.

    2016-01-01

    The practice of extended pelvic lymph node dissection (ePLND) remains one of the most controversial topics in the management of clinically localized prostate cancer. Although most urologists agree on its benefit for staging and prognostication, the role of the ePLND in cancer control continues to be debated. The increased perioperative morbidity makes it unpalatable, especially in patients with low likelihood of lymph node disease. With the advent of robotic assisted laparoscopic prostatectomy, many surgeons were slow to adopt ePLND in the robotic setting. In this study, we summarize the evidence for the prognostic and therapeutic roles of ePLND, review the clinical tools used for lymph node metastasis prediction and survey the numerous experiences of ePLND compiled by robotic urologic surgeons over the years. PMID:27995219

  2. Accelerated Hyperfractionated Radiotherapy for Cervical Cancer: Multi-Institutional Prospective Study of Forum for Nuclear Cooperation in Asia Among Eight Asian Countries

    SciTech Connect

    Ohno, Tatsuya Nakano, Takashi; Kato, Shingo

    2008-04-01

    Purpose: To evaluate the toxicity and efficacy of accelerated hyperfractionated radiotherapy (RT) for locally advanced cervical cancer. Methods and Materials: A multi-institutional prospective single-arm study was conducted among eight Asian countries. Between 1999 and 2002, 120 patients (64 with Stage IIB and 56 with Stage IIIB) with squamous cell carcinoma of the cervix were treated with accelerated hyperfractionated RT. External beam RT consisted of 30 Gy to the whole pelvis, 1.5 Gy/fraction twice daily, followed by 20 Gy of pelvic RT with central shielding at a dose of 2-Gy fractions daily. A small bowel displacement device was used with the patient in the prone position. In addition to central shielding RT, intracavitary brachytherapy was started. Acute and late morbidities were graded according to the Radiation Therapy Oncology Group and Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Results: The median overall treatment time was 35 days. The median follow-up time for surviving patients was 4.7 years. The 5-year pelvic control and overall survival rate for all patients was 84% and 70%, respectively. The 5-year pelvic control and overall survival rate was 78% and 69% for tumors {>=}6 cm in diameter, respectively. No treatment-related death occurred. Grade 3-4 late toxicities of the small intestine, large intestine, and bladder were observed in 1, 1, and 2 patients, respectively. The 5-year actuarial rate of Grade 3-4 late toxicity at any site was 5%. Conclusion: The results of our study have shown that accelerated hyperfractionated RT achieved sufficient pelvic control and survival without increasing severe toxicity. This treatment could be feasible in those Asian countries where chemoradiotherapy is not available.

  3. Geometric parameterisation of pelvic bone and cartilage in contact analysis of the natural hip: An initial study

    PubMed Central

    Hua, Xijin; Li, Junyan; Wilcox, Ruth K; Fisher, John; Jones, Alison C

    2015-01-01

    Parameterised finite element models of the human hip have the potential to allow controlled analysis of the effect of individual geometric features on the contact mechanics of the joint. However, the challenge lies in defining a set of parameters which sufficiently capture the joint geometry in order to distinguish between individuals. In this study, a simple set of parameters to describe the geometries of acetabulum and cartilage in the hip were extracted from two segmentation-based models, which were then used to generate the parameterised finite element models for the two subjects. The contact pressure and contact area at the articular surface predicted from the parameterised finite element models were compared with the results from the segmentation-based models. The differences in the predicted results between the parameterised models and segmentation-based models were found to be within 11% across seven activities simulated. In addition, the parameterised models were able to replicate features of the contact pressure/area fluctuations over the loading cycle that differed between the two subjects. These results provide confidence that the parameterised approach could be used to generate representative finite element models of the human hip for contact analysis. Such a method has the potential to be used to systematically evaluate geometric features that can be captured from simple clinical measurements and provide a cost- and time-effective approach for stratification of the acetabular geometries in the patient population. PMID:26112348

  4. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs.

    PubMed

    Herschorn, Sender

    2004-01-01

    The development of novel, less invasive therapies for stress urinary incontinence in women requires a thorough knowledge of the relationship between the pathophysiology of incontinence and anatomy. This article provides a review of the anatomy of the pelvic floor and lower urinary tract. Also discussed is the hammock hypothesis, which describes urethral support within the pelvis and provides an explanation of the continence mechanism.

  5. Cancer genome-sequencing study design.

    PubMed

    Mwenifumbo, Jill C; Marra, Marco A

    2013-05-01

    Discoveries from cancer genome sequencing have the potential to translate into advances in cancer prevention, diagnostics, prognostics, treatment and basic biology. Given the diversity of downstream applications, cancer genome-sequencing studies need to be designed to best fulfil specific aims. Knowledge of second-generation cancer genome-sequencing study design also facilitates assessment of the validity and importance of the rapidly growing number of published studies. In this Review, we focus on the practical application of second-generation sequencing technology (also known as next-generation sequencing) to cancer genomics and discuss how aspects of study design and methodological considerations - such as the size and composition of the discovery cohort - can be tailored to serve specific research aims.

  6. [CT guidance (125)I seed implantation for pelvic recurrent rectal cancer assisted by 3D printing individual non-coplanar template].

    PubMed

    Wang, H; Wang, J J; Jiang, Y L; Tian, S Q; Ji, Z; Guo, F X; Sun, H T; Fan, J H; Xu, Y P

    2016-12-20

    Objective: To analyze the difference of dosimetric parameters between pre-plan and post-plan of (125)I radioactive seed implantation assisted by 3D printing individual non-coplanar template (3D printing template) for locally recurrent rectal cancer (LRRC). Methods: From February 2016 to April 2016, a total of 10 patients with locally recurrent rectal cancer received (125)I seeds implantation under CT guidance assisted by 3D printing template in Department of Radiation Oncology, Peking University Third Hospital.Each patient underwent CT simulation, three-dimentional treatment planning pre-implantation, 3D printing template design, radioactive seed implantation assisted by 3D printing template and dosimetric verification post implantation. The median activity of seed was 0.63 mCi (0.58 to 0.7 mCi) (2.15- 2.59×10(7) Bq), and the median number of seeds was 80 (19 to 192). D90, D100, V100, V150, CI, EI, HI, D5cc, D2cc of bladder and bowel of pre-plan and post-plan were calculated, respectively.Paired t test was used to evaluate the difference of dosimetric parameters between pre-plan and post-plan. Results: The median D90 of pre-plan and post-plan were 13 761.0 and 12 798.8 cGy, respectively.The median D100 of pre-plan and post-plan were 5 293.6 and 5 397.9 cGy, respectively.The median V100 of pre-plan and post-plan were 90.0% and 90.0%, respectively.The median V150 of pre-plan and post-plan were 63.8% and 62.4%, respectively.The median CI of pre-plan and post-plan were 0.73 and 0.67.The median EI of pre-plan and post-plan were 0.22 and 0.30, respectively. The median HI of pre-plan and post-plan were 0.29 and 0.31.The median bladder D2cc of pre-plan and post-plan were 3 088.8 and 4 240.4 cGy, respectively.The median bowel D2cc of pre-plan and post-plan were 7 051.6 and 7 903.9 cGy, respectively. Conclusions: 3D printing template might be helpful for locally recurrent rectal cancer patients who received (125)I radioactive seed implantation assisted by 3D printing

  7. Conflicting calculations of pelvic incidence and pelvic tilt secondary to transitional lumbosacral anatomy (lumbarization of S-1): case report.

    PubMed

    Crawford, Charles H; Glassman, Steven D; Gum, Jeffrey L; Carreon, Leah Y

    2017-01-01

    Advancements in the understanding of adult spinal deformity have led to a greater awareness of the role of the pelvis in maintaining sagittal balance and alignment. Pelvic incidence has emerged as a key radiographic measure and should closely match lumbar lordosis. As proper measurement of the pelvic incidence requires accurate identification of the S-1 endplate, lumbosacral transitional anatomy may lead to errors. The purpose of this study is to demonstrate how lumbosacral transitional anatomy may lead to errors in the measurement of pelvic parameters. The current case highlights one of the potential complications that can be avoided with awareness. The authors report the case of a 61-year-old man who had undergone prior lumbar surgeries and then presented with symptomatic lumbar stenosis and sagittal malalignment. Radiographs showed a lumbarized S-1. Prior numbering of the segments in previous surgical and radiology reports led to a pelvic incidence calculation of 61°. Corrected numbering of the segments using the lumbarized S-1 endplate led to a pelvic incidence calculation of 48°. Without recognition of the lumbosacral anatomy, overcorrection of the lumbar lordosis might have led to negative sagittal balance and the propensity to develop proximal junction failure. This case illustrates that improper identification of lumbosacral transitional anatomy may lead to errors that could affect clinical outcome. Awareness of this potential error may help improve patient outcomes.

  8. Prevalence of exclusively and concomitant pelvic fractures at magnetic resonance imaging of suspect and occult hip fractures.

    PubMed

    Collin, David; Geijer, Mats; Göthlin, Jan H

    2016-02-01

    Pelvic fractures may occur together with hip fractures as a result of low energy trauma. It is unclear whether they do require special attention. There are conflicting results in the literature about the prevalence of both concomitant hip and pelvic fractures as well as exclusive pelvic fractures. It has been reported that hip fractures and obturator ring fractures are mutually exclusive. To retrospectively analyze the prevalence of exclusively pelvic as well as concomitant hip and pelvic fractures in patients examined with MRI after low-energy trauma in elderly. During 9 years, 316 elderly patients had been examined with MRI for suspected or occult hip fracture after a fall. A fracture was diagnosed when MRI showed focal signal abnormalities in the subcortical bone marrow, with or without disruption of adjacent cortices. One observer reviewed all studies. A second observer verified all studies with hip fractures. Follow-up was available for all but two patients that died prior to hip surgery. The prevalence of concomitant pelvic and femoral neck or trochanteric fractures was statistically compared using chi-squared test for categorical variables. Hip fractures were found in 161 (51 %) patients of which 29 (9 %) had concomitant pelvic fractures. There were exclusively pelvic fractures in 82 (26 %) patients of which 65 (79 %) were on the traumatized side only. In 73 patients, there were no fractures. Occult or suspected hip fractures are not infrequently associated with pelvic fractures. Exclusively pelvic fractures are not uncommon.

  9. Motorcycle petrol tanks and their role in severe pelvic injuries.

    PubMed

    de Peretti, F; Cambas, P M; Hovorka, I; Veneau, B; Argenson, C

    1994-05-01

    Between 1985 and 1992, nine patients who sustained severe pelvic lesions as a result of motorcycle accidents were admitted to and treated in the authors' department. In six of these nine cases the petrol tank of the motorcycle was one of the wounding agents, and all six patients had the same kind of motorcycle with an oversized petrol tank. All six patients had unstable pelvic lesions. In addition, four had subperitoneal haematomas which required multiple transfusions; five had perineal and/or genital lesions, and one had a ruptured membranous urethra. Severe pelvic injuries are rare, but can have after-effects which jeopardize the social and family life of the patients. A national epidemiological study would be useful to evaluate the frequency of such injuries and to draw conclusions leading to improved safety for motorcyclists.

  10. Acute pelvic pain in females in septic and aseptic contexts.

    PubMed

    Pages-Bouic, E; Millet, I; Curros-Doyon, F; Faget, C; Fontaine, M; Taourel, P

    2015-10-01

    Acute pelvic pain in women is a common reason for emergency department admission. There is a broad range of possible aetiological diagnoses, with gynaecological and gastrointestinal causes being the most frequently encountered. Gynaecological causes include upper genital tract infection and three types of surgical emergency, namely ectopic pregnancy, adnexal torsion, and haemorrhagic ovarian cyst rupture. The main gastrointestinal cause is acute appendicitis, which is the primary differential diagnosis for acute pelvic pain of gynaecological origin. The process of diagnosis will be guided by the clinical examination, laboratory study results, and ultrasonography findings, with suprapubic transvaginal pelvic ultrasonography as the first-line examination in this young population, and potentially cross-sectional imaging findings (computed tomography and MR imaging) if diagnosis remains uncertain.

  11. Erectile function after anastomotic urethroplasty for pelvic fracture urethral injuries.

    PubMed

    El-Assmy, A; Harraz, A M; Benhassan, M; Nabeeh, A; Ibrahiem, El Hi

    2016-07-01

    There is an established association between ED and pelvic fracture urethral injuries (PFUIs). However, ED can occur after the injury and/or the urethral repair. To our knowledge, only one study of erectile function (EF) after urethroplasty for PFUIs used a validated questionnaire. This study was carried out to determine the impact of anastomotic posterior urethroplasty for PFUIs on EF. We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic urethroplasty for PFUIs from 1998 to 2014. Those patients were contacted by phone or mail and were re-evaluated in the outpatient clinic by International Index of Erectile Function questionnaire; in unmarried men, the single-question self-report of ED was used for evaluation of EF, clinical examination and penile color Doppler ultrasonography (CDU) for men with ED. Overall, 58 patients were included in the study among whom 36 (62%) men were sexually active and the remaining 22 (38%) were single. The incidence of ED among our group is 72%. All patients developed ED after initial pelvic trauma and none of our patients had impaired EF after urethroplasty. The incidence of ED increased proportionally with severity of pelvic trauma. All patients with type-C pelvic fracture, associated symphysis pubis diastasis, sacroiliac joints diastasis and bilateral pubic ramus fractures had ED. Men with PFUIs had worse EF than men in other series with pelvic fractures without urethral injury. The majority (88%) of men with ED showed veno-occlusive dysfunction on penile CDU. So we concluded that men with PFUIs had a high incidence of ED up to 72%. Anastomotic posterior urethroplasty had no negative impact on EF and the development of ED after PFUIs was related to the severity of the original pelvic trauma. Veno-occlusive dysfunction is the commonest etiology of ED on penile CDU.

  12. CANCER INCIDENCE IN THE AGRICULTURAL HEALTH STUDY

    EPA Science Inventory

    The Agricultural Health Study (AHS) was undertaken to ascertain the etiology of cancers observed to be elevated in agricultural populations. Methods: The AHS is a large prospective, cohort study of private applicators and commercial applicators licensed to apply restricted use ...

  13. Interfractional Variations in the Setup of Pelvic Bony Anatomy and Soft Tissue, and Their Implications on the Delivery of Proton Therapy for Localized Prostate Cancer

    SciTech Connect

    Trofimov, Alexei; Nguyen, Paul L.; Efstathiou, Jason A.; Wang, Yi; Lu, Hsiao-Ming; Engelsman, Martijn; Merrick, Scott; Cheng, Chee-Wai; Wong, James R.; Zietman, Anthony L.

    2011-07-01

    Purpose: To quantify daily variations in the anatomy of patients undergoing radiation therapy for prostate carcinoma, to estimate their effect on dose distribution, and to evaluate the effectiveness of current standard planning and setup approaches employed in proton therapy. Methods: We used series of computed tomography data, which included the pretreatment scan, and between 21 and 43 in-room scans acquired on different treatment days, from 10 patients treated with intensity-modulated radiation therapy at Morristown Memorial Hospital. Variations in femur rotation angles, thickness of subcutaneous adipose tissue, and physical depth to the distal surface of the prostate for lateral beam arrangement were recorded. Proton dose distributions were planned with the standard approach. Daily variations in the location of the prescription isodose were evaluated. Results: In all 10 datasets, substantial variation was observed in the lateral tissue thickness (standard deviation of 1.7-3.6 mm for individual patients, variations of >5 mm from the planning computed tomography observed in all series), and femur rotation angle (standard deviation between 1.3{sup o} and 4.8{sup o}, with the maximum excursion exceeding 10{sup o} in 6 of 10 datasets). Shifts in the position of treated volume (98% isodose) were correlated with the variations in the lateral tissue thickness. Conclusions: Analysis suggests that, combined with image-guided setup verification, the range compensator expansion technique prevents loss of dose to target from femur rotation and soft-tissue deformation, in the majority of cases. Anatomic changes coupled with the uncertainties of particle penetration in tissue restrict possibilities for margin reduction in proton therapy of prostate cancer.

  14. Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture?

    PubMed

    Brown, Carlos V R; Kasotakis, George; Wilcox, Alison; Rhee, Peter; Salim, Ali; Demetriades, Demetrios

    2005-09-01

    Pelvic angiography plays an increasing role in the management of pelvic fractures (PFs). Little has been written regarding the size of pelvic hematoma on admission computed tomography (CT) and how it relates to angiography results after PF. This is a retrospective review of trauma patients with PF who underwent an admission abdominal/pelvic CT scan and pelvic angiography from 2001 to 2003. CT pelvic hematoma was measured and classified as minimal or significant based on hematoma dimensions. Presence of a contrast blush on CT scan was also documented. Thirty-seven patients underwent an admission CT scan and went on to pelvic angiography. Of the 22 patients with significant pelvic hematoma, 73 per cent (n = 16) had bleeding at angiography. Fifteen patients had minimal pelvic hematoma, with 67 per cent (n = 10) showing active bleeding at angiography. In addition, five of six patients (83%) with no pelvic hematoma had active bleeding at angiography. Six patients had a blush on CT scan, with five of these (83%) having a positive angiogram. But, 22 of 31 (71%) patients with no blush on CT scan had bleeding at angiography. The absence of a pelvic hematoma or contrast blush should not alter indications for pelvic angiography, as they do not reliably exclude active pelvic bleeding.

  15. Modelling the pelvic floor for investigating difficulties during childbirth

    NASA Astrophysics Data System (ADS)

    Li, Xinshan; Kruger, Jennifer A.; Chung, Jae-Hoon; Nash, Martyn P.; Nielsen, Poul M. F.

    2008-03-01

    Research has suggested that athletes involved in high-intensity sports for sustained periods have a higher probability of experiencing prolonged second stage of labour compared to non-athletes. The mechanism responsible for this complication is unknown but may depend on the relative size or tone of the pelvic floor muscles. Prolonged training can result in enlargement and stiffening of these muscles, providing increased resistance as the fetal head descends through the birth canal during a vaginal birth. On the other hand, recent studies have suggested an association between increased muscle bulk in athletes and higher distensibility. This project aims to use mathematical modelling to study the relationship between the size and tone of the pelvic floor muscles and the level of difficulty during childbirth. We obtained sets of magnetic resonance (MR) images of the pelvic floor region for a female athlete and a female non-athlete. Thirteen components of the pelvic floor were segmented and used to generate finite element (FE) models. The fetal head data was obtained by laser scanning a skull replica and a FE model was fitted to these data. We used contact mechanics to simulate the motion of the fetal head moving through the pelvic floor, constructed from the non-athlete data. A maximum stretch ratio of 3.2 was induced in the muscle at the left lateral attachment point to the pubis. We plan to further improve our modelling framework to include active muscle contraction and fetal head rotations in order to address the hypotheses that there is a correlation between the level of difficulty and the size or tone of the pelvic floor muscles.

  16. The increasing burden of pelvic fractures in older people, New South Wales, Australia.

    PubMed

    Boufous, Soufiane; Finch, Caroline; Lord, Stephen; Close, Jacqueline

    2005-11-01

    Despite their significant health burden, epidemiological information regarding pelvic fractures is scarce. In this study, we examine trends in admission for pelvic fractures to acute hospitals in New South Wales, Australia, between July 1988 and June 2000, using routinely collected hospital separations statistics. Over this period, the number of admissions for pelvic fractures among those aged 50 years and over increased by 58.4% in men and 110.8% in women. Age-specific rates of admissions per 100,000 population for pelvic fracture also rose significantly, particularly for those aged at least 75 years. The number and proportion of transport related pelvic fractures fell significantly for both men (chi(2)=23.82, d.f.=1, p<0.001) and women (chi(2)=49.26, d.f.=1, p<0.001) while those resulting from falls increased significantly over the 12-year-period. Falls are increasingly becoming the single most important cause of pelvic injuries in older people, suggesting that preventive measures aimed at reducing the risk of falls need to be pursued. Factors contributing to the rise of fall-related pelvic fractures need to be investigated to inform strategies aimed at reversing the observed increase in the number and age-specific rates of pelvic fractures in older people.

  17. Normal serum relaxin in women with disabling pelvic pain during pregnancy.

    PubMed

    Petersen, L K; Hvidman, L; Uldbjerg, N

    1994-01-01

    As part of a case control within cohort study 472 pregnant women answered a questionnaire post partum. Serum relaxin concentrations were measured by a homologous ELISA in samples collected from the women in the 30th week of pregnancy. Serum relaxin concentrations were not associated with pregnancy-associated pelvic pain. Thus, normal pregnant women without pelvic pain (n = 118) had mean concentrations of 343 pg/ml compared to 332 pg/ml in women (n = 59) with pelvic pain and some restriction in daily activities and to 349 pg/ml in women (n = 9) with severe pregnancy-induced pelvic pain. The present results do not suggest a role for relaxin in symptom-giving pelvic relaxation during human pregnancy.

  18. Residual pelvic rotation after single-event multilevel surgery in spastic hemiplegia.

    PubMed

    Chung, C Y; Lee, S H; Choi, I H; Cho, T-J; Yoo, W J; Park, M S

    2008-09-01

    Our aim in this retrospective study of 52 children with spastic hemiplegia was to determine the factors which affected the amount of residual pelvic rotation after single-event multilevel surgery. The patients were divided into two groups, those who had undergone femoral derotation osteotomy and those who had not. Pelvic rotation improved significantly after surgery in the femoral osteotomy group (p < 0.001) but not in the non-femoral osteotomy group. Multiple regressions identified the following three independent variables, which significantly affected residual pelvic rotation: the performance of femoral derotation osteotomy (p = 0.049), the pre-operative pelvic rotation (p = 0.003) and the post-operative internal rotation of the hip (p = 0.001). We concluded that there is a decrease in the amount of pelvic rotation after single-event multilevel surgery with femoral derotation osteotomy. However, some residual rotation may persist when patients have severe rotation before surgery.

  19. Laparoscopically guided bilateral pelvic lymphadenectomy

    NASA Astrophysics Data System (ADS)

    Gershman, Alex; Danoff, Dudley; Chandra, Mudjianto; Grundfest, Warren S.

    1991-07-01

    Pelvic node dissection has gained widespread acceptance as the final staging procedure in patients with normal acid phospatase and bone scan free of metastatic disease prior to definitive therapy for cure. However, the procedure has had a high morbidity (20-34%) and a major economic impact on the patient due to lengthy hospitalization and recuperative time. The development of laparoscopic biopsy techniques suggests that the need for open surgical lymphadenectomy may be reduced by a laparoscopically performed lymphadenectomy. The goal of this report is to investigate the possibility of laparoscopic pelvic lymphadenectomy in an animal model. Our interest in laparoscopy is based on the ability of this technique to permit tissue removal without the need for major incisions. In laparoscopic cholecystectomy and laparoscopic appendectomy, the surgical procedure is essentially unaltered. The diseased organ is removed and there is no need for a large abdominal incision.

  20. Obesity and pelvic floor dysfunction.

    PubMed

    Ramalingam, Kalaivani; Monga, Ash

    2015-05-01

    Obesity is associated with a high prevalence of pelvic floor disorders. Patients with obesity present with a range of urinary, bowel and sexual dysfunction problems as well as uterovaginal prolapse. Urinary incontinence, faecal incontinence and sexual dysfunction are more prevalent in patients with obesity. Uterovaginal prolapse is also more common than in the non-obese population. Weight loss by surgical and non-surgical methods plays a major role in the improvement of these symptoms in such patients. The treatment of symptoms leads to an improvement in their quality of life. However, surgical treatment of these symptoms may be accompanied by an increased risk of complications in obese patients. A better understanding of the mechanism of obesity-associated pelvic floor dysfunction is essential.

  1. Consensus Guidelines and Contouring Atlas for Pelvic Node Delineation in Prostate and Pelvic Node Intensity Modulated Radiation Therapy

    SciTech Connect

    Harris, Victoria A.; Staffurth, John; Naismith, Olivia; Esmail, Alikhan; Gulliford, Sarah; Khoo, Vincent; Lewis, Rebecca; Littler, John; McNair, Helen; Sadoyze, Azmat; Scrase, Christopher; Sohaib, Aslam; Syndikus, Isabel; Zarkar, Anjali; Hall, Emma; Dearnaley, David

    2015-07-15

    Purpose: The purpose of this study was to establish reproducible guidelines for delineating the clinical target volume (CTV) of the pelvic lymph nodes (LN) by combining the freehand Royal Marsden Hospital (RMH) and Radiation Therapy Oncology Group (RTOG) vascular expansion techniques. Methods and Materials: Seven patients with prostate cancer underwent standard planning computed tomography scanning. Four different CTVs (RMH, RTOG, modified RTOG, and Prostate and pelvIs Versus prOsTate Alone treatment for Locally advanced prostate cancer [PIVOTAL] trial) were created for each patient, and 6 different bowel expansion margins (BEM) were created to assess bowel avoidance by the CTV. The resulting CTVs were compared visually and by using Jaccard conformity indices. The volume of overlap between bowel and planning target volume (PTV) was measured to aid selection of an appropriate BEM to enable maximal LN yet minimal normal tissue coverage. Results: In total, 84 nodal contours were evaluated. LN coverage was similar in all groups, with all of the vascular-expansion techniques (RTOG, modified RTOG, and PIVOTAL), resulting in larger CTVs than that of the RMH technique (mean volumes: 287.3 cm{sup 3}, 326.7 cm{sup 3}, 310.3 cm{sup 3}, and 256.7 cm{sup 3}, respectively). Mean volumes of bowel within the modified RTOG PTV were 19.5 cm{sup 3} (with 0 mm BEM), 17.4 cm{sup 3} (1-mm BEM), 10.8 cm{sup 3} (2-mm BEM), 6.9 cm{sup 3} (3-mm BEM), 5.0 cm{sup 3} (4-mm BEM), and 1.4 cm{sup 3} (5-mm BEM) in comparison with an overlap of 9.2 cm{sup 3} seen using the RMH technique. Evaluation of conformity between LN-CTVs from each technique revealed similar volumes and coverage. Conclusions: Vascular expansion techniques result in larger LN-CTVs than the freehand RMH technique. Because the RMH technique is supported by phase 1 and 2 trial safety data, we proposed modifications to the RTOG technique, including the addition of a 3-mm BEM, which resulted in LN-CTV coverage similar

  2. [Stereotactic radiotherapy for pelvic tumors].

    PubMed

    Mazeron, R; Fumagalli, I

    2014-01-01

    Extracranial stereotactic radiotherapy is booming. The development and spread of dedicated accelerators coupled with efficient methods of repositioning can now allow treatments of mobile lesions with moderate size, with high doses per fraction. Intuitively, except for the prostate, pelvic tumours, often requiring irradiation of regional lymph node drainage, lend little to this type of treatment. However, in some difficult circumstances, such as boost or re-radiation, stereotactic irradiation condition is promising and clinical experiences have already been reported.

  3. Study of ovarian cancer management.

    PubMed

    Gaughan, E; Javaid, T; Cooley, S; Byrne, P; Gaughan, G

    2006-10-01

    Ovarian cancer is the most lethal gynecological malignancy. Many patients present at an advanced stage as the symptoms of early stage disease can be vague. AIM We evaluated the demographics, treatment regimens and survival rates of ovarian cancer patients attending Beaumont Hospital Dublin over a nine year period. A retrospective chart review of ovarian cancer patients attending Beaumont Hospital between 11/10/94 and 30/6/3 was performed. Patients were selected from pathology records. Patients with borderline histology and those who died of unrelated causes were excluded. 31% of individuals presented with distension as their only clinical sign. 20% presented with a mass as their only clinical sign. The most common cell type was papillary serous adenocarcinoma in two thirds of cases. 54% presented with advanced disease [stage IIl-IV]. Treatment involved surgical clearance or debulking +/- chemotherapy. 5 year survival for Stage I was 95% versus 19% for Stage IlI. This highlights the importance of early diagnosis.

  4. Pelvic trauma: WSES classification and guidelines.

    PubMed

    Coccolini, Federico; Stahel, Philip F; Montori, Giulia; Biffl, Walter; Horer, Tal M; Catena, Fausto; Kluger, Yoram; Moore, Ernest E; Peitzman, Andrew B; Ivatury, Rao; Coimbra, Raul; Fraga, Gustavo Pereira; Pereira, Bruno; Rizoli, Sandro; Kirkpatrick, Andrew; Leppaniemi, Ari; Manfredi, Roberto; Magnone, Stefano; Chiara, Osvaldo; Solaini, Leonardo; Ceresoli, Marco; Allievi, Niccolò; Arvieux, Catherine; Velmahos, George; Balogh, Zsolt; Naidoo, Noel; Weber, Dieter; Abu-Zidan, Fikri; Sartelli, Massimo; Ansaloni, Luca

    2017-01-01

    Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

  5. Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

    PubMed

    Azevedo, Daniel Camara; Paiva, Edson Barreto; Lopes, Alexia Moura Abuhid; Santos, Henrique de Oliveira; Carneiro, Ricardo Luiz; Rodrigues, André Soares; de Andrade, Marco Antonio Percope; Novais, Eduardo N; Van Dillen, Linda R

    2016-11-01

    Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

  6. Immune mediators of chronic pelvic pain syndrome

    PubMed Central

    Murphy, Stephen F.; Schaeffer, Anthony J.; Thumbikat, Praveen

    2016-01-01

    The cause of chronic pelvic pain syndrome (CPPS) has yet to be established. Since the late 1980s, cytokine, chemokine, and immunological classification studies using human samples have focused on identifying biomarkers for CPPS, but no diagnostically beneficial biomarkers have been identified, and these studies have done little to deepen our understanding of the mechanisms underlying chronic prostatic pain. Given the large number of men thought to be affected by this condition and the ineffective nature of current treatments, there is a pressing need to elucidate these mechanisms. Prostatitis types IIIa and IIIb are classified according to the presence of pain without concurrent presence of bacteria; however, it is becoming more evident that, although levels of bacteria are not directly associated with levels of pain, the presence of bacteria might act as the initiating factor that drives primary activation of mast-cell-mediated inflammation in the prostate. Mast cell activation is also known to suppress regulatory T cell (Treg) control of self-tolerance and also activate neural sensitization. This combination of established autoimmunity coupled with peripheral and central neural sensitization can result in the development of multiple symptoms, including pelvic pain and bladder irritation. Identifying these mechanisms as central mediators in CPPS offers new insight into the prospective treatment of the disease. PMID:24686526

  7. Reprogramming bladder cancer cells for studying cancer initiation and progression.

    PubMed

    Iskender, Banu; Izgi, Kenan; Canatan, Halit

    2016-10-01

    The induced pluripotent stem cell (iPSC) technology is the forced expression of specific transcription factors in somatic cells resulting in transformation into self-renewing, pluripotent cells which possess the ability to differentiate into any type of cells in the human body. While malignant cells could also be reprogrammed into iPSC-like cells with lower efficiency due to the genetic and epigenetic barriers in cancer cells, only a limited number of cancer cell types could be successfully reprogrammed until today. In the present study, we aimed at reprogramming two bladder cancer cell lines HTB-9 and T24 using a non-integrating Sendai virus (SeV) system. We have generated six sub-clones using distinct combinations of four factors-OCT4, SOX2, KLF4 and c-MYC-in two bladder cancer cell lines. Only a single sub-clone, T24 transduced with 4Fs, gave rise to iPSC-like cells. Bladder cancer cell-derived T24 4F cells represent unique features of pluripotent cells such as epithelial-like morphology, colony-forming ability, expression of pluripotency-associated markers and bearing the ability to differentiate in vitro. This is the first study focusing on the reprogramming susceptibility of two different bladder cancer cell lines to nuclear reprogramming. Further molecular characterisation of T24 4F cells could provide a better insight for biomarker research in bladder carcinogenesis and could offer a valuable tool for the development of novel therapeutic approaches in bladder carcinoma.

  8. Tea and cancer prevention: epidemiological studies.

    PubMed

    Yuan, Jian-Min; Sun, Canlan; Butler, Lesley M

    2011-08-01

    Experimental studies have consistently shown the inhibitory activities of tea extracts on tumorigenesis in multiple model systems. Epidemiological studies, however, have produced inconclusive results in humans. A comprehensive review was conducted to assess the current knowledge on tea consumption and risk of cancers in humans. In general, consumption of black tea was not associated with lower risk of cancer. High intake of green tea was consistently associated with reduced risk of upper gastrointestinal tract cancers after sufficient control for confounders. Limited data support a protective effect of green tea on lung and hepatocellular carcinogenesis. Although observational studies do not support a beneficial role of tea intake on prostate cancer risk, phase II clinical trials have demonstrated an inhibitory effect of green tea extract against the progression of prostate pre-malignant lesions. Green tea may exert beneficial effects against mammary carcinogenesis in premenopausal women and recurrence of breast cancer. There is no sufficient evidence that supports a protective role of tea intake on the development of cancers of the colorectum, pancreas, urinary tract, glioma, lymphoma, and leukemia. Future prospective observational studies with biomarkers of exposure and phase III clinical trials are required to provide definitive evidence for the hypothesized beneficial effect of tea consumption on cancer formation in humans.

  9. Childhood Cancer Survivor Study: An Overview

    MedlinePlus

    ... Partners & Collaborators Spotlight on Scientists Research Areas Cancer Biology Cancer Genomics Causes of Cancer Diagnosis Prevention Screening & ... Collaborators Spotlight on Scientists NCI Research Areas Cancer Biology Cancer Genomics Causes of Cancer Diagnosis Prevention Screening & ...

  10. Utilizing Data from Cancer Patient & Survivor Studies

    Cancer.gov

    Utilizing Data from Cancer Patient & Survivor Studies and Understanding the Current State of Knowledge and Developing Future Research Priorities, a 2011 workshop sponsored by the Epidemiology and Genomics Research Program.

  11. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care

    PubMed Central

    Wiegersma, Marian; Panman, Chantal M C R; Kollen, Boudewijn J; Berger, Marjolein Y; Lisman-Van Leeuwen, Yvonne

    2014-01-01

    Objective To compare the effects of pelvic floor muscle training and watchful waiting on pelvic floor symptoms in a primary care population of women aged 55 years and over with symptomatic mild pelvic organ prolapse. Design Randomised controlled trial. Setting Dutch primary care. Participants Women aged 55 years or over with symptomatic mild prolapse (leading edge above the hymen) were identified by screening. Exclusion criteria were current prolapse treatment or treatment in the previous year, malignancy of pelvic organs, current treatment for another gynaecological disorder, severe/terminal illness, impaired mobility, cognitive impairment, and insufficient command of the Dutch language. Interventions Pelvic floor muscle training versus watchful waiting. Main outcome measures The primary outcome was change in bladder, bowel, and pelvic floor symptoms measured with the Pelvic Floor Distress Inventory-20 (PFDI-20), three months after the start of treatment. Secondary outcomes were changes in condition specific and general quality of life, sexual function, degree of prolapse, pelvic floor muscle function, and patients’ perceived change in symptoms. Results Of the 287 women who were randomised to pelvic floor muscle training (n=145) or watchful waiting (n=142), 250 (87%) completed follow-up. Participants in the intervention group improved by (on average) 9.1 (95% confidence interval 2.8 to 15.4) points more on the PFDI-20 than did participants in the watchful waiting group (P=0.005). Of women in the pelvic floor muscle training group, 57% (82/145) reported an improvement in overall symptoms from the start of the study compared with 13% (18/142) in the watchful waiting group (P<0.001). Other secondary outcomes showed no significant difference between the groups. Conclusions Although pelvic floor muscle training led to a significantly greater improvement in PFDI-20 score, the difference between the groups was below the presumed level of clinical relevance (15 points

  12. Recognizing Myofascial Pelvic Pain in the Female Patient with Chronic Pelvic Pain

    PubMed Central

    Pastore, Elizabeth Anne; Katzman, Wendy B.

    2012-01-01

    Myofascial pelvic pain (MFPP) is a major component of chronic pelvic pain (CPP) and often is not properly identified by healthcare providers. The hallmark diagnostic indicator of MFPP is myofascial trigger points in the pelvic floor musculature that refer pain to adjacent sites. Effective treatments are available to reduce MFPP, including myofascial trigger point release, PMID:22862153

  13. Pelvic dimorphism in relation to body size and body size dimorphism in humans.

    PubMed

    Kurki, Helen K

    2011-12-01

    Many mammalian species display sexual dimorphism in the pelvis, where females possess larger dimensions of the obstetric (pelvic) canal than males. This is contrary to the general pattern of body size dimorphism, where males are larger than females. Pelvic dimorphism is often attributed to selection relating to parturition, or as a developmental consequence of secondary sexual differentiation (different allometric growth trajectories of each sex). Among anthropoid primates, species with higher body size dimorphism have higher pelvic dimorphism (in converse directions), which is consistent with an explanation of differential growth trajectories for pelvic dimorphism. This study investigates whether the pattern holds intraspecifically in humans by asking: Do human populations with high body size dimorphism also display high pelvic dimorphism? Previous research demonstrated that in some small-bodied populations, relative pelvic canal size can be larger than in large-bodied populations, while others have suggested that larger-bodied human populations display greater body size dimorphism. Eleven human skeletal samples (total N: male = 229, female = 208) were utilized, representing a range of body sizes and geographical regions. Skeletal measurements of the pelvis and femur were collected and indices of sexual dimorphism for the pelvis and femur were calculated for each sample [ln(M/F)]. Linear regression was used to examine the relationships between indices of pelvic and femoral size dimorphism, and between pelvic dimorphism and female femoral size. Contrary to expectations, the results suggest that pelvic dimorphism in humans is generally not correlated with body size dimorphism or female body size. These results indicate that divergent patterns of dimorphism exist for the pelvis and body size in humans. Implications for the evaluation of the evolution of pelvic dimorphism and rotational childbirth in Homo are considered.

  14. Female Pelvic Floor Anatomy: The Pelvic Floor, Supporting Structures, and Pelvic Organs

    PubMed Central

    Herschorn, Sender

    2004-01-01

    The development of novel, less invasive therapies for stress urinary incontinence in women requires a thorough knowledge of the relationship between the pathophysiology of incontinence and anatomy. This article provides a review of the anatomy of the pelvic floor and lower urinary tract. Also discussed is the hammock hypothesis, which describes urethral support within the pelvis and provides an explanation of the continence mechanism. PMID:16985905

  15. Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm.

    PubMed

    Bendaña, Emma E; Belarmino, James M; Dinh, Jenny H; Cook, Cynthia L; Murray, Brian P; Feustel, Paul J; De, Elise J B

    2009-01-01

    Women with urinary urgency and frequency may also have pelvic floor muscle spasm. Transvaginal biofeedback (TVBF) and electrical stimulation (EStim) is a treatment modality that has been used to treat vaginismus and chronic pelvic pain. In this study, TVBF/EStim was evaluated in women with pelvic floor muscle spasm associated with urinary symptoms. Fifty-two women underwent therapy with TVBF/EStim and reported a mean symptom improvement of 64.5%.

  16. Surgical anatomy for pelvic external fixation.

    PubMed

    Solomon, L B; Pohl, A P; Chehade, M J; Malcolm, A M; Howie, D W; Henneberg, M

    2008-10-01

    Pelvic external fixators have a high rate of reported complications, most of which relate to pin placement. In this descriptive study, we analyzed the morphology of the ilium in cadaveric specimens and compared these with the measures obtained from normal human pelvic computer tomograph scans, and how these related to each of the three basic configurations of pin positioning for the external fixation of a pelvis: anterosuperior (Slätis type), anteroinferior (supra-acetabular), and subcristal. The irregular shape and size of the iliac wing and the abdominal wall overlying the pin's insertion site could hinder accurate placement of anterosuperior pins. Potential disadvantages of the use of anteroinferior pins was found related to the deep location of the anterior inferior iliac spine, interference with the hip flexion area, risk of hip joint penetration, and the variable obliquity of the ilium. As subcristal pins are positioned between two superficial bony landmarks of the iliac crest, our findings suggest that they are more likely to have a correct placement and avoid complications.

  17. Gene expression profile in pelvic organ prolapse†

    PubMed Central

    Brizzolara, S.S.; Killeen, J.; Urschitz, J.

    2009-01-01

    It was hypothesized that the processes contributing to pelvic organ prolapse (POP) may be identified by transcriptional profiling of pelvic connective tissue in conjunction with light microscopy. In order to test this, we performed a frequency-matched case–control study of women undergoing hysterectomy for POP and controls. Total RNA, extracted from uterosacral and round ligament samples used to generate labeled cRNA, was hybridized to microarrays and analyzed for the expression of 32 878 genes. Significance Analysis of Microarrays (Stanford University, CA, USA) identified differentially expressed genes used for ontoanalysis. Quantitative PCR (qPCR) confirmed results. Light microscopy confirmed the tissue type and assessed inflammatory infiltration. The analysis of 34 arrays revealed 249 differentially expressed genes with fold changes (FC) larger than 1.5 and false discovery rates ≤5.2%. Immunity and defense was the most significant biological process differentially expressed in POP. qPCR confirmed the elevated steady-state mRNA levels for four genes: interleukin-6 (FC 9.8), thrombospondin 1 (FC 3.5) and prostaglandin-endoperoxide synthase 2 (FC 2.4) and activating transcription factor 3 (FC 2.6). Light microscopy showed all the samples were composed of fibromuscular connective tissue with no inflammatory infiltrates. In conclusion, genes enriched for ‘immunity and defense’ contribute to POP independent of inflammatory infiltrates. PMID:19056808

  18. Acceptability of Cervical Cancer Screening in Rural Mozambique

    ERIC Educational Resources Information Center

    Audet, Carolyn M.; Matos, Carla Silva; Blevins, Meridith; Cardoso, Aventina; Moon, Troy D.; Sidat, Mohsin

    2012-01-01

    In Zambezia province, Mozambique, cervical cancer (CC) screening was introduced to rural communities in 2010. Our study sought to determine whether women would accept screening via pelvic examination and visual inspection with acetic acid (VIA) at two clinical sites near the onset of a new CC screening program. A cross-sectional descriptive study…

  19. Does bacterial vaginosis cause pelvic inflammatory disease?

    PubMed

    Taylor, Brandie DePaoli; Darville, Toni; Haggerty, Catherine L

    2013-02-01

    Pelvic inflammatory disease (PID), the infection and inflammation of the female genital tract, results in serious reproductive morbidity including infertility and ectopic pregnancy. Bacterial vaginosis (BV) is a complex alteration of the vaginal flora that has been implicated in PID. The role of BV in the etiology and pathogenesis of PID has not been studied extensively. Our objective was to extensively review data related to the relationship between BV and PID (n = 19 studies). Several studies found a link between BV and cervicitis, endometritis, and salpingitis. Furthermore, it seems that some BV-associated organisms are associated with PID, whereas others are not. However, studies demonstrating an independent association between BV-associated organisms and PID are sparse. In addition, a causal association between BV and PID has not been established. Prospective studies are needed to further delineate the role of BV in PID, with particular focus on individual BV-associated organisms.

  20. Medical Treatments for Endometriosis-Associated Pelvic Pain

    PubMed Central

    Luppi, Stefania; Ricci, Giuseppe

    2014-01-01

    The main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors-γ ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studies. PMID:25165691

  1. Neoadjuvant Chemoradiation for Distal Rectal Cancer: 5-Year Updated Results of a Randomized Phase 2 Study of Neoadjuvant Combined Modality Chemoradiation for Distal Rectal Cancer

    SciTech Connect

    Mohiuddin, Mohammed; Paulus, Rebecca; Mitchell, Edith; Hanna, Nader; Yuen, Albert; Nichols, Romaine; Yalavarthi, Salochna; Hayostek, Cherie; Willett, Christopher

    2013-07-01

    Purpose: To assess the efficacy of 2 different approaches to neoadjuvant chemoradiation for distal rectal cancers. Methods and Materials: One hundred six patients with T3/T4 distal rectal cancers were randomized in a phase 2 study. Patients received either continuous venous infusion (CVI) of 5-Fluorouracil (5-FU), 225 mg/m{sup 2} per day, 7 days per week plus pelvic hyperfractionated radiation (HRT), 45.6 Gy at 1.2 Gy twice daily plus a boost of 9.6 to 14.4 Gy for T3 or T4 cancers (Arm 1), or CVI of 5-FU, 225 mg/m{sup 2} per day, Monday to Friday, plus irinotecan, 50 mg/m{sup 2} once weekly × 4, plus pelvic radiation therapy (RT), 45 Gy at 1.8 Gy per day and a boost of 5.4 Gy for T3 and 9 Gy for T4 cancers (Arm 2). Surgery was performed 4 to 10 weeks later. Results: All eligible patients (n=103) are included in this analysis; 2 ineligible patients were excluded, and 1 patient withdrew consent. Ninety-eight of 103 patients (95%) underwent resection. Four patients did not undergo surgery for either disease progression or patient refusal, and 1 patient died during induction chemotherapy. The median time of follow-up was 6.4 years in Arm 1 and 7.0 years in Arm 2. The pathological complete response (pCR) rates were 30% in Arm 1 and 26% in Arm 2. Locoregional recurrence rates were 16% in Arm 1 and 17% in Arm 2. Five-year survival rates were 61% and 75% and Disease-specific survival rates were 78% and 85% for Arm1 and Arm 2, respectively. Five second primaries occurred in patients on Arm 1, and 1 second primary occurred in Arm 2. Conclusions: High rates of disease-specific survival were seen in each arm. Overall survival appears affected by the development of unrelated second cancers. The high pCR rates with 5-FU and higher dose radiation in T4 cancers provide opportunity for increased R0 resections and improved survival.

  2. Genome-Wide Association Studies of Cancer

    PubMed Central

    Stadler, Zsofia K.; Thom, Peter; Robson, Mark E.; Weitzel, Jeffrey N.; Kauff, Noah D.; Hurley, Karen E.; Devlin, Vincent; Gold, Bert; Klein, Robert J.; Offit, Kenneth

    2010-01-01

    Knowledge of the inherited risk for cancer is an important component of preventive oncology. In addition to well-established syndromes of cancer predisposition, much remains to be discovered about the genetic variation underlying susceptibility to common malignancies. Increased knowledge about the human genome and advances in genotyping technology have made possible genome-wide association studies (GWAS) of human diseases. These studies have identified many important regions of genetic variation associated with an increased risk for human traits and diseases including cancer. Understanding the principles, major findings, and limitations of GWAS is becoming increasingly important for oncologists as dissemination of genomic risk tests directly to consumers is already occurring through commercial companies. GWAS have contributed to our understanding of the genetic basis of cancer and will shed light on biologic pathways and possible new strategies for targeted prevention. To date, however, the clinical utility of GWAS-derived risk markers remains limited. PMID:20585100

  3. The influence of pelvic adjustment on vertical jump height in female university students with functional leg length inequality.

    PubMed

    Gong, Wontae

    2015-01-01

    [Purpose] This study aimed to investigate the effect of pelvic adjustment on vertical jump height (VJH) in female university students with functional leg length inequality (FLLI). [Subjects] Thirty female university students with FLLI were divided into a pelvic adjustment group (n = 15) and a stretching (control) group (n = 15). [Methods] VJH was measured using an OptoGait. [Results] After the intervention, jump height improved significantly compared with the pre-intervention height only in the pelvic adjustment group, while FLLI showed statistically significant improvement in both groups. [Conclusion] Pelvic adjustment as per the Gonstead method can be applied as a method of reducing FLLI and increasing VJH.

  4. Evaluation tools and outcomes after osteosynthesis of unstable type B and C pelvic ring injuries.

    PubMed

    Gänsslen, A; Lindahl, J

    2013-01-01

    The evaluation of present long-term studies on results after surgical stabilization of the pelvic ring is difficult, as different treatment concepts are used and the majority of these studies are not comparable regarding selected evaluation parameters. Additionally, no standardized measurement instrument exists to analyze the clinical and radiological result after pelvic ring injuries. Only short-term evaluations with a mandatorily recommended minimum follow-up time of one year are available. Medium-term analyses or real long-term analyses are missing. Present data show an increase of long-term sequelae from stable type A injuries to completely unstable type C injuries. Concomitant injuries of other injury regions around the body as well as additional injuries to the pelvic region (complex pelvic trauma) seem to influence the overall results. Therefore, in the future it is necessary to develop a sufficient pelvic outcome instrument which addresses these parameters. Additionally, results of treatment of specific fracture types depend on the chosen stabilization method. Overall, as single centres have only "limited" experience in treating pelvic ring injuries within a short period of time, and there is a wide range of completely different injury types and different treatment concepts, for future evaluation of long-term results after pelvic ring injuries prospective, multicenter outcome studies are recommended.

  5. [Lesion of pelvic organs in secondary varicose veins of the small pelvis].

    PubMed

    Tsukanov, Yu T; Tsukanov, A Yu; Levdansky, E G

    2015-01-01

    The authors studied peculiarities of pelvic organs lesions in patients presenting with secondary small pelvic varicose veins (SPVV) induced by endured thrombosis of iliac veins. The study included a total of 70 patients after endured thrombosis of iliac veins verified by radiodiagnostic methods. The average duration of thrombosis amounted to 3.8 years. The patients were subdivided into two groups. The Study Group comprised 48 patients presenting with small pelvic varicose veins revealed by duplex scanning; the Control Group was composed of 22 patients with no varicose pelvic veins. It was determined that characteristic features of patients with secondary SPVV having developed after iliac veins thrombosis included chronic pelvic pain, dilatation of cavernous veins of the rectum, inguinal vein varicosity and varicose veins of the groin and anterior abdominal wall. Formation of secondary SPVV after endured iliac vein thrombosis leads to disorders of pelvic organs, similar to those in primary varicosity, but more often being functional. Endured iliac veins thrombosis in formation of secondary SPVV leads to urination impairments with prevalence of moderately pronounced symptomatology. Small pelvic organs dysfunction in women with secondary SPVV due to endured iliac veins thrombosis manifests itself in dyspareunia, leukorrhea, and dysmenorrhea.

  6. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy

    PubMed Central

    Seisen, Thomas; Klotz, Caroline; Mazeron, Renaud; Maroun, Pierre; Petit, Claire; Deutsch, Eric; Bossi, Alberto; Haie-Meder, Christine; Chargari, Cyrus; Blanchard, Pierre

    2017-01-01

    Background Few studies with contradictory results have been published on the safety of pelvic radiation therapy (RT) in patients with inflammatory bowel disease (IBD). Methods From 1989 to 2015, a single center retrospective analysis was performed including all IBD patients who received pelvic external beam radiation therapy (EBRT) or brachytherapy (BT) for a pelvic malignancy. Treatment characteristics, IBD activity and gastrointestinal (GI) toxicity were examined. Results Overall, 28 patients with Crohn’s disease (CD) (n=13) or ulcerative colitis (n=15) were included in the present study. Median follow-up time after irradiation was 5.9 years. Regarding IBD activity, only one and two patients experienced a severe episode within and after 6 months of follow-up, respectively. Grade 3/4 acute GI toxicity occurred in 3 (11%) patients, whereas one (3.6%) patient experienced late grade 3/4 GI toxicity. Only patients with rectal IBD location (P=0.016) or low body mass index (BMI) (P=0.012) experienced more severe IBD activity within or after 6 months following RT, respectively. Conclusions We report an acceptable tolerance of RT in IBD patients with pelvic malignancies. Specifically, a low risk of uncontrolled flare-up was observed. PMID:28280621

  7. Curcumin AntiCancer Studies in Pancreatic Cancer.

    PubMed

    Bimonte, Sabrina; Barbieri, Antonio; Leongito, Maddalena; Piccirillo, Mauro; Giudice, Aldo; Pivonello, Claudia; de Angelis, Cristina; Granata, Vincenza; Palaia, Raffaele; Izzo, Francesco

    2016-07-16

    Pancreatic cancer (PC) is one of the deadliest cancers worldwide. Surgical resection remains the only curative therapeutic treatment for this disease, although only the minority of patients can be resected due to late diagnosis. Systemic gemcitabine-based chemotherapy plus nab-paclitaxel are used as the gold-standard therapy for patients with advanced PC; although this treatment is associated with a better overall survival compared to the old treatment, many side effects and poor results are still present. Therefore, new alternative therapies have been considered for treatment of advanced PC. Several preclinical studies have demonstrated that curcumin, a naturally occurring polyphenolic compound, has anticancer effects against different types of cancer, including PC, by modulating many molecular targets. Regarding PC, in vitro studies have shown potent cytotoxic effects of curcumin on different PC cell lines including MiaPaCa-2, Panc-1, AsPC-1, and BxPC-3. In addition, in vivo studies on PC models have shown that the anti-proliferative effects of curcumin are caused by the inhibition of oxidative stress and angiogenesis and are due to the induction of apoptosis. On the basis of these results, several researchers tested the anticancer effects of curcumin in clinical trials, trying to overcome the poor bioavailability of this agent by developing new bioavailable forms of curcumin. In this article, we review the results of pre-clinical and clinical studies on the effects of curcumin in the treatment of PC.

  8. Curcumin AntiCancer Studies in Pancreatic Cancer

    PubMed Central

    Bimonte, Sabrina; Barbieri, Antonio; Leongito, Maddalena; Piccirillo, Mauro; Giudice, Aldo; Pivonello, Claudia; de Angelis, Cristina; Granata, Vincenza; Palaia, Raffaele; Izzo, Francesco

    2016-01-01

    Pancreatic cancer (PC) is one of the deadliest cancers worldwide. Surgical resection remains the only curative therapeutic treatment for this disease, although only the minority of patients can be resected due to late diagnosis. Systemic gemcitabine-based chemotherapy plus nab-paclitaxel are used as the gold-standard therapy for patients with advanced PC; although this treatment is associated with a better overall survival compared to the old treatment, many side effects and poor results are still present. Therefore, new alternative therapies have been considered for treatment of advanced PC. Several preclinical studies have demonstrated that curcumin, a naturally occurring polyphenolic compound, has anticancer effects against different types of cancer, including PC, by modulating many molecular targets. Regarding PC, in vitro studies have shown potent cytotoxic effects of curcumin on different PC cell lines including MiaPaCa-2, Panc-1, AsPC-1, and BxPC-3. In addition, in vivo studies on PC models have shown that the anti-proliferative effects of curcumin are caused by the inhibition of oxidative stress and angiogenesis and are due to the induction of apoptosis. On the basis of these results, several researchers tested the anticancer effects of curcumin in clinical trials, trying to overcome the poor bioavailability of this agent by developing new bioavailable forms of curcumin. In this article, we review the results of pre-clinical and clinical studies on the effects of curcumin in the treatment of PC. PMID:27438851

  9. Studying the Genetic Basis of Kidney Cancer - TCGA

    Cancer.gov

    Dr. Marston Linehan, NCI's Chief of Urologic Surgery, has spent the last several decades studying kidney cancer genes and treating kidney cancer patients. Learn more about his experience as a kidney cancer physician scientist and TCGA contributor in this

  10. Study Points to Genetic Subtypes of Esophageal Cancer

    Cancer.gov

    A Cancer Currents blog post about a study by The Cancer Genome Atlas Research Network that identified distinct genetic and molecular changes in esophageal cancers that could improve their classification and identify potential new treatments.

  11. NIH study confirms risk factors for male breast cancer

    Cancer.gov

    Pooled data from studies of about 2,400 men with breast cancer and 52,000 men without breast cancer confirmed that risk factors for male breast cancer include obesity, a rare genetic condition called Klinefelter syndrome, and gynecomastia.

  12. Decreasing pelvic incidence is associated with greater risk of cam morphology

    PubMed Central

    Fowers, C. A.; Yuh, R. T.; Gebhart, J. J.; Salata, M. J.; Liu, R. W.

    2016-01-01

    Objectives The spinopelvic relationship (including pelvic incidence) has been shown to influence pelvic orientation, but its potential association with femoroacetabular impingement has not been thoroughly explored. The purpose of this study was to prove the hypothesis that decreasing pelvic incidence is associated with increased risk of cam morphology. Methods Two matching cohorts were created from a collection of cadaveric specimens with known pelvic incidences: 50 subjects with the highest pelvic incidence (all subjects > 60°) and 50 subjects with the lowest pelvic incidence (all subjects < 35°). Femoral version, acetabular version, and alpha angles were directly measured from each specimen bilaterally. Cam morphology was defined as alpha angle > 55°. Differences between the two cohorts were analysed with a Student’s t-test and the difference in incidence of cam morphology was assessed using a chi-squared test. The significance level for all tests was set at p < 0.05. Results Cam morphology was identified in 47/100 (47%) femurs in the cohort with pelvic incidence < 35° and in only 25/100 (25%) femurs in the cohort with pelvic incidence > 60° (p = 0.002). The mean alpha angle was also greater in the cohort with pelvic incidence < 35° (mean 53.7°, sd 10.7° versus mean 49.7°, sd 10.6°; p = 0.008). Conclusions Decreased pelvic incidence is associated with development of cam morphology. We propose a novel theory wherein subjects with decreased pelvic incidence compensate during gait (to maintain optimal sagittal balance) through anterior pelvic tilt, creating artificial anterior acetabular overcoverage and recurrent impingement that increases risk for cam morphology. Cite this article: W. Z. Morris, C. A. Fowers, R. T. Yuh, J. J. Gebhart, M. J. Salata, R. W. Liu. Decreasing pelvic incidence is associated with greater risk of cam morphology. Bone Joint Res 2016;5:387–392. DOI: 10.1302/2046-3758.59.BJR-2016-0028.R1. PMID:27650107

  13. The BMEA study: the impact of meridian balanced method electroacupuncture on women with chronic pelvic pain—a three-arm randomised controlled pilot study using a mixed-methods approach

    PubMed Central

    Chong, Ooi Thye; Critchley, Hilary O D; Horne, Andrew W; Elton, Robert; Haraldsdottir, Erna; Fallon, Marie

    2015-01-01

    Introduction Chronic pelvic pain (CPP) affects 3–4% of women worldwide. Proven treatments for CPP are limited and unsatisfactory. The meridian balance method (BM) electroacupuncture (EA) treatment (BMEA + Traditional Chinese Medicine Health Consultation (TCM HC) may be effective for CPP. Previous EA studies have demonstrated an analgesic effect. Large-scale studies on acupuncture for other chronic pain conditions suggest that patient-healthcare provider interaction might play a role in pain reduction. We propose a pilot study to explore the effectiveness of the meridian BMEA treatment in managing women with CPP to inform a future large randomised controlled trial. Methods and analysis A 3-armed randomised controlled pilot study is proposed with an aim to recruit 30 women with CPP in National Health Service (NHS) Lothian. Randomisation will be to BMEA treatment, TCM HC or standard care (SC). Validated pain, physical and emotional functioning questionnaires will be administered to all participants at weeks 0, 4, 8 and 12. Focus group discussions will be conducted when week 12 questionnaires are completed. The primary objective is to determine, recruitment and retention rates. The secondary objectives are to assess the effectiveness and acceptability of the proposed methods of recruitment, randomisation, interventions and assessment tools. Ethics and dissemination Ethical approval has been obtained from the Scotland Research Ethics Committee (REC 14/SS/1022). Data will be published in peer-reviewed journals and presented at international conferences. Trial registration number NCT02295111. PMID:26576808

  14. Pelvic sepsis after stapled hemorrhoidopexy

    PubMed Central

    van Wensen, Remco JA; van Leuken, Maarten H; Bosscha, Koop

    2008-01-01

    Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons. PMID:18855996

  15. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  16. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  17. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  18. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  19. 38 CFR 4.67 - Pelvic bones.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Pelvic bones. 4.67 Section 4.67 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE FOR RATING DISABILITIES Disability Ratings The Musculoskeletal System § 4.67 Pelvic bones. The variability of...

  20. Primary pelvic hydatid cyst: a case report.

    PubMed

    Parray, Fazl Q; Wani, Shadab Nabi; Bazaz, Sajid; Khan, Shakeel-Ur Rehman; Malik, Nighat Shaffi

    2011-01-01

    This is a case report of a young man who presented to us as a case of hypogastric pain and frequency of micturation. General physical examination and radiological evaluation confirmed a multiloculated pelvic swelling. Patient was subjected to laparotomy which confirmed the diagnosis of a primary pelvic hydatid disease. Patient was put on chemotherapy after surgery and is doing well on follow up.

  1. The posterior medial cortex in urologic chronic pelvic pain syndrome: detachment from default mode network-a resting-state study from the MAPP Research Network.

    PubMed

    Martucci, Katherine T; Shirer, William R; Bagarinao, Epifanio; Johnson, Kevin A; Farmer, Melissa A; Labus, Jennifer S; Apkarian, A Vania; Deutsch, Georg; Harris, Richard E; Mayer, Emeran A; Clauw, Daniel J; Greicius, Michael D; Mackey, Sean C

    2015-09-01

    Altered resting-state (RS) brain activity, as a measure of functional connectivity (FC), is commonly observed in chronic pain. Identifying a reliable signature pattern of altered RS activity for chronic pain could provide strong mechanistic insights and serve as a highly beneficial neuroimaging-based diagnostic tool. We collected and analyzed RS functional magnetic resonance imaging data from female patients with urologic chronic pelvic pain syndrome (N = 45) and matched healthy participants (N = 45) as part of an NIDDK-funded multicenter project (www.mappnetwork.org). Using dual regression and seed-based analyses, we observed significantly decreased FC of the default mode network to 2 regions in the posterior medial cortex (PMC): the posterior cingulate cortex (PCC) and the left precuneus (threshold-free cluster enhancement, family-wise error corrected P < 0.05). Further investigation revealed that patients demonstrated increased FC between the PCC and several brain regions implicated in pain, sensory, motor, and emotion regulation processes (eg, insular cortex, dorsolateral prefrontal cortex, thalamus, globus pallidus, putamen, amygdala, hippocampus). The left precuneus demonstrated decreased FC to several regions of pain processing, reward, and higher executive functioning within the prefrontal (orbitofrontal, anterior cingulate, ventromedial prefrontal) and parietal cortices (angular gyrus, superior and inferior parietal lobules). The altered PMC connectivity was associated with several phenotype measures, including pain and urologic symptom intensity, depression, anxiety, quality of relationships, and self-esteem levels in patients. Collectively, these findings indicate that in patients with urologic chronic pelvic pain syndrome, regions of the PMC are detached from the default mode network, whereas neurological processes of self-referential thought and introspection may be joined to pain and emotion regulatory processes.

  2. Quantification of pelvic soft tissue artifact in multiple static positions.

    PubMed

    Hara, Reiko; Sangeux, Morgan; Baker, Richard; McGinley, Jennifer

    2014-02-01

    Soft tissue artifact (STA) has been identified as the most critical source of error in clinical gait analysis. Multiple calibration is a technique to reduce the impact of STA on kinematic data, which involves several static calibrations through the range of motion of the joint of interest. This study investigated how skin markers at the pelvis were displaced in relation to anatomical body landmarks in multiple static calibration positions. The magnitude and direction of the pelvic marker displacement was assessed in nine different body positions including 90° and 45° hip flexion, maximum hip extension, and pelvic tilt in 20 healthy young adults. ASIS markers were found to be more susceptible to relative displacement than PSIS markers, with displacement particularly evident in positions where the hip was flexed (up to 17 mm). A strong correlation was found between the hip flexion angle and marker displacement (r(2) = 0.70). While the estimated impact of pelvic STA on gait kinematics was relatively small, the findings suggest that activities with large hip flexion would cause larger STA with a greater impact on pelvic kinematics. The skin surface located over the ASIS differed by a mean of 17 mm between standing and supine positions, which could affect the inter-ASIS distance and the location of hip joint center (HJC) by up to 20mm and 10mm, respectively.

  3. Successful Treatment of a Large Pelvic Abscess Using Intraluminal VAC: A Case Report.

    PubMed

    Aras, Abbas; Celik, Sebahattin; Kiziltan, Remzi; Yilmaz, Özkan; Kotan, Çetin

    2016-04-01

    The most feared complication of the surgical treatment of rectal cancer is anastomotic leakage, which is related to high rates of mortality and morbidity. Here, we present a patient who could not be treated with surgical drainage but treated by intraluminal Vacuum Associated Closure (VAC). A 34-year-old male patient was treated for rectal cancer by low anterior resection, colorectal anastomosis, and diverting ileostomy following neoadjuvant CRT. The patient reported with a postoperative anastomotic disruption and a large pelvic abscess. Due to the continuation of foul-smell drainage inspite of perianal incision and drainage, intraluminal VAC was applied and the pelvic abscess and the foul-smell were successfully treated. The presence of an adequate anal sphincter tonus is a disadvantage in anastomotic leakage, since it prevents the emptying of the intestinal content and also precludes the drainage of the pelvic abscess. The endoluminal application of VAC, similar to the results of application of VAC in open wounds, has been demonstrated to decrease fibrin and necrotic tissue in the pelvic cavity and increase granulation tissue. VAC, which has long been used in the treatment of open wounds, is a promising method in the treatment of large pelvic abscesses due to anastomotic leakage following rectum resection.

  4. Synchronized swimming: coordination of pelvic and pectoral fins during augmented punting by the freshwater stingray Potamotrygon orbignyi.

    PubMed

    Macesic, Laura J; Mulvaney, Dana; Blevins, Erin L

    2013-06-01

    Benthic animals live at the juncture of fluid and solid environments, an interface that shapes many aspects of their behavior, including their means of locomotion. Aquatic walking and similar substrate-dependent forms of underwater propulsion have evolved multiple times in benthic invertebrate and vertebrate taxa, including batoid elasmobranchs. Skates (Rajidae) use the pelvic fins to punt across the substrate, keeping the pectoral fin disc still. Other batoids combine pelvic fin motions with pectoral fin undulation in augmented punting, but the coordination of these two modes has not been described. In this study of an augmented punter, the freshwater stingray Potamotrygon orbignyi, we demonstrate the synchrony of pelvic and pectoral fin cycles. The punt begins as the pelvic fins, held in an anterior position, are planted into the substrate and used to push the body forward. Meanwhile, a wave of pectoral fin undulation begins, increasing to maximum height just before the cycle's halfway point, when the pelvic fins reach their furthest posterior extension. The pectoral fin wave subsides as the pelvic fins return to their starting position for subsequent punts. Despite definitive links between pectoral and pelvic fin activity, we find no significant relationship between pectoral fin kinematics (frequency, wave height, and wave speed) and punt performance. However, slip calculations indicate that pectoral undulation can produce thrust and augment punting. Pelvic fin kinematics (frequency and duty factor) have significant effects, suggesting that while both sets of fins contribute to thrust generation, the pelvic fins likely determine punt performance.

  5. Analysis of muscle activity during active pelvic tilting in sagittal plane

    PubMed Central

    TAKAKI, Sho; KANEOKA, Koji; OKUBO, Yu; OTSUKA, Satoru; TATSUMURA, Masaki; SHIINA, Itsuo; MIYAKAWA, Shumpei

    2016-01-01

    Background: Pelvic tilting is performed to improve lumbopelvic flexibility or retrain the motor control of local muscles. However, few studies investigated the activity of local muscles during pelvic tilting. Purpose: The purpose of this study was to investigate muscle activity during anterior and posterior pelvic tilting. Method: Twelve healthy males (age, 22.6 ± 1.4 years) participated. Fine-wire electrodes were inserted into the bilateral lumbar multifidus (MF) and transversus abdominis (TrA). Surface electrodes were used to record activity of the bilateral rectus abdominis, external oblique, and erector spinae (ES), and the unilateral right latissimus dorsi, gluteus maximus, semitendinosus, and rectus femoris muscles. The electromyographic activities during anterior and posterior pelvic tilting in a standing position were recorded and expressed as a percentage of the maximum voluntary contraction (%MVC) for each muscle. Results: The activities of the bilateral MF (right: 23.9 ± 15.9 %MVC, left: 23.9 ± 15.1 %MVC) and right ES (19.0 ± 13.3 %MVC) were significantly greater than those of the other muscles during anterior pelvic tilting. The activity of the left TrA (14.8 ± 16.4 %MVC) was significantly greater than that of the other muscles during posterior pelvic tilting. Conclusions: The results suggested that the MF and ES are related to anterior pelvic tilting. The activity of the TrA, which was classified as a local muscle, was greater during posterior pelvic tilting. This study indicated that local muscles such as the MF and TrA may be related to pelvic tilting. PMID:28289581

  6. Endometrium is not the primary site of origin of pelvic high-grade serous carcinoma in BRCA1 or BRCA2 mutation carriers.

    PubMed

    Reitsma, Welmoed; Mourits, Marian J E; de Bock, Geertruida H; Hollema, Harry

    2013-04-01

    Serous endometrial intraepithelial carcinoma has been proposed to be a potential precursor lesion of pelvic high-grade serous carcinoma. If true, an increased incidence of uterine papillary serous carcinomas would be expected in BRCA1 and BRCA2 mutation carriers, who are at high-risk of developing pelvic high-grade serous carcinoma. This study explored particularly the occurrence of uterine papillary serous carcinoma, as well as other endometrial cancers, following risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 germline mutation attending a tertiary multidisciplinary clinic. A consecutive series of women with a BRCA1 or BRCA2 mutation who had undergone risk-reducing salpingo-oophorectomy without hysterectomy at the University Medical Center Groningen from January 1996 until March 2012 were followed prospectively. They were crossed with the histopathology list of endometrial cancer diagnoses reported by the Dutch nationwide pathology database PALGA. To assess the risk of endometrial cancer, a standardized incidence ratio was calculated comparing the observed with the expected number of endometrial cancer cases. Overall, 201 BRCA1 and 144 BRCA2 mutation carriers at a median age of 50 years (range, 32-78) were analyzed. After a median follow-up period of 6 years, after risk-reducing salpingo-oophorectomy, two cases of endometrial cancer were diagnosed, whereas the expected number was 0.94 cases (standardized incidence ratio 2.13; 95% confidence interval 0.24-7.69; P=0.27). Both endometrial cancer cases were of the endometrioid histological subtype. We showed that the incidence of endometrial cancer following risk-reducing salpingo-oophorectomy, especially uterine papillary serous carcinoma, in women at high-risk of developing pelvic high-grade serous carcinoma is not increased. On the basis of our data, the hypothesis of serous endometrial intraepithelial carcinoma being an important precursor lesion of pelvic high-grade serous carcinoma seems

  7. Male pelvic floor: history and update.

    PubMed

    Dorey, Grace

    2005-08-01

    Our understanding of the male pelvic floor has evolved over more than 2,000 years. Gradually medical science has sought to dispel ancient myths and untruths. The male pelvic floor has many diverse functions. Importantly, it helps to support the abdominal contents, maintains urinary and fecal continence, and plays a major role in gaining and maintaining penile erection. Weakness of the male pelvic floor muscles may cause urinary and fecal incontinence and erectile dysfunction. Function may be restored in each of these areas by a comprehensive pelvic floor muscle training program. Spasm of the pelvic floor muscles may produce pain and require relaxation techniques. Additional research is needed to add further evidence to our knowledge base.

  8. [Current echography diagnosis of pelvic congestion syndrome].

    PubMed

    Malinova, M; Shopov, A

    2012-01-01

    Chronic pelvic pain is a common condition. The sources of pelvic pain are multifactorial, and their causes are difficult to determine. Pelvic congestion syndrome (PCS) is associated with varicose ovarian veins and/or varicose veins in the pelvis. The syndrome is associated with constant dull pelvic pain, abnormal menstrual bleeding, tenderness to touch in lower abdomen, pain during intercourse, painful menstrual periods, vaginal discharge, PCOS. The specific diagnosis of Pelvic Congestion Syndrome is made using several tests which include ultrasound, CAT, MIR, MDCT (multidetector) and venogram. The ultrasound is the first test of choice. It can assess the uterus and other organs in the pelvis. Doppler ultrasound can also help visualize the blood flow and asses the presence of varicosities in the pelvis.

  9. IL-17 is not essential for inflammation and chronic pelvic pain development in an experimental model of chronic prostatitis/chronic pelvic pain syndrome.

    PubMed

    Motrich, Ruben D; Breser, María L; Sánchez, Leonardo R; Godoy, Gloria J; Prinz, Immo; Rivero, Virginia E

    2016-03-01

    Pain and inflammation in the absence of infection are hallmarks in chronic prostatitis and chronic pelvic pain syndrome (CP/CPPS) patients. The etiology of CP/CPPS is unclear, and autoimmunity has been proposed as a cause. Experimental autoimmune prostatitis (EAP) models have long been used for studying CP/CPPS. Herein, we studied prostate inflammation induction and chronic pelvic pain development in EAP using IL-12p40-KO, IL-4-KO, IL-17-KO, and wild-type (C57BL/6) mice. Prostate antigen (PAg) immunization in C57BL/6 mice induced specific Th1 and Th17 immune responses and severe prostate inflammation and cell infiltration, mainly composed of CD4 T cells and macrophages. Moreover, chronic pelvic pain was evidenced by increased allodynia responses. In immunized IL-17-KO mice, the presence of a prominent PAg-specific Th1 immune response caused similar prostate inflammation and chronic pelvic pain. Furthermore, markedly high PAg-specific Th1 immune responses, exacerbated prostate inflammation, and chronic pelvic pain were detected in immunized IL-4-KO mice. Conversely, immunized IL-12p40-KO mice developed PAg-specific Th2 immune responses, characterized by high IL-4 secretion and neither infiltration nor damage in the prostate. As observed in wild-type control animals, IL12p40-KO mice did not evidence tactile allodynia responses. Our results suggest that, as in patients, chronic pelvic pain is a consequence of prostate inflammation. After PAg immunization, a Th1-associated immune response develops and induces prostate inflammation and chronic pelvic pain. The absence of Th1 or Th2 cytokines, respectively, diminishes or enhances EAP susceptibility. In addition, IL-17 showed not to be essential for pathology induction and chronic pelvic pain development.

  10. Chlamydia trachomatis in pelvic inflammatory disease.

    PubMed

    Shrikhande, S N; Joshi, S G; Zodpey, S P; Saoji, A M

    1995-04-01

    The prevalence of genital Chlamydia trachomatis infection and some epidemiologic factors associated with it were studied in 273 pelvic inflammatory disease (PID) patients attending Gynaecologic clinic, Government Medical College, Nagpur. For detection of chlamydial antigen Pharmacia Diagnostics Chlamydia EIA test was used. This study revealed an overall positivity rate of 33% for C. trachomatis infection in PID patients. Of the hypothesised risk factors low socioeconomic status, history of sexual contacts with multiple partners and use of intrauterine devices (IUD) were significantly associated with C. trachomatis infections. However, use of oral contraceptives, barrier contraceptives and increasing age were found to be protective factors for C. trachomatis infection. Thus considering the significant contribution of C. trachomatis in etiology of PID and its independent association with some epidemiologic risk factors, extensive epidemiologic measures are recommended for prevention of these infections.

  11. SU-E-T-157: Evaluation and Comparison of Doses to Pelvic Lymph Nodes and to Point B with 3D Image Guided Treatment Planning for High Dose Brachytherapy for Treatment of Cervical Cancer

    SciTech Connect

    Bhandare, N.

    2014-06-01

    Purpose: To estimate and compare the doses received by the obturator, external and internal iliac lymph nodes and point Methods: CT-MR fused image sets of 15 patients obtained for each of 5 fractions of HDR brachytherapy using tandem and ring applicator, were used to generate treatment plans optimized to deliver a prescription dose to HRCTV-D90 and to minimize the doses to organs at risk (OARs). For each set of image, target volume (GTV, HRCTV) OARs (Bladder, Rectum, Sigmoid), and both left and right pelvic lymph nodes (obturator, external and internal iliac lymph nodes) were delineated. Dose-volume histograms (DVH) were generated for pelvic nodal groups (left and right obturator group, internal and external iliac chains) Per fraction DVH parameters used for dose comparison included dose to 100% volume (D100), and dose received by 2cc (D2cc), 1cc (D1cc) and 0.1 cc (D0.1cc) of nodal volume. Dose to point B was compared with each DVH parameter using 2 sided t-test. Pearson correlation were determined to examine relationship of point B dose with nodal DVH parameters. Results: FIGO clinical stage varied from 1B1 to IIIB. The median pretreatment tumor diameter measured on MRI was 4.5 cm (2.7– 6.4cm).The median dose to bilateral point B was 1.20 Gy ± 0.12 or 20% of the prescription dose. The correlation coefficients were all <0.60 for all nodal DVH parameters indicating low degree of correlation. Only 2 cc of obturator nodes was not significantly different from point B dose on t-test. Conclusion: Dose to point B does not adequately represent the dose to any specific pelvic nodal group. When using image guided 3D dose-volume optimized treatment nodal groups should be individually identified and delineated to obtain the doses received by pelvic nodes.

  12. Numerical simulation of the damage evolution in the pelvic floor muscles during childbirth.

    PubMed

    Oliveira, Dulce A; Parente, Marco P L; Calvo, Begoña; Mascarenhas, Teresa; Natal Jorge, Renato M

    2016-02-29

    Several studies have shown that pelvic floor injuries during a vaginal delivery can be considered a significant factor in the development of pelvic floor dysfunction. Such disorders include a group of conditions affecting women like urinary incontinence, pelvic organ prolapse and fecal incontinence. Numerical simulations are valuable tools that are contributing to the clarification of the mechanisms behind pelvic floor disorders. The aim of this work is to propose a mechanical model implemented in the finite element method context to estimate the damage in the pelvic floor muscles by mechanical effects during a vaginal delivery of a fetus in vertex presentation and occipitoanterior position. The constitutive model adopted has already been successfully used in the simulation of childbirth and the structural damage model added has previously been applied to characterize the damage process in biological soft tissues undergoing finite deformations. The constitutive parameters were fit to experimental data available in the literature and the final proposed material model is suitable to estimate the mechanical damage in the pelvic floor muscle during a vaginal delivery. The computational model predicts that even an apparently uneventful vaginal delivery inflicts injuries to the pelvic floor muscles, particularly during the extension of the fetus head, having been obtained more than 10% of damaged fibers. As a clinical evidence, the present work allows to conclude that the puborectalis component of the levator ani muscle is the most prone to damage.

  13. Role of conventional radiology and MRi defecography of pelvic floor hernias

    PubMed Central

    2013-01-01

    Background Purpose of the study is to define the role of conventional radiology and MRI in the evaluation of pelvic floor hernias in female pelvic floor disorders. Methods A MEDLINE and PubMed search was performed for journals before March 2013 with MeSH major terms 'MR Defecography' and 'pelvic floor hernias'. Results The prevalence of pelvic floor hernias at conventional radiology was higher if compared with that at MRI. Concerning the hernia content, there were significantly more enteroceles and sigmoidoceles on conventional radiology than on MRI, whereas, in relation to the hernia development modalities, the prevalence of elytroceles, edroceles, and Douglas' hernias at conventional radiology was significantly higher than that at MRI. Conclusions MRI shows lower sensitivity than conventional radiology in the detection of pelvic floor hernias development. The less-invasive MRI may have a role in a better evaluation of the entire pelvic anatomy and pelvic organ interaction especially in patients with multicompartmental defects, planned for surgery. PMID:24267789

  14. INCIDENCE AND RISK FACTORS FOR CHRONIC PELVIC PAIN AFTER HYSTEROSCOPIC STERILIZATION

    PubMed Central

    YUNKER, Amanda C.; RITCH, Jessica M. B.; ROBINSON, Erica F.; GOLISH, Cara T.

    2014-01-01

    Objective To investigate the incidence and pre-operative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure™ micro-inserts Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University Medical Center Patients A total of 458 patients who underwent hysteroscopic sterilization with Essure™ between January 1, 2005 and June 30, 2012. Results The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and the incidence of persistent pain after 3 months post-procedure was 4.2%. The range of presentation with pain was 1 to 469 days, with a mean time of 56 days. Of the patients that developed chronic pelvic pain after the procedure, 75% presented within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (OR 6.81, 95% CI 2.95,15.73) and chronic pain (OR 6.15, 95% CI 2.10,18.10) after hysteroscopic sterilization. Conclusions Pelvic pain may develop after hysteroscopic sterilization. Patients with preexisting chronic pain diagnoses may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure™ placement will resolve by 3 months. PMID:24952343

  15. Multiadaptive Plan (MAP) IMRT to Accommodate Independent Movement of the Prostate and Pelvic Lymph Nodes

    DTIC Science & Technology

    2010-12-01

    improve clinical work efficiency. 15. SUBJECT TERMS : Adaptive Radiotherapy , Image guided Radiotherapy , Prostate cancer, Pelvic Lymph nodes 16...17 INTRODUCTION Advances in radiotherapy have made intensity-modulated radiation therapy (IMRT) an effective and widely used modality in the...superiority of IMRT over conventional external beam techniques has allowed for better conformality to target volumes and improved sparing of critical

  16. Measuring morphological parameters of the pelvic floor for finite element modelling purposes.

    PubMed

    Janda, Stepán; van der Helm, Frans C T; de Blok, Sjoerd B

    2003-06-01

    The goal of this study was to obtain a complete data set needed for studying the complex biomechanical behaviour of the pelvic floor muscles using a computer model based on the finite element (FE) theory. The model should be able to predict the effect of surgical interventions and give insight into the function of pelvic floor muscles. Because there was a lack of any information concerning morphological parameters of the pelvic floor muscle structures, we performed an experimental measurement to uncover those morphological parameters. Geometric parameters as well as muscle parameters of the pelvic floor muscles were measured on an embalmed female cadaver. A three-dimensional (3D) geometric data set of the pelvic floor including muscle fibre directions was obtained using a palpator device. A 3D surface model based on the experimental data, needed for mathematical modelling of the pelvic floor, was created. For all parts of the diaphragma pelvis, the optimal muscle fibre length was determined by laser diffraction measurements of the sarcomere length. In addition, other muscle parameters such as physiological cross-sectional area and total muscle fibre length were determined. Apart from these measurements we obtained a data set of the pelvic floor structures based on nuclear magnetic resonance imaging (MRI) on the same cadaver specimen. The purpose of this experiment was to discover the relationship between the MRI morphology and geometrical parameters obtained from the previous measurements. The produced data set is not only important for biomechanical modelling of the pelvic floor muscles, but it also describes the geometry of muscle fibres and is useful for functional analysis of the pelvic floor in general. By the use of many reference landmarks all these morphologic data concerning fibre directions and optimal fibre length can be morphed to the geometrical data based on segmentation from MRI scans. These data can be directly used as an input for building a

  17. Comparison of bony dimensions at the level of the pelvic floor in women with and without pelvic organ prolapse

    PubMed Central

    Stein, Tamara A.; Kaur, Gurpreet; Summers, Aimee; Larson, Kindra A.; Delancey, John O. L.

    2010-01-01

    Objective Compare bony pelvis dimensions at the level of pelvic support in women with and without pelvic organ prolapse (POP). Study Design Pelvic floor dimensions of 42 Caucasian women with POP ≥ 1cm beyond the hymen were compared to 42 age and parity-matched women with normal support. Bony landmarks relevant to connective tissue and levator attachments were identified on MRI. Dimensions were independently measured by two examiners and averaged for each subject. Results Measurements (cms) for cases and controls are as follows: Interspinous Diameter, 11.2±0.8 vs. 11.1±0.7, p=0.19; Anterior-Posterior Outlet Diameter, 11.7±0.7 vs. 11.7±0.8, p=0.71; Pubic Symphysis to Ischial Spine - Left, 9.5±0.5 vs. 9.5±0.4, p=0.91; -Right, 9.5±0.4 vs. 9.5±0.5, p=0.81; Sacrococcygeal junction to Ischial Spine - Left, 7.0±0.6 vs. 7.0±0.5, p=0.54; - Right, 7.0±0.6 vs. 6.9±0.4, p=0.32. Conclusion Bony pelvis dimensions are similar at the level of the muscular pelvic floor in Caucasian women with and without POP. PMID:19254580

  18. Diagnostic studies of thyroid cancer

    SciTech Connect

    Rosen, I.B.

    1981-01-01

    Patient with goiter usually has benign disease. While investigation is important, clinical factors weight heavily in the diagnosis of cancer. Aside from serum calcitonin and CEA, biochemical findings are of little help. Radioisotope scanning is of fundamental importance and has an implication in history. Ultrasonography has a diminishing role although its use has led to the widespread acceptance of needle aspiration. Needle aspiration cytology is now the most important maneuver in preoperative assessment and management of the goiter patient. Its results permit refined operative selection, the institution of safe conservative management, and greater organization in surgical treatment. Persistent cooperation between clinician and pathologist can yield a high rate of the reliable preoperative cytological diagnosis obtained by needle aspiration.

  19. BRCA, the oviduct, and the space and time continuum of pelvic serous carcinogenesis.

    PubMed

    Crum, Christopher P; McKeon, Frank D; Xian, Wa

    2012-05-01

    In recent years, the distal oviduct has emerged as a critical organ in the pathogenesis of pelvic ("ovarian") serous cancer. Studies have uncovered early serous tubal intraepithelial carcinomas in approximately 8% of asymptomatic women with germline BRCA1 or BRCA2 mutations, linked serous tubal intraepithelial carcinomas to one half of serous cancers irrespective of genetic risk, and described a precursor lesion in the distal tube with early alterations in p53 function (the p53 signature). This work has established a linear serous carcinogenic sequence in a single focus within the fimbria. In addition, a more broadly distributed array of gene alterations has been discovered in the oviduct, manifested as secretory (or stem) cell outgrowths that are increased in frequency as a function of older age and serous cancer status. These "surrogate precursors" expand the existing model beyond the fimbria, implying that the molecular events leading to serous cancer are distributed over space and time. The potential promise of these discoveries is "targeted prevention" by discovering of multiple pathways integral to carcinogenesis and successfully preventing malignancy by interrupting one or a few of these pathways.

  20. Pharmacological treatment of chronic pelvic ischemia.

    PubMed

    Andersson, Karl-Erik; Nomiya, Masanori; Sawada, Norifumi; Yamaguchi, Osamu

    2014-06-01

    Epidemiological studies have shown that lower urinary tract symptoms, including overactive bladder, commonly occur in both men and women, with an age-related increase in both sexes. Vascular endothelial dysfunction and urological symptoms are common in the metabolic syndrome; they also occur during the human ageing process and are independent risk factors for the development of atherosclerosis and hypertension. Pelvic arterial insufficiency may lead to impaired lower urinary tract perfusion and play an important role in the development of bladder dysfunction such as detrusor overactivity and overactive bladder. It seems reasonable, but has not been definitely established clinically, that chronic ischemia-related bladder dysfunction will progress to bladder underactivity. Studies in experimental models in rabbits and rats have shown that pelvic arterial insufficiency may result in significant bladder ischemia with reduced bladder wall oxygen tension, oxidative stress, increased muscarinic receptor activity, ultrastructural damage, and neurodegeneration. Several types of drug may be able to prevent some of these changes. Even if the α1-adrenoceptor blocker, silodosin, the phosphodiesterase type 5 inhibitor, tadalafil, the β3-α1-adrenoceptor agonist, mirabegron, and the free radical scavenger, melatonin, were unable to prevent the development of neointimal hyperplasia and consequent luminal occlusion in animal models, they all exerted a protecting effect on urodynamic parameters, and on the functional and morphological changes of the bladder demonstrable in vitro. The different mechanisms of action of the drugs suggest that many factors are involved in the pathogenesis of chronic ischemia-induced bladder dysfunction and can be targets for intervention. Since several of the agents tested are used clinically and effectively for relieving lower urinary tract symptoms, the results from animal models of chronic bladder ischemia seem to have translational value

  1. What harm does a second delivery to the pelvic floor?

    PubMed Central

    2010-01-01

    Objective To compare the pelvic floor function of primiparous women to women after a second delivery regarding symptoms of urinary and anal incontinence, anal sphincter ruptures and bladder-neck mobility. Methods A questionnaire evaluating symptoms of urinary and anal incontinence was used in nulliparous women before and 27 months after childbirth. Furthermore these symptoms were correlated with functional changes of the pelvic floor based on a careful gynecologic examination as well as perineal and endoanal ultrasound. Results 112 nulliparous women were included, 49 women returned for follow-up on average 27 months (SD 4.4 months) after the first delivery. 39 women (group A) had just one delivery, 10 women (group B - 10/49) had had a second delivery. Apart from levator ani muscle strength, no significant difference between pelvic floor function of group A vs group B was demonstrable. Furthermore, we could show no significant difference for symptoms of urinary (11 (28.2%) vs. 5 (50.0%)) and anal incontinence (14 (35.9%) vs. 4 (40.0%)) between both groups. However, we found a lasting increase of stress urinary and anal incontinence as well as overactive bladder symptoms after one or more deliveries. The position of the bladder neck at rest was lower in both groups compared to the position before the first delivery and bladder neck mobility increased after one or more deliveries. Discussion Our study shows several statistically significant changes of the pelvic floor function even on average 27 months after delivery, but a subsequent delivery did not compromise the pelvic floor any further. PMID:20947474

  2. Total pelvic floor ultrasound for pelvic floor defaecatory dysfunction: a pictorial review.

    PubMed

    Hainsworth, Alison J; Solanki, Deepa; Schizas, Alexis M P; Williams, Andrew B

    2015-01-01

    Total pelvic floor ultrasound is used for the dynamic assessment of pelvic floor dysfunction and allows multicompartmental anatomical and functional assessment. Pelvic floor dysfunction includes defaecatory, urinary and sexual dysfunction, pelvic organ prolapse and pain. It is common, increasingly recognized and associated with increasing age and multiparity. Other options for assessment include defaecation proctography and defaecation MRI. Total pelvic floor ultrasound is a cheap, safe, imaging tool, which may be performed as a first-line investigation in outpatients. It allows dynamic assessment of the entire pelvic floor, essential for treatment planning for females who often have multiple diagnoses where treatment should address all aspects of dysfunction to yield optimal results. Transvaginal scanning using a rotating single crystal probe provides sagittal views of bladder neck support anteriorly. Posterior transvaginal ultrasound may reveal rectocoele, enterocoele or intussusception whilst bearing down. The vaginal probe is also used to acquire a 360° cross-sectional image to allow anatomical visualization of the pelvic floor and provides information regarding levator plate integrity and pelvic organ alignment. Dynamic transperineal ultrasound using a conventional curved array probe provides a global view of the anterior, middle and posterior compartments and may show cystocoele, enterocoele, sigmoidocoele or rectocoele. This pictorial review provides an atlas of normal and pathological images required for global pelvic floor assessment in females presenting with defaecatory dysfunction. Total pelvic floor ultrasound may be used with complementary endoanal ultrasound to assess the sphincter complex, but this is beyond the scope of this review.

  3. Clinical study of duloxetine hydrochloride combined with doxazosin for the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome

    PubMed Central

    Zhang, Mingxin; Li, Hanzhong; Ji, Zhigang; Dong, Dexin; Yan, Su

    2017-01-01

    Abstract To explore the safety and efficacy of the selective 5-serotonin and norepinephrine reuptake inhibitor duloxetine hydrochloride and alpha-adrenergic receptor blocker (alpha-blocker) doxazosin mesylate-controlled tablets in the treatment of pain disorder in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In all, 150 patients were enrolled and 126 patients completed the study (41 patients in the doxazosin group, 41 patients in the sertraline group, and 44 patients in the duloxetine group). This was an open randomized 6-month study. CP/CPPS patients who met the diagnostic criteria were randomized into 3 groups. The patients in the duloxetine group received doxazosin 4 mg + duloxetine 30 mg once a day, and the dosage of duloxetine was increased to 60 mg after a week. The patients in the doxazosin group received doxazosin 4 mg once a day. The patients in the sertraline group received doxazosin 4 mg + sertraline 50 mg once a day. National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, the short-form McGill Pain questionnaire (SF-MPQ), and the hospital anxiety and depression scale (HAD) were applied for evaluations during follow-up of 1, 3, and 6 months after treatment.There were slight positive significant correlations between NIH-CPSI scores and HAD scores, moderate positive significant correlations between the quality of life (QOL) and SF-MPQ, and slight positive significant correlations between HAD and QOL. The effective rate in the doxazosin group was 4.88%, 19.51%, and 56.10% after 1, 3, and 6 months, respectively (P < 0.05). The SF-MPQ score in the doxazosin group decreased to 1.80 ± 1.29, 2.66 ± 1.57, and 3.24 ± 1.67 after 1, 3, and 6 months, respectively (P < 0.05). The HAD score in the doxazosin group decreased to 2.24 ± 2.17, 4 ± 2.11, and 4.90 ± 2.62 after 1, 3, and 6 months, respectively (P < 0.05). The effective rate in the sertraline group was 9.76%, 36

  4. Study: California Ethnic Groups Seeing Increased Cancer Rates

    ERIC Educational Resources Information Center

    Black Issues in Higher Education, 2005

    2005-01-01

    A statewide study on cancer and ethnicity hints that cancer rates among immigrant groups may be tied to their degree of assimilation into American culture. The study, released by the University of Southern California's Norris Comprehensive Cancer Center, marks the first statewide look at cancer rates among Vietnamese and South Asians and provides…

  5. Racial Differences in Pelvic Organ Prolapse

    PubMed Central

    Whitcomb, Emily L.; Rortveit, Guri; Brown, Jeanette S.; Creasman, Jennifer M.; Thom, David H.; Van Den Eeden, Stephen K.; Subak, Leslee L.

    2010-01-01

    OBJECTIVE To compare the estimated prevalence of, risk factors for, and level of bother associated with subjectively reported and objectively measured pelvic organ prolapse in a racially diverse cohort. METHODS The Reproductive Risks for Incontinence Study at Kaiser 2 is a population-based cohort study of 2,270 middle-aged and older women. Symptomatic prolapse was self-reported, and bother was assessed on a five-point scale. In 1,137 women, prolapse was measured with the Pelvic Organ Prolapse Quantification (POP-Q) system. Multivariable logistic regression analysis was used to identify the independent association of prolapse and race while controlling for risk factors. RESULTS The participants’ mean (standard deviation) age was 55 (9) years, and 44% were white, 20% were African American, 18% were Asian American, and 18% were Latina or other race. Seventy-four women (3%) reported symptomatic prolapse. In multivariable analysis, the risk of symptomatic prolapse was higher in white (prevalence ratio 5.35, 95% confidence interval [CI] 1.89–15.12) and Latina (prevalence ratio 4.89, 95% CI 1.64–14.58) compared with African-American women. Race was not associated with report of moderate to severe bother. Degree of prolapse by POP-Q stage was similar across all racial groups; however, the risk of the leading edge of prolapse at or beyond the hymen was higher in white (prevalence ratio 1.40, 95% CI 1.02–1.92) compared with African-American women. CONCLUSION Compared with African-American women, Latina and white women had four to five times higher risk of symptomatic prolapse, and white women had 1.4-fold higher risk of objective prolapse with leading edge of prolapse at or beyond the hymen. PMID:19935029

  6. Aortoiliac aneurysm with congenital right pelvic kidney.

    PubMed

    Date, Kazuma; Okada, Shuuichi; Ezure, Masahiko; Takihara, Hitomi; Okonogi, Shuuichi; Hasegawa, Yutaka; Sato, Yasushi; Kaneko, Tatsuo

    2015-05-01

    The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54 mm and a right common iliac aneurysm of 45 mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.

  7. Image-Guided Radiotherapy and -Brachytherapy for Cervical Cancer

    PubMed Central

    Dutta, Suresh; Nguyen, Nam Phong; Vock, Jacqueline; Kerr, Christine; Godinez, Juan; Bose, Satya; Jang, Siyoung; Chi, Alexander; Almeida, Fabio; Woods, William; Desai, Anand; David, Rick; Karlsson, Ulf Lennart; Altdorfer, Gabor

    2015-01-01

    Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT), and 2-dimensional intracavitary brachytherapy. Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron-emission tomography and magnetic resonance imaging has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT) may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT), allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer. PMID:25853092

  8. Image-guided radiotherapy and -brachytherapy for cervical cancer.

    PubMed

    Dutta, Suresh; Nguyen, Nam Phong; Vock, Jacqueline; Kerr, Christine; Godinez, Juan; Bose, Satya; Jang, Siyoung; Chi, Alexander; Almeida, Fabio; Woods, William; Desai, Anand; David, Rick; Karlsson, Ulf Lennart; Altdorfer, Gabor

    2015-01-01

    Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT), and 2-dimensional intracavitary brachytherapy. Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron-emission tomography and magnetic resonance imaging has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT) may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT), allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer.

  9. Adenosine deaminase complexing protein in cancer studies.

    PubMed

    Ten Kate, J; Dinjens, W N; Meera Khan, P; Bosman, F T

    1986-01-01

    ADCP is a dimeric glycoprotein of about 200KD, for which the physiological role is still obscure. This protein occurs mainly in a membrane bound form in various human tissues. In this paper we review the current literature on ADCP in cancer studies. Soluble ADCP was described to be consistently decreased or absent in cancers of lung, liver, kidney and colon. These findings could not be confirmed by immunohistochemical and quantitative biochemical studies in a series of colorectal-, prostatic-, and renal carcinomas. Only in a third of these tumors a decrease could be demonstrated, whereas in the other cases unaltered or even increased amounts were observed. However, in virally transformed human fibroblasts a consistent decrease or complete absence of ADCP was seen, while primary fibroblasts were found to contain high amounts of this protein. Recently, the use of ADCP as a differentiation marker in colonic cancer has been advocated. Furthermore the presence of ADCP in the serum of renal adenocarcinoma patients was found to be indicative of a better chance of five year survival. These studies suggest that ADCP may be a differentiation marker useful for immunohistochemical characterization of colonic and renal carcinomas as well as a serum marker useful for follow-up studies of these types of cancer, analogous to CEA. Finally, ADCP has been found to be selectively expressed by certain T-cell subsets and henceforth may be useful in the studies on leukemias.

  10. Informed Consent for Reconstructive Pelvic Surgery.

    PubMed

    Alam, Pakeeza; Iglesia, Cheryl B

    2016-03-01

    Informed consent is the process in which a patient makes a decision about a surgical procedure or medical intervention after adequate information is relayed by the physician and understood by the patient. This process is critical for reconstructive pelvic surgeries, particularly with the advent of vaginal mesh procedures. In this article, we review the principles of informed consent, the pros and cons of different approaches in reconstructive pelvic surgery, the current legal issues surrounding mesh use for vaginal surgery, and tips on how to incorporate this information when consenting patients for pelvic floor surgery.

  11. The effect of contralateral pelvic drop and trunk lean on frontal plane knee biomechanics during single limb standing.

    PubMed

    Takacs, Judit; Hunt, Michael A

    2012-11-15

    Pelvic drop as a result of hip abductor weakness has been hypothesized as a potential modifier of frontal plane knee joint kinetics during gait in individuals with pathology such as knee osteoarthritis (OA). However, hip muscle strengthening interventions have failed to find significant reductions in frontal plane loading measures such as the external knee adduction moment (KAM) with altered hip strength. Since this could in part be due to a lack of change in pelvic kinematics between conditions or test sessions or due to alterations in lateral trunk lean angle, the relationship between pelvic drop and subsequent changes in centre of mass with knee joint loading remains unclear. The purpose of this study was to examine the effect of a consciously altered frontal plane centre of mass position (pelvic drop and trunk lean to the contralateral side) on the KAM during single limb standing. Twenty healthy individuals performed a series of single limb standing trials, where they were asked to balance on their dominant leg. KAM was assessed during single limb stance in two conditions: with pelvis and trunk maintained in a level position, and with contralateral pelvic drop. A third condition involving contralateral pelvic drop and trunk lean was assessed to examine exaggerated changes in centre of mass. The KAM increased significantly with contralateral pelvic drop (p=0.001) and with combined contralateral pelvic drop and trunk lean (p<0.001) compared to the level pelvis trials. These findings suggest that pelvic drop alone can significantly increase KAM magnitude, a risk factor for the progression of knee OA. Assessment of pelvic obliquity prior to treatment may allow those with marked pelvic drop to be targeted for hip muscle strengthening.

  12. Phenotyping Clinical Disorders: Lessons Learned From Pelvic Organ Prolapse

    PubMed Central

    Wu, Jennifer M.; Ward, Renée M.; Allen-Brady, Kristina L.; Edwards, Todd L.; Norton, Peggy A.; Hartmann, Katherine E.; Hauser, Elizabeth R.; Velez Edwards, Digna R.

    2012-01-01

    Genetic epidemiology, the study of genetic contributions to risk for disease, is an innovative area in medicine. While research in this arena has advanced in other disciplines, few genetic epidemiologic studies have been conducted in obstetrics and gynecology. It is crucial that we study the genetic susceptibility for issues in women’s health, as this information will shape the new frontier of “personalized medicine.” To date, preterm birth may be one of the best examples of genetic susceptibility in obstetrics and gynecology, but many areas are being evaluated including endometriosis, fibroids, polycystic ovarian syndrome and pelvic floor disorders. An essential component to genetic epidemiologic studies is to characterize, or “phenotype,” the disorder in order to identify genetic effects. Given the growing importance of genomics and genetic epidemiology, we discuss the importance of accurate phenotyping of clinical disorders and highlight critical considerations and opportunities in phenotyping, using pelvic organ prolapse as a clinical example. PMID:23200709

  13. EXAFS studies of prostate cancer cell lines

    NASA Astrophysics Data System (ADS)

    Czapla, J.; Kwiatek, W. M.; Lekki, J.; Kisiel, A.; Steininger, R.; Goettlicher, J.

    2013-04-01

    Sulphur plays a vital role in every human organism. It is known, that sulphur-bearing compounds, such as for example cysteine and glutathione, play critical roles in development and progression of many diseases. Any alteration in sulphur's biochemistry could become a precursor of serious pathological conditions. One of such condition is prostate cancer, the most frequently diagnosed malignancy in the western world and the second leading cause of cancer related death in men. The purpose of presented studies was to examine what changes occur in the nearest chemical environment of sulphur in prostate cancer cell lines in comparison to healthy cells. The Extended X-ray Absorption Fine Structure (EXAFS) spectroscopy was used, followed by theoretical calculations. The results of preliminary analysis is presented.

  14. [Aging-related changes of the female pelvic floor].

    PubMed

    Scheiner, David; Betschart, Cornelia; Perucchini, Daniele

    2010-01-01

    The pelvic floor as lower closure of the abdominal cavity has to withstand the abdominal pressure. Meanwhile, the pelvic floor has to allow physiologic functions like micturition, defecation, sexual function and reproduction. But while pregnancy and vaginal delivery damage the pelvic floor directly, chronic stress like caugh, heavy lifting, or obesity lead to a chronic overstraining of the pelvic floor. Aging, structural changes, and possibly estrogen deficiency have a negative impact on the pelvic floor.

  15. [Functional anatomy of the female pelvic floor: interdisciplinary continence and pelvic floor surgery].

    PubMed

    Muctar, S; Schmidt, W U; Batzill, W; Westphal, J

    2011-07-01

    Knowledge of functional anatomy is a prerequisite for the safe and targeted reconstructive therapy of incontinence and the prolapse syndrome of the female pelvic floor. We illustrate the interaction of muscles and connective tissue of the pelvic floor with anatomical illustrations and demonstrate their impact on the function of the urethra, bladder, vagina, uterus and rectum. Examples for the therapeutic rationale for a surgical reconstruction of the pelvic floor are defined and justified from their functional anatomy.

  16. Methodological considerations in the analysis of the therapeutic significance of lymphadenectomy in endometrial cancer.

    PubMed

    Todo, Yukiharu; Sakuragi, Noriaki

    2013-03-01

    There needs to be clarification on eligibility requirements and procedure standardization with regard to the therapeutic role of lymphadenectomy. If this is not done, consensus on the role of lymphadenectomy will not be reached. Although pelvic lymphadenectomy is not necessary for patients with low-risk Stage I endometrial cancer, it has been suggested that combined pelvic and para-aortic lymphadenectomy is useful for patients with intermediate-/high-risk endometrial cancer. Therefore, the therapeutic role of lymphadenectomy should be continuously evaluated. If such a study is planned, it should not include patients with low risk of nodal metastasis, and one experimental arm of the study should assess combined pelvic and para-aortic lymphadenectomy (fundamentally including the area above the inferior mesenteric artery and the renal vein). It is necessary to establish a pre-operative risk assessment for nodal metastasis and procedural classification of lymphadenectomy. Some pre-operative risk assessments for nodal metastasis have been proposed from Asian countries. The extent of the surgical field is defined as the pelvic area alone, or combined pelvic and para-aortic area. The thoroughness of removal can be split into removal of only suspicious nodes, selective dissection, or systematic dissection. Although randomized controlled trials provide the highest level of clinical evidence, special difficulties are presented in randomized surgical trials. Nonentry of surgeons is a threat to external validity. The role of observational studies, especially prospective cohort studies should be reconsidered when assessing the therapeutic significance of lymphadenectomy.

  17. Intensity-Modulated Whole Abdominal Radiotherapy After Surgery and Carboplatin/Taxane Chemotherapy for Advanced Ovarian Cancer: Phase I Study

    SciTech Connect

    Rochet, Nathalie; Sterzing, Florian; Jensen, Alexandra D.; Dinkel, Julien; Herfarth, Klaus K.; Schubert, Kai; Eichbaum, Michael H.; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen; Harms, Wolfgang

    2010-04-15

    Purpose: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials: Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Results: Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. Conclusions: The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

  18. Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence.

    PubMed

    Manley, Lauren; Gibson, Luke; Papa, Nathan; Beharry, Bhawanie Koonj; Johnson, Liana; Lawrentschuk, Nathan; Bolton, Damien M

    2016-12-01

    The aim of the study was to evaluate the effect of pelvic floor muscle (PFM) assessment and training before and after robot-assisted laparoscopic radical prostatectomy (RARP) in improving PFM strength and urinary continence. We performed an analysis of a database of patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) performed by two urologists from 2011 to 2013. Pelvic floor muscle (PFM) activation and strength were graded by a trained pelvic floor physiotherapist. Patients were given an exercise program, grouped according to the strength of their pelvic floor as graded by assessment, to complete before and after surgery. PFM strength was recorded preoperatively, 4 days post-catheter removal and 4 weeks post-catheter removal. Continence was recorded at 4 weeks postop and was defined as the requirement of no continence aids. A total of 98 patients had RARP and a preoperative physiotherapy assessment plus postoperative appointments at around 1 and 4 weeks post-RARP. The majority of men improved their PFM strength regardless of preoperative strength with no significant predictors of postoperative strength found. Age was the only significant predictor of postoperative incontinence. In this pilot study, a majority of patients increased their pelvic floor strength with time. Pelvic floor physiotherapy is an important modifiable patient factor, which does have an impact in improving patients' urinary continence by strengthening the pelvic floor muscles. Patient age influences response to pelvic floor physiotherapy.

  19. Spine lateral flexion strength development differences between exercises with pelvic stabilization and without pelvic stabilization

    NASA Astrophysics Data System (ADS)

    Straton, Alexandru; Gidu, Diana Victoria; Micu, Alexandru

    2015-02-01

    Poor lateral flexor muscle strength can be an important source of lumbar/thoracic back pain in women. The purpose of this study was to evaluate pelvic stabilization (PS) and no pelvic stabilization (NoPS) lateral flexion strength exercise training on the development of isolated right and left lateral flexion strength. Isometric torque of the isolated right and left lateral flexion muscles was measured at two positions (0° and 30° opposed angle range of motion) on 42 healthy women before and after 8 weeks of PS and NoPS lateral flexion strength exercise training. Subjects were assigned in three groups, the first (n=14) trained 3 times/week with PS lateral flexion strength exercise, the second (n=14) trained 3 times/week with NoPS lateral flexion strength exercise and the third (control, n=14) did not train. Post training isometric strength values describing PS and NoPS lateral flexion strength improved in greater extent for the PS lateral flexion strength exercise group and in lesser extent for the NoPS lateral flexion strength exercise group, in both angles (p<0.05) relative to controls. These data indicate that the most effective way of training the spine lateral flexion muscles is PS lateral flexion strength exercises; NoPS lateral flexion strength exercises can be an effective way of training for the spine lateral flexion muscles, if there is no access to PS lateral flexion strength training machines.

  20. The use of intrauterine contraceptive devices, pelvic inflammatory disease, and Chlamydia trachomatis infection.

    PubMed

    Edelman, D A

    1988-04-01

    With the same epidemiologic approach taken in a recent study that suggested that oral contraceptive use may not protect against chlamydial pelvic inflammatory disease, the risks of chlamydial pelvic inflammatory disease were evaluated for intrauterine contraceptive device users. Compared with women using no method of contraception, intrauterine contraceptive device users were not found to be at any higher risk of cervical chlamydial infection. Whether this places intrauterine contraceptive device users at no increased risk of chlamydial pelvic inflammatory disease cannot be ascertained from the available data. Further research is needed before any conclusions can be made regarding the risks of chlamydial pelvic inflammatory disease to users of intrauterine contraceptive devices, oral contraceptives, and other contraceptive methods.

  1. Risk of Salivary Gland Cancer After Childhood Cancer: A Report From the Childhood Cancer Survivor Study

    SciTech Connect

    Boukheris, Houda; Stovall, Marilyn; Gilbert, Ethel S.; Stratton, Kayla L.; Smith, Susan A.; Weathers, Rita; Hammond, Sue; Mertens, Ann C.; Donaldson, Sarah S.; Armstrong, Gregory T.; Robison, Leslie L.; Neglia, Joseph P.; Inskip, Peter D.

    2013-03-01

    Purpose: To evaluate effects of radiation therapy, chemotherapy, cigarette smoking, and alcohol consumption on the risk of second primary salivary gland cancer (SGC) in the Childhood Cancer Survivor Study (CCSS). Methods and Materials: Standardized incidence ratios (SIR) and excess absolute risks (EAR) of SGC in the CCSS were calculated using incidence rates from Surveillance, Epidemiology, and End Results population-based cancer registries. Radiation dose to the salivary glands was estimated based on medical records. Poisson regression was used to assess risks with respect to radiation dose, chemotherapy, smoking, and alcohol consumption. Results: During the time period of the study, 23 cases of SGC were diagnosed among 14,135 childhood cancer survivors. The mean age at diagnosis of the first primary cancer was 8.3 years, and the mean age at SGC diagnosis was 24.8 years. The incidence of SGC was 39-fold higher in the cohort than in the general population (SIR = 39.4; 95% CI = 25.4-57.8). The EAR was 9.8 per 100,000 person-years. Risk increased linearly with radiation dose (excess relative risk = 0.36/Gy; 95% CI = 0.06-2.5) and remained elevated after 20 years. There was no significant trend of increasing risk with increasing dose of chemotherapeutic agents, pack-years of cigarette smoking, or alcohol intake. Conclusion: Although the cumulative incidence of SGC was low, childhood cancer survivors treated with radiation experienced significantly increased risk for at least 2 decades after exposure, and risk was positively associated with radiation dose. Results underscore the importance of long-term follow up of childhood cancer survivors for the development of new malignancies.

  2. Pelvic Surgical Site Infections in Gynecologic Surgery

    PubMed Central

    Lachiewicz, Mark P.; Moulton, Laura J.; Jaiyeoba, Oluwatosin

    2015-01-01

    The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery. PMID:25788822

  3. Postoperative pelvic pain: An imaging approach.

    PubMed

    Farah, H; Laurent, N; Phalippou, J; Bazot, M; Giraudet, G; Serb, T; Poncelet, E

    2015-10-01

    Postoperative pelvic pain after gynecological surgery is a readily detected but unspecific sign of complication. Imaging as a complement to physical examination helps establish the etiological diagnosis. In the context of emergency surgery, vascular, urinary and digestive injuries constitute the most frequent intraoperative complications. During the follow-up of patients who had undergone pelvic surgery, imaging should be performed to detect recurrent disease, postoperative fibrosis, adhesions and more specific complications related to prosthetic material. Current guidelines recommend using pelvic ultrasonography as the first line imaging modality whereas the use of pelvic computed tomography and/or magnetic resonance imaging should be restricted to specific situations, depending on local availability of equipment and suspected disease.

  4. Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence.

    PubMed

    Chen, Shu-Yueh; Tzeng, Ya-Ling

    2009-06-01

    This study developed and tested the accuracy of a model designed to predict adherence to a pelvic floor muscle exercise regimen by Taiwanese women with urinary incontinence. The sample was composed of 106 women treated for urinary incontinence at urban hospitals in central and northern Taiwan from April 2000 to March 2003. All participants had practiced prescribed pelvic floor muscle exercises for at least 6 weeks at the time they completed study measures, which included adherence to pelvic floor muscle exercise, self-efficacy for the exercise, knowledge of the exercise, attitudes toward the exercise, dyadic cohesion, perceived benefits of the exercise, and severity of urine loss. After stepwise multiple regression analysis, a path analysis was conducted, with significant paths retained as modifiers. Self-efficacy for pelvic floor muscle exercise strongly and directly affected adherence to the exercise regimen. Attitudes toward the exercise, dyadic cohesion, and perceived benefits of the exercise affected adherence when mediated by self-efficacy for pelvic floor muscle exercise. Severity of urine loss also directly affected adherence. Exercise knowledge affected neither self-efficacy nor adherence. The model fit the data and accounted for 40% of adherence variance. Findings affirm the significant role of self-efficacy in predicting adherence to pelvic floor muscle exercise. Thus, self-efficacy for exercise can be an indicator for nurses to tailor exercise-training programs for women with urinary incontinence. Nurses can use the study findings to develop interventions to increase women's adherence to the exercise.

  5. Imaging biomarker roadmap for cancer studies.

    PubMed

    O'Connor, James P B; Aboagye, Eric O; Adams, Judith E; Aerts, Hugo J W L; Barrington, Sally F; Beer, Ambros J; Boellaard, Ronald; Bohndiek, Sarah E; Brady, Michael; Brown, Gina; Buckley, David L; Chenevert, Thomas L; Clarke, Laurence P; Collette, Sandra; Cook, Gary J; deSouza, Nandita M; Dickson, John C; Dive, Caroline; Evelhoch, Jeffrey L; Faivre-Finn, Corinne; Gallagher, Ferdia A; Gilbert, Fiona J; Gillies, Robert J; Goh, Vicky; Griffiths, John R; Groves, Ashley M; Halligan, Steve; Harris, Adrian L; Hawkes, David J; Hoekstra, Otto S; Huang, Erich P; Hutton, Brian F; Jackson, Edward F; Jayson, Gordon C; Jones, Andrew; Koh, Dow-Mu; Lacombe, Denis; Lambin, Philippe; Lassau, Nathalie; Leach, Martin O; Lee, Ting-Yim; Leen, Edward L; Lewis, Jason S; Liu, Yan; Lythgoe, Mark F; Manoharan, Prakash; Maxwell, Ross J; Miles, Kenneth A; Morgan, Bruno; Morris, Steve; Ng, Tony; Padhani, Anwar R; Parker, Geoff J M; Partridge, Mike; Pathak, Arvind P; Peet, Andrew C; Punwani, Shonit; Reynolds, Andrew R; Robinson, Simon P; Shankar, Lalitha K; Sharma, Ricky A; Soloviev, Dmitry; Stroobants, Sigrid; Sullivan, Daniel C; Taylor, Stuart A; Tofts, Paul S; Tozer, Gillian M; van Herk, Marcel; Walker-Samuel, Simon; Wason, James; Williams, Kaye J; Workman, Paul; Yankeelov, Thomas E; Brindle, Kevin M; McShane, Lisa M; Jackson, Alan; Waterton, John C

    2017-03-01

    Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing 'translational gaps' through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored 'roadmap'. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use.

  6. Imaging biomarker roadmap for cancer studies

    PubMed Central

    O’Connor, James P. B.; Aboagye, Eric O.; Adams, Judith E.; Aerts, Hugo J. W. L.; Barrington, Sally F.; Beer, Ambros J.; Boellaard, Ronald; Bohndiek, Sarah E.; Brady, Michael; Brown, Gina; Buckley, David L.; Chenevert, Thomas L.; Clarke, Laurence P.; Collette, Sandra; Cook, Gary J.; deSouza, Nandita M.; Dickson, John C.; Dive, Caroline; Evelhoch, Jeffrey L.; Faivre-Finn, Corinne; Gallagher, Ferdia A.; Gilbert, Fiona J.; Gillies, Robert J.; Goh, Vicky; Griffiths, John R.; Groves, Ashley M.; Halligan, Steve; Harris, Adrian L.; Hawkes, David J.; Hoekstra, Otto S.; Huang, Erich P.; Hutton, Brian F.; Jackson, Edward F.; Jayson, Gordon C.; Jones, Andrew; Koh, Dow-Mu; Lacombe, Denis; Lambin, Philippe; Lassau, Nathalie; Leach, Martin O.; Lee, Ting-Yim; Leen, Edward L.; Lewis, Jason S.; Liu, Yan; Lythgoe, Mark F.; Manoharan, Prakash; Maxwell, Ross J.; Miles, Kenneth A.; Morgan, Bruno; Morris, Steve; Ng, Tony; Padhani, Anwar R.; Parker, Geoff J. M.; Partridge, Mike; Pathak, Arvind P.; Peet, Andrew C.; Punwani, Shonit; Reynolds, Andrew R.; Robinson, Simon P.; Shankar, Lalitha K.; Sharma, Ricky A.; Soloviev, Dmitry; Stroobants, Sigrid; Sullivan, Daniel C.; Taylor, Stuart A.; Tofts, Paul S.; Tozer, Gillian M.; van Herk, Marcel; Walker-Samuel, Simon; Wason, James; Williams, Kaye J.; Workman, Paul; Yankeelov, Thomas E.; Brindle, Kevin M.; McShane, Lisa M.; Jackson, Alan; Waterton, John C.

    2017-01-01

    Imaging biomarkers (IBs) are integral to the routine management of patients with cancer. IBs used daily in oncology include clinical TNM stage, objective response and left ventricular ejection fraction. Other CT, MRI, PET and ultrasonography biomarkers are used extensively in cancer research and drug development. New IBs need to be established either as useful tools for testing research hypotheses in clinical trials and research studies, or as clinical decision-making tools for use in healthcare, by crossing ‘translational gaps’ through validation and qualification. Important differences exist between IBs and biospecimen-derived biomarkers and, therefore, the development of IBs requires a tailored ‘roadmap’. Recognizing this need, Cancer Research UK (CRUK) and the European Organisation for Research and Treatment of Cancer (EORTC) assembled experts to review, debate and summarize the challenges of IB validation and qualification. This consensus group has produced 14 key recommendations for accelerating the clinical translation of IBs, which highlight the role of parallel (rather than sequential) tracks of technical (assay) validation, biological/clinical validation and assessment of cost-effectiveness; the need for IB standardization and accreditation systems; the need to continually revisit IB precision; an alternative framework for biological/clinical validation of IBs; and the essential requirements for multicentre studies to qualify IBs for clinical use. PMID:27725679

  7. Pelvic actinomycosis associated with intrauterine devices.

    PubMed

    O'Connor, K F; Bagg, M N; Croley, M R; Schabel, S I

    1989-02-01

    The authors describe two women with pelvic pain, long-term use of an intrauterine device, and a pelvic mass due to Actinomyces israelii. The diagnostic imaging findings were nonspecific but included mass effect and mucosal irregularity of the rectosigmoid colon at barium enema examination and complex masses and inflammatory changes at computed tomography and magnetic resonance imaging. Radiologists should be aware of the imaging findings of this potentially lethal but curable condition.

  8. Primary Pelvic Hydatid Cyst: A Case Report

    PubMed Central

    Parray, Fazl Q.; Wani, Shadab Nabi; Bazaz, Sajid; Khan, Shakeel-ur Rehman; Malik, Nighat Shaffi

    2011-01-01

    This is a case report of a young man who presented to us as a case of hypogastric pain and frequency of micturation. General physical examination and radiological evaluation confirmed a multiloculated pelvic swelling. Patient was subjected to laparotomy which confirmed the diagnosis of a primary pelvic hydatid disease. Patient was put on chemotherapy after surgery and is doing well on follow up. PMID:22606594

  9. The Posterior Medial Cortex in Urologic Chronic Pelvic Pain Syndrome: Detachment from Default Mode Network. A Resting-State Study from the MAPP Research Network

    PubMed Central

    Martucci, Katherine T.; Shirer, William R.; Bagarinao, Epifanio; Johnson, Kevin A.; Farmer, Melissa A.; Labus, Jennifer S.; Apkarian, A. Vania; Deutsch, Georg; Harris, Richard E.; Mayer, Emeran A.; Clauw, Daniel J.; Greicius, Michael D.; Mackey, Sean C.

    2015-01-01

    Altered resting-state brain activity, as a measure of functional connectivity, is commonly observed in chronic pain. Identifying a reliable signature pattern of altered resting-state activity for chronic pain could provide strong mechanistic insights and serve as a highly beneficial neuroimaging-based diagnostic tool. We collected and analyzed resting-state fMRI data from female patients with urologic chronic pelvic pain syndrome (UCPPS, N = 45) and matched healthy participants (N = 45) as part of a NIDDK funded multicenter project (www.mappnetwork.org). Using dual regression and seed-based analyses, we observed significantly decreased functional connectivity of the default mode network (DMN) to two regions in the posterior medial cortex (PMC): the posterior cingulate cortex (PCC) and left precuneus (TFCE, FWE corrected p<0.05). Further investigation revealed that patients demonstrated increased functional connectivity between the PCC and several brain regions implicated in pain, sensory, motor, and emotion regulation processes (e.g., insular cortex, dorsolateral prefrontal cortex, thalamus, globus pallidus, putamen, amygdala, hippocampus). The left precuneus demonstrated decreased functional connectivity to several regions of pain processing, reward, and higher executive functioning within the prefrontal (orbitofrontal, anterior cingulate, ventromedial prefrontal) and parietal cortices (angular gyrus, superior and inferior parietal lobules). The altered PMC connectivity was associated with several phenotype measures, including pain and urologic symptom intensity, depression, anxiety, quality of relationships and self-esteem levels in patients. Collectively, these findings indicate that in UCPPS patients, regions of the PMC are detached from the DMN, while neurological processes of self-referential thought and introspection may be joined to pain and emotion regulatory processes. PMID:26010458

  10. The role of computed tomography in the classification and management of pelvic fractures.

    PubMed

    Draffan, D; Clements, D; Farrell, M; Heller, J; Bennett, D; Carmichael, S

    2009-01-01

    Computed tomography (CT) imaging is an important component in the pre-operative assessment of pelvic fractures in humans. The value of CT images in the management of small animal pelvic fractures is presently undetermined. The objective of this study was to investigate the benefits of CT images on the management of pelvic fractures. A prospective study of 25 traumatised cases of canine and feline pelvic fractures were evaluated, where CT images and conventional orthogonal radiographic assessments were performed on each case. Three diplomat orthopaedic surgeons independently reviewed the radiographs and CT images on separate occasions and determined fracture classification, management plan, estimated recovery time and prognosis. A consensus review of the imaging modalities and surgical reports was used as the definitive fracture description. For all observers, management was not found to differ significantly between radiographic and CT analysis (P< 0.05). There was moderate agreement between observers and between imaging modalities for fracture description. Greatest discrepancy was found as the fracture complexity increased, such as with acetabula and sacral fractures, whereby CT was the most sensitive. Clinically high quality radiography would be recommended for all pelvic fracture cases; CT may be beneficial where there is uncertainty, particularly with acetabula fractures or sacral fractures causing neurological deficits. Experienced orthopaedic surgeons often disagreed on the diagnosis, treatment and prognosis of pelvic trauma.

  11. A Pelvic Phantom for Modeling Internal Organ Motions

    SciTech Connect

    Kovacs, Peter; Sebestyen, Zsolt; Farkas, Robert; Bellyei, Szabolcs; Szigeti, Andras; Liposits, Gabor; Hideghety, Katalin; Derczy, Katalin; Mangel, Laszlo

    2011-10-01

    A pelvic phantom was developed for use in testing image-guided radiation therapy (IGRT) and adaptive applications in radiation therapy (ART) with simulating the anterior-posterior internal organ motions during prostate radiotherapy. Measurements could be done with an ionization chamber (IC) in the simulated prostate. The rectum was simulated by air-equivalent material (AEM). The volume superior to the IC placement was considered as the bladder. The extension of AEM volume could be varied. The vertical position of the IC placement could be shifted by {+-}1 cm to simulate the prostate motion parallel to the changes in bladder volume. The reality of the simulation was inspected. Three-millimeter-slice-increment computed tomography (CT) scans were taken for irradiation planning. The structure set was adapted to the phantom from a treated patient. Planning target volume was delineated according to the RTOG 0126 study. IMRT and 3D conformal radiation therapy (3D-CRT) plans were made. Prostate motion and rectum volume changes were simulated in the phantom. IC displacement was corrected by phantom shifting. The delivered dose was measured with IC in 7 cases using intensity-modulated radiation therapy (IMRT) and 3D-CRT fractions, and single square-shaped beams: anteroposterior (AP), posteroanterior (PA), and lateral (LAT). Variations from the calculated doses were slightly below 1% at IMRT and around 1% at 3D-CRT; below 4.5% at square AP beam; up to 9% at square PA beam; and around 0.5% at square LAT beam. Other authors have already shown that by using planning systems and ultrasonic and cone beam CT guidance, correction of organ motions in a real patient during prostate cancer IGRT does not have a significant dosimetric effect. The inspection of our phantom-as described here-ended with similar results. Our team suggested that our model is sufficiently realistic and can be used for IGRT and ART testing.

  12. Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome.

    PubMed

    Arora, Hans C; Eng, Charis; Shoskes, Daniel A

    2017-01-01

    Analysis of the human microbiome continues to reveal new and previously unrealized associations between microbial dysbiosis and disease. Novel approaches to bacterial identification using culture-independent methods allow practitioners to discern the presence of alterations in the taxa and diversity of the microbiome and identify correlations with disease processes. While some of these diseases that have been extensively studied are well-defined in their etiology and treatment methods (colorectal cancer), others have provided much more significant challenges in both diagnosis and treatment. One such condition, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), has several etiological and potentiating contributions from infection, inflammation, central nervous system (CNS) changes, stress, and central sensitization-all factors that play important roles in the crosstalk between the human body and its microbiome. No singular cause of CP/CPPS has been identified and it is most likely a syndrome with multifactorial causes. This heterogeneity and ambiguity are sources of significant frustration for patients and providers alike. Despite multiple attempts, treatment of chronic prostatitis with monotherapy has seen limited success, which is thought to be due to its heterogeneous nature. Phenotypic approaches to both classify the disease and direct treatment for CP/CPPS have proven beneficial in these patients, but questions still remain regarding etiology. Newer microbiome research has found correlations between symptom scores and disease severity and the degree of dysbiosis in urine and gut (stool) microbiomes in these patients as compared to un-afflicted controls. These findings present potential new diagnostic and therapeutic targets in CP/CPPS patients.

  13. Gut microbiome and chronic prostatitis/chronic pelvic pain syndrome

    PubMed Central

    Arora, Hans C.; Eng, Charis

    2017-01-01

    Analysis of the human microbiome continues to reveal new and previously unrealized associations between microbial dysbiosis and disease. Novel approaches to bacterial identification using culture-independent methods allow practitioners to discern the presence of alterations in the taxa and diversity of the microbiome and identify correlations with disease processes. While some of these diseases that have been extensively studied are well-defined in their etiology and treatment methods (colorectal cancer), others have provided much more significant challenges in both diagnosis and treatment. One such condition, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), has several etiological and potentiating contributions from infection, inflammation, central nervous system (CNS) changes, stress, and central sensitization—all factors that play important roles in the crosstalk between the human body and its microbiome. No singular cause of CP/CPPS has been identified and it is most likely a syndrome with multifactorial causes. This heterogeneity and ambiguity are sources of significant frustration for patients and providers alike. Despite multiple attempts, treatment of chronic prostatitis with monotherapy has seen limited success, which is thought to be due to its heterogeneous nature. Phenotypic approaches to both classify the disease and direct treatment for CP/CPPS have proven beneficial in these patients, but questions still remain regarding etiology. Newer microbiome research has found correlations between symptom scores and disease severity and the degree of dysbiosis in urine and gut (stool) microbiomes in these patients as compared to un-afflicted controls. These findings present potential new diagnostic and therapeutic targets in CP/CPPS patients. PMID:28217695

  14. Evaluation of Tookad-mediated photodynamic effect on peripheral nerve and pelvic nerve in a canine model

    NASA Astrophysics Data System (ADS)

    Hetzel, Fred W.; Chen, Qun; Dole, Kenneth C.; Blanc, Dominique; Whalen, Lawrence R.; Gould, Daniel H.; Huang, Zheng

    2006-02-01

    Photodynamic therapy (PDT) mediated with a novel vascular targeting photosensitizer pd-bacteriopheophorbide (Tookad) has been investigated as an alternative modality for the treatment of prostate cancer and other diseases. This study investigated, for the first time, the vascular photodynamic effects of Tookad-PDT on nerve tissues. We established an in situ canine model using the cutaneous branches of the saphenous nerve to evaluate the effect of Tookad-PDT secondary to vascular damage on compound-action potentials. With Tookad dose of 2 mg/kg, treatment with 50 J/cm2 induced little change in nerve conduction. However, treatment with 100 J/cm2 resulted in decreases in nerve conduction velocities, and treatment with 200 J/cm2 caused a total loss of nerve conduction. Vasculature surrounding the saphenous nerve appeared irritated. The nerve itself looked swollen and individual fibers were not as distinct as they were before PDT treatment. Epineurium had mild hemorrhage, leukocyte infiltration, fibroplasias and vascular hypertrophy. However, the nerve fascicles and nerve fibers were free of lesions. We also studied the effect of Tookad-PDT secondary to vascular damage on the pelvic nerve in the immediate vicinity of the prostate gland. The pelvic nerve and saphenous nerve showed different sensitivity and histopathological responses to Tookad-PDT. Degeneration nerve fibers and necrotic neurons were seen in the pelvic nerve at a dose level of 1 mg/kg and 50 J/cm2. Adjacent connective tissue showed areas of hemorrhage, fibrosis and inflammation. Our preliminary results suggest that possible side effects of interstitial PDT on prostate nerve tissues need to be further investigated.

  15. Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

    PubMed Central

    Corradi, Renato B.; Galvão, Gustavo Jaime Climaco; Oliveira, Gabriel M.; Carneiro, Vinicius F.; Miconi, Wadson Gomes; Salles, Paulo Guilherme Oliveira; Cabral, Walter Luiz Ribeiro; Corradi, Carlos; Salazar, Andre Lopes Lopes

    2016-01-01

    ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity. PMID:27286104

  16. Continuous 7-Days-A-Week External Beam Irradiation in Locally Advanced Cervical Cancer: Final Results of the Phase I/II Study

    SciTech Connect

    Serkies, Krystyna; Dziadziuszko, Rafal; Jassem, Jacek

    2012-03-01

    Purpose: To evaluate the feasibility and efficacy of definitive continuous 7-days-a-week pelvic irradiation without breaks between external beam radiotherapy and brachytherapy in locally advanced cervical cancer. Methods and Materials: Between November 1998 and December 1999, 30 patients with International Federation of Obstetrics and Gynecology Stage IIB or IIIB cervical cancer were included in a prospective Phase I/II study of continuous 7-days-a-week pelvic irradiation, to the total Manchester point B dose of 40.0-57.6 Gy. The first 13 patients (Group A) were given a daily tumor dose of 1.6 Gy, and the remaining 17 patients (Group B) were given 1.8 Gy. One or two immediate brachytherapy applications (point A dose 10-20 Gy, each) were performed in 28 cases. Results: Two patients did not complete the irradiation because of apparent early progression of disease during the irradiation. Eleven of the 28 evaluable patients (39%; 45% and 35% in Groups A and B, respectively) completed their treatment within the prescribed overall treatment time. Acute toxicity (including severe European Organisation for Research and Treatment of Cancer/Radiation Therapy Oncology Group Grade 3 and 4 effects in 40%) was experienced by 83% of patients and resulted in unplanned treatment interruptions in 40% of all patients (31% and 47% of patients in Groups A and B, respectively). Severe intestinal side effects occurred in 31% and 41% of Patients in Groups A and B, respectively (p = 0.71). The 5-year overall survival probability was 33%. Cancer recurrence occurred in 63% of patients: 20% inside and 57% outside the pelvis. Cumulative incidence of late severe bowel and urinary bladder toxicity at 24 months was 15%. Conclusion: Continuous irradiation in locally advanced cervical cancer is associated with a high incidence of severe acute toxicity, resulting in unplanned treatment interruptions. Late severe effects and survival after continuous radiotherapy do not substantially differ from

  17. Advances for Studying Clonal Evolution in Cancer

    PubMed Central

    Raphael, Benjamin J.; Chen, Feng; Wendl, Michael C.

    2013-01-01

    The “clonal evolution” model of cancer emerged and “evolved” amid ongoing advances in technology, especially in recent years during which next generation sequencing instruments have provided ever higher resolution pictures of the genetic changes in cancer cells and heterogeneity in tumors. It has become increasingly clear that clonal evolution is not a single sequential process, but instead frequently involves simultaneous evolution of multiple subclones that co-exist because they are of similar fitness or are spatially separated. Co-evolution of subclones also occurs when they complement each other’s survival advantages. Recent studies have also shown that clonal evolution is highly heterogeneous: different individual tumors of the same type may undergo very different paths of clonal evolution. New methodological advancements, including deep digital sequencing of a mixed tumor population, single cell sequencing, and the development of more sophisticated computational tools, will continue to shape and reshape the models of clonal evolution. In turn, these will provide both an improved framework for the understanding of cancer progression and a guide for treatment strategies aimed at the elimination of all, rather than just some, of the cancer cells within a patient. PMID:23353056

  18. The history and evolution of sutures in pelvic surgery

    PubMed Central

    Muffly, Tyler M; Tizzano, Anthony P; Walters, Mark D

    2011-01-01

    Summary The purpose of the study is to review the history and innovations of sutures used in pelvic surgery. Based on a review of the literature using electronic- and hand-searched databases we identified appropriate articles and gynaecology surgical textbooks regarding suture for wound closure. The first documented uses of suture are explored and then the article focuses on the use of knotted materials in pelvic surgery. The development of suture of natural materials is followed chronologically until the present time where synthetic suture is implanted during countless surgeries every day. This millennial history of suture contains an appreciation of the early work of Susruta, Celsus, Paré and Lister, including a survey of some significant developments of suture methods over the last 100 years. Most surgeons know little about the history and science of sutures. A retrospective view of suture is critical to the appreciation of the current work and development of this common tool. PMID:21357979

  19. Percutaneous malathion absorption in the harvested perfused anuran pelvic limb.

    PubMed

    Willens, Scott; Stoskopf, Michael K; Baynes, Ronald E; Lewbart, Gregory A; Taylor, Sharon K; Kennedy-Stoskopf, Suzanne

    2006-11-01

    The objective of this study was to establish an accurate in vitro model for cutaneous absorption in anurans. The harvested perfused anuran pelvic limb (HPAPL) model maintains the anatomic and physiologic integrity of the skin from the pelvic limb, including the intact capillary network. Radiolabeled malathion was applied to the skin of the dorsal thigh, and perfusate was collected over a 6h period. Residues from the skin surface, stratum externum, and dosed area beneath the stratum externum were analyzed. Kinetic parameters were calculated from these data. Absorption was significantly less for the HPAPL than previously reported for Teflon flow-through diffusion cells. However, partitioning effects were comparable. The HPAPL is an appropriate in vitro model for examining cutaneous absorption kinetics in the bullfrog.

  20. PELVIC FLOOR SYMPTOMS AND QUALITY OF LIFE ANALYSES IN WOMEN UNDERGOING SURGERY FOR RECTAL PROLPASE

    PubMed Central

    ELLINGTON, DR; MANN, M; BOWLING, CB; DRELICHMAN, ER; GREER, WJ; SZYCHOWSKI, JM; RICHTER, HE

    2014-01-01

    Objective Characterize pelvic floor symptom distress and impact, sexual function and quality of life in women who underwent rectal prolapse surgery. Methods Subjects undergoing rectal prolapse surgery from 2004–2009 completed questionnaires including the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and the Prolapse/Urinary Incontinence Sexual Questionnaire. Baseline demographic, medical, and surgical characteristics were extracted by chart review. Demographic and clinic outcomes of women undergoing transperineal and abdominal approaches were compared. Wilcoxon rank-sum test was used for continuous variables and Fisher’s exact test for categorical measures. Results 45 were identified; two deceased at follow-up. 28/43 subjects (65.1%) responded to the questionnaires. Mean time from original procedure was 3.9 ± 3.1 years. No differences in median total Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and subscale scores, and Prolapse/Urinary Incontinence Sexual Questionnaire scores in women undergoing open rectopexy versus transperineal proctectomy were seen (all p>0.05). 26 (60%) participants answered the Prolapse/Urinary Incontinence Sexual Questionnaire, nine reported sexual activity within the last month. All underwent abdominal procedures. Conclusion There are few colorectal or other pelvic floor symptoms after rectal prolapse repair. Robust prospective studies are needed to more fully characterize and understand issues associated with rectal prolapse surgery in women. PMID:25379122