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Sample records for postoperative pelvic external

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Postoperative Radiotherapy for the Treatment of Solitary Fibrous Tumor With Malignant Transformation of the Pelvic

    PubMed Central

    Gao, Chao; Zhang, Yong; Jing, Ming; Qu, Wei; Li, Jia; Zhao, Xiang-Rong; Yu, Yong-Hua

    2016-01-01

    Abstract Solitary fibrous tumor of the pelvic is an uncommon neoplasm with nonspecific symptoms. Reports of malignant transformation are especially rare. We report a case of solitary fibrous tumor in pelvic. A unique feature of our case compared with previously reported is that this patient relapsed with malignant transformation and had significant response to radiotherapy. The patient was initially treated with surgery, followed by postoperative dimensional conformal intensity modulated radiation therapy (dynamic MLC VRIAN 23EX Linac, inversely optimized by the Eclipse system) to provide a radical cure for residual tumor. In this case, there were no signs of recurrence after six and a half years of further follow-up, indicating that postoperation radiotherapy may be an effective treatment for SFT with malignant transformation in pelvic. PMID:26765426

  7. Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction.

    PubMed

    Khatri, Gaurav; Carmel, Maude E; Bailey, April A; Foreman, Melissa R; Brewington, Cecelia C; Zimmern, Philippe E; Pedrosa, Ivan

    2016-01-01

    Pelvic floor dysfunction encompasses an extremely common set of conditions, with various surgical and nonsurgical treatment options. Surgical options include injection of urethral bulking agents, native tissue repair with or without bioabsorbable or synthetic graft material, placement of synthetic midurethral slings or use of vaginal mesh kits, and mesh sacrocolpopexy procedures. Numerous different synthetic products with varied imaging appearances exist, and some of these products may be difficult to identify at imaging. Patients often present with recurrent or new symptoms after surgery; and depending on the presenting complaint and the nature of the initial intervention, imaging with ultrasonography (US), magnetic resonance (MR) imaging, voiding cystourethrography, or computed tomography (CT) may be indicated. US and MR imaging can both be used to image urethral bulking agents; US is often used to follow potential changes in bulking agent volume with time. Compared with MR imaging, US depicts midurethral slings better in the urethrovaginal space, and MR imaging is better than US for depiction of the arms in the retropubic space and obturator foramen. Mesh along the vaginal wall may be depicted with both US and MR imaging; however, the distal arms of the mesh traversing the sacrospinous ligaments or within the ischiorectal fossae (ischioanal fossae) are better depicted with MR imaging. Scarring can mimic slings and mesh at both US and MR imaging. MR imaging is superior to US for depiction of sacrocolpopexy mesh and associated complications. Voiding cystourethrography and CT are used less commonly because they rarely allow direct depiction of implanted material. Online supplemental material is available for this article. (©)RSNA, 2016.

  8. Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

    SciTech Connect

    Fiorica, J.V.; Roberts, W.S.; Greenberg, H.; Hoffman, M.S.; LaPolla, J.P.; Cavanagh, D. )

    1990-03-01

    Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphedema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

  9. Anterior pre-tensioned external fixator for pelvic fractures and dislocations. Initial clinical series.

    PubMed

    Queipo-de-Llano, A; Lombardo-Torre, M; Leiva-Gea, A; Delgado-Rufino, F B; Luna-González, F

    2016-12-01

    In the treatment of unstable pelvic ring fractures, external fixators have the limitation of not adequately stabilizing the injured posterior elements. This article presents a novel and simple technique of temporary external fixation of the pelvic ring, able to produce compression of both the anterior and posterior pelvic elements. A curved flexible carbon-fiber rod is used, pre-tensioned before attachment to supra-acetabular Schanz screws. Although more extensive clinical experience is required, favorable preliminary results in a series of 13 patients with unstable pelvic fracture were encouraging: the aim of closing the posterior and anterior elements of the pelvic ring was achieved in all cases treated with this technique, and 12 patients survived. Radiological results were excellent in 3 cases and good in 9 cases. No major complications, such as secondary displacement, vertical re-displacement or deep infection, were observed. Mean operative time was 25min, compatible with emergency management.

  10. Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review.

    PubMed

    Pahwa, Avita K; Siegelman, Evan S; Arya, Lily A

    2015-04-01

    Pelvic organ prolapse, a herniation of pelvic organs through the vagina, is a common condition in older women. Pelvic organ prolapse distorts vaginal anatomy making pelvic examination difficult. A clinician must accurately identify anatomic landmarks both in women presenting with symptoms of prolapse and in women noted to have coincidental prolapse during routine gynecologic examination. We present a systematic approach to the female pelvic examination including anatomic landmarks of the external genitalia, vagina, and uterus in women with normal support as well as changes that occur with pelvic organ prolapse. Knowledge and awareness of normal anatomic landmarks will improve a clinician's ability to identify defects in pelvic support and allow for better diagnosis and treatment of pelvic organ prolapse.

  11. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation

    PubMed Central

    2014-01-01

    Background Although useful in the emergency treatment of pelvic ring injuries, external fixation is associated with pin tract infections, the patient’s limited mobility and a restricted surgical accessibility to the lower abdomen. In this study, the mechanical stability of a subcutaneous internal anterior fixation (SIAF) system is investigated. Methods A standard external fixation and a SIAF system were tested on pairs of Polyoxymethylene testing cylinders using a universal testing machine. Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1 Hz with sinusoidal lateral compression/distraction (+/−50 N) and torque (+/− 0.5 Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700 and 900 cycles. Results There was no significant difference in translational stiffness between the SIAF and the standard external fixation when compared at 500 (p = .089), 700 (p = .081), and 900 (p = .266) cycles. Rotational stiffness observed for the SIAF was about 50 percent higher than the standard external fixation at 300 (p = .005), 500 (p = .020), and 900 (p = .005) cycles. No loosening or failure of the rod-pin/rod-screw interfaces was seen. Conclusions In comparison with the standard external fixation system, the tested device for subcutaneous internal anterior fixation (SIAF) in vitro has similar translational and superior rotational stiffness. PMID:24684828

  12. Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

    SciTech Connect

    Akhan, Okan Karcaaltincaba, Musturay; Ozmen, Mustafa N.; Akinci, Devrim; Karcaaltincaba, Deniz; Ayhan, Ali

    2007-04-15

    The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

  13. 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

  14. 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.

  15. Endovascular management of postoperative pseudoaneurysms of the external carotid artery.

    PubMed

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Grigoriadis, Savvas; Ramirez de Noriega, Fernando; Itshayek, Eyal

    2012-05-01

    Hemorrhage secondary to postoperative pseudoaneurysm is a rare event, but may complicate the clinical course of straightforward and common interventions such as sinonasal procedures, tonsillectomy, and maxillofacial and plastic surgeries. We report our experience with the endovascular management of iatrogenic pseudoaneurysm in eight patients who had undergone recent craniomaxillofacial surgery. Computed tomography (CT), including CT-angiography, detected only three of the eight lesions. In all patients, endovascular embolization achieved successful occlusion of the pseudoaneurysm without local or general procedure-related complications. Immediate proximal arterial occlusion with detachable coils was performed in every case, and pseudoaneurysm coiling was performed in three cases presenting with active hemorrhage. Endovascular therapy proved to be safe and effective in the management of postoperative pseudoaneurysms. Surgeons involved in the craniomaxillofacial procedures should be aware of this complication and its management.

  16. 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.

  17. 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.

  18. Pelvic floor muscles and the external urethral sphincter have different responses to applied bladder pressure during continence

    PubMed Central

    Jiang, Hai-Hong; Salcedo, Levilester B.; Song, Bo; Damaser, Margot S.

    2010-01-01

    Objectives To determine the functional innervation of the pelvic floor muscles (PFM) and if there is PFM activity during an external pressure increase to the bladder in female rats. Methods Thirty-one female adult virgin Sprague Dawley rats received an external increase in bladder pressure until urinary leakage was noted while bladder pressure was recorded (leak point pressure; LPP) under urethane anesthesia. Six of the rats underwent repeat LPP testing after bilateral transection of the levator ani nerve. Another 6 rats underwent repeat LPP testing after bilateral transection of the pudendal nerve. Simultaneous recordings of PFM (pubo-/iliococcygeus muscles) electromyogram (EMG) and external urethral sphincter (EUS) EMG were recorded during cystometry and LPP testing. Results Thirteen rats (42%) showed tonic PFM EMG activity during filling cystometry. Eighteen rats (58%) showed no tonic PFM EMG activity at baseline, but PFM EMG could be activated by pinching the perineal skin. This activity could be maintained unless voiding occurred. The external increase in bladder pressure caused significantly increased EUS EMG activity as demonstrated by increased amplitude and frequency. However, there was no such response in PFM EMG. LPP was not significantly different after levator ani nerve transection, but was significantly decreased after pudendal nerve transection. Conclusions PFM activity was not increased during external pressure increases to the bladder in female rats. Experimental designs using rats should consider this result. PMID:20206969

  19. Postoperative External Beam Radiotherapy for Differentiated Thyroid Cancer: Outcomes and Morbidity With Conformal Treatment

    SciTech Connect

    Schwartz, David L. Lobo, Mark J.; Ang, K. Kian; Morrison, William H.; Rosenthal, David I.; Ahamad, Anesa; Evans, Douglas B.; Clayman, Gary; Sherman, Steven I.; Garden, Adam S.

    2009-07-15

    Purpose: To review institutional outcomes for patients treated for differentiated thyroid cancer with postoperative conformal external beam radiotherapy (EBRT). Methods and Materials: This is a single-institution retrospective review of 131 consecutive patients with differentiated thyroid cancer who underwent EBRT between January 1996 and December 2005. Histologic diagnoses included 104 papillary, 21 follicular, and six mixed papillary-follicular types. American Joint Committee on Cancer stage distribution was Stage III in 2 patients, Stage IVa-IVc in 128, and not assessable in 1. Thirty-four patients (26%) had high-risk histologic types and 76 (58%) had recurrent disease. Extraglandular disease spread was seen in 126 patients (96%), microscopically positive surgical margins were seen in 62 patients (47%), and gross residual disease was seen in 15 patients (11%). Median EBRT dose was 60 Gy (range, 38-72 Gy). Fifty-seven patients (44%) were treated with intensity-modulated radiotherapy (IMRT) to a median dose of 60 Gy (range, 56-66 Gy). Median follow-up was 38 months (range, 0-134 months). Results: Kaplan-Meier estimates of locoregional relapse-free survival, disease-specific survival, and overall survival at 4 years were 79%, 76%, and 73%, respectively. On multivariate analysis, high-risk histologic features and gross residual disease predicted for inferior locoregional relapse-free survival, whereas high-risk histologic features, M1 disease, and gross residual disease predicted for inferior disease-specific and overall survival. The IMRT did not impact on survival outcomes, but was associated with less frequent severe late morbidity (12% vs. 2%). Conclusions: Postoperative conformal EBRT provides durable locoregional disease control for patients with high-risk differentiated thyroid cancer if disease is reduced to microscopic burden. Patients with gross disease face significantly worse outcomes. The IMRT may significantly reduce chronic radiation morbidity, but

  20. 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

  1. 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

  2. Postoperative monitoring of free flap reconstruction: A comparison of external Doppler ultrasonography and the implantable Doppler probe

    PubMed Central

    Hosein, Rayaad C; Cornejo, Agustin; Wang, Howard T

    2016-01-01

    HYPOTHESIS: The time to detection of vascular compromise and the postoperative time to re-exploration are shorter using the implantable Doppler (ID) probe, thereby resulting in earlier surgical re-exploration and a higher flap salvage rate. METHODS: A single-centre experience with 176 consecutive free flap reconstructions in 167 patients from 2000 to 2008 in a university-based teaching hospital by retrospective chart review is presented. RESULTS: There was a significant difference in overall flap survival (ID 98.0%, external Doppler [ED] 89.3%) and total flap loss (ID 2.0%, ED 10.7%) between the two groups (P=0.03). The difference in flap salvage rate was not significant (ID 90.9%, ED 63.6%; P=0.068). The false-positive (ID 0%, ED 3%; P=0.18) and false-negative rates (ID 0.0%, ED 4.5%; P=1.0) were not significantly different. There was also a lower median postoperative time to re-exploration for the ID group, from 48 h to one week after initial surgery (ID 74.5 h, ED 136.8 h; P=0.05). CONCLUSION: The present analysis revealed a potential benefit for the ID probe in the postoperative monitoring of free tissue transfers. PMID:27054132

  3. External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis

    SciTech Connect

    Berger, Bernhard . E-mail: Bernhard.Berger@med.uni-tuebingen.de; Ganswindt, Ute; Bamberg, Michael; Hehr, Thomas

    2007-03-15

    Purpose: Diffuse pigmented villonodular synovitis is a rare proliferative disorder of synovial membranes with invasive and expansive growth patterns. Radical synovectomy is regarded as the treatment of choice. However, because of the high recurrence rates, additive treatment might be useful. Radiotherapy (RT) has been evaluated with positive results, but the optimal treatment schedules are vague. We have reviewed our experience with postoperative RT in cases of suspected or proven residual disease. Methods and Materials: Between December 1996 and January 2006, 7 diffuse pigmented villonodular synovitis patients underwent RT at our institution. The most common location was the knee joint (5 patients). All patients underwent radical surgery and were treated subsequently with 6-MV photon RT. The total doses applied were 30-50 Gy, depending on the resection status and estimated risk of relapse. For analysis, we retrospectively reviewed all patients in April 2006. Results: The mean follow-up time was 29 months (range, 3-112 months). RT had no acute adverse effects. At the assessment, no evidence was found of recurrent or persisting disease in any patient. Of the 7 patients, 6 reported asymptomatic limb function and excellent quality of life; 1 patient had persistent restriction of joint movement after repeated surgery. No radiotherapeutic late effects were seen. Conclusion: The results of our series have confirmed the efficacy and safety of postoperative RT for diffuse pigmented villonodular synovitis. Hence, this treatment should be considered for patients with suspected or proven residual disease.

  4. 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].

  5. High-dose rate brachytherapy for local recurrent adenoid cystic carcinoma of the tongue base following postoperative external beam radiotherapy

    PubMed Central

    Lee, Sun Young; Kim, Jung Soo; Kwon, Hyoung Cheol

    2016-01-01

    Adenoid cystic carcinoma is a rare neoplasm commonly originating from the minor salivary glands. The clinical findings typical of this tumor include slow growth, perineural invasion and high frequency of local recurrence. In this study, a patient presented with a tongue base lesion that was treated with surgical excision and additional postoperative external beam radiotherapy. However, local recurrence occurred 8 months after radiotherapy. If recurrence occurs after radiation therapy, total glossectomy should be considered. However, the patient refused re-operation and, considering the patient's age, brachytherapy was used to ensure organ preservation. Complete remission was achieved following brachytherapy, without serious side effects. There has been no progression of the lesion during a follow-up period of 2 years. PMID:27882233

  6. 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.

  7. The role of postoperative external-beam radiotherapy in the management of patients with papillary thyroid cancer invading the trachea

    SciTech Connect

    Keum, Ki Chang; Suh, Yang Gun; Koom, Woong Sub; Cho, Jae Ho; Shim, Su Jung; Lee, Chang Geol; Park, Chung Soo; Chung, Woong Youn; Kim, Gwi Eon . E-mail: gekim@yumc.yonsei.ac.kr

    2006-06-01

    Purpose: To determine the role of adjuvant external-beam radiotherapy (EBRT) in the management of patients with well-differentiated thyroid cancer invading the trachea. Methods and Materials: Of 1,098 thyroid cancer patients, 68 (6%) were found to have tracheal invasion, and they all received 'shave' excision of the tracheal cartilage. Among them, 12 patients had no postoperative residuum, 43 patients had microscopic residuum, and 13 patients had macroscopic residuum. All patients were divided into two groups according to treatment modality with or without EBRT; (1) the control group (n = 43) and (2) the EBRT group (n = 25). Results: The locoregional recurrence rate for EBRT patients was much lower than that of control patients (51% for the control group vs. 8% for the EBRT group) (p < 0.01). The 10-year local progression-free survival rate for the EBRT group was significantly better than that of the control group (89% in the EBRT group vs. 38% in the control group) (log-rank, p < 0.01). The use of adjuvant EBRT after conservative surgery was an independent prognostic factor in univariate and multivariate analyses. Conclusions: External-beam radiotherapy was found to be effective, particularly in patients with thyroid cancer invading the trachea with microscopic or gross residuum after conservative surgery.

  8. 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 - ...

  9. A prospective trial of postoperative vaginal radium/cesium for grade 1-2 less than 50% myometrial invasion and pelvic radiation therapy for grade 3 or deep myometrial invasion in surgical stage I endometrial adenocarcinoma

    SciTech Connect

    Piver, M.S.; Hempling, R.E. )

    1990-09-15

    A prospective trial was performed to evaluate the recurrence rate and 5-year disease-free survival rate in patients with surgical Stage I endometrial adenocarcinoma. Patients with Stage I, Grade 1 or 2 disease, less than 50% myometrial invasion, and no evidence of disease outside the corpus of the uterus were treated by hysterectomy and bilateral salpingo-oophorectomy and postoperative vaginal radium/cesium (Group 1). Patients with surgical Stage I, Grade 3 disease or deep myometrial invasion, and histologically negative paraaortic lymph nodes were treated with postoperative pelvic radiation therapy (5000-5040 cGY) (Group 2). Patients with malignant peritoneal cytologic findings also received progesterone therapy. Of the 92 Group 1 patients, there have been no recurrences and the 5-year estimated disease-free survival rate was 99%. Of the 41 Group 2 patients, there have been four (9.7%) recurrences but only one (2.4%) within the treated field (pelvis), and the 5-year estimated disease-free survival rate was 88%. Of the 133 patients, the 5-year estimated disease-free survival rate was 96%, and only one patient (0.7%) had a local pelvic recurrence. Of the 16 patients with malignant peritoneal cytologic findings who were treated with progesterone therapy, none has had a recurrence.

  10. Postoperative extended-volume external-beam radiation therapy in high-risk esophageal cancer patients: a prospective experience

    PubMed Central

    Yu, E.; Tai, P.; Younus, J.; Malthaner, R.; Truong, P.; Stitt, L.; Rodrigues, G.; Ash, R.; Dar, R.; Yaremko, B.; Tomiak, A.; Dingle, B.; Sanatani, M.; Vincent, M.; Kocha, W.; Fortin, D.; Inculet, R.

    2009-01-01

    Background and Purpose Extended-volume external-beam radiation therapy (rt) following esophagectomy is controversial. The present prospective study evaluates the feasibility of extended-volume rt treatment in high-risk esophagectomy patients with a cervical anastomosis receiving postoperative combined chemoradiation therapy. Patients and Methods From 2001 to 2006, 15 patients with resected esophageal cancer were prospectively accrued to this pilot study to evaluate the adverse effects of extended-volume rt. Postoperative management was carried out at London Regional Cancer Program. Eligibility criteria were pathology-proven esophageal malignancy (T3–4, N0–1), disease amenable to surgical resection, and esophagectomy with or without resection margin involvement. Patients with distant metastases (M1) and patients treated with previous rt were excluded. All 15 study patients received 4 cycles of 5-fluorouracil–based chemotherapy. External-beam rt was conducted using conformal computed tomography planning, with multi-field arrangement tailored to the pathology findings, with coverage of a clinical target volume encompassing the primary tumour bed and the anastomotic site in the neck. The radiation therapy dose was 50.40 Gy at 1.8 Gy per fraction. The rt was delivered concurrently with the third cycle of chemotherapy. The study outcomes—disease-free survival (dfs) and overall survival (os)—were calculated by the Kaplan–Meier method. Treatment-related toxicities were assessed using the U.S. National Cancer Institute’s Common Toxicity Criteria. Results The study accrued 10 men and 5 women of median age 64 years (range: 48–80 years) and TNM stages T3N0 (n = 1), T2N1 (n = 2), T3N1 (n = 11), and T4N1 (n = 1). Histopathology included 5 adenocarcinomas and 10 squamous-cell carcinomas. Resection margins were clear in 10 patients. The median follow-up time was 19 months (range: 3.5–53.4 months). Before radiation therapy commenced, delay in chemotherapy occurred

  11. Management of a Case of Severe Pelvic Fracture Related Bladder Trauma

    PubMed Central

    Myers, Jeremy B.; Hotaling, James M.; Brant, William O.; Enniss, Toby M.

    2015-01-01

    A 62-year-old male was admitted after being struck by a bus. He sustained a severe pelvic fracture, sigmoid colon injury, and both intraperitoneal and extraperitoneal bladder injury. He underwent initial successful bladder repair. However, at 7 days post-operatively he manifested a leak from the repair and urine was evident coming from the pins of his pelvic external fixator. A repeat cystogram showed massive extravasation, which was managed by operative ligation of the lower ureters and placement of percutaneous nephrostomy tubes. He underwent ureteral reconstruction and colostomy reversal at 9 months. He has both bladder and bowel control. PMID:26793492

  12. Management of a Case of Severe Pelvic Fracture Related Bladder Trauma.

    PubMed

    Myers, Jeremy B; Hotaling, James M; Brant, William O; Enniss, Toby M

    2015-03-01

    A 62-year-old male was admitted after being struck by a bus. He sustained a severe pelvic fracture, sigmoid colon injury, and both intraperitoneal and extraperitoneal bladder injury. He underwent initial successful bladder repair. However, at 7 days post-operatively he manifested a leak from the repair and urine was evident coming from the pins of his pelvic external fixator. A repeat cystogram showed massive extravasation, which was managed by operative ligation of the lower ureters and placement of percutaneous nephrostomy tubes. He underwent ureteral reconstruction and colostomy reversal at 9 months. He has both bladder and bowel control.

  13. 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.

  14. Immediate postoperative morbidity in patients with indwelling double-J stent versus overnight-externalized ureteral catheter after tubeless percutaneous nephrolithotomy: a prospective, randomized study.

    PubMed

    Mercado, Alejandro; Fernández, Mario I; Recabal, Pedro; Fleck, Daniela; Ledezma, Rodrigo; Moya, Francisco; Sepúlveda, Francisco; Vilches, Roberto; Reyes, Diego; Marchant, Fernando

    2013-06-01

    The conventional technique for percutaneous nephrolithotomy (PNL) ends by placing a nephrostomy tube within the access tract. However, feasibility and safety of tubeless PNL have been widely demonstrated. In this modification, a ureteral stent is usually left in place instead of the nephrostomy tube. The aim of this study is to compare the use of a postoperative indwelling double-J stent versus an overnight-externalized ureteral catheter in patients undergoing tubeless PNL. Sixty-eight patients undergoing tubeless PNL were randomized either for a postoperative double-J stent (group 1) or for an overnight-externalized ureteral catheter (group 2). Outcomes evaluated included postoperative pain, hospital stay length, incidence of hemorrhagic complications, residual lithiasis and urinary leakage. Groups were similar according to age, sex, body mass index and stone burden. There were no significant differences in terms of postoperative pain, incidence of perirenal hematomas, residual lithiasis and urinary leakage. However, patients in group 1 presented longer hospital stays (3.7 ± 1.7 vs. 1.9 ± 0.3 days; p < 0.001) and greater hematocrit drops (4.9 ± 2.2 vs. 2.1 ± 1.8 %; p < 0.001). Our results confirm that among patients undergoing tubeless PNL, both alternatives (i.e. leaving a double-J stent or an overnight-externalized ureteral catheter) are reliable and safe. However, further considerations, like the need of double-J stent removal under cystoscopy, need to be taken into account when deciding which modality to use.

  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. 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 ...

  17. 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 ...

  18. Postoperative Intensity-Modulated Radiotherapy for Squamous Cell Carcinoma of the External Auditory Canal and Middle Ear: Treatment Outcomes, Marginal Misses, and Perspective on Target Delineation

    SciTech Connect

    Chen, Wan-Yu; Kuo, Sung-Hsin; Chen, Yu-Hsuan; Lu, Szu-Huai; Tsai, Chiao-Ling; Chia-Hsien Cheng, Jason; Hong, Ruey-Long; Chen, Ya-Fang; Hsu, Chuan-Jen; Lin, Kai-Nan; Ko, Jenq-Yuh; Lou, Pei-Jen; Wang, Cheng-Ping; Chong, Fok-Ching; Wang, Chun-Wei

    2012-03-15

    Purpose: To report outcomes of the rare disease of squamous cell carcinoma (SCC) of the external auditory canal (EAC) and middle ear treated with surgery and postoperative intensity-modulated radiotherapy (IMRT). Failure patterns related to spatial dose distribution were also analyzed to provide insight into target delineation. Methods and Materials: A retrospective review was conducted of the records of 11 consecutive patients with SCC of the EAC and middle ear who were treated with curative surgery and postoperative IMRT at one institution between January 2007 and February 2010. The prescribed IMRT dose was 60 to 66 Gy at 2 Gy per fraction. Three patients also received concurrent cisplatin-based chemotherapy, and 1 patient received concurrent oral tegafur/uracil. The median follow-up time was 19 months (range, 6-33 months). Results: Four patients had locoregional recurrence, yielding an estimated 2-year locoregional control rate of 70.7%. Among them, 1 patient had persistent disease after treatment, and 3 had marginal recurrence. Distant metastasis occurred in 1 patient after extensive locoregional recurrence, yielding an estimated 2-year distant control rate of 85.7%. The estimated 2-year overall survival was 67.5%. The three cases of marginal recurrence were near the preauricular space and glenoid fossa of the temporomandibular joint, adjacent to the apex of the ear canal and glenoid fossa of the temporomandibular joint, and in the postauricular subcutaneous area and ipsilateral parotid nodes, respectively. Conclusions: Marginal misses should be recognized to improve target delineation. When treating SCC of the EAC and middle ear, care should be taken to cover the glenoid fossa of the temporomandibular joint and periauricular soft tissue. Elective ipsilateral parotid irradiation should be considered. The treatment planning procedure should also be refined to balance subcutaneous soft-tissue dosimetry and toxicity.

  19. 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 ...

  20. 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 ...

  1. Acute Bladder Necrosis after Pelvic Arterial Embolization for Pelvic Trauma: Lessons Learned from Two Cases of Immediate Postembolization Bladder Necrosis

    PubMed Central

    Osterberg, E. Charles; Elliott, Sean P.; Hittelman, Adam B.

    2016-01-01

    We report two cases of acute bladder injury with bladder neck necrosis identified during the initial operative evaluation and within the early postprocedural period in patients with significant pelvic trauma requiring pelvic vascular embolization. To our knowledge, this is the first report of bladder neck necrosis found during the initial intraoperative surgical evaluation or early postoperative setting. PMID:27656309

  2. Functional pelvic orientation measured from lateral standing and sitting radiographs.

    PubMed

    DiGioia, Anthony M; Hafez, Mahmoud A; Jaramaz, Branislav; Levison, Timothy J; Moody, James E

    2006-12-01

    We prospectively obtained preoperative and 3-month postoperative lateral pelvic radiographs in the standing and sitting positions from 84 patients who underwent total hip arthroplasty. We measured pelvic orientation (flexion extension) using the anterior pelvic plane as defined by the anterior superior iliac spines and pubic tubercles as references. There was a trend towards upright pelvic alignment when standing, with a mean anterior pelvic plane angle of 1.2 degrees (range, -22 degrees - +27 degrees). In the sitting position the pelvis tended to extend posteriorly, with a mean anterior pelvic plane angle of -36.2 degrees (range, -64 degrees - +4 degrees). There was a wide variation in the arc of pelvic flexion extension as patients moved from standing to sitting, with are of pelvic motion in some patients as mobile as 70 degrees and in others as stiff as 5 degrees. There was no significant variation between males and females or between preoperative and postoperative pelvic flexion extension. There were substantial variations in pelvic orientation when comparing standing and sitting for an individual patient and between different patients. This variation can be unpredictable, and may influence implant alignment and stability after total hip arthroplasty.

  3. Less invasive lumbopelvic fixation technique using a percutaneous pedicle screw system for unstable pelvic ring fracture in a patient with severe multiple traumas.

    PubMed

    Yano, Sei; Aoki, Yasuchika; Watanabe, Atsuya; Nakajima, Takayuki; Takazawa, Makoto; Hirasawa, Hiroyuki; Takahashi, Kazuhisa; Nakagawa, Koichi; Nakajima, Arata; Takahashi, Hiroshi; Orita, Sumihisa; Eguchi, Yawara; Suzuki, Takane; Ohtori, Seiji

    2017-02-01

    Pelvic ring fractures are defined as life-threatening injuries that can be treated surgically with external or internal fixation. The authors report on an 81-year-old woman with an unstable pelvic fracture accompanying multiple traumas that was successfully treated with a less invasive procedure. The patient was injured in a traffic accident and sustained a total of 20 fractures, including pelvic ring, bilateral rib, and lumbar transverse processes fractures, and multiple fractures of both upper and lower extremities. The pelvic ring fracture was unstable with fractures of the bilateral sacrum with right sacroiliac disruption, right superior and inferior pubic rami, left superior pubic ramus, and ischium. During emergency surgery, bilateral external fixation was applied to the iliac crest to stabilize the pelvic ring. Second and third surgeries were performed 11 and 18 days after the first emergency surgery, respectively, to treat the multiple fractures. At the third surgery, the pelvic ring fracture was stabilized surgically using a less invasive posterior fixation technique. In this technique, 2 iliac screws were inserted on each side following an 8-cm midline posterior incision from the S-1 to S-3 spinous process, with the subcutaneous tissue detached from the fascia of the paraspinal muscles. The S-2 spinous process was removed and 2 rods were connected to bilateral iliac screws to stabilize the bilateral ilium in a switchback fashion. A crosslink device was applied to connect the 2 rods at the base of the S-2 spinous process. Following pelvic fixation, percutaneous pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides, and connected to the cranial rod connecting the bilateral iliac screws, thus completing the lumbopelvic fixation. The postoperative course was favorable with no postoperative complications. At the 10-month follow-up, bone union had been achieved at the superior ramus of the pubis, the patient did not complain of pain, and

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. 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 ...

  9. 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 ...

  10. 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

  11. 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 ...

  12. Combination of a fillet flap, free tissue transfer, and autologous tissue grafts in pelvic reconstruction following retroperitoneal sarcoma: a case report.

    PubMed

    Saksena, Anshuman; Aho, Johnathon; Winocour, Sebastian; Maricevich, Renata; Senchenkov, Alex; Rose, Peter; Leibovich, Bradley; Zietlow, Scott; Saint-Cyr, Michel

    2015-05-01

    The resection of large pelvic tumors is challenging due to their infiltrative nature into multiple structures and organ systems. In this report, we describe the use of multiple vascularized and nonvascularized spare parts to reconstruct a pelvic defect in a patient with a uniquely large pelvic sarcoma invading the spinal canal. A 39-year-old Caucasian female who presented with a large retroperitoneal sarcoma where the tumor encased the left ureter, kidney, colon, and external iliac vessels and invaded the L3-S1 vertebral bodies. An extensive hemipelvectomy and reconstruction was performed over two days. A free thigh and leg fillet flap together with ipsilateral fibula flap, based on the superficial femoral artery and venae comitantes, was used for spinal reinforcement as well as abdominal and pelvic wall reconstruction. The postoperative course was uneventful without complications, no flap compromise or wound healing problems. After a follow-up period of 4 months, the patient had no complications and returned to activities of daily living with mild limitations. The success of this flap procedure shows the practicality and usefulness of using the full spectrum of tissue transfer for the purposes of a large pelvic reconstruction.

  13. [Complex pelvic trauma caused by an accidental side split].

    PubMed

    Heinermann, J D B; Hessmann, M H; Rommens, P M

    2005-04-01

    Complex pelvic ring fractures are defined as injuries of the pelvic ring in association with lesions of the pelvic organs or the pelvic soft tissues. These injuries are typically caused by high-energy accidents. In contrast to the typical mechanism of injury a case is described in which a low energy trauma led to a complex pelvic ring trauma. An obese woman suffered an open-book injury of the pelvis with severe open urogenital soft-tissue damage by accidentally doing forced splits. Primary stabilization of the pelvic ring with external fixation and secondary internal fixation with a double-plate osteosynthesis of the symphysis led to a good clinical outcome concerning the osseous lesion. The urogenital injuries with rupture of the bladder, the urethra and the vagina led despite immediate urological management to an incontinence, which finally required definitive urine drainage via an ileum conduit.

  14. [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

  15. [Postoperative hypothyroidism].

    PubMed

    Olifirova, O S; Trynov, N N

    2015-01-01

    There is a number of factors such as the thyroidectomy and limiting subtotal thyroid resection against the background of euthyroidism and initial hypothyroidism (in any extent of operation) which leads to the prediction of early postoperative hypothyroidism origin during 10 days of the postoperative peri- od. The early postoperative hypothyroidism is accompanied by activation processes of lipid peroxide oxidation and at the same time by reduction of antioxidant protection.

  16. 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.

  17. 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 ...

  18. 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 ...

  19. 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.

  20. 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 ...

  1. Physical activity and the pelvic floor.

    PubMed

    Nygaard, Ingrid E; Shaw, Janet M

    2016-02-01

    women. However, future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods.

  2. 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

  3. 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.

  4. PHYSICAL ACTIVITY AND THE PELVIC FLOOR

    PubMed Central

    Nygaard, Ingrid E.; Shaw, Janet M.

    2015-01-01

    , future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods. PMID:26348380

  5. 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

  6. [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.

  7. 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 ...

  8. 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.

  9. 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: ...

  10. 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.

  11. 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.

  12. [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.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. Normal Vulvovaginal, Perineal, and Pelvic Anatomy with Reconstructive Considerations

    PubMed Central

    Yavagal, Sujata; de Farias, Thais F.; Medina, Carlos A.; Takacs, Peter

    2011-01-01

    A thorough insight into the female genital anatomy is crucial for understanding and performing pelvic reconstructive procedures. The intimate relationship between the genitalia and the muscles, ligaments, and fascia that provide support is complex, but critical to restore during surgery for correction of prolapse or aesthetic reasons. The external female genitalia include the mons pubis, labia majora and minora, clitoris, vestibule with glands, perineal body, and the muscles and fascia surrounding these structures. Through the perineal membrane and the perineal body, these superficial vulvar structures are structurally related to the deep pelvic muscle levator ani with its fascia. The levator ani forms the pelvic floor with the coccygeus muscle and provides vital support to all the pelvic organs and stability to the perineum. The internal female genital organs include the vagina, cervix, uterus, tubes, and ovaries with their visceral fascia. The visceral fascia also called the endopelvic fascia, surrounds the pelvic organs and connects them to the pelvic walls. It is continuous with the paraurethral and paravaginal fascia, which is attached to the perineal membrane. Thus, the internal and external genitalia are closely related to the muscles and fascia, and work as one functioning unit. PMID:22547969

  18. Postoperative astigmatism.

    PubMed

    Swinger, C A

    1987-01-01

    With the numerous significant advances in surgical methodology--e.g., microinstrumentation, the operating microscope, the surgical keratometer, and intraocular lenses--that have been developed over the past two decades, both surgeons and patients have become increasingly aware of the final optic result of any surgical intervention. This is especially so since the development of refractive surgery, where good uncorrected vision is frequently the final arbiter of success. We have progressed to the stage where the optic manipulation of the cornea, whether intentional or otherwise, can be understood in terms of a number of variables. These include the preparation and closure of the surgical wound, the choice of suture material, and both intraoperative and postoperative manipulations. Where these have failed and postoperative astigmatism still occurs, a number of surgical procedures are available to reduce the astigmatic error to an acceptable level.

  19. 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.

  20. 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

  1. 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, ...

  2. 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 ...

  3. [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.

  4. 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.

  5. [Prostate cancer external beam radiotherapy].

    PubMed

    de Crevoisier, R; Pommier, P; Latorzeff, I; Chapet, O; Chauvet, B; Hennequin, C

    2016-09-01

    The prostate external beam radiotherapy techniques are described, when irradiating the prostate or after prostatectomy, with and without pelvic lymph nodes. The following parts are presented: indications of radiotherapy, total dose and fractionation, planning CT image acquisition, volume of interest delineation (target volumes and organs at risk) and margins, Intensity modulated radiotherapy planning and corresponding dose-volume constraints, and finally Image guided radiotherapy.

  6. Anterior subcutaneous internal fixation for treatment of unstable pelvic fractures

    PubMed Central

    2014-01-01

    Background Fractures of the pelvic ring including disruption of the posterior elements in high-energy trauma have both high morbidity and mortality rates. For some injury pattern part of the initial resuscitation includes either external fixation or plate fixation to close the pelvic ring and decrease blood loss. In certain situations – especially when associated with abdominal trauma and the need to perform laparotomies – both techniques may put the patient at risk of either pintract or deep plate infections. We describe an operative approach to percutaneously close and stabilize the pelvic ring using spinal implants as an internal fixator and report the results in a small series of patients treated with this technique during the resuscitation phase. Findings Four patients were treated by subcutaneous placement of an internal fixator. Screw fixation was carried out by minimally invasive placement of two supra-acetabular iliac screws. Afterwards, a subcutaneous transfixation rod was inserted and attached to the screws after reduction of the pelvic ring. All patients were allowed to fully weight-bear. No losses of reduction or deep infections occurred. Fracture healing was uneventful in all cases. Conclusion Minimally invasive fixation is an alternative technique to stabilize the pelvic ring. The clinical results illustrate that this technique is able to achieve good results in terms of maintenance of reduction the pelvic ring. Also, abdominal surgeries no longer put the patient at risk of infected pins or plates. PMID:24606833

  7. Role of pelvic floor in lower urinary tract function.

    PubMed

    Chermansky, Christopher J; Moalli, Pamela A

    2016-10-01

    The pelvic floor plays an integral part in lower urinary tract storage and evacuation. Normal urine storage necessitates that continence be maintained with normal urethral closure and urethral support. The endopelvic fascia of the anterior vaginal wall, its connections to the arcus tendineous fascia pelvis (ATFP), and the medial portion of the levator ani muscles must remain intact to provide normal urethral support. Thus, normal pelvic floor function is required for urine storage. Normal urine evacuation involves a series of coordinated events, the first of which involves complete relaxation of the external urethral sphincter and levator ani muscles. Acquired dysfunction of these muscles will initially result in sensory urgency and detrusor overactivity; however, with time the acquired voiding dysfunction can result in intermittent urine flow and incomplete bladder emptying, progressing to urinary retention in severe cases. This review will start with a discussion of normal pelvic floor anatomy and function. Next various injuries to the pelvic floor will be reviewed. The dysfunctional pelvic floor will be covered subsequently, with a focus on levator ani spasticity and stress urinary incontinence (SUI). Finally, future research directions of the interaction between the pelvic floor and lower urinary tract function will be discussed.

  8. 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

  9. 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

  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. Postoperative hyperkalemia.

    PubMed

    Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A

    2015-03-01

    Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.

  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. 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. [Retroperitoneal hematoma in pelvic fractures].

    PubMed

    Purghel, F; Jemna, C; Ciuvică, R

    2011-01-01

    Retroperitoneal trauma implies a wide variety of organs in multiple systems (digestive, urinary, circulatory, musculoskeletal); although their common result is the retroperitoneal hematoma, their management is completely different, an intervention indicated for a particular lesion being able to completely decompensate other lesions in case of insufficient diagnostic. The present material highlights the recent diagnostic and therapeutic particularities in retroperitoneal hematoma from pelvic fractures. We noted a recent trend in diminishing the role of the fracture pattern on standard pelvis X-ray in assessing the risk of hemodinamic instability, new markers being indicated as more predictive. CT scan with contrast substance, when applies, remains the gold standard in identifying the source of the vascular bleeding and in guiding the subsequent therapeutic maneuvers. The angiographic embolisation in arterial lesions remains the main therapeutic procedure in hemodinamical unstable patients, with the possibility of repeating it when needed; the C-clamp external fixator application is associated. The pre-peritoneal packing constantly gains support as an emergency hemostasis maneuver. The treatment should be adapted in each case, the hemodinamic instability being the trigger in initiation and repetition of the emergency therapeutic interventions mentioned above.

  15. 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.

  16. INFIX/EXFIX: Massive Open Pelvic Injuries and Review of the Literature

    PubMed Central

    Nasr, Kerellos; Feria-Arias, Enrique; Fisher, Rebecca; Kajy, Marvin; Diebel, Lawrence N.

    2016-01-01

    Introduction. Open pelvic fractures make up 2–5% of all pelvic ring injuries. Their mortality has been reported to be as high as 50%. During Operation Enduring Freedom protocols for massive open pelvic injuries lead to the survival of injuries once thought to be fatal. The INFIX is a subcutaneous anterior fixator for pelvic stabilization which is stronger than external fixation. The purpose of this paper is to describe the use of INFIX and modern algorithms for massive open pelvic injuries. Methods. An IRB approved retrospective review describes 4 cases in civilian practice with massive open pelvic injuries. We also review the modern literature on open pelvic injures. Discussion. Key components in the care of massive open pelvic injuries include hemorrhage control by clamping of the aorta or REBOA when necessary and fecal/urinary diversion. The INFIX can be used internally, as a partial INFIX partial EXFIX, or as an EXFIX. Its low profile allows for easy application of wound vacs and wound care and when subcutaneous avoids pin tract infections. Conclusion. Massive open pelvic injuries are a difficult problem. Following modern protocols can help prevent mortality. PMID:27493818

  17. 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

  18. 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.

  19. [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

  20. 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

  1. Changes in Sexual Function and Comparison of Questionnaires Following Surgery for Pelvic Organ Prolapse

    PubMed Central

    Kim, Soo Rim; Moon, Yeo Jung; Kim, Sei Kwang

    2014-01-01

    Purpose The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires. Materials and Methods From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively. Results Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p<0.001). Specifically, postoperative scores for questions 8 and 12 were higher than their respective preoperative scores (p<0.001). Postoperatively, mean FSFI score changed only slightly (p=0.76), and only the score for the satisfaction domain was improved (p=0.023). In regards to vaginal anatomy, vaginal length was significantly greater postoperatively (6.99±0.18 vs. 7.56±1.08, p<0.001), and postoperative vaginal caliber was narrowed to a two-finger width. Conclusion In this study, surgery for pelvic organ prolapse was shown to affect female sexual function. Moreover, menopause was associated with a change in postoperative sexual function. PMID:24339303

  2. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum.

    PubMed

    Grimm, M R; Vrahas, M S; Thomas, K A

    1998-03-01

    Hemorrhage is a major cause of mortality in pelvic fractures. Bleeding can be controlled in hypotensive patients by direct ligation, angiographic embolization, pelvic packing, and acute external fixation. Acute application of an external fixator can reduce pelvic volume and reduce bleeding fractures to effect tamponade. This therapy assumes that the pelvis represents a closed space, which clearly is not true anatomically. However, the premise may hold functionally. This study explored the relationship between pressure and volume in the intact and disrupted pelvic retroperitoneum. In cadaveric specimens, the external iliac vein was dissected, ruptured, and cannulated. This method allowed controlled flow of fluid, with simultaneous measurement of pressure, into the intact retroperitoneum. Open book pelvic fractures were created by applying external rotation to the pelvis through the femoral heads. The pressure-volume measurements, without and with external fixation applied, were repeated after the fracture, as well as after a laparotomy. In the intact retroperitoneum, pressures rapidly rose to an average of 30 mm Hg after infusion of 5 liters of fluid. After fracture, up to 20 liters of fluid could be infused at pressures not exceeding 35 mm Hg. External fixation increased pressures approximately 3 mm Hg at low fluid volumes, and approximately 11 mm Hg at the highest fluid volumes. Laparotomy decreased retroperitoneal pressure from approximately 35 mm Hg to approximately 15 mm Hg. The results of the study suggest that low-pressure venous hemorrhage may be tamponaded by an external fixator, given that enough fluid volume is present in the pelvic retroperitoneum. However, external fixation may not generate sufficient pressure to stop arterial bleeding. In any case, it seems that a large volume of fluid must be lost into the pelvis before an external fixator can have much effect on retroperitoneal pressures.

  3. 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.

  4. 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 ...

  5. Laparoscopic management of a strangulated internal hernia underneath the left external iliac artery☆

    PubMed Central

    Dumont, Karl-Andreas; Wexels, Jan Cyril

    2013-01-01

    INTRODUCTION Internal herniation of a small bowel behind pelvic vessels is a rare complication seen after pelvic lymphadenectomy. PRESENTATION OF CASE A 56-year-old woman was operated due to a gynecological cancer. 4 years thereafter she presented with a 2 days history of abdominal pain and vomiting. Clinical and radiological findings indicated a small bowel obstruction. A loop of small bowel had herniated behind the left external iliac artery. Using laparoscopic technique the herniated bowel was reduced. Due to limited peritoneum around the area and skeletonized vessel, we decided not to do any repair of the hernia orifice. The postoperative recovery was uneventful, bowel activity returned to normal and she was discharged the next day. Follow-up was done at 1 month and the latest at 10 months. She didn’t experience pain or discomfort after the operation. DISCUSSION Due to limited peritoneum around the skeletonized vessel, we decided to leave the hernia orifice unrepaired. We found it hazardous to do any direct suture of the orifice or use a free peritoneal graft to repair the defect as the fibrosis and inflammatory process might have compromised the artery or the vein. A longer follow-up of the patient is needed to clearly conclude if this simple procedure has been sufficient. We agreed that if the patient would experience any sign of recurrence and need another operation we would close the defect at that time. CONCLUSION 4 years after pelvic lymphadenectomy a small bowel herniation behind an external iliac artery occurred. The patient was successfully treated with reduction of the small bowel using laparoscopic technique. A quick recovery with minimal discomfort and no sign of recurrence after 10 months made our approach an acceptable surgical option. PMID:24121051

  6. 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.

  7. Factors affecting pelvic rotation in idiopathic scoliosis

    PubMed Central

    Zhao, Yunfei; Qi, Lin; Yang, Jun; Zhu, Xiaodong; Yang, Changwei; Li, Ming

    2016-01-01

    Abstract Pelvic rotation (PR) is commonly seen in patients with idiopathic scoliosis (IS), but factors contributing to this phenomenon and its relationship with the surgical outcome are not well established. This retrospective study included 85 IS patients in 2 groups: thoracic curve dominance group (group A) and lumbar curve dominance group (group B). Pre- and postoperative PR was measured on standing posteroanterior radiographs by the left/right ratio (L/R ratio) of horizontal distance between the anterior superior iliac spine (ASIS) and the inferior ilium (SI) at the sacroiliac joint on the same side in both groups. Other radiographic data, age, sex, and Risser sign of each patient were recorded to analyze their correlations with PR before and after operation. The patients ranged in age from 10 to 35 years with a mean of 17.0 ± 5.2 years. The mean L/R ratio of PR before operation was 0.99 (0.73–1.40) versus 0.98 (0.87–1.26) after operation. The L/R ration was beyond the range of 1 ± 0.1 (indicating the presence of PR) in 17 (20%) patients before operation and in 14 (16.5%) patients after operation. There was no significant difference in PR between the 2 groups of patients either before (P = 0.468) or after (P = 0.944) surgery. The preoperative PR showed a very low correlation with Risser sign (r = 0.220, P = 0.043), apex vertebral rotation (AVR) in the proximal thoracic curve (r = 0.242, P = 0.026), and AVR in the lumbar curve (r = 0.213, P = 0.049), while the postoperative PR showed a very low correlation with Risser sign (r = −0.341, P = 0.001) and postoperative trunk shift (TS) (r = −0.282, P = 0.009). Multiple stepwise regression analysis showed that preoperative PR was affected by proximal thoracic curve AVR and lumbar curve AVR. There was no significant difference between PR before operation and 2 years after operation. Preoperative PR was mainly correlated with Risser sign and the rotation

  8. Obesity and Pelvic Floor Disorders: A Review of the Literature

    PubMed Central

    Pomian, Andrzej; Lisik, Wojciech; Kosieradzki, Maciej; Barcz, Ewa

    2016-01-01

    Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very strong effect on pelvic floor disorders, and, considering the high prevalence of both problems worldwide, it is of utmost importance to evaluate the association between these pathologies as well as the impact of obesity on treatment efficacy. This review is based on a selection of reports in the literature (PubMed search), including guidelines and Cochrane reviews. Obesity seems to be a well-documented risk factor for lower urinary tract symptoms (LUTS) and is a predictor of exacerbation of stress urinary incontinence (SUI) and overactive bladder (OAB). Weight loss is also associated with improvement or resolution of SUI and OAB. In the case of pelvic organ prolapse (POP), weight loss is associated with improvement in quality of life. Although obesity is associated with POP in general, the exact role of obesity in symptomatic POP remains uncertain. While outcomes of anti-incontinence surgery among obese women are similar to those in non-obese women, postoperative urge incontinence is more likely to occur. It seems that obesity is not a risk factor for postoperative complications or short-term efficacy of POP surgical treatment. Long-term effects are still uncertain. Obesity is a strong risk factor for LUTS, but in most cases it does not affect efficacy of operative treatment. It may be associated with some post-operative complications. Weight loss in many cases allows avoiding surgical intervention. PMID:27255341

  9. Obesity and Pelvic Floor Disorders: A Review of the Literature.

    PubMed

    Pomian, Andrzej; Lisik, Wojciech; Kosieradzki, Maciej; Barcz, Ewa

    2016-06-03

    Overweight and obesity are becoming a worldwide health problem associated with numerous co-morbidities. National costs of obesity and pelvic flor disorders have been rising since the 1950s across the world. Obesity is thought to have a very strong effect on pelvic floor disorders, and, considering the high prevalence of both problems worldwide, it is of utmost importance to evaluate the association between these pathologies as well as the impact of obesity on treatment efficacy. This review is based on a selection of reports in the literature (PubMed search), including guidelines and Cochrane reviews. Obesity seems to be a well-documented risk factor for lower urinary tract symptoms (LUTS) and is a predictor of exacerbation of stress urinary incontinence (SUI) and overactive bladder (OAB). Weight loss is also associated with improvement or resolution of SUI and OAB. In the case of pelvic organ prolapse (POP), weight loss is associated with improvement in quality of life. Although obesity is associated with POP in general, the exact role of obesity in symptomatic POP remains uncertain. While outcomes of anti-incontinence surgery among obese women are similar to those in non-obese women, postoperative urge incontinence is more likely to occur. It seems that obesity is not a risk factor for postoperative complications or short-term efficacy of POP surgical treatment. Long-term effects are still uncertain. Obesity is a strong risk factor for LUTS, but in most cases it does not affect efficacy of operative treatment. It may be associated with some post-operative complications. Weight loss in many cases allows avoiding surgical intervention.

  10. Postoperative surgical complications of lymphadenohysterocolpectomy

    PubMed Central

    Marin, F; Pleşca, M; Bordea, CI; Voinea, SC; Burlănescu, I; Ichim, E; Jianu, CG; Nicolăescu, RR; Teodosie, MP; Maher, K; Blidaru, A

    2014-01-01

    Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer – group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. Porcine Small Intestinal Submucosa Mesh for Treatment of Pelvic Organ Prolapsed

    PubMed Central

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

    2016-01-01

    Background: Pelvic organ prolapse (POP) is a major health concern that affects women. Surgeons have increasingly used prosthetic meshes to correct POP. However, the most common used is synthetic mesh, and absorbable mesh is less reported. This research aimed to evaluate the clinical effectiveness of porcine small intestinal submucosa (SIS). Methods: Consecutive forty POP patients who met the inclusion criteria underwent pelvic reconstruction surgery with SIS between March 2012 and December 2013. The patients’ clinical characteristics were recorded preoperatively. Surgical outcomes, measured by objective and subjective success rates, were investigated. We evaluated the quality of life (QOL) using the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Sexual QOL was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12). Results: At postoperative 12 months, the subjective recurrence rate (7.5%) was much lower than the objective recurrence rate (40.0%). Postoperatively, no erosion was identified. One underwent a graft release procedure because of urinary retention, and one had anus sphincter reconstruction surgery due to defecation urgency. Another experienced posterior vaginal wall infection where the mesh was implanted, accompanied by severe vaginal pain. Estrogen cream relieved the pain. One patient with recurrence underwent a secondary surgery with Bard Mesh because of stage 3 anterior vaginal wall prolapse. Scoring system of PFDI-20 was from 59.150 ± 13.143 preoperatively to 8.400 ± 4.749 postoperatively and PFIQ-7 was from 73.350 ± 32.281 to 7.150 ± 3.110, while PISQ-12 was from 15.825 ± 4.050 to 12.725 ± 3.471. Conclusions: QOL and the degree of subjective satisfaction were significantly improved postoperatively. Anterior repair deserves more attention because of the higher recurrence rate. The long-term follow-up of the patient is warranted to draw firm

  16. 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 ...

  17. 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 ...

  18. 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 ...

  19. Voiding trial outcome following pelvic floor repair without incontinence procedures

    PubMed Central

    Wang, Rui; Won, Sara; Haviland, Miriam J.; Bargen, Emily Von; Hacker, Michele R.; Li, Janet

    2016-01-01

    Introduction and hypothesis Our aim was to identify predictors of postoperative voiding trial failure among patients who had a pelvic floor repair without a concurrent incontinence procedure in order to identify low-risk patients in whom postoperative voiding trials may be modified. Methods We conducted a retrospective cohort study of women who underwent pelvic floor repair without concurrent incontinence procedures at two institutions from 1 November 2011 through 13 October 2013 after abstracting demographic and clinical data from medical records. The primary outcome was postoperative retrograde voiding trial failure. We used modified Poisson regression to calculate the risk ratio (RR) and 95 % confidence interval (CI). Results Of the 371 women who met eligibility criteria, 294 (79.2 %) had complete data on the variables of interest. Forty nine (16.7%) failed the trial, and those women were less likely to be white (p = 0.04), more likely to have had an anterior colporrhaphy (p = 0.001), and more likely to have had a preoperative postvoid residual (PVR) ≥150 ml (p = 0.001). After adjusting for race, women were more likely to fail their voiding trial if they had a preoperative PVR of ≥150 ml (RR: 1.9; 95 % CI: 1.1–3.2); institution also was associated with voiding trial failure (RR: 3.0; 95 % CI: 1.6–5.4). Conclusions Among our cohort, postoperative voiding trial failure was associated with a PVR of ≥150 ml and institution at which the surgery was performed. PMID:26886553

  20. 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.

  1. Prospective Phase I-II Trial of Helical Tomotherapy With or Without Chemotherapy for Postoperative Cervical Cancer Patients

    SciTech Connect

    Schwarz, Julie K.; Wahab, Sasa; Grigsby, Perry W.

    2011-12-01

    Purpose: To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy. Patients and Methods: A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0. Results: The median follow-up was 24 months (range, 4-49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively. Conclusion: The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Fluid dynamic modelling of renal pelvic pressure during endoscopic stone removal

    NASA Astrophysics Data System (ADS)

    Oratis, Alexandros; Subasic, John; Bird, James; Eisner, Brian

    2015-11-01

    Endoscopic kidney stone removal procedures are known to increase internal pressure in the renal pelvis, the kidney's urinary collecting system. High renal pelvic pressure incites systemic absorption of irrigation fluid, which can increase the risk of postoperative fever and sepsis or the unwanted absorption of electrolytes. Urologists choose the appropriate surgical procedure based on patient history and kidney stone size. However, no study has been conducted to compare the pressure profiles of each procedure, nor is there a precise sense of how the renal pelvic pressure scales with various operational parameters. Here we develop physical models for the flow rates and renal pelvic pressure for various procedures. We show that the results of our models are consistent with existing urological data on each procedure and that the models can predict pressure profiles where data is unavailable.

  8. Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool

    PubMed Central

    Khan, Abdul Qayyum; Keane, Sean

    2016-01-01

    Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy. PMID:27847791

  9. [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.

  10. 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.

  11. 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.

  12. Improvements in hip- and pelvic motion for patients with osseointegrated trans-femoral prostheses.

    PubMed

    Tranberg, R; Zügner, R; Kärrholm, J

    2011-02-01

    This study describes the changes in hip and pelvic kinematics in 19 trans-femoral amputees, who were treated with an osseointegrated trans-femoral prosthesis. Patients were studied with 3-dimensional gait analysis, walking with socket prosthesis within two days before the osseointergration procedure. The post-operative gait analysis was carried out at the 2 year follow-up visit. Fifty-seven; age-, side- and gender-matched healthy subjects served as controls. Post-operative data showed that patients who had an osseointegrated transfemoral prosthesis increased their hip extension by 7.3° (p=0.007), changing from -2.6° (range -13.4° to 10.7°) to -9.9° (range -29.4° to 5°). Moreover, the pre-operative anterior pelvic tilt was reduced by 4.0° (p=0.016), changing from 21.7° (range 11.9-34.8°) to 17.7° (range 5.5-25.7°). Values for hip extension and pelvic tilt changed toward those of controls. These results confirm that patients treated with osseointegrated trans-femoral prosthesis encounter significant changes of their kinematic pattern in terms of hip extension and anterior pelvic tilt. Even though the changes were moderate they may, in the long-term have a positive influence on low-back biomechanics and could contribute to reducing the risk of further problems with low back pain.

  13. [Postoperative pain in craniotomy].

    PubMed

    Peón, Andréa Ungaro; Diccini, Solange

    2005-01-01

    In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0-10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain.

  14. 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

  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. 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.

  17. The effects of a pelvic belt on trunk and lower extremity muscles in the bridge position

    PubMed Central

    Cha, Hyun-Gyu; Wu, Yan-Ting; Kim, Myoung-Kwon

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of a pelvic belt on the activities of trunk and lower extremity muscles in normal adults. [Subjects and Methods] The subjects were 20 normal individuals without a history of orthopedic problems. The pelvic compression belt (The Com-Pressor, OPTP, Minneapolis, MN, USA) was an adjustable body belt with four elastic compression bands that provide stabilizing pressure and was designed to adjust the amount of force applied and to alter sites of compression. The body belt was placed below the anterior superior iliac spine, and stabilizing pressure was applied to the belt using the elastic compression bands in the bridge position after confirming the site of compression. [Results] The subjects showed a significant decrease in muscle activation in the erector spinae, oblique internus abdominis, rectus femoris, and biceps femoris while wearing the pelvic belt. [Conclusion] The use of a pelvic compression belt with external pelvic compression might improve pelvic joint stability and alter neuromotor control of the lumbopelvic and thigh muscles. PMID:28174437

  18. 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.

  19. 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

  20. SURGICAL TREATMENT OF UNSTABLE PELVIC RING FRACTURE IN SKELETALLY IMMATURE PATIENTS

    PubMed Central

    Guimarães, Joao Antonio Matheus; de Souza Portes Meirelles, Ricardo; Júnior, Luiz Augusto Peçanha Tavares; Goldsztajn, Flávio; Rocha, Tito; Mendes, Pedro Henrique Barros

    2015-01-01

    Objectives: To present the outcomes from definitive surgical treatment for unstable fractures of the pelvic ring in children undergoing surgical reduction and stabilization. Methods: We studied 10 patients with immature skeletons who suffered unstable fractures of the pelvic ring and were treated between March 2004 and January 2008. The study was retrospective, based on clinical and radiographic evaluations. Results: The mean age at the time of the trauma was 8.8 years (2 to 13 years). Seven patients were female and three was male. There were eight cases of trauma caused by being run over, and one case each of a motorcycle accident and falling from a height. Five patients had other associated injuries such as fractures of the clavicle, femoral diaphysis, proximal humerus, lower leg bones, olecranon and bladder injury. All the patients evaluated showed an excellent clinical outcome. The pelvic asymmetry before surgery ranged from 0.7 to 2.9 cm (mean 1.45 cm), and dropped to values between 0.2 and 0.9 cm (mean 0.39 cm) after reduction. In no case was any change observed in pelvic asymmetry measured in the immediate postoperative period and at the end of follow-up. Conclusion: Pelvic ring fractures in skeletally immature patients are rare and surgical treatment is unusual. Several authors have questioned conservative treatment because of the complications encountered. Bone remodeling does not seem enough to cause an improvement in pelvic asymmetry, and this justifies the choice of surgical treatment for reduction and correction of pelvic ring deformities. PMID:27026968

  1. 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.

  2. 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.

  3. Understanding postoperative fatigue.

    PubMed

    Rose, E A; King, T C

    1978-07-01

    Performance characteristics of the central nervous, cardiovascular, respiratory and muscular systems in man postoperatively have received little investigative attention, despite the well known syndrome of postoperative fatigue. The impairmen in perception and psychomotor skills that has been shown to result from caloric restriction, bedrest, sedation and sleep deprivation suggests that a similar deficit may occur after surgical procedures. After a simple elective surgical procedure, maximal oxygen uptake decreases and the adaptability of heart rate to submaximal workloads is impaired. Similar deleterious effects on cardiorespiratory performance have been documented with starvation and bedrest; an understanding of cardiorespiratory performance postoperatively awaits further investigation. Maximal muscular force of contraction is also impaired by caloric restriction and bedrest, suggesting that similar effects may be seen in the postoperative state, although this has not been studied. A better understanding of the syndrome of postoperative fatigue could be achieved by a descriptive analysis of physiologic performance postoperatively. Such descriptive data could form the basis for objective evaluation of therapeutic measures intended to improve performance, such as nutritional supplementation and pharmacologic intervention. The observation that exercise with the patient in the supine position may decrease the impairment in maximal aerobic power otherwise expected in immobilized patients suggests that controlled exercise therapy may be of value in reducing physiologic impairment postoperatively.

  4. [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.

  5. Predicting postoperative gait in cerebral palsy.

    PubMed

    Galarraga C, Omar A; Vigneron, Vincent; Dorizzi, Bernadette; Khouri, Néjib; Desailly, Eric

    2016-11-09

    In this work, postoperative lower limb kinematics are predicted with respect to preoperative kinematics, physical examination and surgery data. Data of 115 children with cerebral palsy that have undergone single-event multilevel surgery were considered. Preoperative data dimension was reduced utilizing principal component analysis. Then, multiple linear regressions with 80% confidence intervals were performed between postoperative kinematics and bilateral preoperative kinematics, 36 physical examination variables and combinations of 9 different surgical procedures. The mean prediction errors on test vary from 4° (pelvic obliquity and hip adduction) to 10° (hip rotation and foot progression), depending on the kinematic angle. The unilateral mean sizes of the confidence intervals vary from 5° to 15°. Frontal plane angles are predicted with the lowest errors, however the same performance is achieved when considering the postoperative average signals. Sagittal plane angles are better predicted than transverse plane angles, with statistical differences with respect to the average postoperative kinematics for both plane's angles except for ankle dorsiflexion. The mean prediction errors are smaller than the variability of gait parameters in cerebral palsy. The performance of the system is independent of the preoperative state severity of the patient. Even if the system is not yet accurate enough to define a surgery plan, it shows an unbiased estimation of the most likely outcome, which can be useful for both the clinician and the patient. More patients' data are necessary for improving the precision of the model in order to predict the kinematic outcome of a large number of possible surgeries and gait patterns.

  6. 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.

  7. [Chronic postoperative pain].

    PubMed

    Cachemaille, Matthieu; Blanc, Catherine

    2016-06-22

    Chronic postoperative pain remains a frequent pathology whose global impact approximates 20 and 30% and accounts for 20% of the consultations in a pain center. Risk factors consider firstly each patient's feature and comorbidity and also different surgical procedures with their technical approach. Neuropathic pain compared to nociceptive pain is a great component in the postoperative period and needs to be recognized by specific tests (DN4). Pain prevention involves risk factors' detection, appropriate anesthetic support and effective postoperative pain management. Treatment is based on the type of pain and includes a multimodal analgesia with interventional pain therapy.

  8. [Characteristics of postoperative peritonitis].

    PubMed

    Lock, J F; Eckmann, C; Germer, C-T

    2016-01-01

    Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.

  9. 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

  10. 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

  11. 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

  12. Postoperative permanent pressure alopecia.

    PubMed

    Chang, Zi Yun; Ngian, Jan; Chong, Claudia; Chong, Chin Ted; Liew, Qui Yin

    2016-04-01

    A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient. We report this case of postoperative permanent pressure alopecia due to its rarity in the anaesthesia/local literature, and review the risk factors for its development.

  13. 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

  14. 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.

  15. 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

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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.

  2. Sexual Function Before and After Sacrocolpopexy for Pelvic Organ Prolapse

    PubMed Central

    Handa, Victoria L.; Zyczynski, Halina M.; Brubaker, Linda; Nygaard, Ingrid; Janz, Nancy K.; Richter, Holly E.; Wren, Patricia A.; Brown, Morton B.; Weber, Anne M.

    2008-01-01

    Objective To describe sexual function before and after sacrocolpopexy. Study design In the Colpopexy and Urinary Reduction Efforts trial, sexual function was assessed in 224 women with sexual partners before and 1 year after surgery using validated questionnaires. Results After surgery, significantly fewer women reported sexual interference from “pelvic or vaginal symptoms” (32.5% one year after surgery versus 7.8% prior to surgery), fear of incontinence (10.7% versus 3.3%), vaginal bulging (47.3% versus 4.6%), or pain (39.9% versus 21.6%). The proportion of women with infrequent sexual desire (32%) did not change. More women were sexually active 1 year after surgery (171, 76.3%) than before surgery (148, 66.1%). The 11 women (7.4%) who became sexually inactive were more likely than sexually active women to report infrequent sexual desire (70.05% versus 22.1%, p<0.001). The addition of Burch colposuspension did not impact postoperative sexual function. Conclusions After sacrocolpopexy, most women reported improvements in pelvic floor symptoms that previously interfered with sexual function. These improvements were not impacted by concomitant Burch colposuspension. PMID:18060957

  3. Pelvic primary staphylococcal infection presenting as a thigh abscess.

    PubMed

    Abbas, T O

    2013-01-01

    Intra-abdominal disease can present as an extra-abdominal abscess and can follow several routes, including the greater sciatic foramen, obturator foramen, femoral canal, pelvic outlet, and inguinal canal. Nerves and vessels can also serve as a route out of the abdomen. The psoas muscle extends from the twelfth thoracic and fifth lower lumbar vertebrae to the lesser trochanter of the femur, which means that disease in this muscle group can migrate along the muscle, out of the abdomen, and present as a thigh abscess. We present a case of a primary pelvic staphylococcal infection presenting as a thigh abscess. The patient was a 60-year-old man who presented with left posterior thigh pain and fever. Physical examination revealed a diffusely swollen left thigh with overlying erythematous, shiny, and tense skin. X-rays revealed no significant soft tissue lesions, ultrasound was suggestive of an inflammatory process, and MRI showed inflammatory changes along the left hemipelvis and thigh involving the iliacus muscle group, left gluteal region, and obturator internus muscle. The abscess was drained passively via two incisions in the posterior left thigh, releasing large amounts of purulent discharge. Subsequent bacterial culture revealed profuse growth of Staphylococcus aureus. The patient recovered uneventfully except for a moderate fever on the third postoperative day.

  4. 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.

  5. 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.

  6. [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.

  7. Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse

    PubMed Central

    van Iersel, Jan J; Paulides, Tim J C; Verheijen, Paul M; Lumley, John W; Broeders, Ivo A M J; Consten, Esther C J

    2016-01-01

    External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy (VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented. PMID:27275090

  8. Postoperative infusional continuous regional analgesia. A technique for relief of postoperative pain following major extremity surgery.

    PubMed

    Malawer, M M; Buch, R; Khurana, J S; Garvey, T; Rice, L

    1991-05-01

    A new technique using postoperative infusional continuous regional analgesia (PICRA) for postoperative pain relief was investigated in 23 surgical patients treated by amputation (12 patients) or by limb-salvage resection operations (11 patients). Bupivacaine was delivered into peripheral nerve sheaths via catheters placed therein at the time of surgery. Only patients in whom the nerves were easily accessible were treated. Catheters were placed in the axillary sheath, the lumbosacral trunk, and the femoral nerve sheaths of patients treated with shoulder girdle and pelvic procedures (resections and amputations), and within the sciatic nerve sheath of those treated with lower extremity procedures. The anesthetic agent was delivered at controllable rates. Regional analgesia was obtained in the operative site with minimal motor or sensory decrease. To assess the efficacy of this technique, the results of this study group were compared with those of a matched group of 11 patients treated with similar surgical procedures but who received epidural morphine. Eleven of the 23 patients on PICRA required no supplemental narcotic agents. The mean level of the narcotic agents required by the remaining 13 PICRA patients was approximately one third of that required by the matched group of 11 patients receiving epidural morphine. Overall, the patients on PICRA had an 80% reduction of narcotic requirements when compared to the historical controls. The technique is reliable and can be performed by the surgeon, requiring about a ten-minute increase in operating time. It has potentially wide application in orthopedics in procedures in which the major nerves are easily accessible (e.g., pelvic fractures and revision hip surgery) and for patients with intractable pain of the extremities.

  9. 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.

  10. Our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction

    PubMed Central

    Shahnawaz; Shahzad, Ali; Shahzad, Iqbal; Baloch, Muhammad Umar

    2014-01-01

    Objective: To report our experience with open dismembered pyeloplasty for uretero-pelvic junction obstruction. Methods: Retrospective study was conducted in the Department of Urology, Jinnah Postgraduate Medical Centre, Karachi for a period of five and half years from May, 2006 to December, 2011. All patients with uretero-pelvic junction obstruction were entered into a database to record patients clinical features, diagnostic tools, operative and post-operative details and follow-up. Over a five-years period, 13 procedures were performed. After clinical evaluation all patient had extensive haematological and radiological workup for diagnosis of uretero-pelvic junction obstruction. All were subjected to open pyeloplasties, out of these 13 patients; one had an aberrant lower pole vessel compressing uretero-pelvic-junction. All procedures were stented. Repair was done with 3/0 vicryl sutures all patients were catheterized and wound drained. Results: Mean operating time was 60 – 100 minutes with about 100cc blood loss requiring no transfusion. The mean follow up was one year. One patient developed post-operative haematuria and was managed conservatively. Two patients developed fever secondary to urinary tract infection despite adequate treatment of urinary tract infection according to culture and sensitivity pre-operatively. One patient developed surgical emphysema detected post-operatively, which required tube thoracostomy. Neither patient developed recurrent symptoms nor had any evidence of obstruction on the renogram on follow-up. Objectively all patients were followed up by intravenous urogram, stress renogram, Urine C/S. Subjective and objective follow-up revealed success in 100% of patients whereas success is defined as no or minimal holder on DTPA renogram, improving renal function and decreasing dilatation on successive intravenous urogram. All patients had a mean post-operative hospital stay of 02 – 04 days Folley catheter was removed after 10-days, double

  11. Postoperative intravenous morphine titration.

    PubMed

    Aubrun, F; Mazoit, J-X; Riou, B

    2012-02-01

    Relief of acute pain during the immediate postoperative period is an important task for anaesthetists. Morphine is widely used to control moderate-to-severe postoperative pain and the use of small i.v. boluses of morphine in the post-anaesthesia care unit allows a rapid titration of the dose needed for adequate pain relief. The essential principle of a titration regimen must be to adapt the morphine dose to the pain level. Although morphine would not appear to be the most appropriate choice for achieving rapid pain relief, this is the sole opioid assessed in many studies of immediate postoperative pain management using titration. More than 90% of the patients have pain relief using a protocol of morphine titration and the mean dose required to obtain pain relief is 12 (7) mg, after a median of four boluses. Sedation is frequent during i.v. morphine titration and should be considered as a morphine-related adverse event and not evidence of pain relief. The incidence of ventilatory depression is very low when the criteria to limit the dose of i.v. morphine are enforced. Morphine titration can be used with caution in elderly patients, in children, or in obese patients. In practice, i.v. morphine titration allows the physician to meet the needs of individual patients rapidly and limits the risk of overdose making this method the first step in postoperative pain management.

  12. Transvaginal Drainage of Pelvic Abscesses and Collections Using Transabdominal Ultrasound Guidance.

    PubMed

    Ching, Kevin C; Sumkin, Jules H

    2015-01-01

    Objectives. To evaluate clinical outcomes following transvaginal catheter placement using transabdominal ultrasound guidance for management of pelvic fluid collections. Methods. A retrospective review was performed for all patients who underwent transvaginal catheter drainage of pelvic fluid collections utilizing transabdominal ultrasound guidance between July 2008 and July 2013. 24 consecutive patients were identified and 24 catheters were placed. Results. The mean age of patients was 48.1 years (range = 27-76 y). 88% of collections were postoperative (n = 21), 8% were from pelvic inflammatory disease (n = 2), and 4% were idiopathic (n = 1). Of the 24 patients, 83% of patients (n = 20) had previously undergone a hysterectomy and 1 patient (4%) was pregnant at the time of drainage. The mean volume of initial drainage was 108 mL (range = 5 to 570). Catheters were left in place for an average of 4.3 days (range = 1-17 d). Microbial sampling was performed in all patients with 71% (n = 17) returning a positive culture. All collections were successfully managed percutaneously. There were no technical complications. Conclusions. Transvaginal catheter drainage of pelvic fluid collections using transabdominal ultrasound guidance is a safe and clinically effective procedure. Appropriate percutaneous management can avoid the need for surgery.

  13. External hydrocephalus in two cats.

    PubMed

    Dewey, Curtis W; Coates, Joan R; Ducoté, Julie M; Stefanacci, Joseph D; Walker, Michael A; Marino, Dominic J

    2003-01-01

    External hydrocephalus describes an accumulation of cerebrospinal fluid (CSF) between the cerebral hemispheres and the overlying arachnoid membrane, rather than within the lateral ventricles. Two young cats with encephalopathic signs were diagnosed with external hydrocephalus, one via magnetic resonance imaging and one via computed tomography. Both cats had abnormally large, broad heads, with no evidence of open fontanelles. A surgical shunt was placed in each cat to divert the accumulated CSF within the cranial cavity to the peritoneal space. Both cats improved dramatically soon after surgical shunting was performed, and they continue to do well clinically, approximately 42 months and 8 months postoperatively, respectively.

  14. Postoperative incentive spirometry use.

    PubMed

    Hassanzadeh, Hamid; Jain, Amit; Tan, Eric W; Stein, Benjamin E; Van Hoy, Megan L; Stewart, Nadine N; Lemma, Mesfin A

    2012-06-01

    The authors hypothesized that the use of incentive spirometry by orthopedic patients is less than the recommended level and is affected by patient-related factors and type of surgery. To determine its postoperative use, the authors prospectively surveyed all patients in their institution's general orthopedic ward who had undergone elective spine surgery or total knee or hip arthroplasty during a consecutive 3-month period in 2010, excluding patients with postoperative delirium or requiring a monitored bed. All 182 patients (74 men, 108 women; average age, 64.5 years; range, 32-88 years; spine group, n=55; arthroplasty group, n=127), per protocol, received preoperative spirometry education by a licensed respiratory therapist (recommended use, 10 times hourly) and reinforcement education by nurses. Patients were asked twice daily (morning and evening) regarding their spirometry use during the previous 1-hour period by a registered nurse on postoperative days 1 through 3. All data were collected by the same 2 nurses using the same standardized questionnaire. Spirometry use was correlated with surgery type, postoperative day/time, and patient's age and sex. Student's t test, Spearman test, and one-way analysis of variance were used to compare differences (P<.05). Spirometry use averaged 4.1 times per hour (range, 0-10 times). No statistical correlations were found between spirometry use and age. Sex did not influence spirometry use. The arthroplasty group reported significantly higher use than did the spine group: 4.3 and 3.5 times per hour, respectively. Mean use increased significantly between postoperative days 1, 2, and 3.

  15. Pelvic rotation torque during fast-pitch softball hitting under three ball height conditions.

    PubMed

    Iino, Yoichi; Fukushima, Atsushi; Kojima, Takeji

    2014-08-01

    The purpose of this study was to investigate the relevance of hip joint angles to the production of the pelvic rotation torque in fast-pitch softball hitting and to examine the effect of ball height on this production. Thirteen advanced female softball players hit stationary balls at three different heights: high, middle, and low. The pelvic rotation torque, defined as the torque acting on the pelvis through the hip joints about the pelvic superior-inferior axis, was determined from the kinematic and force plate data using inverse dynamics. Irrespective of the ball heights, the rear hip extension, rear hip external rotation, front hip adduction, and front hip flexion torques contributed to the production of pelvic rotation torque. Although the contributions of the adduction and external rotation torques at each hip joint were significantly different among the ball heights, the contributions of the front and rear hip joint torques were similar among the three ball heights owing to cancelation of the two torque components. The timings of the peaks of the hip joint torque components were significantly different, suggesting that softball hitters may need to adjust the timings of the torque exertions fairly precisely to rotate the upper body effectively.

  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. 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.

  18. 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.

  19. [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.

  20. [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.

  1. 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

  2. Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse.

    PubMed

    Sentilhes, Loïc; Berthier, Aurélien; Sergent, Fabrice; Verspyck, Eric; Descamps, Philippe; Marpeau, Loïc

    2008-06-01

    The aim of the study was to assess sexual function in women before and after surgery with transvaginal mesh for pelvic organ prolapse. Women were invited to complete a sexual function questionnaire including the Lemack and the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaires (PISQ-12) before undergoing surgery and 1 year after surgery. Eighty-three complete pre and postoperative questionnaires were analyzed. Mean age was 65.1 years. Forty-six were sexually inactive and 37 were sexually active women. Two sexually active women completed the preoperative PISQ-12 questionnaire retrospectively after surgery. There were no significant differences after surgery in the answers to the Lemack questionnaire and PISQ-12 scores. These results suggest that nonabsorbable transvaginal mesh repair of genital prolapse does not impair sexual function 1 year after surgery. Nevertheless, patients should not necessarily expect a significant improvement in sexual function outcome following transvaginal mesh repair for genital prolapse.

  3. Breast malignant phyllodes tumor with rare pelvic metastases and long-term overall survival

    PubMed Central

    Shan, Jinlan; Zhang, Shizhen; Wang, Zhen; Fu, Yanbiao; Li, Ling; Wang, Xiaochen

    2016-01-01

    Abstract Background: Malignant phyllodes tumor (PT) is a rare fibro epithelial neoplasm of the breast, which is poor prognosis due to high risk of recurrence and distant metastasis. Methods: We report a case of malignant PT. It had recurred locally five times, and the sixth relapse was occurred 54 months after first diagnosis, presenting a huge pelvic mass (14 cm × 11 cm) by CT scan. Histopathological examination has demonstrated a metastatic phyllodes tumor. After postoperative chemotherapy treatment, a longer survival has been achieved, which is more than 72 months. Results: Our case report describes a breast PT with several local recurrences and a rare metastasis (pelvic cavity), but long-term overall survival was achieved after surgery and chemotherapy. Conclusion: We conclude that trustworthy prognosticators that identify patients with excessive potential of aggressive clinical course should be explored. Moreover, proper treatment could prolong overall survival of metastatic PT patients. PMID:27661051

  4. Prevention and management of postoperative urinary retention after urogynecologic surgery

    PubMed Central

    Geller, Elizabeth J

    2014-01-01

    Postoperative urinary retention (POUR) is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it is easily diagnosed and typically self-resolves. Clinician awareness of the condition and vigilance in its diagnosis are the key factors to successful care for patients undergoing surgical repair. PMID:25210477

  5. 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

  6. Keratophakia--postoperative astigmatism.

    PubMed

    Swinger, C A; Troutman, R C; Forman, J S

    1987-01-01

    Forty-nine cases of primary keratophakia and 13 cases of secondary keratophakia were analyzed for postoperative astigmatism. For primary cases, the surgically induced astigmatism was 1.55 D, whereas for secondary cases it was 0.19 D (insignificant). There was a tendency for both procedures to induce against-the-rule astigmatism, and both procedures were found capable of producing irregular astigmatism.

  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. New concepts on functional chronic pelvic and perineal pain: pathophysiology and multidisciplinary management.

    PubMed

    Ploteau, Stéphane; Labat, Jean Jacques; Riant, Thibault; Levesque, Amélie; Robert, Roger; Nizard, Julien

    2015-03-01

    The management of chronic pelvic and perineal pain has been improved by a better understanding of the mechanisms of this pain and an optimized integrated multidisciplinary approach to the patient. The concept of organic lesions responsible for a persistent nociceptive factor has gradually been replaced by that of dysregulation of nociceptive messages derived from the pelvis and perineum. In this setting, painful diseases identified by organ specialists are usually also involved and share several common denominators (triggering factors, predisposing clinical context). These diseases include painful bladder syndrome, irritable bowel syndrome, vulvodynia, and chronic pelvic pain syndrome. The painful symptoms vary from one individual to another and according to his or her capacity to activate pain inhibition/control processes. Although the patient often attributes chronic pain to a particular organ (with the corollary that pain will persist until the organ has been treated), this pain is generally no longer derived from the organ but is expressed via this organ. Several types of clinical presentation of complex pelvic pain have therefore been pragmatically identified to facilitate the management of treatment failures resulting from a purely organ-based approach, which can also reinforce the patient's impression of incurability. These subtypes correspond to neuropathic pain, central sensitization (fibromyalgia), complex regional pain syndrome, and emotional components similar to those observed in post-traumatic stress disorder. These various components are also often associated and self-perpetuating. Consequently, when pelvic pain cannot be explained by an organ disease, this model, using each of these four components associated with their specific mechanisms, can be used to propose personalized treatment options and also to identify patients at high risk of postoperative pelvic pain (multi-operated patients, central sensitization, post-traumatic stress disorder, etc

  10. Chronic Pelvic Pain due to Pelvic Congestion Syndrome: The Role of Diagnostic and Interventional Radiology

    SciTech Connect

    Ganeshan, Arul; Upponi, Sara; Hon, Lye-Quen; Uthappa, M. C.; Warakaulle, Dinuke R.; Uberoi, Raman

    2007-11-15

    Chronic pelvic pain (CPP) is a common cause of gynecologic referral. Pelvic congestion syndrome, which is said to occurs due to ovarian vein incompetence, is a recognized cause of CPP. The aim of this paper is to briefly describe the clinical manifestations, and to review the role of diagnostic and interventional radiology in the management of this probably under-diagnosed condition.

  11. Demonstration of Pelvic Anatomy by Modified Midline Transection that Maintains Intact Internal Pelvic Organs

    ERIC Educational Resources Information Center

    Steinke, Hanno; Saito, Toshiyuki; Herrmann, Gudrun; Miyaki, Takayoshi; Hammer, Niels; Sandrock, Mara; Itoh, Masahiro; Spanel-Borowski, Katharina

    2010-01-01

    Gross dissection for demonstrating anatomy of the human pelvis has traditionally involved one of two approaches, each with advantages and disadvantages. Classic hemisection in the median plane through the pelvic ring transects the visceral organs but maintains two symmetric pelvic halves. An alternative paramedial transection compromises one side…

  12. 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.

  13. Initial experiences with laparoscopy and flexible ureteroscopy combination pyeloplasty in management of ectopic pelvic kidney with stone and ureter-pelvic junction obstruction.

    PubMed

    Yin, Zhuo; Wei, Y B; Liang, B L; Zhou, K Q; Gao, Y L; Yan, B; Wang, Z; Yang, J R

    2015-06-01

    To demonstrate the safety and efficacy of combine laparoscopy and flexible ureteroscopy to treat ectopic pelvic kidneys with ureteropelvic junction obstruction (UPJO) and stones. 16 patients of ectopic pelvic kidneys with ureteropelvic junction obstruction and stones were treated with laparoscopy and flexible ureteroscopy (FURS). The operative time, required dose of tramadol, visual analog pain scale (VAPS), postoperative day, stone-free rates (SFRs), perioperative complications, and serum creatinine were evaluated. The SFRs were evaluated with noncontrasted renal computed tomography (CT). Intravenous pyelography (IVP) and CT scan were used to evaluate the UPJO. Stone-free status was defined as absence of stone fragments in kidney or the size of that is less than 3 mm. Operation time from 118 to 225 min, average time (171 ± 28) min; lithotomy time from 16 to 45 min, average time (32 ± 6) min. Average tramadol required at the first day postoperation was (118 ± 49.6) mg; at the second day was (78 ± 24.8) mg. VAPS score at 24 h (5.0 ± 0.7), VAPS score at 48 h (2.5 ± 0.8). Postoperative day (3.9 ± 0.6) days. Stone-free rate was 100%. Average serum creatinine was (88.7 ± 24.3) mol/L before surgery and (92.8 ± 21.6) mol/L after surgery. No major complication. No stone and obstruction recurrence in the follow-up of average 29.3 months. Combined FUR and LC is a good option for patient of ectopic pelvic kidney with renal stone and UPJO. From our initial experience, the SFRs and the effect of pyeloplasty are satisfactory and without major complication, the operative time is acceptable.

  14. Postoperative conversion disorder.

    PubMed

    Afolabi, Kola; Ali, Sameer; Gahtan, Vivian; Gorji, Reza; Li, Fenghua; Nussmeier, Nancy A

    2016-05-01

    Conversion disorder is a psychiatric disorder in which psychological stress causes neurologic deficits. A 28-year-old female surgical patient had uneventful general anesthesia and emergence but developed conversion disorder 1 hour postoperatively. She reported difficulty speaking, right-hand numbness and weakness, and right-leg paralysis. Neurologic examination and imaging revealed no neuronal damage, herniation, hemorrhage, or stroke. The patient mentioned failing examinations the day before surgery and discontinuing her prescribed antidepressant medication, leading us to diagnose conversion disorder, with eventual confirmation by neuroimaging and follow-up examinations.

  15. Evaluation of the levator ani and pelvic wall muscles in levator ani syndrome.

    PubMed

    Hull, Margaret; Corton, Marlene M

    2009-01-01

    Chronic pelvic pain is a difficult problem to evaluate and treat. Knowledge of the pelvic floor and pelvic wall muscles may enable the provider to identify levator ani spasm syndrome, a possible cause of chronic pelvic pain.

  16. Fecal Impaction Causing Pelvic Venous Compression and Edema

    PubMed Central

    Naramore, Sara; Aziz, Faisal; Alexander, Chandran Paul; Methratta, Sosamma; Cilley, Robert; Rocourt, Dorothy

    2015-01-01

    Chronic constipation is a common condition which may result in fecal impaction. A 13-year-old male with chronic constipation and encopresis presented with fecal impaction for three weeks. The impaction caused abdominal pain, distension, encopresis, and decreased oral intake. He was found in severe distress with non-pitting edema of his feet and ankles along with perineal edema. The pedal edema worsened after receiving a fluid bolus, so concern arose for venous compression or a thrombus. A Duplex Ultrasound demonstrated changes in the venous waveforms of the bilateral external iliac and common femoral veins without thrombosis. Manual disimpaction and polyethylene glycol 3350 with electrolytes resolved the pedal and perineal edema. Four months later, he had soft bowel movements without recurrence of the edema. A repeat Duplex Ultrasound was normal. We present a child in whom severe fecal impaction caused pelvic venous compression resulting in bilateral pedal and perineal edema. PMID:26500749

  17. [Characteristics of postoperative period in children with funnel chest deformity after thoracoplasty].

    PubMed

    Mishina, T P; Isalabdulaeva, P A; Magomedov, A D; Makhachev, S M

    2010-01-01

    The efficiency of postoperative analgesia using the epidural infusion of bupivacaine (0.2 mg/kg/hr) in 42 children and with opioid analgesics (1 mg per year of life) was studied in 17 children after Paltia thoracoplasty for funnel chest deformity. Analysis of hemodynamic and external respiratory parameters and visual pain scores demonstrated the high postoperative efficiency of analgesia using the epidural infusion of bupivacaine. By causing respiratory depression, opioid analgesics did not deteriorate alveolar ventilation during active postoperative management.

  18. [External pancreatic fistulas management].

    PubMed

    Stepan, E V; Ermolov, A S; Rogal', M L; Teterin, Yu S

    2017-01-01

    The main principles of treatment of external postoperative pancreatic fistulas are viewed in the article. Pancreatic trauma was the reason of pancreatic fistula in 38.7% of the cases, operations because of acute pancreatitis - in 25.8%, and pancreatic pseudocyst drainage - in 35.5%. 93 patients recovered after the treatment. Complex conservative treatment of EPF allowed to close fistulas in 74.2% of the patients with normal patency of the main pancreatic duct (MPD). The usage of octreotide 600-900 mcg daily for at least 5 days to decrease pancreatic secretion was an important part of the conservative treatment. Endoscopic papillotomy was performed in patients with major duodenal papilla obstruction and interruption of transporting of pancreatic secretion to duodenum. Stent of the main pancreatic duct was indicated in patients with extended pancreatic duct stenosis to normalize transport of pancreatic secretion to duodenum. Surgical formation of anastomosis between distal part of the main pancreatic duct and gastro-intestinal tract was carried out when it was impossible to fulfill endoscopic stenting of pancreatic duct either because of its interruption and diastasis between its ends, or in the cases of unsuccessful conservative treatment of external pancreatic fistula caused by drainage of pseudocyst.

  19. Postoperative fluid management

    PubMed Central

    Kayilioglu, Selami Ilgaz; Dinc, Tolga; Sozen, Isa; Bostanoglu, Akin; Cete, Mukerrem; Coskun, Faruk

    2015-01-01

    Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients’ status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient’s body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of over-hydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient’s actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient’s specific condition. PMID:26261771

  20. Comparison of two pelvic positioning belt configurations in a pediatric wheelchair.

    PubMed

    Cimolin, Veronica; Avellis, Martino; Piccinini, Luigi; Corbetta, Claudio; Cazzaniga, Andrea; Turconi, Anna Carla; Galli, Manuela

    2013-01-01

    Maintenance of stability for children in a wheelchair, particularly for those with spasticity, can be achieved through external stabilization components, such as pelvic positioning belts. Different kinds of pelvic belts exist on the market and one of the main characteristics is the different number of attachment points between the seat and the belt. As literature on this topic is limited to qualitative assessments, this study compared quantitatively 4-point versus 2-point pelvic positioning belts for the trunk fixation in 20 young patients with spasticity. Our data showed that 70% of the children required the use of pelvic belts on wheelchairs for stability and a better stability was observed with the 4-point belts than compared to the 2-point. Data generally showed in fact a higher percent of variation in terms of trunk flexion angleand knee joint angle with the 2-point belt than the 4-point belt, indicating increased submarining with the 2-point belt during sitting maintenance if compared to the 4-point belt (p < 0.05). According to our results, the 4-point belts seem to be the most effective configuration for patient stabilization, suggesting that its use prevents the thigh from submarining.

  1. Pelvic girdle and fin of Tiktaalik roseae.

    PubMed

    Shubin, Neil H; Daeschler, Edward B; Jenkins, Farish A

    2014-01-21

    A major challenge in understanding the origin of terrestrial vertebrates has been knowledge of the pelvis and hind appendage of their closest fish relatives. The pelvic girdle and appendage of tetrapods is dramatically larger and more robust than that of fish and contains a number of structures that provide greater musculoskeletal support for posture and locomotion. The discovery of pelvic material of the finned elpistostegalian, Tiktaalik roseae, bridges some of these differences. Multiple isolated pelves have been recovered, each of which has been prepared in three dimensions. Likewise, a complete pelvis and partial pelvic fin have been recovered in association with the type specimen. The pelves of Tiktaalik are paired and have broad iliac processes, flat and elongate pubes, and acetabulae that form a deep socket rimmed by a robust lip of bone. The pelvis is greatly enlarged relative to other finned tetrapodomorphs. Despite the enlargement and robusticity of the pelvis of Tiktaalik, it retains primitive features such as the lack of both an attachment for the sacral rib and an ischium. The pelvic fin of Tiktaalik (NUFV 108) is represented by fin rays and three endochondral elements: other elements are not preserved. The mosaic of primitive and derived features in Tiktaalik reveals that the enhancement of the pelvic appendage of tetrapods and, indeed, a trend toward hind limb-based propulsion have antecedents in the fins of their closest relatives.

  2. Pelvic girdle and fin of Tiktaalik roseae

    PubMed Central

    Shubin, Neil H.; Daeschler, Edward B.; Jenkins, Farish A.

    2014-01-01

    A major challenge in understanding the origin of terrestrial vertebrates has been knowledge of the pelvis and hind appendage of their closest fish relatives. The pelvic girdle and appendage of tetrapods is dramatically larger and more robust than that of fish and contains a number of structures that provide greater musculoskeletal support for posture and locomotion. The discovery of pelvic material of the finned elpistostegalian, Tiktaalik roseae, bridges some of these differences. Multiple isolated pelves have been recovered, each of which has been prepared in three dimensions. Likewise, a complete pelvis and partial pelvic fin have been recovered in association with the type specimen. The pelves of Tiktaalik are paired and have broad iliac processes, flat and elongate pubes, and acetabulae that form a deep socket rimmed by a robust lip of bone. The pelvis is greatly enlarged relative to other finned tetrapodomorphs. Despite the enlargement and robusticity of the pelvis of Tiktaalik, it retains primitive features such as the lack of both an attachment for the sacral rib and an ischium. The pelvic fin of Tiktaalik (NUFV 108) is represented by fin rays and three endochondral elements: other elements are not preserved. The mosaic of primitive and derived features in Tiktaalik reveals that the enhancement of the pelvic appendage of tetrapods and, indeed, a trend toward hind limb-based propulsion have antecedents in the fins of their closest relatives. PMID:24449831

  3. Pelvic-fracture urethral injury in children

    PubMed Central

    Hagedorn, Judith C.; Voelzke, Bryan B.

    2015-01-01

    Objective To review paediatric posterior urethral injuries and the current potential management options; because urethral injury due to pelvic fracture in children is rare and has a low incidence, the management of this type of trauma and its complications remains controversial. Methods We reviewed previous reports identified by searching the PubMed Medline electronic database for clinically relevant articles published in the past 25 years. The search was limited to the keywords ‘pediatric’, ‘pelvic fracture’, ‘urethral injury’, ‘stricture’, ‘trauma’ and ‘reconstruction’. Results Most paediatric urethral injuries are a result of pelvic fractures after high-impact blunt trauma. After the diagnosis, immediate bladder drainage via a suprapubic cystotomy, or urethral realignment, are the initial management options, except for a possible immediate primary repair in girls. The common complications of pelvic fracture-associated urethral injury include urethral stricture formation, incontinence and erectile dysfunction. Excellent results can be achieved with delayed urethroplasty for pelvic fracture-associated urethral injuries. Conclusion Traumatic injury to the paediatric urethra is rare and calls for an immediate diagnosis and management. These devastating injuries have a high complication rate and therefore a close follow-up is warranted to assure adequate delayed repair by a reconstructive urologist. PMID:26019977

  4. Changes in serum sodium, sodium balance, water balance, and plasma hormone levels as the result of pelvic surgery in women.

    PubMed

    Amede, Francis J; James, Kenneth A; Michelis, Michael F; Gleim, Gilbert W

    Postoperative hyponatremia in women has been associated with the development of serious neurological disorders and even death, with a predisposition for menstruant women. The objective of this study was to evaluate the immediate hormonal, water and electrolyte responses to pelvic surgery in both pre and postmenopausal women. Of the twenty-five consecutive women studied, twenty were premenopausal while five were postmenopausal. Mean age was 45.4 +/- 1.6 years. Measurements of plasma renin activity, follicular stimulating hormone and luteinizing hormone showed no significant change pre to postoperatively. There was a significant decrease in pre to postoperative values of estrogen, 97.4 +/- 20.3 to 36.3 +/- 7.5 pg/mL (p < 0.05). There was also a significant decline in postoperative values for plasma aldosterone and plasma progesterone. Data were similar in pre and postmenopausal patients. Serum sodium levels decreased from 141.5 +/- 0.5 to 137.2 +/- 0.5 mEq/L (p < 0.01). During the twenty-four hours following surgery, mean net sodium balance was positive 122 mEq and mean measured fluid balance was positive 1108 mL. Ringers lactate or normal saline were used. On the first postoperative day, plasma arginine vasopressin levels were elevated at 4.0 +/- 0.8 pg/mL, with a mean urine osmolality of 504 +/- 29 mOsm/kg H2O. The data illustrate that women undergoing pelvic surgery decrease their serum sodium in the immediate postoperative period. Despite both positive sodium and water balance, there is a stronger tendency to conserve water. Decreased estrogen levels occur and this decrease may facilitate brain cell adaptation to plasma hypotonicity. Since the administration of isotonic fluid will not protect against the decrease in serum sodium, postoperative sodium concentration should be carefully monitored.

  5. [Postoperative analgesia and dexamethasone].

    PubMed

    Miralles, F S; Cárceles, M D; Micol, J A; Hernández, J; del Pino, A

    1989-01-01

    A randomized, double-blind, prospective study was carried out in 100 patients who had undergone some type of surgical treatment in order to evaluate the degree of pain and relief of pain, the degree of achieved analgesia according to the opinion of the observer and consumption of analgesic agents. The evaluation was carried out on seven occasions during the first 12 hours of the postoperative period. Patients received dexamethasone (4 mg before or after the operation or 8 mg after the operation), 6-methylprednisolone (16 mg at the end of the operation) or nothing (control group). Regardless of type, dose or timing of administration of the drugs, all patients receiving corticosteroids presented less pain, more relief of pain (expressed by themselves or in opinion of the observer) and needed lower doses of analgesics during the studied time.

  6. Imaging of postoperative shoulder instability.

    PubMed

    De Filippo, M; Pesce, A; Barile, A; Borgia, D; Zappia, M; Romano, A; Pogliacomi, F; Verdano, M; Pellegrini, A; Johnson, K

    2017-03-01

    Postoperative imaging in shoulder instability is still a challenge for radiologists due to various postsurgical anatomical findings that could be considered pathologic in treated shoulder. For this reason is very important a deep knowledge about surgical procedures, anatomical changes after surgery and the appropriate diagnostic imaging modalities to work up the symptomatic postoperative shoulder. Postoperative imaging options include use conventional radiography, magnetic resonance imaging (MRI), MRI arthrography, computed tomography (CT) and CT arthrography. The purpose of our review is to explain the different surgical procedures and to describe postoperative changes detected with radiological imaging.

  7. Pelvic floor muscle training in males: practical applications.

    PubMed

    Siegel, Andrew L

    2014-07-01

    The pelvic floor muscles are vital to male genitourinary health. Pelvic floor muscle training may prove helpful in a variety of clinical circumstances: stress urinary incontinence that follows prostate surgery, overactive bladder, postvoid dribbling, erectile dysfunction, ejaculation issues including premature ejaculation, and pelvic pain due to levator muscle spasm.

  8. Role of female pelvic anatomy in infertility.

    PubMed

    Harris-Glocker, Miranda; McLaren, Janet F

    2013-01-01

    Infertility is defined as a couple's failure to achieve pregnancy after one year of regular, unprotected intercourse. The etiology of infertility can be due to female factors, male factors, combined male and female factors, or have an unknown etiology. This review focuses on the role of female pelvic anatomy in infertility. Normal anatomy and the physiology of reproduction will be discussed, as well as the anatomic and pathophysiologic processes that cause infertility including ovulatory disorders, endometriosis, pelvic adhesions, tubal blockage, mullerian anomalies, and abnormalities affecting the uterine cavity such as leiomyomata and endometrial polyps.

  9. Diagnosis and therapy of pelvic actinomycosis.

    PubMed

    Taga, Shigeki

    2007-12-01

    Pelvic actinomycosis is difficult to diagnose. In most cases, it is not diagnosed until after surgery. If this condition is diagnosed preoperatively, it can be treated in many cases. Three cases of actinomycosis are reported here. Three women with intrauterine devices (IUD) each presented with lower abdominal pain and pelvic mass, and elevated white blood cell count and C-reactive protein. Left salpingo-oophorectomy was performed for one the women. The pathological diagnosis was actinomycosis. For the other two women, a Gram or Papanicolaou stain of the IUD sample showed actinomycetes. They were discharged after intravenous administration of penicillin without surgery.

  10. 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

  11. Abdominal aortic aneurysm repair in a patient with a congenital solitary pelvic kidney. A case report.

    PubMed

    Murakami, T; Makino, Y; Suto, Y; Yasuda, K

    2004-10-01

    Abdominal aortic aneurysm (AAA) is rarely associated witha congenital pelvic kidney. To date only 11 cases have been reported in the literature in which a solitary pelvic' kidney was associated in only 1 patient. Repair of thesaneurysm is technically demanding because the abnormal origin of the renal arteries presents the problem of renal ischemia duringaortic cross-clamping. We report a case of a 77-year-old man who was found to have an AAA associated with a congenital solitary pelvic kidney. An abdominal aortography dearly showed 2 aberrant renal arteries, one of which originated from the aortic wall just above the aortic bifurcation and the other from the left common iliac artery. At surgery, we found other associated anomalies including malrotation of the gut and a left undescended testis. The surgical procedure consisted of an aneurysmorrhaphy followed by a tube graft replacement with therenal arteries being left intact to the distal aortic wall or below. Renal preservation during aortic cross-clamping was achieved by direct perfusion of the upper renal artery with cold lactated Ringer's solution together with topical cooling with ice slush. The patient's postoperative course was uneventful. Urinary output was satisfactory and serum creatinine level remained unchanged throughout his hospital stay. The renal preservation method used in this case was simple and effective.

  12. Assessment of the pubic force as a pelvic injury criterion in side impact.

    PubMed

    Leport, Tiphaine; Baudrit, Pascal; Trosseille, Xavier; Petit, Philippe; Palisson, Anna; Vallancien, Guy

    2007-10-01

    In the literature, injuries at the ischio or ilio pubic ramus level are reported to occur to approximately (3/4) of the occupants injured at the pelvis during side impact. Assuming that the load going through the pubis was a good indicator of the ramus stress, the pubic force was widely accepted as a protection criterion for pelvic fractures on side impact dummies. However, no data regarding the actual loads going through the pubis is currently available in the literature for Post Mortem Human Subjects (PMHS) in dynamic conditions. The goal of this study was to determine pelvic biofidelity specifications in terms of load path, to evaluate the pertinence of the pubic force as a criterion, and to develop a pelvic injury risk curve as a function of the pubic force. For that purpose, a pubic load cell was developed for PMHS use, and 16 side impact tests were performed on 8 PMHS using boundary conditions similar to impactor tests and sled tests reported in the literature. One kind of impact was applied on one side of a subject and the other kind of impact was then applied on the other side of the same subject, at non injury severities. The ratio between the peak external force and the peak pubic force was calculated for each subject, and a mean ratio was then calculated for each of the test conditions. These ratios were finally used to calculate the pubic forces from the external pelvic forces for 90 PMHS side impact test data available in the literature. Injury risk curves as a function of the pubic force were developed from these data. Two normalized pubic force corridors from the 16 tests are presented, the first one for the impactor tests, the second one for the sled-like tests. The test results show statistically different ratios between the peak external force and the peak pubic force, for the two configurations (an average ratio of 3.3 for impactor tests and 4.6 for sled-like tests). The PMHS injury risk curves based on the external pelvic force were observed to

  13. [Severe haemorrhage secondary to an osteoporotic pelvic fracture: presentation of a case].

    PubMed

    Palacio, J; Albareda, J

    2014-01-01

    Low-energy osteoporotic pelvic fractures in the elderly are a very common problem. They are usually stable fractures, non-life threatening and only require conservative treatment. The pelvic bone structure is closely related to important vascular structures. The Corona Mortis, located in the retropubis, has an important anastomotic value as it serves as communication between the internal and external iliac vessels. The case is presented of an 87 year-old woman, who, after a casual fall, was diagnosed with an osteoporotic fracture of the left pubic rami associated to a lesion of the Corona Mortis, which led to a severe picture of haemodynamic instability. After angiography with supra-selective embolisation of the lesioned vessel, and the transfusion of several haemoderivatives, the patient progressed satisfactorily, and was discharged after a few days.

  14. [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.

  15. Pelvic lymphangioleiomyomatosis treated successfully with everolimus

    PubMed Central

    Wahid, Sharjil; Chiang, Ping Chia; Luo, Hao Lun; Huang, Shun-Chen; Tsai, Eing-Mei; Chiang, Po Hui

    2017-01-01

    Abstract Background: Lymphangioleiomyomatosis (LAM) is a rare disease affecting young women caused by abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs and extrapulmonary sites (extrapulmonary LAM). The objective of this case series is to demonstrate marked regression in 2 cases of retroperitoneal LAM after treatment with everolimus, an mTOR inhibitor. Methods: We enrolled 2 cases with large volume, extrapulmonary pelvic LAM, and evaluated them with contrast-enhanced abdominal computed tomographic (CT) scans at presentation and serially during treatment with everolimus. Results were objectively quantified using the Response Evaluation Criteria in Solid Tumors, RECIST, Version 1.1. Results: After 12 to 18 months of treatment with everolimus, both patients showed substantial reduction in the volume of their tumors. The first had about 50% regression of the pelvic LAM and renal angiomyolipoma (AML). The second patient had extensive abdomino-pelvic LAM which after treatment showed complete remission. Both patients have not demonstrated disease progression after nearly 4 and 2 years of follow-up, respectively. Conclusions: This case series demonstrates the enormous value of mTOR inhibitors (specifically everolimus) in the management of extrapulmonary pelvic LAM, of which there is no effective treatment currently available. PMID:28272193

  16. Magnetic resonance imaging of fetal pelvic cysts.

    PubMed

    Archontaki, Styliani; Vial, Yvan; Hanquinet, Sylviane; Meuli, Reto; Alamo, Leonor

    2016-12-01

    The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.

  17. Iatrogenic water intoxication after pelvic ultrasonography imaging.

    PubMed

    Camkurt, Meltem Akkaş; Coşkun, Figen; Aksu, Nalan Metin; Akpinar, Erhan; Ay, Didem

    2010-03-01

    Ultrasound (US) is a simple, easily accessible, and noninvasive method. Thus, it is commonly used. The bladder should be sufficiently filled to acquire pelvic images by US. This report describes water poisoning in 3 patients with no hepatic, cardiac, or renal disease. Both patients had a history of excessive fluid intake.

  18. Combined latissimus dorsi and serratus anterior flaps for pelvic reconstruction.

    PubMed

    Phan, Truong Q V; Spilker, Gerald; Theodorou, Panagiotis; Gossmann, Andreas; Heiss, Michael; Weinand, Christian

    2011-10-01

    In recurrent pressure sores, adjacent tissue has already been consumed by multiple surgeries. Additional problems are several co-morbidities of patients. Especially, severe atherosclerosis would be a contraindication for using free flaps. However, microsurgical techniques allow circumventing these limitations and preparing even severely atherosclerotic vessels. We performed a total of eight sacral pressure sore coverage in our standardized fashion, using the free combined latissimus dorsi and serratus anterior free flaps. All patients had severe atherosclerosis and needed large soft tissue coverage of the sacral defects. Five patients presented after bowel resection, three with recurrent sacral pressure sores. The average follow-up was 12 months. Postoperatively, all patients were allowed to be prone on the operated area. One minor wound dehiscence was sutured in local anesthesia. CT imaging analysis of the pelvis showed complete void space coverage. The combined latissimus dorsi and serratus anterior flaps are a valuable tool for pelvic reconstruction in our hands. In addition, severe atherosclerosis should not be considered an obstacle to microsurgery and the use of free flaps.

  19. Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse

    PubMed Central

    Rosati, Maurizio; Bracale, Umberto; Pignata, Giusto; Azioni, Guglielmo

    2013-01-01

    Background and Objectives: To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse. Methods: One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define “surgical failure” as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure. Results: The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction. Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse. PMID:23925017

  20. Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis.

    PubMed

    Baader, B; Herrmann, M

    2003-03-01

    Bladder, bowel, and sexual dysfunction caused by iatrogenic lesions of the inferior hypogastric plexus (IHP) are well known and commonly tolerated in pelvic surgery. Because the pelvic autonomic nerves are difficult to define and dissect in surgery, and their importance often ignored, we conducted a gross anatomic study of 90 adult and four fetal hemipelves. Using various non-surgical approaches, the anatomic relations and pathways of the IHP were dissected. The IHP extended from the sacrum to the genital organs at the level of the lower sacral vertebrae. It originated from three different sources: the hypogastric nerve, the sacral splanchnic nerves from the sacral sympathetic trunk (mostly the S2 ganglion), and the pelvic splanchnic nerves, which branched primarily from the third and fourth sacral ventral rami. These fibers converge to form a uniform nerve plate medial to the vascular layer and deep to the peritoneum. The posterior portion of the IHP supplied the rectum and the anterior portion of the urogenital organs; nerve fibers traveled directly from the IHP to the anterolateral wall of the rectum and to the inferolateral and posterolateral aspects of the urogenital organs. The autonomic supply from the IHP was supplemented by nerves accompanying the ureter and the arteries. An understanding of the location of the autonomic pelvic network, including important landmarks, should help prevent iatrogenic injury through the adoption of surgical techniques that reduce or prevent postoperative autonomic dysfunction.

  1. Postoperative Prostate-Specific Antigen Velocity Independently Predicts for Failure of Salvage Radiotherapy After Prostatectomy

    SciTech Connect

    King, Christopher R. Presti, Joseph C.; Brooks, James D.; Gill, Harcharan; Spiotto, Michael T.

    2008-04-01

    Purpose: Identification of patients most likely to benefit from salvage radiotherapy (RT) using postoperative (postop) prostate-specific antigen (PSA) kinetics. Methods and Materials: From 1984 to 2004, 81 patients who fit the following criteria formed the study population: undetectable PSA after radical prostatectomy (RP); pathologically negative nodes; biochemical relapse defined as a persistently detectable PSA; salvage RT; and two or more postop PSAs available before salvage RT. Salvage RT included the whole pelvic nodes in 55 patients and 4 months of total androgen suppression in 56 patients. The median follow-up was >5 years. All relapses were defined as a persistently detectable PSA. Kaplan-Meier and Cox proportional hazards multivariable analysis were performed for all clinical, pathological, and treatment factors predicting for biochemical relapse-free survival (bRFS). Results: There were 37 biochemical relapses observed after salvage RT. The 5-year bRFS after salvage RT for patients with postop prostate-specific antigen velocity {<=}1 vs. >1 ng/ml/yr was 59% vs. 29%, p = 0.002. In multivariate analysis, only postop PSAV (p = 0.0036), pre-RT PSA level {<=}1 (p = 0.037) and interval-to-relapse >10 months (p = 0.012) remained significant, whereas pelvic RT, hormone therapy, and RT dose showed a trend (p = {approx}0.06). PSAV, but not prostate-specific antigen doubling time, predicted successful salvage RT, suggesting an association of zero-order kinetics with locally recurrent disease. Conclusions: Postoperative PSA velocity independently predicts for the failure of salvage RT and can be considered in addition to high-risk features when selecting patients in need of systemic therapy following biochemical failure after RP. For well-selected patients, salvage RT can achieve high cure rates.

  2. Female pelvic floor dysfunction--an imaging perspective.

    PubMed

    Dietz, Hans Peter

    2011-12-20

    Female pelvic floor dysfunction encompasses a range of morbidities, including urinary incontinence, female pelvic organ prolapse, anal incontinence and obstructed defecation. Patients often present with symptoms covered by several specialties including gastroenterology, colorectal surgery, urology and gynecology. Imaging can therefore bring clinicians from multiple specialties together by revealing that we frequently deal with different aspects of one underlying problem or pathophysiological process. This article provides an interdisciplinary imaging perspective on the pelvic floor. Modern pelvic floor imaging comprises defecation proctography, translabial and endorectal ultrasound, and static and dynamic MRI. This Perspectives focuses on the potential use of translabial ultrasound, including 3D and 4D applications, for diagnosis of pelvic floor disorders. Over the next decade, pelvic floor imaging will most likely be integrated into mainstream diagnostics in obstetrics and gynecology and colorectal surgery. Using imaging to facilitate communication between different specialties has the potential to greatly improve the multidisciplinary management of complex pelvic floor disorders.

  3. Effects of Soft Tissue Surgery on Pelvic and Hip Rotation in Patients with Spastic Diplegia: A Meta-Analysis

    PubMed Central

    Jung, Hun Jae; Yoon, Ji Yeon; Oh, Min Kyung; Kim, Young Chang; Kim, Jae Hyun; Eom, Tae Woong

    2016-01-01

    Background There are several different opinions regarding the improvements seen on the transverse plane after soft tissue surgery alone in independently ambulant patients with cerebral palsy. We performed a meta-analysis using data from previous studies to identify the effects of soft tissue surgery alone on pelvic and hip rotation in children with spastic diplegia. Methods We conducted a pilot study to evaluate the improvement in pelvic and hip rotation after muscle-tendon lengthening surgery in children with spastic diplegia. We also searched EMBASE and PubMed and selected 2 previous studies using the same test conditions with kinematic data on the pelvis and hip joints. A meta-analysis of the results of these 3 studies, including this pilot study, was then performed. Results The meta-analysis results showed an external rotation decrease (p = 0.005) in the mean difference of pelvic rotation of -3.61 (95% confidence interval [CI], -6.13 to –1.09) and a mean difference in hip rotation of 6.60 (95% CI, 3.34 to 9.86), indicating a significant increase in the hip external rotation after surgery (p < 0.001). Conclusions In independently community-ambulant pediatric patients with spastic diplegia, pelvic retraction and hip internal rotation could be improved after soft tissue surgery. PMID:27247745

  4. Postoperative complications of spine surgery.

    PubMed

    Swann, Matthew C; Hoes, Kathryn S; Aoun, Salah G; McDonagh, David L

    2016-03-01

    A variety of surgical approaches are available for the treatment of spine diseases. Complications can arise intraoperatively, in the immediate postoperative period, or in a delayed fashion. These complications may lead to severe or even permanent morbidity if left unrecognized and untreated [1-4]. Here we review a range of complications in the early postoperative period from more benign complications such as postoperative nausea and vomiting (PONV) to more feared complications leading to permanent loss of neurological function or death [5]. Perioperative pain management is covered in a separate review (Chapter 8).

  5. [Management of postoperative pancreatic fistula].

    PubMed

    Hackert, T; Büchler, M W

    2015-06-01

    The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication varies between 3 % after pancreatic head resection and up to 35 % following distal pancreatectomy. In 2005, the international definition of postoperative pancreatic fistula was standardized according to the approach of the International Study Group of Pancreatic Surgery (ISGPS) including an A-C grading system of the severity. Consequently, results from different studies have become comparable and the historically reported fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, fistula-associated complications and management of postoperative pancreatic fistula.

  6. Imaging of the Postoperative Orbit.

    PubMed

    Learned, Kim O; Nasseri, Farbod; Mohan, Suyash

    2015-08-01

    Imaging evaluation of the postoperative orbit remains challenging even for the expert neuroradiologist. This article provides a simplified framework for understanding the complex postoperative appearances of the orbit, in an attempt to enhance the diagnostic accuracy of postoperative computed tomography and MR imaging of the orbit. Readers are familiarized with the normal appearances of common eye procedures and orbit reconstructions to help avoid interpretative pitfalls. Also reviewed are imaging features of common surgical complications, and evaluation of residual/recurrent neoplasm in the setting of oncologic imaging surveillance.

  7. [Postoperative imaging of the shoulder].

    PubMed

    Wörtler, K; Rummeny, E J

    2004-06-01

    Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primary impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications.

  8. Bladder incarceration following anterior external fixation of a traumatic pubic symphysis diastasis treated with immediate open reduction and internal fixation

    PubMed Central

    Finnan, Ryan P; Herbenick, Michael A; Prayson, Michael J; McCarthy, Mary C

    2008-01-01

    Anterior pelvic ring disruptions are often associated with injuries to the genitourinary structures with the potential for considerable resultant morbidity. Herniation of the bladder into the symphyseal region after injury with subsequent entrapment upon reduction of the symphyseal diastasis has seldom been reported in the literature. We report such a case involving bladder herniation and subsequent entrapment after attempted closed reduction with anterior pelvic external fixation immediately treated with open reduction and internal fixation along with a review of the literature. PMID:18928569

  9. [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.

  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. Reduction of postoperative adhesion development.

    PubMed

    Diamond, Michael P

    2016-10-01

    Despite use of meticulous surgical techniques, and regardless of surgical access via laparotomy or laparoscopy, postoperative adhesions develop in the vast majority of women undergoing abdominopelvic surgery. Such adhesions represent not only adhesion reformation at sites of adhesiolysis, but also de novo adhesion formation at sites of surgical procedures. Application of antiadhesion adjuvants compliment the benefits of meticulous surgical techniques, providing an opportunity to further reduce postoperative adhesion development. Improved understanding of the pathophysiology of adhesion development and distinguishing variations in the molecular biologic mechanisms from adhesion-free peritoneal repair represent future opportunities to improve the reduction of postoperative adhesions. Optimization of the reduction of postoperative adhesions will likely require identification of unique, personalized approaches in each individual, representing interindividual variation in peritoneal repair processes.

  12. Sacrohysteropexy performed as uterus conserving surgery for pelvic organ prolapse: Review of case files

    PubMed Central

    Khan, Ayesha; Jaleel, Riffat; Nasrullah, Farah Deeba

    2016-01-01

    Objective: To assess the outcome and safety of sacrohysteropexy as uterus conserving surgery for pelvic organ prolapse in young women and to assess patients’ satisfaction with the procedure. Methods: This is a case series of patients operated at Sind Government Lyari General Hospital and Civil Hospital Karachi, between January, 2007 to October, 2015. Data of the patients who had sacrohysteropexy were reviewed. Complications during surgery and post-operative period including haemorrhage, visceral injury, paralytic ileus and peritonitis were studied. Success of procedure, need of blood transfusion, hospital stay and condition on discharge and six weeks follow-up were noted. Data were analyzed using SPSS version 16. Mean ± SD was calculated for numerical, while frequencies were computed for categorical variables. Results: Data of 60 patients were reviewed. Early post-operative success was 100%. Duration of surgery was less than two hours in 57 (95%) patients. Blood loss was negligible in majority of cases. Out of all 60 cases, 52 (86.7%) did not suffer any complication. One patient had ureteric injury, while one patient sustained bowel injury. Two patients had paralytic ileus. Four patients suffered from abdominal wound infection. All patients were managed satisfactorily. Mean duration of stay in hospital was four days. Upon follow up 96.7% patients were satisfied with results of operative procedure. Sixteen (26.7%) patients complained of backache on follow-up visit. Conclusion: This review concludes that sacrohysteropexy was successful in all cases in early post-operative period. It is a safe procedure and should be considered as an option for the treatment of pelvic organ prolapse in young women, in whom uterine conservation is required. PMID:27882016

  13. An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing's Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

    PubMed Central

    Höch, Andreas; Pieroh, Philipp; Dehghani, Faramarz; Josten, Christoph; Böhme, Jörg

    2016-01-01

    Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing's disease. The combination of adrenocorticotropic hormone-dependent Cushing's disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors' knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation. PMID:26904337

  14. Prominent metalware from pelvic surgery causing dyspareunia.

    PubMed

    Nambiar, Mithun; Heaton, Samuel Raymond; Stevenson, Andrew John; Bucknill, Andrew Thomas

    2017-01-06

    We present a case of female dyspareunia secondary to metalware placement during extensive pelvic surgery following a motor vehicle accident. The patient initially had an uneventful recovery from her operations. However, she noticed pain with vaginal intercourse, due to a screw tip which was palpable on vaginal examination. X-ray imaging confirmed long screws in the medial part of an anterior column plate, which were impacting on the anterior vaginal wall. Subsequent percutaneous removal of two screws resulted in resolution of her symptoms of painful vaginal intercourse. While the pain from mechanical irritation of the vagina was resolved, the patient continues to have difficulty with intercourse, which is related to hip pain as a result of her initial injury and complex pelvic surgery.

  15. Male chronic pelvic pain: An update

    PubMed Central

    Smith, Christopher P.

    2016-01-01

    Introduction: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and interstitial cystitis/bladder pain syndrome collectively referred to as urologic CPPS (UCPPS) is defined by the absence of identifiable bacterial infection as a cause for the chronic pain and urinary symptoms. Methods: A PubMed search of all recent relevant articles using the keywords/phrases: CPPS, CPPS, and male pelvic pain, was conducted. Results: CPPS has a high worldwide prevalence and its negative impact on quality of life compares with or exceeds common chronic morbidities. Triggers include certain comestibles as well as psychosocial factors that promote catastrophizing and illness focused behavior. Several validated tools are currently available to help diagnose and direct targeted therapy. Treatment should begin with the most simple and least invasive based on the presenting clinical phenotype. Conclusions: Although no gold-standard treatment exists, a multidisciplinary approach with multimodal therapy gives the UCPPS patient the best chance of symptom relief. PMID:26941492

  16. 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

  17. 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

  18. Pelvic position and movement during hip replacement.

    PubMed

    Grammatopoulos, G; Pandit, H G; da Assunção, R; Taylor, A; McLardy-Smith, P; De Smet, K A; Murray, D W; Gill, H S

    2014-07-01

    The orientation of the acetabular component is influenced not only by the orientation at which the surgeon implants the component, but also the orientation of the pelvis at the time of implantation. Hence, the orientation of the pelvis at set-up and its movement during the operation, are important. During 67 hip replacements, using a validated photogrammetric technique, we measured how three surgeons orientated the patient's pelvis, how much the pelvis moved during surgery, and what effect these had on the final orientation of the acetabular component. Pelvic orientation at set-up, varied widely (mean (± 2, standard deviation (sd))): tilt 8° (2sd ± 32), obliquity -4° (2sd ± 12), rotation -8° (2sd ± 14). Significant differences in pelvic positioning were detected between surgeons (p < 0.001). The mean angular movement of the pelvis between set-up and component implantation was 9° (sd 6). Factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > total hip replacement) and type of support (p < 0.001). Although, on average, surgeons achieved their desired acetabular component orientation, there was considerable variability (2sd ± 16) in component orientation. We conclude that inconsistency in positioning the patient at set-up and movement of the pelvis during the operation account for much of the variation in acetabular component orientation. Improved methods of positioning and holding the pelvis are required.

  19. 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.

  20. [Pelvic floor disorders from the surgeon's viewpoint].

    PubMed

    Schiedeck, T H

    2013-10-01

    Pelvic floor disorders present very differently with regard to symptoms and manifestation. Both diagnostic and treatment options require specific experience and an interdisciplinary approach. Diagnostic work-up is primarily based on medical history, physical examination and procto-rectoscopy. Furthermore, endosonography and perineal sonography have also gained importance. In almost all cases following these basic examinations conservative therapy options should be considered. As the interdisciplinary concept is very important, for careful diagnosis of pelvic floor disorders it became crucial to find an adequate form of treatment. Every decision for surgical therapy should not only focus on the results of previous examinations but should also consider the individual situation of each patient. In pelvic floor disorders a large variety of symptoms are confronted with a vast number of different and often highly specific procedures. The decisions on who to treat and how to treat are not only based on individual patient requests and desires but also on the experience and preference of the surgeon.

  1. 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.

  2. 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

  3. Pelvic fins in teleosts: structure, function and evolution.

    PubMed

    Yamanoue, Y; Setiamarga, D H E; Matsuura, K

    2010-10-01

    The pelvic fins of teleosts are paired appendages that are considered to be homologous to the hind limbs of tetrapods. Because they are less important for swimming, their morphology and function can be flexibly modified, and such modifications have probably facilitated the adaptations of teleosts to various environments. Recently, among these modifications, pelvic-fin loss has gained attention in evolutionary developmental biology. Pelvic-fin loss, however, has only been investigated in a few model species, and various biological aspects of pelvic fins in teleosts in general remain poorly understood. This review summarizes the current state of knowledge regarding pelvic fins, such as their structure, function and evolution, to elucidate their contribution to the considerable diversity of teleosts. This information could be invaluable for future investigations into various aspects of pelvic fins, which will provide clues to understanding the evolution, diversity and adaptations of teleosts.

  4. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

    PubMed Central

    Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

    2012-01-01

    Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy. PMID:22305030

  5. 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.

  6. Sexual function in women with pelvic floor disorders

    PubMed Central

    Rogers, Rebecca G.

    2013-01-01

    Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction. PMID:24523846

  7. New developments in the pharmacotherapy of neuropathic chronic pelvic pain.

    PubMed

    Carey, Erin T; As-Sanie, Sawsan

    2016-12-01

    Advancements in further understanding the pathophysiology of chronic pelvic pain syndromes continue to direct therapy. The mechanisms of chronic pelvic pain are often multifactorial and therefore require a multidisciplinary approach. The final treatment plan is often an accumulation of organ-specific treatment and chronic pain medications directed to the CNS and PNS. This article is a review of commonly used medications for chronic pelvic neuropathic pain disorders as well as an introduction to recent innovative developments in pain medicine.

  8. New developments in the pharmacotherapy of neuropathic chronic pelvic pain

    PubMed Central

    Carey, Erin T; As-Sanie, Sawsan

    2016-01-01

    Advancements in further understanding the pathophysiology of chronic pelvic pain syndromes continue to direct therapy. The mechanisms of chronic pelvic pain are often multifactorial and therefore require a multidisciplinary approach. The final treatment plan is often an accumulation of organ-specific treatment and chronic pain medications directed to the CNS and PNS. This article is a review of commonly used medications for chronic pelvic neuropathic pain disorders as well as an introduction to recent innovative developments in pain medicine. PMID:28116131

  9. 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.

  10. 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.

  11. Augmentation mastopexy using adjustable implants with external injection domes.

    PubMed

    Becker, Hilton; Hartog, Jeffrey

    2006-01-01

    For augmentation mastopexy, the authors use adjustable implants that are deflated at the end of the procedure and then inflated to the desired size 5 to 10 days postoperatively using external injection domes. Reported advantages, based on 175 cases, include increased perioperative safety for the nipple areolar complex, the ability to adjust for size and symmetry postoperatively with patient input, and better scar healing with less widening.

  12. 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

  13. Pelvic congestion syndrome masquerading as osteoarthritis of the hip

    PubMed Central

    Dos Santos, Scott J; Whiteley, Mark S

    2016-01-01

    Objectives: Pelvic congestion syndrome (PCS) is associated with pelvic vein reflux (PVR), occasionally secondary to venous compression. Its symptoms, usually intra-pelvic, are alleviated following the abolition of this reflux by pelvic vein embolisation (PVE). The objective of this report is to present two cases of left hip pain, erroneously diagnosed as osteoarthritis, which disappeared after successful PVE and abolition of PVR. Methods: Two females presented with lower limb varicose veins, and also had a history of left-sided hip pain. Both had previously been investigated for the hip pain and diagnosed as osteoarthritis despite minimal arthritic changes on pelvic X-rays. During investigation for lower limb varicose veins, both showed a pelvic origin for their leg veins and hence underwent transvaginal duplex ultrasound. This revealed PVR, and PVE was planned in both patients. Results: Both patients underwent PVE and reported ‘miraculous’ resolution of left hip pain and also PCS symptoms including pelvic pain, irritable bowel issues and the disappearance of pelvic dragging, with almost immediate disappearance of vulval and vaginal varicosities. One patient also noted reduced clitoral sensitivity. Conclusion: Manifestations of PCS may vary in terms of intra- or extra-pelvic signs. PCS and PVR should be considered in the differential diagnosis of patients with arthritic symptoms in the hip without evident radiographic evidence. PMID:27994874

  14. 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.

  15. Pelvic artery embolization in the management of pelvic arterial bleeding following midurethral sling surgery for stress urinary incontinence

    PubMed Central

    Cho, Eun-Ji; Kim, Jun-Bum; Park, So-Yun; Kim, Sung-Hoon; Kim, Chung-Hoon; Kang, Byung-Moon

    2016-01-01

    The transobturator tape (TOT) method is the recent minimally invasive midurethral sling surgery. The TOT method was invented to reduce complication rate of surgical technique for female stress urinary incontinence. Pelvic bleeding following TOT procedure, although extremely rare, could be occurred. We presented three cases which treat pelvic arterial bleeding after midurethral sling (TOT and tension-free vaginal tape Secur) surgery via pelvic artery embolization. Therefore we report our cases with brief review of the literature. PMID:27004210

  16. Post-operative urinary retention.

    PubMed

    Steggall, Martin; Treacy, Colm; Jones, Mark

    Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.

  17. SPONTANEOUS RESOLUTION OF PSEUDOANEURYSM OF AN ILIAC ARTERY BRANCH IN A MULTIPLE TRAUMA PATIENT WITH PELVIC FRACTURE: CLINICAL CASE

    PubMed Central

    Sousa, Cristina Maria Varino; Silva, Luís Filipe Pires; Rodrigues, Maria Elisa; Félix, António; Alpoim, Bruno; Marques, Pedro; Oliveira, Joana Alexandra Gonçalves; Alves, Carlos; Costa, Maieiro; Rodrigues, António

    2015-01-01

    In patients who have been the victims of high-energy trauma, severe pelvic injury should always be suspected. Most of these fractures are stable and respond well to conservative treatment. Pelvic fractures constitute 3% of all skeletal fractures and are associated with high-energy trauma. They are potentially serious injuries with significant mortality and large numbers of associated lesions. There are fundamentally three sources of bleeding in pelvic fractures: arterial, venous and through the bone ends of the fracture. Arterial bleeding is more associated with hemodynamic instability. In such cases, both early external fixation of the pelvic fracture and angiography with selective embolization of the bleeding vessels are effective methods for achieving hemostasis. Aneurysms of iliac artery branches are rare and are mostly pseudoaneurysm relating to the traumatic event. The natural history of pseudoaneurysms is unknown because of their rarity, but if they rupture, the mortality rate is high. We report a case of spontaneous thrombosis of a pseudoaneurysm of a branch of the right iliac artery. PMID:27026992

  18. [Endovascular treatment of persistent dysuria and chronic pelvic pain in women with pelvic varicose veins].

    PubMed

    Neĭmark, A I; Shelkovnikova, N V

    2012-01-01

    The results of the examination and treatment of 16 patients aged from 26 to 46 years with persistent urinary disorders and chronic pelvic pain due to severe pelvic varicose veins are presented. Using ultrasound with color Doppler mapping and venography of renal and ovarian vein for evaluation of condition of the venous system of the pelvis, the significant dilation of the internal iliac, ovarian and uterine veins with a pronounced decrease in blood flow in veins up to the stasis of blood, accompanied by flow turbulence and powerful backflow of renal blood through ovarian veins were found in all patients. According to uroflowmetry, there was a decrease in detrusor tone and a violation of evacuation capacity of the bladder. Evaluation of microcirculation using LDF allowed to diagnose congestive hemodynamic type of microcirculation. Scleroembolization for varicose ovarian vein with Gianturco coil and ethoxysclerol was performed in all patients. Positive therapeutic effect in the form of eliminating varicose pelvic veins, pain relieve, disappearance of persistent dysuria, and the remission of chronic cystitis was achieved in 86% of women. This intervention provided the normal outflow of blood from the pelvic veins, contributed to the normalization of uroflowmetry data and restoration of normal microcirculation in the urinary bladder.

  19. 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.

  20. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results

    PubMed Central

    Chopra, Sameer; Satkunasivam, Raj; Aron, Monish

    2016-01-01

    Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127–259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score – 14 (1–19); Sexual Health Inventory for Men – 6 (−14–22); and NIH-CPSI total – 23.5 (13–33). Median length of follow-up (range) was 34 (24–43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively. PMID:27555685

  1. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results.

    PubMed

    Chopra, Sameer; Satkunasivam, Raj; Aron, Monish

    2016-01-01

    Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127-259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score - 14 (1-19); Sexual Health Inventory for Men - 6 (-14-22); and NIH-CPSI total - 23.5 (13-33). Median length of follow-up (range) was 34 (24-43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  2. [Active alveolar expansion for prevention of postoperative atelectasis. Functional and clinical effectiveness].

    PubMed

    Adolf, J; Dickmann, A

    1985-12-13

    In a prospective study, the functional and clinical effectiveness of active alveolar expansion was tested by means of an incentive spirometer on 30 patients each of a treatment and control group. All patients (average age 61 and 58 years, respectively) had undergone a transabdominal pelvic artery reconstruction. Pre-operatively active alveolar expansion significantly reduced intrapulmonary right to left shunting from 11.1% to 4.2% of cardiac output (P less than 0.01). Correspondingly, right to left shunting on the second to fifth postoperative day was reduced significantly (P less than 0.05) by 5-10% of cardiac output in the treatment group, cardiac output being significantly (P less than 0.05) reduced by 1 l/min average. Clinically and radiologically there was a definite reduction in pulmonary complications from 40% to 13%. Peri-operatively performed active alveolar expansion is thus an effective method for the reduction of postoperative functional atelectasis and pulmonary complications.

  3. 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

  4. Intraovarian oxidized cellulose (Surgicel) mimicking acute ovarian pathology after recent pelvic surgery

    PubMed Central

    Zhang, Feng; Bonidie, Michael J.; Ventrelli, Stephen M.; Furlan, Alessandro

    2015-01-01

    Oxidized regenerated cellulose (Ethicon Surgicel) is often used during surgery to achieve hemostasis. The appearance of Surgicel on postoperative computed tomography (CT) may be mistaken for abscess. Meanwhile, the literature regarding its ultrasound appearance remains scant. We report the CT and sonographic appearances of Surgicel in the right ovary of a 21-year-old woman presenting to the emergency department with pelvic pain 7 days after ovarian cystectomy. The patient was discharged home with only supportive measures, and follow-up ultrasound obtained 26 days later demonstrated resolution of the sonographic abnormality. This case stresses the importance of familiarity with common imaging appearances of topical hemostatic agents and the need to correlate radiologic findings with the patient's clinical condition and prior operative reports to identify patients suitable for conservative management. PMID:26649116

  5. Intraovarian oxidized cellulose (Surgicel) mimicking acute ovarian pathology after recent pelvic surgery.

    PubMed

    Zhang, Feng; Bonidie, Michael J; Ventrelli, Stephen M; Furlan, Alessandro

    2015-12-01

    Oxidized regenerated cellulose (Ethicon Surgicel) is often used during surgery to achieve hemostasis. The appearance of Surgicel on postoperative computed tomography (CT) may be mistaken for abscess. Meanwhile, the literature regarding its ultrasound appearance remains scant. We report the CT and sonographic appearances of Surgicel in the right ovary of a 21-year-old woman presenting to the emergency department with pelvic pain 7 days after ovarian cystectomy. The patient was discharged home with only supportive measures, and follow-up ultrasound obtained 26 days later demonstrated resolution of the sonographic abnormality. This case stresses the importance of familiarity with common imaging appearances of topical hemostatic agents and the need to correlate radiologic findings with the patient's clinical condition and prior operative reports to identify patients suitable for conservative management.

  6. 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.

  7. ACUTE PELVIC PAIN IN THE ADOLESCENT: A CASE REPORT

    PubMed Central

    Samuels-Kalow, M.; Mollen, C.

    2015-01-01

    Diagnosis and treatment of acute pelvic pain in the adolescent female requires differentiating among a broad differential diagnosis that includes potentially serious illness across several organ systems. The case presented provides an illustration of the assessment and management of acute pelvic pain, and key teaching points about important potential causes. PMID:26273230

  8. Pathologic Malgaigne fracture following pelvic irradiation. A case report

    SciTech Connect

    Jones, A.R.; Lachiewicz, P.F.

    1987-08-01

    A 48-year-old woman developed symptomatic superior and inferior pubic rami fractures with a concomitant subluxation of the ipsilateral sacroiliac joint three years after pelvic irradiation for a gynecologic malignancy. Pathologic pelvic fractures (PPF) caused by irradiation may be difficult to distinguish from those caused by metastatic disease. PPF produce prolonged disability.

  9. "How-To" Guide to Pelvic Floor Muscle Dysfunction.

    PubMed

    Albrecht, Katie B

    2015-09-01

    The purpose of this paper is to assist the clinician in recognizing pelvic floor muscle dysfunction in women with vulvar symptoms, to provide general treatment algorithms, and to facilitate understanding of the scientific rationale behind appropriate treatment. In short, this paper is meant to provide a "how-to" guide to pelvic floor pain management for the Ob/Gyn.

  10. Fully automated localization of multiple pelvic bone structures on MRI.

    PubMed

    Onal, Sinan; Lai-Yuen, Susana; Bao, Paul; Weitzenfeld, Alfredo; Hart, Stuart

    2014-01-01

    In this paper, we present a fully automated localization method for multiple pelvic bone structures on magnetic resonance images (MRI). Pelvic bone structures are currently identified manually on MRI to identify reference points for measurement and evaluation of pelvic organ prolapse (POP). Given that this is a time-consuming and subjective procedure, there is a need to localize pelvic bone structures without any user interaction. However, bone structures are not easily differentiable from soft tissue on MRI as their pixel intensities tend to be very similar. In this research, we present a model that automatically identifies the bounding boxes of the bone structures on MRI using support vector machines (SVM) based classification and non-linear regression model that captures global and local information. Based on the relative locations of pelvic bones and organs, and local information such as texture features, the model identifies the location of the pelvic bone structures by establishing the association between their locations. Results show that the proposed method is able to locate the bone structures of interest accurately. The pubic bone, sacral promontory, and coccyx were correctly detected (DSI > 0.75) in 92%, 90%, and 88% of the testing images. This research aims to enable accurate, consistent and fully automated identification of pelvic bone structures on MRI to facilitate and improve the diagnosis of female pelvic organ prolapse.

  11. Clinical Outcomes and Urodynamic Effects of Tailored Transvaginal Mesh Surgery for Pelvic Organ Prolapse

    PubMed Central

    Chang, Ting-Chen; Hsiao, Sheng-Mou; Chen, Chi-Hau; Wu, Wen-Yih; Lin, Ho-Hsiung

    2015-01-01

    Objective. To evaluate the clinical outcomes and urodynamic effects of tailored anterior transvaginal mesh surgery (ATVM) and tailored posterior transvaginal mesh surgery (PTVM). Methods. We developed ATVM for the simultaneous correction of cystocele and stress urinary incontinence and PTVM for the simultaneous correction of enterocoele, uterine prolapse, vaginal stump prolapse, and rectocele. Results. A total of 104 women enrolled. The median postsurgical follow-up was 25.5 months. The anatomic cure rate was 98.1% (102/104). Fifty-eight patients underwent urodynamic studies before and after surgeries. The pad weight decreased from 29.3 ± 43.1 to 6.4 ± 20.9 g at 3 months. Among the 20 patients with ATVM, 13 patients had objective stress urinary incontinence (SUI) at baseline while 8 patients came to have no demonstrated SUI (NDSUI), and 2 improved after surgery. Among the 38 patients who underwent ATVM and PTVM, 24 had objective SUI at baseline while 18 came to have NDSUI, and 2 improved after surgery. Mesh extrusion (n = 4), vaginal hematoma (n = 3), and voiding difficulty (n = 2) were noted postoperatively. Quality of life was substantially improved. Conclusions. Our findings document the advantages of these two novel pelvic reconstructive surgeries for pelvic organ prolapse, which had a positive impact on quality of life. ATVM surgery additionally provided an anti-incontinence effect. This clinical trial is registered at ClinicalTrials.gov (NCT02178735). PMID:26634203

  12. Immediate and perioperative outcomes of polypropylene mesh in pelvic floor repair in a predominantly obese population.

    PubMed

    Adedipe, T O; Vine, S J

    2010-01-01

    This retrospective study was to identify perioperative and postoperative complications associated with use of polypropylene mesh for pelvic floor repair in a UK district general hospital in a predominantly obese population. The sample size was 27 women with data retrieved from records. Total mesh was used in 37.1%, isolated anterior mesh in 44.4%, and an isolated posterior mesh in 18.5%. There was a high incidence of obese (BMI kg/m2 > or = 30.0) women (66.67%). The highest recorded thus far. A high proportion of the women (44.4%) were also over the age of 65 years with attendant comorbidities. The age range was 45-77 years. Complications included mesh exposure (7.4%), catheterization at discharge (7.4%), bladder injury during dissection (3.7%) and recurrent prolapse (7.4%). In the carefully selected individuals, polypropylene mesh for prolapse repair appears to be a safe technique to correct pelvic organ prolapse. However, long-term follow-up is needed with further research.

  13. The External Degree.

    ERIC Educational Resources Information Center

    Houle, Cyril O.

    This book examines the external degree in relation to the extremes of attitudes, myths, and data. Emphasis is placed on the emergence of the American external degree, foreign external-degree programs, the purpose of the external degree, the current scene, institutional issues, and problems of general policy. (MJM)

  14. Comparison of Clinical Outcomes Using “Elevate Anterior” versus “Perigee” System Devices for the Treatment of Pelvic Organ Prolapse

    PubMed Central

    Wu, Ming-Ping; Wu, Chin-Hu; Lin, Kun-Ling; Tsai, Eing-Mei; Shen, Ching-Ju

    2015-01-01

    Objective. This study aims to compare clinical outcomes using the Perigee versus Elevate anterior devices for the treatment of pelvic organ prolapse (POP). Study Design. One hundred and forty-one women with POP stages II to IV were scheduled for either Perigee (n = 91) or Elevate anterior device (n = 50). Preoperative and postoperative assessments included pelvic examination, urodynamic study, and a personal interview about quality of life and urinary symptoms. Results. Despite postoperative point C of Elevate group being significantly deeper than the Perigee group (median: −7.5 versus −6; P < 0.01), the 1-year success rates for two groups were comparable (P > 0.05). Apart from urgency incontinence, women with advanced POP experienced significant resolution of irritating and obstructive symptoms after both procedures (P < 0.05), generating the improvement in postoperative scores of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) (P < 0.01). On urodynamics, only the residual urine decreased significantly following these two procedures (P < 0.05). Women undergoing Perigee mesh experienced significantly higher visual analogue scale (VAS) scores and vaginal extrusion rates compared with the Elevate anterior procedure (P < 0.05). Conclusions. With comparable success rates, the Elevate procedure has advantages over the Perigee surgery with lower extrusion rate and postoperative day 1 VAS scores. PMID:25893193

  15. Surgical resolution of obstructive dyspareunia after traumatic pelvic injury.

    PubMed

    Lee, Yoon Kyung; Kim, Su Mi; Jeung, In Cheul; Park, Eun Kyung; Kim, Weon Yoo; Lee, Yong Seok

    2015-01-01

    As more of the patients with traumatic pelvic injuries survive, they desire an optimal quality of life, including normal sexual function, even after the most severe injuries. We present the case of a 31-year-old woman who had dyspareunia due to impaired vaginal penetration after severe pelvic injury. After excision of a disunited fragment of pelvic bone and an adhesion band at the vaginal wall, dyspareunia was considerably resolved and the patient resumed sexual function. In cases of severe pelvic injury, physicians used to be satisfied with the patient's survival alone, and tended to regard sexual dysfunction as a trivial outcome. However, restoration of sexual function is an important part of management of these patients. In selected cases, obstructive dyspareunia resulting from traumatic pelvic injury can be managed by planned surgical intervention.

  16. 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

  17. Ultrasound guided transrectal catheter drainage of pelvic collections.

    PubMed

    Thakral, Anuj; Sundareyan, Ramaniwas; Kumar, Sheo; Arora, Divya

    2015-01-01

    The transrectal approach to draining deep-seated pelvic collections may be used to drain The transrectal approach to draining deep-seated pelvic collections may be used to drain intra-abdominal collections not reached by the transabdominal approach. We discuss 6 patients with such pelvic collections treated with transrectal drainage using catheter placement via Seldinger technique. Transrectal drainage helped achieve clinical and radiological resolution of pelvic collections in 6 and 5 of 6 cases, respectively. It simultaneously helped avoid injury to intervening bowel loops and neurovascular structures using real-time visualization of armamentarium used for drainage. Radiation exposure from fluoroscopic/CT guidance was avoided. Morbidity and costs incurred in surgical exploration were reduced using this much less invasive ultrasound guided transrectal catheter drainage of deep-seated pelvic collections.

  18. Inguinal polypropylene plug: a cause of unusual testicular tumor pelvic metastasis.

    PubMed

    Grasso, Marco; Blanco, Salvatore; Grasso, Angelica Anna Chiara; Nespoli, Luca

    2013-04-19

    We report the case of a patient who had undergone polypropylene plug placement 3 years before and referred to our institution with testicular tumor. CT scan demonstrated an enlargement of pelvic lymph nodes on the tumor side while retroperitoneal nodes were normal. Orchifunicolectomy was performed and histopathological examination showed a mixed germ cell tumor involving the tunica vaginalis, rete testis, epididymis and spermatic cord. After surgery the patient was addressed to adjuvant chemotherapy according to PEB scheme. Clinical re-staging showed a decrease of the pelvic bulk disease whereas retroperitoneal nodes were still normal and tumor markers were negative. Left external, internal and common iliac lymphadenectomy as well as left modified template nervesparing retroperitoneal lymph node dissection was performed. Intraoperatively the node bulk was firmly adherent to the external iliac artery and extended until the common iliac bifurcation. In the deeper part of this enlarged and firm lymphatic chain the polypropylene plug placed at the time of hernioplasty was found. Behind the plug all retroperitoneal nodes appeared normal and resulted negative on histopathologic examination. The patient had an unusual metastatization, probably due to the plug.

  19. The arterial supply of the pelvic limb of the adult ostrich (Struthio camelus).

    PubMed

    el-Nahla, S M; el-Mahdy, T; Abbott, L C; Hassan, S A M

    2010-08-01

    Blood to the pelvic limb of the ostrich is provided by the external iliac and ischiatic arteries that arise from the descending aorta. The external iliac artery (a.) gave rise to the pubic a. that supplied the obturator muscles and continued as the femoral a. The femoral a. gave off three branches: (1) cranial coxal a. to muscles above the pre-acetabular ilium; (2) cranial femoral a. to muscles cranial to the femur, the gastrocnemius muscle, hip and stifle joints and (3) medial femoral a. to muscles caudal and medial to the femur. The ischiatic a. gave rise to the caudal coxal a. that supplied muscles caudal to the femur, muscular branches to the iliotibialis lateralis muscle and to the deep femoral a. that supplied the iliofibularis muscle, cutanea femoralis caudalis and lateralis aa., and branches to the flexors of the leg and knee joint, then terminated as the sural and popliteal arteries. The sural a. supplied most of the flexors of the foot. The popliteal a. supplied the knee joint and flexors of the leg, and then terminated as the cranial and caudal tibial arteries. The caudal tibial a. supplied flexors of the foot. The cranial tibial a. provided four branches to the knee and ankle joints and to the leg. The cranial tibial a. continued into the foot as the common dorsal metatarsal a., which gave off seven different branches to the ankle and foot. With few exceptions, the arteries of the ostrich pelvic limb are similar to those of domestic fowl.

  20. Pelvic pain from a giant presacral Tarlov cyst successfully obliterated using aneurysm clips in a patient with Marfan syndrome.

    PubMed

    Wang, Bonnie; Moon, Seong-Jin; Olivero, William C; Wang, Huan

    2014-11-01

    Patients with Marfan syndrome used to succumb early in life from cardiovascular complications. With the current rapid advance in medical and surgical care, such patients may now have near-normal longevities. Consequently, rare late-life complications are emerging in these patients and represent challenges to clinicians for their diagnoses and treatments. The authors report a rare case of pelvic pain and genital prolapse from a giant presacral Tarlov cyst in a 67-year-old patient with Marfan syndrome. This 67-year-old Caucasian female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a nontender, cyst-like mass fixed in the midline. She underwent ultrasound, CT, and eventually MRI evaluations that led to the diagnosis of a giant (6.7 × 6.4 × 6.6 cm) Tarlov cyst originating from the right S-2 nerve root sleeve/sacral foramen with intrapelvic extension. She underwent S1-S2 and S2-S3 laminectomy with obliteration of the Tarlov cyst using aneurysm clips. Postoperatively, her pelvic pain and bowel symptoms resolved and the bladder symptoms improved. The 3-month follow-up CT of abdomen/pelvis demonstrated resolution of the cyst. The present case illustrates that clinicians caring for elderly patients with Marfan syndrome need to increasingly recognize such unusual late-life complications. Also, these large Tarlov cysts can be simply and effectively obliterated with aneurysm clips.

  1. 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

  2. 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.

  3. Morphological And Molecular Analyses of an Anatomical Novelty: The Pelvic Fin Filaments of the South American Lungfish.

    PubMed

    Lima, Sergio Q; Costa, Carinne M; Amemiya, Chris T; Schneider, Igor

    2017-01-01

    The pelvic fins of male South American lungfish, Lepidosiren paradoxa, are adorned with a distinctive array of filaments, which grow and become highly vascularized during the breeding season. The resemblance between these pelvic fin filaments (PFFs) and external gills of other vertebrates suggested that this gill-like structure was used for physiological gas exchange. It has been proposed that the unique pelvic fin of male L. paradoxa is used for release of oxygen from its blood into the environment in order to aerate its nesting brood, or, conversely, as an auxiliary respiratory organ by absorbing oxygen from the environment into its bloodstream. Here, we employed histology, scanning electron microscopy (SEM) and quantitative PCR (qPCR) to assess whether the morphology and molecular profile of PFFs are compatible with a role in gas exchange. First, we closely examined its external morphology and showed that PFFs develop from short papillae during the rainy season, but remain covered by a thick nonvascularized epithelium. Histological examination confirmed that capillaries within the filaments are separated from the exterior by a basement membrane and a stratified epithelium composed of four to five cell layers. In addition, SEM analysis revealed significant differences between the fin filament epithelium and typical gill epithelium. Finally, our qPCR results showed that five genes commonly expressed in gills were downregulated in PFFs relative to their expression in regular pectoral fin epidermis. Collectively, our results do not directly support a role for PFFs, commonly referred to as "limb gills", in oxygen release or uptake.

  4. Functional anatomy of the female pelvic floor.

    PubMed

    Ashton-Miller, James A; DeLancey, John O L

    2007-04-01

    The anatomic structures in the female that prevent incontinence and genital organ prolapse on increases in abdominal pressure during daily activities include sphincteric and supportive systems. In the urethra, the action of the vesical neck and urethral sphincteric mechanisms maintains urethral closure pressure above bladder pressure. Decreases in the number of striated muscle fibers of the sphincter occur with age and parity. A supportive hammock under the urethra and vesical neck provides a firm backstop against which the urethra is compressed during increases in abdominal pressure to maintain urethral closure pressures above the rapidly increasing bladder pressure. This supporting layer consists of the anterior vaginal wall and the connective tissue that attaches it to the pelvic bones through the pubovaginal portion of the levator ani muscle, and the uterosacral and cardinal ligaments comprising the tendinous arch of the pelvic fascia. At rest the levator ani maintains closure of the urogenital hiatus. They are additionally recruited to maintain hiatal closure in the face of inertial loads related to visceral accelerations as well as abdominal pressurization in daily activities involving recruitment of the abdominal wall musculature and diaphragm. Vaginal birth is associated with an increased risk of levator ani defects, as well as genital organ prolapse and urinary incontinence. Computer models indicate that vaginal birth places the levator ani under tissue stretch ratios of up to 3.3 and the pudendal nerve under strains of up to 33%, respectively. Research is needed to better identify the pathomechanics of these conditions.

  5. 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

  6. Chronic Pelvic Pain in Endometriosis: An Overview

    PubMed Central

    Triolo, Onofrio; Laganà, Antonio Simone; Sturlese, Emanuele

    2013-01-01

    Chronic pelvic pain (CPP) could be considered nowadays a deep health problem that challenges physicians all over the world. This because its aetiology is still unclear, the course of the disease could vary a lot among different patients and through time in the same patient, and the response to treatments is not every time successful. Among women who underwent laparoscopy for CPP, endometriosis is found in about 1/3 of the cases, while only 25% of women with histological confirmed endometriosis are asymptomatic. A wide range of variables may exert their influence on the resulting pain syndrome in endometriosis; for example, score according to American society for reproductive medicine (rASRM), size of the sub-peritoneal and pelvic wall implants, Douglas obliteration, previous surgery. It is widely accepted nowadays that central nervous system (CNS) and peripheral nervous system (PNS) seems to influence each other and this interconnection play a key role in pain modulation. Moreover, the phenomena induced by endometriosis in the pelvis, including the breakdown of peritoneal homeostasis and the induction of the production of proinflammatory and proangiogenic cytokines, are responsible of altered innervations and modulation of pain pathways in these patients. There are many proposed medical and surgical approach to treat this painful syndrome, although there is necessity of more efforts to create new non-invasive strategies that set a more accurate diagnosis of the causes of endometriotic-related CPP, and therefore facilitate its eradication. PMID:23671540

  7. [Pelvic type of chronic recurrent multifocal osteomyelitis].

    PubMed

    Schilling, F; Coerdt, W; Eckardt, A; Full, H; Hospach, T; Kessler, S; Köcher, M; Kreitner, K F

    2001-01-01

    We report about the juvenile and adolescent pelvic type of CRMO in 7 girls and 4 boys. The results show from solitary up to 7 pelvic lesions (average 3 lesions) predominantly in the acetabular and paraacetabular region (sometimes with hip joint effusion as a sign for concomitant coxitis).Tc99m-bone-scan is helpful to evaluate exactly the pattern of bone affection. We find 3 stages of an primarily chronic, non-purulent osteomyelitis going along with a "plasma-cell-sclerotic process", leading to a Garrè-type sclerosing end-stage, which probably heals after some years spontaneously, projecting on clinical symptoms and radiological appearance. The concomitant coxitis ("sympathetic coxitis") is clinically often in the foreground, but reversible. Pain in case of CRMO responds surprisingly well on medication with acithromycine. Knowing about CRMO in its different clinical appearances - especially concerning what we call "sympathetic coxitis" - can be a useful for pediatric rheumatologists and orthopedic surgeons, as well as MRI-focused radiologists and pathologists. Therapy might find a useful drug in acithromycine. In conclusion we d like to point out, that CRMO is one entity under the "roof" of the so called SAPHO-syndrome, which again shows us, that SAPHO-syndrome ist not a diagnosis itself but more a sign-post on the way to a correct diagnosis.

  8. 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

  9. Gluteal Compartment Syndrome Secondary to Pelvic Trauma

    PubMed Central

    Taype Zamboni, Danilo E. R.; Carabelli, Guido S.; Barla, Jorge D.; Sancineto, Carlos F.

    2016-01-01

    Gluteal compartment syndrome (GCS) is extremely rare when compared to compartment syndrome in other anatomical regions, such as the forearm or the lower leg. It usually occurs in drug users following prolonged immobilization due to loss of consciousness. Another possible cause is trauma, which is rare and has only few reports in the literature. Physical examination may show tense and swollen buttocks and severe pain caused by passive range of motion. We present the case of a 70-year-old man who developed GCS after prolonged anterior-posterior pelvis compression. The physical examination revealed swelling, scrotal hematoma, and left ankle extension weakness. An unstable pelvic ring injury was diagnosed and the patient was taken to surgery. Measurement of the intracompartmental pressure was measured in the operating room, thereby confirming the diagnosis. Emergent fasciotomy was performed to decompress the three affected compartments. Trauma surgeons must be aware of the possibility of gluteal compartment syndrome in patients who have an acute pelvic trauma with buttock swelling and excessive pain of the gluteal region. Any delay in diagnosis or treatment can be devastating, causing permanent disability, irreversible loss of gluteal muscles, sciatic nerve palsy, kidney failure, or even death. PMID:27579205

  10. 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.

  11. Vertical displacement of the symphysis pubis in unilateral open book pelvic injury.

    PubMed

    Ebraheim, N A; Mekhail, A O; Checroun, A J; Georgiadis, G M

    1997-07-01

    Nineteen cases of external rotation (open book) injury of the pelvis were studies retrospectively. An apparent vertical displacement of the hemipelvis was detected on anteroposterior radiographic views in association with the separation of the symphysis pubis and opening of the sacroiliac joint. This could be confused with a vertically unstable situation; however, careful examination of the radiographs revealed that the public bone on the side of injury was displaced inferiorly. The articular portion of the corresponding sacroiliac joint on computed tomography was opened anteriorly, and the hemipelvis on the same side was externally rotated in all cases (indicating that the posterior sacroiliac ligaments were intact). An anatomic study was then performed on 10 cadaveric pelves. The symphysis pubis and the anterior sacroiliac ligament on one side were sharply disrupted, and the pelvis was gradually externally rotated. The pubic bone on the side of the sacroiliac disruption displaced inferiorly as the external rotation progressed. It is important to differentiate between the inferiorly displaced pubic bone on the side of injury in cases of external rotation injury and the superiorly displaced pubic bone on the side of injury in cases of vertically unstable pelvic injuries. This may eliminate unnecessary procedures such as skeletal traction or pinning of the sacroiliac joint.

  12. Postoperative singultus: an osteopathic approach.

    PubMed

    Petree, Kristie; Bruner, Jonathan

    2015-03-01

    Singultus, or hiccups, is a common medical condition. Despite exponential leaps in medicine, the pathophysiologic cause remains poorly defined. Persistent singultus has been associated with conditions such as pulmonary embolism and myocardial infarction. Singultus is also a well-known postoperative complication. The criterion standard of care for patients with singultus involves ruling out lethal pathologic causes, attempting physical stimulation with Valsava maneuvers or drinking water, and, if no relief has been achieved, administering drugs to ease the symptoms. The authors report a case of a man whose postoperative singultus was successfully managed with osteopathic manipulative treatment. This approach addresses many of the possible underlying neuromechanical causes of the aberrant reflex with minimal potential for adverse effects. Physicians should consider osteopathic manipulative treatment in the care of patients with singultus.

  13. The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones.

    PubMed

    Tefekli, Ahmet; Tepeler, Abdulkadir; Akman, Tolga; Akçay, Muzaffer; Baykal, Murat; Karadağ, Mert Ali; Muslumanoglu, Ahmet Y; de la Rosette, Jean

    2012-10-01

    The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large (>4 cm(2)) renal pelvic stones were treated by LPL and their charts were compared to 26 match-paired patients treated with PNL during the same period. The patients were matched for age, BMI, stone size and location as well as presence of congenital anomalies. Perioperative and postoperative findings were compared. The mean age, mean stone size, rate of congenital anomalies, history open renal surgery and shock wave lithotripsy were similar in both groups (p > 0.05). The mean operation time was 138.40 ± 51.19 (range 70-240) min in LPL group as compared to 57.92 ± 21.12 (range 40-110) min in PNL group (p < 0.0001). There was one (3.8%) open conversion in the LPL group due to dense perirenal adhesions making the dissection difficult. The ureteropelvic junction (UPJ) obstruction concomitant to pelvic stones was successfully repaired laparoscopically in two cases. The mean drop in postoperative hemoglobin level was 0.9 ± 0.6 (range 0-2) g/dl in LPL group and 1.7 ± 1.1 (range 0-4) g/dl in PNL group (p = 0.024). Hospitalization was significantly shorter in PNL than LPL group (p = 0.0001). Stone-free rates were similar. Laparoscopic pyelolithotomy is associated with a longer operation time, is more invasive, and requires more skills when compared to PNL. However, LPL is associated with less blood loss. Laparoscopic pyelolithotomy is indicated for congenitally anomalous kidneys and especially in patients with concomitant UPJ.

  14. 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

  15. Postoperative pain assessment after septorhinoplasty.

    PubMed

    Wittekindt, D; Wittekindt, C; Schneider, G; Meissner, W; Guntinas-Lichius, O

    2012-06-01

    Postoperative pain after septorhinoplasty and its optimal management has not been described in detail. Fifty-two adult septorhinoplasty patients were included in a prospective cohort single center study. Patients' and surgical characteristics were evaluated. Outcome and process parameters were analyzed using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Management (QUIPS) on the first postoperative day. Pain during the first operative day after septorhinoplasty was moderate. Pain management predominately consisted of remifentanil intraoperatively, metamizole in the recovery room, in combination with piritramide in one-third of the patients, and metamizole on ward. Patients younger than 31 years were less satisfied with pain management (P = 0.018). Open rhinoplasty was associated with less satisfaction with pain management (P = 0.007). Use of rib grafts led to more mobility, breathing, sleeping and mood disturbances (P = 0.003, 0.047; 0.047; 0.022, respectively). Preoperative pain counseling was followed by higher satisfaction, less breathing and mood disturbances after surgery (P = 0.021; 0.004; 0.046, respectively). Opioids in the recovery room in addition to non-opioids and treatment with non-opioids on ward led to less maximal pain (P = 0.027 and 0.040, respectively). We conclude that QUIPS is an easy tool to evaluate the quality of postoperative pain management following rhinoplasty. Preoperative pain counseling, specific care for patients with rib grafts, consequent use of opioids in the recovery room in addition to non-opioids, and use of non-opioids on ward seem to be effective to improve pain management after septorhinoplasty.

  16. Effect of an Exercise Protocol on Pelvic Muscle Resting Pressure in Healthy Adult Women.

    DTIC Science & Technology

    1992-01-01

    Anatomy and Physiology............. 7 Causes of Pelvic Muscle Dysfunction .............. 9 Pelvic Muscle Assessment Methods................. 12...muscle dysfunction , (c) pelvic muscle assessment methods, (d) exercise and the pelvic muscles, (e) principles of exercise training, and (f) application of...extends from the pubic bone to the coccyx, with gaps for the passage of the urethra, vagina, and anus. The iliococcygeus originates from a fascial

  17. Postoperative (pressure) alopecia following sacrocolpopexy.

    PubMed

    Bagaria, Madhu; Luck, Ali Maria

    2015-06-01

    Postoperative alopecia is a rare occurrence seen after a variety of surgical procedures performed under general anesthesia. The speculated cause is pressure-induced ischemia due to prolonged head immobilization. This case describes a patient who developed this complication after undergoing sacrocolpopexy. A 57-year-old postmenopausal Caucasian female was consented to undergo a robotic-assisted sacrocolpopexy, perineoplasty, and midurethral sling with possible conversion to an open procedure. The indication was symptomatic proximal and distal rectocele with foreshortened vagina. It was converted to laparotomy due to difficult presacral dissection. Her total operative time was 540 with 240 min in the Trendelenburg position. No intraoperative hypotension or excessive blood loss was noted. She started complaining of scalp pain in the postoperative recovery area. She developed soreness, crusting, and later alopecia in the same area. It was noted at her 3-week office visit. Referral was made for dermatology and anesthesiology evaluation. There was spontaneous full recovery by the 5th month. Postoperative alopecia is a rare condition mimicking alopecia areata but it is preceded by inciting events. There is some evidence to suggest that it is a preventable condition by frequent head repositioning during surgery. This case report is intended to increase the surgeon's awareness about this rare complication as its occurrence can be distressing for the patient.

  18. MR imaging in deep pelvic endometriosis: a pictorial essay.

    PubMed

    Coutinho, Antônio; Bittencourt, Leonardo Kayat; Pires, Cíntia E; Junqueira, Flávia; Lima, Cláudio Márcio Amaral de Oliveira; Coutinho, Elisa; Domingues, Marisa A; Domingues, Romeu C; Marchiori, Edson

    2011-01-01

    Deep pelvic endometriosis is an important gynecologic disorder that is responsible for severe pelvic pain and is defined as subperitoneal invasion that exceeds 5 mm in depth. Deep pelvic endometriosis can affect the retrocervical region, uterosacral ligaments, rectum, rectovaginal septum, vagina, urinary tract, and other extraperitoneal pelvic sites. It is commonly associated with dysmenorrhea, dyspareunia, pelvic pain, urinary tract symptoms, and infertility. Because surgery remains the best therapeutic option for affected patients, the accurate preoperative assessment of the extension of endometriotic disease is extremely important. Pelvic magnetic resonance (MR) imaging is a noninvasive method with high spatial resolution that allows multiplanar evaluation of deep pelvic endometriosis and good tissue characterization, but without the use of ionizing radiation or iodinated contrast agents. MR imaging yields important findings that help grade the disease and identify subperitoneal lesion extension and other associated disease entities, thereby facilitating accurate diagnosis and adequate treatment. Radiologists should be familiar with the MR imaging findings of deep infiltrating endometriosis in various anatomic locations so that they can provide information that allows adequate presurgical counseling.

  19. Treatment of symptomatic pelvic varices by ovarian vein embolization

    SciTech Connect

    Capasso, Patrizio; Simons, Christine; Trotteur, Genevieve; Dondelinger, Robert F.; Henroteaux, Denis; Gaspard, Ulysse

    1997-03-15

    Purpose. Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of lower abdominal pain in patients presenting with pelvic varicosities. Methods. Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments and 5 treated recurrences (a total of 30 procedures). All embolizations were performed with either enbucrilate and/or macrocoils, and there was an average clinical and Doppler duplex follow-up of 15.4 months. Results. The initial technical success rate was 96.7%. There were no immediate or long-term complications. Variable symptomatic relief was observed in 73.7% of cases with complete responses in 57.9%. All 8 patients who had partial or no pain relief complained of dyspareunia. The direct relationship between varices and chronic pelvic pain was difficult to ascertain in a significant number of clinical failures. Conclusion. Transcatheter embolization of lumboovarian varices is a safe technique offering symptomatic relief of pelvic pain in the majority of cases. The presence of dyspareunia seemed to be a poor prognostic factor, indicating that other causes of pelvic pain may coexist with pelvic varicosities.

  20. 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

  1. 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.

  2. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

    PubMed

    Bo, Kari; Frawley, Helena C; Haylen, Bernard T; Abramov, Yoram; Almeida, Fernando G; Berghmans, Bary; Bortolini, Maria; Dumoulin, Chantale; Gomes, Mario; McClurg, Doreen; Meijlink, Jane; Shelly, Elizabeth; Trabuco, Emanuel; Walker, Carolina; Wells, Amanda

    2017-02-01

    Introduction and hypothesis There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. Methods This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. Results A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. Conclusion A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

  3. Changes in trunk muscle activation and lumbar-pelvic position associated with abdominal hollowing and reach during a simulated manual material handling task.

    PubMed

    Butler, Heather L; Hubley-Kozey, Cheryl L; Kozey, John W

    2007-03-01

    The purpose of this study was to investigate the effect of abdominal hollowing (AH) on trunk muscle activation and lumbar-pelvic motion during a controlled lift and replace task. Surface electromyograms were recorded from five abdominal and two back muscle sites. Sagittal lumbar-pelvic motion was recorded by video. Subjects lifted a 3.8 kg load in normal, maximum and extreme reaches, first while performing their preferred lifting style (PLS) and then maintaining an AH technique. The external oblique muscle site activities were significantly higher (p < 0.05) for the AH technique (ranging from 7-20% of maximal voluntary activation (MVIC)) than at any of the abdominal sites for the PLS (ranging from 2-10% MVIC). Differences were found among abdominal sites for the AH, but not for the PLS. The back muscle site activities (ranging from 9-30% MVIC) were significantly higher (p < 0.05) than for any of the abdominal muscles for all conditions, except for the anterior external oblique for AH. The pelvic and lumbar angles changed significantly (p < 0.05) between normal and maximal reaches and between techniques. The AH technique altered abdominal muscle activation amplitudes, with minimal differences in trunk extensors compared to the PLS. The AH resulted in more posterior pelvic tilt.

  4. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    PubMed

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  5. Retained foetal bones: an intrauterine cause of chronic pelvic pain.

    PubMed

    Kalu, Emmanuel; Richardson, Robert

    2009-02-01

    Intrauterine retention of foetal bones is an uncommon but recognised complication of late termination of pregnancy. Secondary subfertility, abnormal uterine bleeding and vaginal discharge are the usual presenting complaints. We report a case of prolonged retention of foetal bones for 14 years in a woman who presented with chronic pelvic pain. Hysteroscopic examination was diagnostic and therapeutic. Retained foetal bones are an uncommon intrauterine cause of chronic pelvic pain that should be considered particularly when a woman with a history of late termination presents with pelvic pain. Hysteroscopic evacuation is curative.

  6. 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.

  7. 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

  8. [Vascular complications after pelvic rami fracture].

    PubMed

    Fernández-Lombardía, J; Paz-Aparicio, A; Hernández-Vaquero, D

    2014-01-01

    The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patient́s situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries.

  9. A rare abdomino-pelvic tumor: paraganglioma.

    PubMed

    Pedroso, Célia; Robalo, Raquel; Sereno, Pedro; Barros, Carlos; Marques, Carlos

    2015-01-01

    Paragangliomas are rare tumors, with a reported incidence of 2-8 per million. They are chromaffin cell tumors that develop from the neural crest cells and may be divided in tumors derived from the parasympathetic or sympathetic ganglia. We report a case a of a 32-year-old nulliparous woman, referred to our Infertility Clinic. Abdomino-pelvic ultrasound identified a large abdominopelvic tumor, without ovarian origin (both ovaries were identified and had normal morphology). Magnetic Resonance Imaging suggested a right adnexal multicystic, vascularized mass close to iliac vessels and questioning an ovarian origin. At exploratory laparotomy, a 10 cm encapsulated and vascularized mass was found beginning just below right renal artery and extending to the level of the broad ligament. This mass was totally excised and histopathology was consistent with Paraganglioma.

  10. 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.

  11. 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

  12. 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

  13. Full-term newborn after repeated ovarian tissue transplants in a patient treated for Ewing sarcoma by sterilizing pelvic irradiation and chemotherapy

    PubMed Central

    Rodriguez-Wallberg, Kenny A; Karlström, Per-Olof; Rezapour, Masoumeh; Castellanos, Enrique; Hreinsson, Julius; Rasmussen, Carsten; Sheikhi, Mona; Ouvrier, Bettina; Bozóky, Béla; Olofsson, Jan I; Lundqvist, Monalill; Hovatta, Outi

    2015-01-01

    We report the first successful transplantation of cryopreserved ovarian cortical tissue into heavily irradiated tissues in a patient who had received sterilizing pelvic radiotherapy (54 Gy) and 40 weeks of intensive high-dose chemotherapy for the treatment of Ewing’s sarcoma 14 years earlier. Repeated transplantation procedures were required to obtain fully functional follicular development. Enlargement of the transplants over time and increase of the size of the uterus were demonstrated on sequential ultrasonographic examinations. Eggs of good quality that could be fertilized in vitro were obtained only after a substantial incremental increase of the amount of ovarian tissue transplanted. Single embryo replacement resulted in a normal pregnancy and the birth of a healthy child by cesarean section at full-term. No neonatal or maternal postoperative complications occurred. Women facing high-dose pelvic radiotherapy should not be systematically excluded from fertility preservation options, as is currently the trend. PMID:25545009

  14. Redo Ileal pouch-anal anastomosis combined with anti-TNF-α maintenance therapy for Crohn's disease with pelvic fistula: report of two cases.

    PubMed

    Araki, Toshimitsu; Okita, Yoshiki; Fujikawa, Hiroyuki; Ohi, Masaki; Tanaka, Koji; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Kusunoki, Masato

    2014-10-01

    Pouch failure has been reported to occur after ileal pouch-anal anastomosis for Crohn's disease. We report two cases of patients with Crohn's disease, who underwent redo ileal pouch-anal anastomosis (redo-IPAA) combined with anti-TNF-α maintenance therapy, with good functional results. The first patient, a man with presumed ulcerative colitis, suffered pelvic fistula recurrence and anastomotic dehiscence. He underwent redo-IPAA, at which time longitudinal ulcers were found. Infliximab was started 4 days postoperatively and continued. The second patient, a woman treated for ulcerative colitis, underwent laparoscopic IPAA 8 years later. After the development of a pelvic fistula, twisted mesentery of the ileal pouch was found intraoperatively and Crohn's disease was diagnosed. Adalimumab therapy resulted in fistula closure. Redo-IPAA was performed to normalize the twisted mesentery of the ileal pouch. No complications have been observed in either patient, both of whom have experienced good functional results after closure of the covering stomas.

  15. External artery heat pipe

    NASA Technical Reports Server (NTRS)

    Gernert, Nelson J. (Inventor); Ernst, Donald M. (Inventor); Shaubach, Robert M. (Inventor)

    1989-01-01

    An improved heat pipe with an external artery. The longitudinal slot in the heat pipe wall which interconnects the heat pipe vapor space with the external artery is completely filled with sintered wick material and the wall of the external artery is also covered with sintered wick material. This added wick structure assures that the external artery will continue to feed liquid to the heat pipe evaporator even if a vapor bubble forms within and would otherwise block the liquid transport function of the external artery.

  16. 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 ...

  17. Functional specialisation of pelvic limb anatomy in horses (Equus caballus)

    PubMed Central

    Payne, RC; Hutchinson, JR; Robilliard, JJ; Smith, NC; Wilson, AM

    2005-01-01

    We provide quantitative anatomical data on the muscle–tendon units of the equine pelvic limb. Specifically, we recorded muscle mass, fascicle length, pennation angle, tendon mass and tendon rest length. Physiological cross sectional area was then determined and maximum isometric force estimated. There was proximal-to-distal reduction in muscle volume and fascicle length. Proximal limb tendons were few and, where present, were relatively short. By contrast, distal limb tendons were numerous and long in comparison to mean muscle fascicle length, increasing potential for elastic energy storage. When compared with published data on thoracic limb muscles, proximal pelvic limb muscles were larger in volume and had shorter fascicles. Distal limb muscle architecture was similar in thoracic and pelvic limbs with the exception of flexor digitorum lateralis (lateral head of the deep digital flexor), the architecture of which was similar to that of the pelvic and thoracic limb superficial digital flexors, suggesting a functional similarity. PMID:15960766

  18. 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.

  19. Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

    PubMed Central

    Williams, E. M.; Markey, C. M.; Johnson, A. M.; Morales-Ramirez, P. B.

    2017-01-01

    Pelvic actinomycosis is an uncommon, slowly progressing granulomatous infection that has been associated with the presence of intrauterine devices. Due to its unspecific clinical and radiologic findings, it can mimic pelvic or intra-abdominal malignancy leading to mutilating surgery of high morbidity. Rarely, diagnosis is made preoperatively and in most cases surgical intervention is necessary. The patient in our case is a 42-year-old female with an IUD for 15 years diagnosed with pelvic actinomycosis. Patient was uniquely diagnosed preoperatively through paracentesis and treated conservatively with prolonged antibiotic therapy and without any type of surgical intervention. Follow-up at 1 year showed almost complete radiologic resolution of the inflammatory mass, nutritional recovery, and absence of symptoms. Pelvic actinomycosis can be successfully diagnosed and treated medically without surgical interventions. PMID:28299218

  20. MR demonstration of extensive pelvic involvement in vulvar hemangiomas.

    PubMed

    O'Neal, M F; Amparo, E G

    1988-01-01

    Magnetic resonance imaging of two patients with vulvar hemangiomas noninvasively demonstrated unexpected pelvic involvement. Magnetic resonance is an excellent method for initial evaluation and follow-up of these lesions.

  1. 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

  2. Comparative financial analysis of laparoscopic pelvic lymph node dissection performed in 1990-1992 v 1993-1994.

    PubMed

    Troxel, S A; Winfield, H N

    1996-08-01

    In 1994, it was reported that laparoscopic pelvic lymph node dissection (L-PLND) was US $1350 more expensive than open pelvic lymph node dissection (O-PLND) for the staging of prostate cancer. Despite the lower postoperative expenses associated with L-PLND, the intraoperative expenditures were 52% higher, primarily because of the prolonged operating time and the cost of disposable instrumentation. The objective of the present study was to determine if, with increasing laparoscopic experience and a more competitive surgical supply market, the intraoperative as well as the overall hospital expenses would diminish. The study population consisted of 105 men who underwent staging L-PLND for cancer of the prostate. Group I was composed of 50 patients who underwent surgery between 1990 and 1992, and Group II consisted of 55 patients operated on in 1993 and 1994. All hospital-related expenses were reorganized into preoperative, intraoperative, and postoperative and subsequently corrected for inflationary changes to a base year of 1993-1994. The total overall expenses of the two groups were similar, differing by only $65. Despite a lowering of preoperative and postoperative expenses in the 1993-1994 group by 112% and 31%, respectively, the intraoperative expenses were still $571 higher. The operative time decreased by 19 minutes in the contemporary group, but the expense of surgical supplies continued to increase up to $910 (104%) more than the 1990-1992 group. It is hoped that the use of "laparoscopic kits" as well hospital equipment consortiums will help slow the escalating costs of surgical care. However, it is the responsibility of the laparoscopic surgeon to demonstrate that these procedures are as safe, efficient, and cost-effective as their open counterpart.

  3. Chronic pelvic pain: clinical dilemma or clinician's nightmare

    PubMed Central

    Ghaly, A.; Chien, P.

    2000-01-01

    Chronic pelvic pain is a common problem presenting a major challenge to healthcare professionals. This is partly due to the lack of understanding of the aetiology and natural history of the disease. This condition is best managed using a multidisciplinary approach. In recent years, the emphasis in the clinical management has tended towards psychosocial or psychosexual involvement after organic disease has been excluded. Key Words: pelvic pain PMID:11229349

  4. 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

  5. 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.

  6. [Trochanteric bursitis, pelvic enthesopathy and giant cell arteritis].

    PubMed

    Lorléac'h, A; Duffau, P; Michaux, C; Greib, C; Caubet, O; Viallard, J-F; Pellegrin, J-L

    2008-12-01

    Giant cell arteritis, a large-sized vessel vasculitis, may be associated with musculoskeletal proximal (polymyalgia rheumatica) or distal manifestations. A 68-year-old woman, who had inflammatory pelvic girdle pain, was diagnosed with giant cell arteritis and was successfully treated with corticosteroids. The magnetic resonance imaging and ultrasonography revealed a bilateral bursitis and pelvic girdle enthesopathy. Bursitis is the main anatomic lesion occurring in polymyalgia rheumatica and can be underlined by ultrasonography.

  7. Transmission block to simplify combined pelvic and inguinal radiation therapy.

    PubMed

    Kalnicki, S; Zide, A; Maleki, N; DeWyngaert, J K; Lipsztein, R; Dalton, J F; Bloomer, W D

    1987-08-01

    A homogeneous dose distribution of radiation to inguinal lymph nodes and deep pelvic structures can be achieved with use of a transmission block over the central portion of a large anterior pelvic-inguinal portal, together with a smaller posterior field. This relatively simple technique permits individualization of isodose distributions and eliminates the problems of matching abutting portals. Reproducibility of daily setup and optimization of machine utilization are both improved.

  8. 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.

  9. 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.

  10. 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

  11. [Postoperative radiotherapy of prostate cancer].

    PubMed

    Guérif, S; Latorzeff, I; Lagrange, J-L; Hennequin, C; Supiot, S; Garcia, A; François, P; Soulié, M; Richaud, P; Salomon, L

    2014-10-01

    Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery.

  12. Pelvic floor neuropathy in relation to the outcome of Burch colposuspension.

    PubMed

    Kjølhede, P; Lindehammar, H

    1997-01-01

    The aim of the study was to determine the role of neurogenic damage to pelvic floor muscles on the outcome of Burch colposuspension. Thirty women objectively continent after Burch colposuspension and 18 women with recurrent stress urinary incontinence (RSUI) were investigated with concentric needle electrode electromyography (EMG) in both pubococcygeus muscles and the external anal sphincter muscle. Neurogenic EMG patterns were significantly more often seen in the pubococcygeus muscles in women with RSUI than in women continent after the colposuspension (P < 0.05). The distribution of neurogenic EMG patterns in the investigated muscles was significantly more pronounced in women with RSUI than in continent women: at least one pubococcygeus muscle with neurogenic EMG pattern, 72% vs. 34% (P < 0.05); both pubococcygeus muscles, 50% vs. 13% (P < 0.05); and all three investigated muscles 41% vs. 10% (P < 0.05). In conclusion, the results imply an association between the outcome of the Burch colposuspension and the occurrence of neuropathy in the pelvic floor muscles. Occurrence of neurogenic damage in the pubococcygeus muscles seems to impair the outcome of Burch colposuspension.

  13. 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

  14. Postoperative Intensity Modulated Radiation Therapy in High Risk Prostate Cancer: A Dosimetric Comparison

    SciTech Connect

    Digesu, Cinzia; Cilla, Savino; De Gaetano, Andrea; Massaccesi, Mariangela; Macchia, Gabriella; Ippolito, Edy; Deodato, Francesco; Panunzi, Simona; Iapalucci, Chiara; Mattiucci, Gian Carlo; D'Angelo, Elisa; Padula, Gilbert D.A.; Valentini, Vincenzo; Cellini, Numa

    2011-10-01

    The aim of this study was to compare intensity-modulated radiation therapy (IMRT) with 3D conformal technique (3D-CRT), with respect to target coverage and irradiation of organs at risk for high dose postoperative radiotherapy (PORT) of the prostate fossa. 3D-CRT and IMRT treatment plans were compared with respect to dose to the rectum and bladder. The dosimetric comparison was carried out in 15 patients considering 2 different scenarios: (1) exclusive prostate fossa irradiation, and (2) pelvic node irradiation followed by a boost on the prostate fossa. In scenario (1), a 3D-CRT plan (box technique) and an IMRT plan were calculated and compared for each patient. In scenario (2), 3 treatment plans were calculated and compared for each patient: (a) 3D-CRT box technique for both pelvic (prophylactic nodal irradiation) and prostate fossa irradiation (3D-CRT only); (b) 3D-CRT box technique for pelvic irradiation followed by an IMRT boost to the prostatic fossa (hybrid 3D-CRT and IMRT); and (c) IMRT for both pelvic and prostate fossa irradiation (IMRT only). For exclusive prostate fossa irradiation, IMRT significantly reduced the dose to the rectum (lower Dmean, V50%, V75%, V90%, V100%, EUD, and NTCP) and the bladder (lower Dmean, V50%, V90%, EUD and NTCP). When prophylactic irradiation of the pelvis was also considered, plan C (IMRT only) performed better than plan B (hybrid 3D-CRT and IMRT) as respect to both rectum and bladder irradiation (reduction of Dmean, V50%, V75%, V90%, equivalent uniform dose [EUD], and normal tissue complication probability [NTCP]). Plan (b) (hybrid 3D-CRT and IMRT) performed better than plan (a) (3D-CRT only) with respect to dose to the rectum (lower Dmean, V75%, V90%, V100%, EUD, and NTCP) and the bladder (Dmean, EUD, and NTCP). Postoperative IMRT in prostate cancer significantly reduces rectum and bladder irradiation compared with 3D-CRT.

  15. Postoperative blood loss prevention in total knee arthroplasty.

    PubMed

    Banerjee, Samik; Kapadia, Bhaveen H; Issa, Kimona; McElroy, Mark J; Khanuja, Harpal S; Harwin, Steven F; Mont, Michael A

    2013-12-01

    Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.

  16. 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.

  17. Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions--an overview.

    PubMed

    Rosenfeld, Hannah; Byard, Roger W

    2012-05-01

    Venous stasis predisposes to thrombosis. One hundred and sixty cases of fatal pulmonary thromboembolism were reviewed to determine how many cases had deep venous thromboses associated with venous blood flow reduction caused by external pressure from benign pelvic masses. Three cases were identified, representing 2% of cases overall (3/160): a 44-year-old woman with a large uterine leiomyoma (1048 g); a 74-year-old man with prostatomegaly and bladder distension (containing 1 L of urine); and a 70-year-old man with prostatomegaly and bladder distension (containing 3 L of urine). Although a rare cause of fatal deep venous thrombosis and pulmonary thromboembolism, space-occupying pelvic lesions can lead to extrinsic pressure on adjacent veins reducing blood flow and causing stasis and thrombosis. Individuals with large pelvic masses may, therefore, be at increased risk of pulmonary thromboembolism from deep venous thrombosis, particularly in the presence of concurrent risk factors such as immobility, thrombophilias, malignancy, and significant cardiopulmonary disease.

  18. External radiation surveillance

    SciTech Connect

    Antonio, E.J.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report describes how external radiation was measured, how surveys were performed, and the results of these measurements and surveys. External radiation exposure rates were measured at locations on and off the Hanford Site using thermoluminescent dosimeters (TLD). External radiation and contamination surveys were also performed with portable radiation survey instruments at locations on and around the Hanford Site.

  19. MRI simulation: end-to-end testing for prostate radiation therapy using geometric pelvic MRI phantoms

    NASA Astrophysics Data System (ADS)

    Sun, Jidi; Dowling, Jason; Pichler, Peter; Menk, Fred; Rivest-Henault, David; Lambert, Jonathan; Parker, Joel; Arm, Jameen; Best, Leah; Martin, Jarad; Denham, James W.; Greer, Peter B.

    2015-04-01

    To clinically implement MRI simulation or MRI-alone treatment planning requires comprehensive end-to-end testing to ensure an accurate process. The purpose of this study was to design and build a geometric phantom simulating a human male pelvis that is suitable for both CT and MRI scanning and use it to test geometric and dosimetric aspects of MRI simulation including treatment planning and digitally reconstructed radiograph (DRR) generation. A liquid filled pelvic shaped phantom with simulated pelvic organs was scanned in a 3T MRI simulator with dedicated radiotherapy couch-top, laser bridge and pelvic coil mounts. A second phantom with the same external shape but with an internal distortion grid was used to quantify the distortion of the MR image. Both phantoms were also CT scanned as the gold-standard for both geometry and dosimetry. Deformable image registration was used to quantify the MR distortion. Dose comparison was made using a seven-field IMRT plan developed on the CT scan with the fluences copied to the MR image and recalculated using bulk electron densities. Without correction the maximum distortion of the MR compared with the CT scan was 7.5 mm across the pelvis, while this was reduced to 2.6 and 1.7 mm by the vendor’s 2D and 3D correction algorithms, respectively. Within the locations of the internal organs of interest, the distortion was <1.5 and <1 mm with 2D and 3D correction algorithms, respectively. The dose at the prostate isocentre calculated on CT and MRI images differed by 0.01% (1.1 cGy). Positioning shifts were within 1 mm when setup was performed using MRI generated DRRs compared to setup using CT DRRs. The MRI pelvic phantom allows end-to-end testing of the MRI simulation workflow with comparison to the gold-standard CT based process. MRI simulation was found to be geometrically accurate with organ dimensions, dose distributions and DRR based setup within acceptable limits compared to CT.

  20. 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

  1. [Management of uncomplicated pelvic inflammatory disease].

    PubMed

    Bourret, A; Fauconnier, A; Brun, J-L

    2012-12-01

    Since the 1993 French consensus conference on uncomplicated pelvic inflammatory diseases (uPID), new antibiotics appeared and bacterial resistances did evoluate. This methodic analysis of the literature updates different aspects of its treatment. Antibiotherapy must be established early (EL3). Inpatient and intravenous treatment is not superior to outpatient and oral treatment (EL1). Ofloxacine+metronidazole association can be proposed in first intention (EL1). If case of Neisseria gonorrhoeae infection, one ceftriaxone injection must be associated (EL4). All the other antibiotics associations have shown to be efficient except the metronidazole+doxycycline association, which is not indicated (EL2). Two weeks treatment seems to be a sufficient duration. Laparoscopic treatment in first intention is not justified except for diagnostic doubts or unfavorable evolution of the medical treatment (EL4). Neither non-steroidic antiinflamatorries, nor corticosteroids, have been proved to be efficient to decrease the adherence risk in uPID (EL3). Early extraction of an intra uterine device (IUD) allows symptomatologic improvement (EL2). Partners treatment with azithromycin improves the 4 months bacteriologic results (EL2). HIV positive patients do not need specific treatment (EL3).

  2. Pelvic inflammatory disease and oral contraceptive use.

    PubMed

    Feldblum, P J; Burton, N; Rosenberg, M J

    1986-10-01

    Oral contraceptive use has been shown to protect against gonococcal pelvic inflammatory disease (PID), but the effect on chlamydial PID is uncertain. Chlamydia infection is rising in incidence and has become the major cause of PID in many areas. PID may cause infertility, impairing the future reproduction of women. Previous studies on oral contraceptives and PID relied on hospitalized women, which may have biased the sample to include mainly gonococcal PID. Several studies show increased risk of endocervical chlamydia infection in users of oral contraceptives. The postulated mechanism is cervical ectopy, exposing more squamous epithelium to the organisms. Nevertheless, there is evidence indicating that despite the increased incidence of endocervical infection, oral contraceptives may inhibit the organisms from ascending, thus still offering a protective affect against both gonococcal and chlamydial PID. Future research must focus on the prevalence of chlamydia infection in Africa, and the natural history of the illness. The effect of different types of oral contraceptives on chlamydia infection must be evaluated.

  3. [Abdomino-pelvic actinomycosis: a case report].

    PubMed

    Bedoui, Riadh; Nouira, Ramzi; Zribi, Riadh; Guesmi, Fethi; Ben Achour, Jamel; Daghfous, Mounir; Cherif, Ali; Zoghlami, Ayoub; Najah, Nabil

    2002-10-01

    The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery.

  4. [Pelvic actinomycosis simulating adnexal malignant tumor].

    PubMed

    Benkiran, L; Gamra, L; Lamalmi, N; Essouyeh, M; Regragui, A; Amrani, M; Souadka, A; Melabbas, M A

    2002-01-01

    The purpose of this report is to describe the case of a 35-year-old patient admitted to the National Oncology Institute in Rabat, Morocco for pelvic pain and deteriorating general status ongoing for 8 months. Clinical and ultrasonographic examination showed a heterogenous mass measuring 7 cm in maximum width located inferior and lateral to the inferior aspect of the right side of the uterus. These findings were suggestive of a malignant tumor of the right ovary. Ovariectomy and omentectomy were performed. Histological examination of surgical specimens demonstrated right tubo-ovarian actinomycosis associated with peritonitis. Genital tract actinomycosis is an uncommon finding in women of childbearing age. It is due to colonization by a pyogenic bacteria (Actinomyces) usually secondary to a gastrointestinal infection, e.g. ileocecum, and sometimes in association with the presence of an intrauterine device or foreign body. Based on this case report, the authors discuss abdominopelvic actinomyocosis with emphasis on tumor-like findings that can lead to misdiagnosis by clinicians and radiologists.

  5. Geometric modeling of pelvic organs with thickness

    NASA Astrophysics Data System (ADS)

    Bay, T.; Chen, Z.-W.; Raffin, R.; Daniel, M.; Joli, P.; Feng, Z.-Q.; Bellemare, M.-E.

    2012-03-01

    Physiological changes in the spatial configuration of the internal organs in the abdomen can induce different disorders that need surgery. Following the complexity of the surgical procedure, mechanical simulations are necessary but the in vivo factor makes complicate the study of pelvic organs. In order to determine a realistic behavior of these organs, an accurate geometric model associated with a physical modeling is therefore required. Our approach is integrated in the partnership between a geometric and physical module. The Geometric Modeling seeks to build a continuous geometric model: from a dataset of 3D points provided by a Segmentation step, surfaces are created through a B-spline fitting process. An energy function is built to measure the bidirectional distance between surface and data. This energy is minimized with an alternate iterative Hoschek-like method. A thickness is added with an offset formulation, and the geometric model is finally exported in a hexahedral mesh. Afterward, the Physical Modeling tries to calculate the properties of the soft tissues to simulate the organs displacements. The physical parameters attached to the data are determined with a feedback loop between finite-elements deformations and ground-truth acquisition (dynamic MRI).

  6. Computed tomography of the postoperative lumbar spine

    SciTech Connect

    Teplick, J.G.; Haskin, M.E.

    1983-11-01

    In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period.

  7. The impact of the pelvic floor muscles on dynamic ventilation maneuvers

    PubMed Central

    Park, Hankyu; Hwang, Byoungha; Kim, Yeoungsung

    2015-01-01

    [Purpose] The aim of the present study was to examine the impact of the pelvic floor muscles (PFM) on dynamic ventilation maneuvers. [Subjects and Methods] The subjects were 19 healthy female adults in their 20s who consented to participate in the present study. Electromyography (EMG) was used to examine respiratory muscle activity, and a spirometer was used to examine vital capacity before and during contraction of the PFM. [Results] There were statistically significant differences in the sternocleidomastoid (SCM), rectus abdominis (RA), external oblique (EO), transverse abdominis/internal oblique (TrA/IO), and maximal voluntary ventilation (MVV) when the PFM was contracted. [Conclusion] Contraction of the PFM can be effective in promoting activation of the respiratory muscles and vital capacity. Therefore, the PFM should be considered to improve the effects of respiratory activity. PMID:26644664

  8. 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.

  9. External approach to rhinoplasty.

    PubMed

    Goodman, Wilfred S; Charbonneau, Paul A

    2015-07-01

    The technique of external rhinoplasty is outlined. Having reviewed 74 cases, its advantages and disadvantages are discussed. Reluctance to use this external approach seems to be based on emotional rather than radical grounds, for its seems to be the procedure of choice for many problems.

  10. 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.

  11. AB059. A novel technique of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure

    PubMed Central

    Song, Le-Ming; Deng, Xiao-Lin

    2015-01-01

    postoperative day one and day 30 were 89.2% (33/37) and 94.6% (35/37), respectively. Complications were noted in 3 (8.1%) cases according to the Clavien classification, including systemic inflammatory response syndrome (SIRS) (grade I) in one case (2.7%), and fever (grade I) in two cases (5.4%). No sepsis occurred. Conclusions The technology is safe, and efficacious for treating upper urinary calculi with advantages breaking stones more effectively and low complication rates because of automatically of controlling renal pelvic pressure.

  12. The Influence of Dual Pressure Biofeedback Units on Pelvic Rotation and Abdominal Muscle Activity during the Active Straight Leg Raise in Women with Chronic Lower Back Pain.

    PubMed

    Noh, Kyung-Hee; Kim, Ji-Won; Kim, Gyoung-Mo; Ha, Sung-Min; Oh, Jae-Seop

    2014-05-01

    [Purpose] This study was performed to assess the influence of applying dual pressure biofeedback units (DPBUs) on the angle of pelvic rotation and abdominal muscle activity during the active straight leg raise (ASLR). [Subjects] Seventeen patients with low-back pain (LBP) participated in this study. [Methods] The subjects were asked to perform an active straight leg raise (ASLR) without a PBU, with a single PBU, and with DPBUs. The angles of pelvic rotation were measured using a three-dimensional motion-analysis system, and the muscle activity of the bilateral internal oblique abdominis (IO), external oblique abdominis (EO), and rectus abdominis (RA) was recorded using surface electromyography (EMG). One-way repeated-measures ANOVA was performed to determine the rotation angles and muscle activity under the three conditions. [Results] The EMG activity of the ipsilateral IO, contralateral EO, and bilateral RA was greater and pelvic rotation was lower with the DPBUs than with no PBU or a single PBU. [Conclusion] The results of this study suggest that applying DPBUs during ASLR is effective in decreasing unwanted pelvic rotation and increasing abdominal muscle activity in women with chronic low back pain.

  13. Personalizing pelvic floor reconstructive surgery in aging women.

    PubMed

    Mannella, Paolo; Giannini, Andrea; Russo, Eleonora; Naldini, Gabriele; Simoncini, Tommaso

    2015-09-01

    Pelvic floor dysfunction is a growingly frequent condition in aging individuals. Urinary or rectal incontinence, constipation, pelvic organ prolapse, pelvic pain or sexual dysfunction are common problems in this age range. Such conditions carry a severe impact on quality of life, but also limit individual independence in daily activities, favor social isolation and carry health risks. Diagnosis and treatment of pelvic floor dysfunction in aging women is tricky, since multiple interfering conditions affecting muscle tone and nerve function are common in these individuals. Diabetes mellitus, sarcopenia, use of drugs that affect cognition or impact bowel or urinary function are just a few examples. These conditions need to be thoroughly taken into account during pre-operative work up for their potential impact on the success of surgery and vice versa. Functional reconstruction aimed at treating symptoms rather than anatomic defects is key to success. The recent advancements in surgical treatment of urinary incontinence and pelvic organ prolapse allow for more options to achieve the best surgery in each patient.

  14. Automated Localization of Multiple Pelvic Bone Structures on MRI.

    PubMed

    Onal, Sinan; Lai-Yuen, Susana; Bao, Paul; Weitzenfeld, Alfredo; Hart, Stuart

    2016-01-01

    In this paper, we present a fully automated localization method for multiple pelvic bone structures on magnetic resonance images (MRI). Pelvic bone structures are at present identified manually on MRI to locate reference points for measurement and evaluation of pelvic organ prolapse (POP). Given that this is a time-consuming and subjective procedure, there is a need to localize pelvic bone structures automatically. However, bone structures are not easily differentiable from soft tissue on MRI as their pixel intensities tend to be very similar. In this paper, we present a model that combines support vector machines and nonlinear regression capturing global and local information to automatically identify the bounding boxes of bone structures on MRI. The model identifies the location of the pelvic bone structures by establishing the association between their relative locations and using local information such as texture features. Results show that the proposed method is able to locate the bone structures of interest accurately (dice similarity index >0.75) in 87-91% of the images. This research aims to enable accurate, consistent, and fully automated localization of bone structures on MRI to facilitate and improve the diagnosis of health conditions such as female POP.

  15. 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.

  16. [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.

  17. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  18. Epidural Analgesia in the Postoperative Period

    DTIC Science & Technology

    2001-10-01

    violations. VI ABSTRACT Postoperative pain is an unwanted side effect of surgery, and is associated with many postoperative complications...This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when...epidural medication, side effects , incidence of breakthrough pain, and treatments were recorded and cross-tabulated. The following surgical categories

  19. Preoperative Sleep Disruption and Postoperative Delirium

    PubMed Central

    Leung, Jacqueline M.; Sands, Laura P.; Newman, Stacey; Meckler, Gabriela; Xie, Yimeng; Gay, Caryl; Lee, Kathryn

    2015-01-01

    Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43–91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was significantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the first 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. Conclusions: In this pilot study of adults over 40 years of age, sleep disruption was more severe before surgery in the patients who experienced postoperative

  20. Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys.

    PubMed

    Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Çakmakçı, Süleyman; Hatipoglu, Namık Kemal

    2016-08-01

    Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 ± 12.9 years and mean stone size was 524.1 ± 430.3 mm(2). Mean operation time was 150.5 ± 40.0 (77-210) min which was composed of retrograde catheterization (14.8 ± 2.9 min), laparoscopic procedure (48.7 ± 20.6 min) and PNL procedure (86.8 ± 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 ± 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.

  1. Pregnancy hemoperitoneum and placenta percreta in a patient with previous pelvic irradiation and ovarian failure

    SciTech Connect

    Pridjian, G.; Rich, N.E.; Montag, A.G. )

    1990-05-01

    Placenta percreta in a patient with previous pelvic irradiation has never been described. Reported is a case of placenta percreta with hemoperitoneum associated with a second-trimester incomplete abortion in a patient with previous pelvic irradiation and ovarian failure.

  2. Recovery from post-operative anaemia.

    PubMed

    Wallis, J P; Wells, A W; Whitehead, S; Brewster, N

    2005-10-01

    Acceptance of lower transfusion thresholds and shorter post-operative stays results in patients leaving hospital after surgery with lower haemoglobin (Hb) than previously. We undertook a prospective observational study to assess the haematological response to post-operative anaemia and to determine the utility of quality of life (QoL) measures in assessing the impact of anaemia on such patients. Thirty patients undergoing unilateral hip arthroplasty had blood samples taken and QoL questionnaires administered pre-operatively and at 7, 28 and 56 days post-operatively. Increased erythropoiesis was evident at day 7 post-operatively. Approximately two-thirds of the post-operative Hb deficit was corrected by day 28. There was evidence of functional iron deficiency in more than one-quarter of patients at day 56. QoL scores used did not show any relationship with Hb in the post-operative period. Red cell 2,3-diphosphoglycerate (2,3DPG) levels increased in proportion to the degree of post-operative anaemia. We concluded that substantial recovery of Hb occurs between day 7 and day 28 post-operatively. Complete recovery of Hb may be delayed beyond day 56 due to development of iron deficiency. Patients are at significant risk of developing post-operative iron deficiency depending on operative blood loss and pre-operative iron stores. Increased red cell 2,3DPG may offset the effect of anaemia on oxygen delivery. We found no evidence that anaemia produces a measurable effect on chosen QoL scores in the post-operative period.

  3. 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.

  4. 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.

  5. Effect of Letrozole on endometriosis-related pelvic pain

    PubMed Central

    Almassinokiani, Fariba; Almasi, Alireza; Akbari, Peyman; Saberifard, Mahboubeh

    2014-01-01

    Background: To determine the role of Letrozole, an aromatase inhibitor, in the treatment of endometriotic pain. Methods: In this prospective, randomized, controlled clinical trial in minimally invasive surgery research center, 51 women with pelvic endometriosis and endometriotic pain (dyspareunia, dysmenorrhea, pelvic pain) score of 5 or more (for at least one of these endometriotic pain), after laparoscopic diagnosis and conservative laparoscopic surgery were treated with either Letrozole plus OCP (n=25) or only OCP (n=26) for 4 months continuously. Results: Using VAS test, the score of dyspareunia, dysmenorrhea and pelvic pain 4 months after the laparoscopic surgery declined significantly in both groups but the difference between results of the two groups was not significant. Conclusion: Both treatment modalities showed comparable effectiveness in the treatment of pains related to endometriosis and in comparison with OCP, Letrozole did not affect the outcome. PMID:25664308

  6. Development and Evolution of the Muscles of the Pelvic Fin

    PubMed Central

    Cole, Nicholas J.; Hall, Thomas E.; Don, Emily K.; Berger, Silke; Boisvert, Catherine A.; Neyt, Christine; Ericsson, Rolf; Joss, Jean; Gurevich, David B.; Currie, Peter D.

    2011-01-01

    Locomotor strategies in terrestrial tetrapods have evolved from the utilisation of sinusoidal contractions of axial musculature, evident in ancestral fish species, to the reliance on powerful and complex limb muscles to provide propulsive force. Within tetrapods, a hindlimb-dominant locomotor strategy predominates, and its evolution is considered critical for the evident success of the tetrapod transition onto land. Here, we determine the developmental mechanisms of pelvic fin muscle formation in living fish species at critical points within the vertebrate phylogeny and reveal a stepwise modification from a primitive to a more derived mode of pelvic fin muscle formation. A distinct process generates pelvic fin muscle in bony fishes that incorporates both primitive and derived characteristics of vertebrate appendicular muscle formation. We propose that the adoption of the fully derived mode of hindlimb muscle formation from this bimodal character state is an evolutionary innovation that was critical to the success of the tetrapod transition. PMID:21990962

  7. 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.

  8. Multicystic benign cystic mesothelioma presenting as a pelvic mass.

    PubMed

    Momeni, Mazdak; Pereira, Elena; Grigoryan, Gennadiy; Zakashansky, Konstantin

    2014-01-01

    Background. Benign cystic mesothelioma (BCM) is a rare tumor that arises from the abdominal peritoneum with a predilection to the pelvic peritoneum. For this reason, it can often mimic gynecologic malignancies. Case. A 47-year-old perimenopausal female presented reporting several weeks of abdominal distention associated with abdominal tenderness and constipation. Computed tomography revealed a 24 cm multiloculated pelvic mass, and tumor markers were notable for an elevated CA-125. The patient was taken to the operating room for an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingoophorectomy, and removal of pelvic mass. Final pathologic evaluation revealed a benign cystic mesothelioma. Conclusion. Classically these tumors present as large multicystic masses with thin-walled septations and on preoperative evaluation BCM can mimic many different disease entities including ovarian malignancies and cystic lymphangioma. Often diagnosis can only be made at time of surgery.

  9. Laparoscopic Extirpation of a Schwannoma in the Lateral Pelvic Space

    PubMed Central

    Ishiyama, Yasuhiro; Maeda, Chiyo; Nakahara, Kenta; Mukai, Shumpei; Ishida, Fumio

    2016-01-01

    Schwannomas in the lateral pelvic space are very rare. Here, we report the case of a 48-year-old woman who had a tumor detected in her abdomen by abdominal ultrasonography. Abdominal computed tomography and magnetic resonance imaging revealed a well-defined solid tumor of 65 mm in diameter in the right lateral pelvic space. We performed laparoscopic surgery under a diagnosis of a gastrointestinal tumor or neurogenic tumor. The tumor was safely dissected and freed from the surrounding tissues using sharp and blunt maneuvers. The tumor originated from the right sciatic nerve. Complete laparoscopic extirpation was performed with preservation of the right sciatic nerve. Pathological examination suggested schwannoma. The patient recovered well but had remaining sciatic nerve palsy in her right foot. Laparoscopic extirpation for a schwannoma in the lateral pelvic space was safe and feasible due to the magnified surgical field afforded by laparoscopy. PMID:27900226

  10. Postoperative radicular neuroma. Case report.

    PubMed

    Erman, T; Tuna, M; Göçer, A I; Idan, F; Akgül, E; Zorludemir, S

    2001-11-15

    Lumbar discectomy is the most common surgical procedure performed in neurosurgery clinics. Such a large number of procedures underscore not only the prevalence of conditions such as intervertebral disc herniation, but also the strong belief of surgeons that the operation does provide benefits to patients suffering from sciatica. In spite of this belief, sciatic pain may continue after the surgery. The recurrence of sciatic and/or back pain after primary discectomy is called the "failed back surgery syndrome." The rate of the complications involved in standard lumbar discectomy ranges from 5.4 to 14%. One of the complications of the lumbar disc surgery is nerve root injury. The complication rate of this injury ranges from 0.7 to 2.2%. Postoperative radicular neuroma must be considered in differential diagnosis for the patient who has failed back surgery syndrome. In this study the authors evaluate a patient who had undergone surgery for lumbar disc herniation and suffered intractable pain. A traumatic radicular neuroma is demonstrated and the pertinent literature is presented.

  11. Hypothermic anesthesia attenuates postoperative proteolysis.

    PubMed Central

    Johnson, D J; Brooks, D C; Pressler, V M; Hulton, N R; Colpoys, M F; Smith, R J; Wilmore, D W

    1986-01-01

    The catabolic response that commonly occurs after major operation is characterized by net skeletal muscle proteolysis and accelerated nitrogen excretion. This response was absent in patients undergoing cardiac surgical procedures associated with the combination of cardiopulmonary bypass, narcotic anesthesia, neuromuscular blockade, and hypothermia. Forearm nitrogen release was 422 +/- 492 nmol/100 ml X min on the first postoperative day, approximately 25% of preoperative values (1677 +/- 411, p less than 0.05). Nitrogen excretion and the degree of negative nitrogen balance were comparable to levels observed in nonstressed, fasting subjects. The potential role of hypothermia, high-dose fentanyl anesthesia, and neuromuscular blockade in modifying the catabolic response to laparotomy and retroperitoneal dissection was further evaluated in animal studies. Six hours after operation, amino acid nitrogen release from the hindquarter was 84% less than control values (p less than 0.05). Nitrogen excretion and urea production were also reduced compared to normothermic controls. It is concluded that the combination of hypothermia, narcotic anesthesia, and neuromuscular blockade attenuates the catabolic response to injury and thus may be useful in the care of critically ill surgical patients. PMID:3767477

  12. Management of postoperative spinal infections

    PubMed Central

    Hegde, Vishal; Meredith, Dennis S; Kepler, Christopher K; Huang, Russel C

    2012-01-01

    Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique, prophylactic antibiotics, avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinal instrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure. PMID:23330073

  13. Accuracy of concepts in female pelvic floor anatomy: facts and myths!

    PubMed

    Fritsch, H; Zwierzina, M; Riss, P

    2012-08-01

    The pelvic floor is characterized by a complex morphology because different functional systems join here. Since a clear understanding of the pelvic floor region is crucial for female pelvic surgery and fundamental mechanisms of urogenital dysfunction and treatment, we here describe the accurate and functional anatomy of important pelvic structures and landmarks, clarify their terminology and point out possible errors or misunderstandings as to their existence.

  14. The “peritoneal scaffold” technique of extended pelvic lymph node dissection during radical prostatectomy: A novel technique

    PubMed Central

    Mallikarjuna, Chiruvella; Nayak, Prasant; Ghouse, Syed Mohammed; Reddy, K. Purnachandra; Ragoori, Deepak Reddy; Bendigeri, M. T.; Reddy, Siva

    2016-01-01

    Introduction: Laparoscopic or robotic-assisted laparoscopic radical prostatectomy (RALP) is a frequently used approach for localized carcinoma prostate. For intermediate and high-risk cancers, extended pelvic lymph node dissection (e-PLND), is often performed. Conventional e-PLND involves piecemeal retrieval of lymphatic tissue. We describe a novel technique of laparoscopic e-PLND, which involves en-masse removal of pelvic lymph nodes from each side, based on an overlying peritoneal scaffold. Materials and Methods: Fifteen cases of intermediate and high-risk carcinoma prostate underwent laparoscopic radical prostatectomy (LRP) with peritoneal scaffold based e-PLND within a period of 1 year. We describe the surgical techqniue and outcomes in terms of operative time and lymph nodes retrieved. Results: The mean operating times for “peritoneal scaffold” lymphatic dissection was 48 min (38–64). The total number of lymph nodes retrieved was 18 (14–22). There were no cases with postoperative lymph collection or hematoma. Conclusion: The “peritoneal scaffold” technique of e-PLND is a novel technique, which involves having a peritoneal scaffold to bind and hold all the lymphatic tissues together in its anatomical orientation during dissection. This enables complete retrieval of specimen during LRP and RALP. PMID:27843216

  15. Significance of preoperative calculation of uterine weight as an indicator for preserving the uterus in pelvic reconstructive surgery.

    PubMed

    Sheng, Qingsong; Ma, Ning; Huang, Huijuan; Xu, Bo; He, Chunni; Song, Yanfeng

    2015-01-01

    Recently, increasing evidence has shown that uterus preservation is beneficial for pelvic organ prolapse (POP) patients, both physiologically and psychologically. However, the preoperative indicators for uterus preservation have rarely been examined. The current study was designed to determine the relationship between the preoperative evaluated uterus weight and the operation selection (preserving the uterus or not) in pelvic reconstructive surgery (PRS) using vaginal meshes. First, in a series of 96 patients undergoing hysterectomy, the uterine weight was calculated by preoperative ultrasound measurements, and was then compared with the postoperative actual weight of the uterus. Subsequently, in a series of 65 patients undergone PRS using vaginal meshes and preserving the uterus, the uterine weight was calculated by preoperative ultrasound measurements. Lastly, in a series of 43 patients with a uterine weight > 56.12 g who had undergone PRS using vaginal meshes, the operation success rate in patients with a preserved uterus was compared to patients for whom the uterus was not preserved. The results showed that uterus weight can be evaluated by ultrasound and used as a preoperative indicator for whether the uterus should be preserved or not in PRS when using vaginal meshes. It was indicated that preoperative evaluation of uterine weight is beneficial for surgical planning and guidance.

  16. Correlation between bone marrow dose volumes and acute hematological toxicity in postoperative gynecological cancer patients

    PubMed Central

    Li, Qian; Jiang, Ming-Hua; Chen, Jing; Liu, Wei; Zhu, Bi-Qing; Lu, E-Mei

    2016-01-01

    Objective: To identify the association between radiation dose volume and acute hematological toxicity (HT) in postoperative gynecological cancer patients receiving whole pelvic radiotherapy (RT) or intensity-modulated RT (IMRT), a principal component regression model was used to calculate HT. Methods: Women (n=100) receiving with or without chemotherapy RT were retrospectively analyzed, 52 of whom received chemotherapy (paclitaxel and nedaplatin). The pelvis and lumbar vertebrae, defined as the prolong-pelvic bone marrow, were divided into the (1) combined ilium, ischium and pubis and the (2) lumbar vertebrae and the sacrum. The V5-V40 of subsides was calculated. The complete blood counts were recorded weekly. The principal component analysis was performed on volumes which generated the principal components (PCs), followed by using a logistic regression model. Results: Forty-seven patients presented with grade 2-3 HT during RT. Chemotherapy increased the incidence of HT compared with RT alone (70.21% vs. 29.79%; p=0.001). Fifty-three patients with persistent HT developed more serious HT at an earlier stage of RT. The chemotherapy cycles and three PCs associated with grade 2-3 HT was identified to form the resulting principal logistic regression model. Conclusion: A new method to calculate the NTCP was achieved by PCs logistic regression. PMID:28083062

  17. 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.

  18. 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.

  19. Oncological and surgical outcome after treatment of pelvic sarcomas

    PubMed Central

    Puchner, Stephan E.; Funovics, Philipp T.; Böhler, Christoph; Kaider, Alexandra; Stihsen, Christoph; Hobusch, Gerhard M.; Panotopoulos, Joannis; Windhager, Reinhard

    2017-01-01

    Background and objectives Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients. Methods Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing’s Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints. Results The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001). Conclusions Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation. PMID:28199377

  20. Future of External Reporting

    ERIC Educational Resources Information Center

    Powers, Kristina

    2015-01-01

    This chapter builds on prior chapters and focuses on higher education trends on the horizon and the resulting impact on external reporting for institutional researchers. Three practical recommendations and examples for institutional researchers are also presented.

  1. Bleomycin Sclerotherapy for Severe Symptomatic and Persistent Pelvic Lymphocele

    PubMed Central

    Fernandes, Ana Sofia; Costa, Antónia; Mota, Raquel; Paiva, Vera

    2014-01-01

    Background. Pelvic lymphoceles are frequently described as a complication of pelvic lymphadenectomy performed for surgical staging of gynaecologic malignancies. Case Report. A 72-year-old woman presented with severe symptomatic and refractory lymphocele associated with persistent lower limb lymphedema and recurrent erysipelas. After four CT fluoroscopy scan guided percutaneous catheter drainages, the lymphocele complicated with infection finally resolved with two sessions of bleomycin sclerotherapy. Conclusion. Symptomatic persistent lymphoceles require treatment and nowadays the first option is interventional radiologic procedures. Bleomycin is a safe and effective sclerosing agent and therefore should be regarded as a first-line treatment choice. PMID:25105040

  2. 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.

  3. A strong pelvic floor: how nurses can spread the word.

    PubMed

    Berzuk, Kelli

    2007-02-01

    The pelvic floor contains muscles that support continence, sexual functioning, childbirth and more. Yet, few people even know these muscles exist or how important they are to overall health and well-being. This article explains in detail the anatomy, functions and importance of the pelvic floor musculature (PFM) and how nurses can educate and empower women of all ages about its important role in many aspects of their health and well-being. Accompanying this article is a patient education page with specific instructions on how to exercise the PFM.

  4. 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

  5. Externally modulated theranostic nanoparticles.

    PubMed

    Urban, Cordula; Urban, Alexander S; Charron, Heather; Joshi, Amit

    2013-08-01

    Externally modulated nanoparticles comprise a rapidly advancing class of cancer nanotherapeutics, which combine the favorable tumor accumulation of nanoparticles, with external spatio-temporal control on therapy delivery via optical, magnetic, or ultrasound modalities. The local control on therapy enables higher tumor treatment efficacy, while simultaneously reducing off-target effects. The nanoparticle interactions with external fields have an additional advantage of frequently generating an imaging signal, and thus such agents provide theranostic (both diagnostic and therapeutic) capabilities. In this review, we classify the emerging externally modulated theranostic nanoparticles according to the mode of external control and describe the physiochemical mechanisms underlying the external control of therapy, and illustrate the major embodiments of nanoparticles in each class with proven biological efficacy: (I) electromagnetic radiation in visible and near-infrared range is being exploited for gold based and carbon nanostructures with tunable surface plasmon resonance (SPR) for imaging and photothermal therapy (PTT) of cancer, photochemistry based manipulations are employed for light sensitive liposomes and porphyrin based nanoparticles; (II) Magnetic field based manipulations are being developed for iron-oxide based nanostructures for magnetic resonance imaging (MRI) and magnetothermal therapy; (III) ultrasound based methods are primarily being employed to increase delivery of conventional drugs and nanotherapeutics to tumor sites.

  6. Externally modulated theranostic nanoparticles

    PubMed Central

    Urban, Cordula; Urban, Alexander S.; Charron, Heather; Joshi, Amit

    2013-01-01

    Externally modulated nanoparticles comprise a rapidly advancing class of cancer nanotherapeutics, which combine the favorable tumor accumulation of nanoparticles, with external spatio-temporal control on therapy delivery via optical, magnetic, or ultrasound modalities. The local control on therapy enables higher tumor treatment efficacy, while simultaneously reducing off-target effects. The nanoparticle interactions with external fields have an additional advantage of frequently generating an imaging signal, and thus such agents provide theranostic (both diagnostic and therapeutic) capabilities. In this review, we classify the emerging externally modulated theranostic nanoparticles according to the mode of external control and describe the physiochemical mechanisms underlying the external control of therapy, and illustrate the major embodiments of nanoparticles in each class with proven biological efficacy: (I) electromagnetic radiation in visible and near-infrared range is being exploited for gold based and carbon nanostructures with tunable surface plasmon resonance (SPR) for imaging and photothermal therapy (PTT) of cancer, photochemistry based manipulations are employed for light sensitive liposomes and porphyrin based nanoparticles; (II) Magnetic field based manipulations are being developed for iron-oxide based nanostructures for magnetic resonance imaging (MRI) and magnetothermal therapy; (III) ultrasound based methods are primarily being employed to increase delivery of conventional drugs and nanotherapeutics to tumor sites. PMID:24834381

  7. 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.

  8. Deep brain stimulation: postoperative issues.

    PubMed

    Deuschl, Günther; Herzog, Jan; Kleiner-Fisman, Galit; Kubu, Cynthia; Lozano, Andres M; Lyons, Kelly E; Rodriguez-Oroz, Maria C; Tamma, Filippo; Tröster, Alexander I; Vitek, Jerrold L; Volkmann, Jens; Voon, Valerie

    2006-06-01

    Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments. A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.

  9. [Postoperative complications in plastic surgery].

    PubMed

    Vogt, P M

    2009-09-01

    aspects of postoperative complication management in plastic surgery.

  10. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: mass contraction of the pelvic floor muscles.

    PubMed

    Shafik, A

    1998-01-01

    We have previously demonstrated both anatomically and physiologically that the external anal (EAS) and urethral (EUS) sphincters and the bulbocavernosus muscle (BC) originate from the puborectalis muscle (PR). It is hypothesized that stimulation of any of these muscles would lead to contraction of all the others. Because the levator ani (pubococcygeus) muscle (LA) also has the same innervation as the above-mentioned muscles, it is further suggested that it, too, contracts reflexly upon stimulation of any of those muscles. The purpose of this study was to test this hypothesis. The study comprised 18 healthy volunteers (mean age 36.6 +/- 8.4 years; 10 men, 8 women). The EAS was stimulated and the response of the EUS, PR, LA and BC was determined. Each muscle was thereafter stimulated separately and the response of the other pelvic floor muscles registered. Stimulation of any of the pelvic floor muscles effected an increased EMG activity of the rest of the muscles. The muscle contraction was instantaneous with no latency in all the muscles except the LA EMG activity, which showed a mean latency of 21.3 +/- 6.6 ms. The pelvic floor muscles' response seems to be attributable to muscle stimulation both directly and indirectly through activation of pudendal nerve fibers in the muscles. The study demonstrated that the pelvic floor muscles behave as one muscle: they contract or relax en masse. This 'mass contraction' might explain some of the physiologic phenomena that occur during pelvic organ evacuation. However, besides this mass contraction, a voluntary 'selective' individual muscle activity exists by which each individual muscle acts independently of the others.

  11. [Postoperative peritonitis: pronostic factors of mortality].

    PubMed

    Marzougui, Y; Missaoui, K; Hannachi, Z; Dhibi, Y; Kouka, J; Dziri, C; Houissa, M

    2014-01-01

    The postoperative peritonitis (POP) remains formidable conditions due to a high mortality rate of between 20 and 80%. The purpose of this study is to identify risk factors for mortality. This study is a retrospective, descriptive analysis carried out over a period of 09 years (1/1/2003 - 30/11/2011) and interesting 102 patients supported for POP following general surgery. Achieved in department of General Surgery B Charles Nicolle hospital Tunis. The parameters measured included epidemiological data, data related to the Initial Surgical Intervention and reoperation for POP, terms of management and evolution. Bacteriological data were also seized. The incidence of POP was 0.90%. The average age of our patients was 58 +/- 19 years with a sex ratio of 1.08. Forty-seven percent of our patients belonged to the ASAII class. The initial operation was performed urgently in 49 patients (48%) with a majority belonging to the class II Altemeier (49.01%). Colorectal pathology (373%) and hepatobiliay (176%) were the most frequent reasons for the initial intervention. The frequency of clinical signs were fever (75.5%), hypothermia (6.9%), abdominal pain (725%), abdominal distension (46.1%), productive gastric aspiration (30.4%), abdominal defense (25.5%), externalizing the digestive fluid (25.5%), vomiting (19.6%), diarrhea (12.7%), tachycardia (569%), oliguria (42.2%), respiratory failure (40.2%), hypotension (35.3%), neuropsychiatric disorders ( 23.5%) and jaundice (69%). The treatment period was 2.95 +/- 3.16 days. The surgical recovery time was 78 days +/- 5.66. At the time of reoperation, the APACHE II score was 8.43 +/- 6.26 and 25.1 +/- MPI score 8.53. The POP was generalized in 52.9% of cases with purulent peritoneal fluid in 51% of cases. The most common cause was the dropping of the anastomosis (59.8%). Empirical antibiotic therapy was appropriate in 69.44 % of cases. The mortality rate was 39.2%. Multivariate analysis using multiple logistic regression identified the

  12. Oxaliplatin Plus Dual Inhibition of Thymidilate Synthase During Preoperative Pelvic Radiotherapy for Locally Advanced Rectal Carcinoma: Long-Term Outcome

    SciTech Connect

    Avallone, Antonio; Delrio, Paolo; Pecori, Biagio; Tatangelo, Fabiana; Petrillo, Antonella; Scott, Nigel; Marone, Pietro; Aloi, Luigi; Sandomenico, Claudia; Lastoria, Secondo; Iaffaioli, Vincenzo Rosario; Scala, Dario; Iodice, Giovanni; Budillon, Alfredo; Comella, Pasquale

    2011-03-01

    Purpose: To assess the safety and efficacy of oxaliplatin (OXA) plus dual inhibition of thymidilate synthase during preoperative pelvic radiotherapy (RT) in patients with poor prognosis for rectal carcinoma. Methods and Materials: Sixty-three patients with the following characteristics, a clinical (c) stage T4, cN1-2, or cT3N0 of {<=}5 cm from the anal verge and/or with a circumferential resection margin (CRM) of {<=}5 mm (by magnetic resonance imaging), received three biweekly courses of chemotherapy with OXA, 100 mg/m{sup 2}; raltitrexed (RTX), 2.5 mg/m{sup 2} on day 1, and 5-fluorouracil (5-FU), 900 mg/m{sup 2} (31 patients) or 800 mg/m{sup 2} (32 patients); levo-folinic acid (LFA), 250 mg/m{sup 2} on day 2, during pelvic RT (45 Gy). Pathologic response was defined as complete pathological response (ypCR), major (tumor regression grade(TRG) 2 to 3, with ypCRM-ve and ypN-ve) or minor or no response (TRG4 to -5, or ypCRM+ve, or ypN+ve). Adjuvant 5-FU/LFA regimen was given in cases of cT4, ypN+ve, or ypCRM+ve. Results: Overall, neutropenia (40%) and diarrhea (13%) were the most common grade {>=}3 toxicities, and tolerability was better with a 5-FU dose reduction. No significant difference in pathologic response was seen according 5-FU dosage: overall, a ypCR was obtained in 24 (39%) patients, and a major response in 20 (32%) patients. The 5-year probability of freedom from recurrence was 80% (95% confidence interval, 68%-92%); it was 56% for the minor/no response group, while it was around 90% for both the ypCR and the major response group. Conclusions: OXA, RTX, and 5-FU/LFA administered during pelvic RT produced promising early and long-term results in rectal carcinoma patients with poor prognosis. The postoperative treatment strategy applied in our study supports the risk-adapted approach in postoperative management.

  13. 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.

  14. 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.

  15. Tetrapod-like pelvic girdle in a walking cavefish.

    PubMed

    Flammang, Brooke E; Suvarnaraksha, Apinun; Markiewicz, Julie; Soares, Daphne

    2016-03-24

    Fishes have adapted a number of different behaviors to move out of the water, but none have been described as being able to walk on land with a tetrapod-like gait. Here we show that the blind cavefish Cryptotora thamicola walks and climbs waterfalls with a salamander-like diagonal-couplets lateral sequence gait and has evolved a robust pelvic girdle that shares morphological features associated with terrestrial vertebrates. In all other fishes, the pelvic bones are suspended in a muscular sling or loosely attached to the pectoral girdle anteriorly. In contrast, the pelvic girdle of Cryptotora is a large, broad puboischiadic plate that is joined to the iliac process of a hypertrophied sacral rib; fusion of these bones in tetrapods creates an acetabulum. The vertebral column in the sacral area has large anterior and posterior zygapophyses, transverse processes, and broad neural spines, all of which are associated with terrestrial organisms. The diagonal-couplet lateral sequence gait was accomplished by rotation of the pectoral and pelvic girdles creating a standing wave of the axial body. These findings are significant because they represent the first example of behavioural and morphological adaptation in an extant fish that converges on the tetrapodal walking behaviour and morphology.

  16. Tetrapod-like pelvic girdle in a walking cavefish

    PubMed Central

    Flammang, Brooke E.; Suvarnaraksha, Apinun; Markiewicz, Julie; Soares, Daphne

    2016-01-01

    Fishes have adapted a number of different behaviors to move out of the water, but none have been described as being able to walk on land with a tetrapod-like gait. Here we show that the blind cavefish Cryptotora thamicola walks and climbs waterfalls with a salamander-like diagonal-couplets lateral sequence gait and has evolved a robust pelvic girdle that shares morphological features associated with terrestrial vertebrates. In all other fishes, the pelvic bones are suspended in a muscular sling or loosely attached to the pectoral girdle anteriorly. In contrast, the pelvic girdle of Cryptotora is a large, broad puboischiadic plate that is joined to the iliac process of a hypertrophied sacral rib; fusion of these bones in tetrapods creates an acetabulum. The vertebral column in the sacral area has large anterior and posterior zygapophyses, transverse processes, and broad neural spines, all of which are associated with terrestrial organisms. The diagonal-couplet lateral sequence gait was accomplished by rotation of the pectoral and pelvic girdles creating a standing wave of the axial body. These findings are significant because they represent the first example of behavioural and morphological adaptation in an extant fish that converges on the tetrapodal walking behaviour and morphology. PMID:27010864

  17. 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

  18. 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:...

  19. 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:...

  20. 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:...

  1. Pharmacological Management of Chronic Pelvic Pain in Women.

    PubMed

    Carey, Erin T; Till, Sara R; As-Sanie, Sawsan

    2017-03-01

    Chronic pelvic pain (CPP) is a multifaceted condition that often has both peripheral and central generators of pain. An understanding of neurobiology and neuropsychology of CPP should guide management. Successful treatment of CPP is typically multimodal, and pharmacologic treatment strategies include analgesics, hormonal suppression, anesthetics, antidepressants, membrane stabilizers, and anxiolytics. Evidence for these and other emerging pharmacologic therapies is presented in this article.

  2. 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.

  3. Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children

    PubMed Central

    Cezarino, Bruno Nicolino; Park, Rubens; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Denes, Francisco T.; Srougi, Miguel

    2016-01-01

    ABSTRACT Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with an increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. Patient and Methods: A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria, with previous history of urinary infections‥ Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. Results: The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Conclusions: Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. PMID:27813386

  4. Printed Three-dimensional Anatomic Templates for Virtual Preoperative Planning Before Reconstruction of Old Pelvic Injuries: Initial Results

    PubMed Central

    Wu, Xin-Bao; Wang, Jun-Qiang; Zhao, Chun-Peng; Sun, Xu; Shi, Yin; Zhang, Zi-An; Li, Yu-Neng; Wang, Man-Yi

    2015-01-01

    Background: Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures. Methods: First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8–17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure. Results: The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6–9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3–29 months (median: 5 months). The fracture healing time was 9–17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The

  5. 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.

  6. Postoperative Delirium in the Geriatric Patient

    PubMed Central

    Schenning, Katie J.; Deiner, Stacie G.

    2015-01-01

    SYNOPSIS Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients over the age of 65 years receive greater than 1/3 of the over 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium. PMID:26315635

  7. Epidural Analgesia in the Postoperative Period

    DTIC Science & Technology

    2001-10-01

    an unwanted side effect of surgery, and is associated with many postoperative complications. This descriptive study was conducted to determine which...surgical patients experienced the most analgesia with the fewest side effects when receiving epidural analgesia in the postoperative period. A...hospital. A description of the patients age, gender, type of surgery, type of epidural medication, side effects , incidence of breakthrough pain, and

  8. [Caloric substrates in postoperative parenteral nutrition].

    PubMed

    De Salvo, L; Romairone, E; Ansaldo, G L; Mattioli, G

    1991-05-31

    The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.

  9. Metasurface external cavity laser

    SciTech Connect

    Xu, Luyao Curwen, Christopher A.; Williams, Benjamin S.; Hon, Philip W. C.; Itoh, Tatsuo; Chen, Qi-Sheng

    2015-11-30

    A vertical-external-cavity surface-emitting-laser is demonstrated in the terahertz range, which is based upon an amplifying metasurface reflector composed of a sub-wavelength array of antenna-coupled quantum-cascade sub-cavities. Lasing is possible when the metasurface reflector is placed into a low-loss external cavity such that the external cavity—not the sub-cavities—determines the beam properties. A near-Gaussian beam of 4.3° × 5.1° divergence is observed and an output power level >5 mW is achieved. The polarized response of the metasurface allows the use of a wire-grid polarizer as an output coupler that is continuously tunable.

  10. 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

  11. Pelvic Breadth and Locomotor Kinematics in Human Evolution.

    PubMed

    Gruss, Laura Tobias; Gruss, Richard; Schmitt, Daniel

    2017-04-01

    A broad pelvis is characteristic of most, if not all, pre-modern hominins. In at least some early australopithecines, most notably the female Australopithecus afarensis specimen known as "Lucy," it is very broad and coupled with very short lower limbs. In 1991, Rak suggested that Lucy's pelvic anatomy improved locomotor efficiency by increasing stride length through rotation of the wide pelvis in the axial plane. Compared to lengthening strides by increasing flexion and extension at the hips, this mechanism could avoid potentially costly excessive vertical oscillations of the body's center of mass (COM). Here, we test this hypothesis. We examined 3D kinematics of walking at various speeds in 26 adult subjects to address the following questions: Do individuals with wider pelves take longer strides, and do they use a smaller degree of hip flexion and extension? Is pelvic rotation greater in individuals with shorter legs, and those with narrower pelves? Our results support Rak's hypothesis. Subjects with wider pelves do take longer strides for a given velocity, and for a given stride length they flex and extend their hips less, suggesting a smoother pathway of the COM. Individuals with shorter legs do use more pelvic rotation when walking, but pelvic breadth was not related to pelvic rotation. These results suggest that a broad pelvis could benefit any bipedal hominin, but especially a short-legged australopithecine such as Lucy, by improving locomotor efficiency, particularly when carrying an infant or traveling in a foraging group with individuals of varying sizes. Anat Rec, 300:739-751, 2017. © 2017 Wiley Periodicals, Inc.

  12. 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

  13. Working with External Evaluators

    ERIC Educational Resources Information Center

    Silver, Lauren; Burg, Scott

    2015-01-01

    Hiring an external evaluator is not right for every museum or every project. Evaluations are highly situational, grounded in specific times and places; each one is unique. The museum and the evaluator share equal responsibility in an evaluation's success, so it is worth investing time and effort to ensure that both are clear about the goals,…

  14. [Internal and external haemorrhoids].

    PubMed

    Schuurman, J P; Go, P M N Y H

    2011-01-01

    In this article, we present 3 cases of patients with different types of haemorrhoidal disease. The first patient is a 27-year-old woman who had been experiencing incidental rectal blood loss without pain during defecation for 3 months. The second patient is a 76-year-old woman who had been bothered by varying degrees of pain from a swelling nearby the anus for 1 year. The third case involves a 31-year-old man who had had continuous severe pain in the anal area for 3 consecutive days. The first patient appeared to have internal hemorrhoids, whereas different forms of external hemorrhoids affected the patients in the other 2 cases. Internal haemorrhoids develop from the intraluminal corpus cavernosum recti; external haemorrhoids from the perianal marginal veins. Patients with internal haemorrhoids present with symptoms that include blood loss and prolaps feeling during defecation. In patients with external haemorrhoids pain is the prominent symptom. Internal haemorrhoids are treated either conservatively or surgically, depending upon their severity. Considering external haemorrhoidal disease surgical treatment provides the most rapid and persistent relief of symptoms.

  15. External College Survey.

    ERIC Educational Resources Information Center

    Gold, Ben K.

    This report presents the results of a community survey which attempted to determine the demand for another college in the Los Angeles Community College District. The function of this "community campus" or "external college" would be to serve members of the community who are not already served by the eight existing colleges. Questionnaires received…

  16. External Interest Group Impingements.

    ERIC Educational Resources Information Center

    Millard, Richard M.

    The history of the interrelation among state approval, accreditation, and institutional eligibility is considered. It is suggested that faculty and college administrators can be either an internal or external group in relationship to the planning process. The federal government, or the state government, passes legislation that may have both…

  17. Soft-laser use in the preoperative preparation and postoperative treatment of the patients with chronic lung abscesses

    NASA Astrophysics Data System (ADS)

    Ledin, A. O.; Dobkin, V. G.; Sadov, A. Y.; Galichev, K. V.; Rzeutsky, V. S.

    1999-07-01

    We counted expedient to include different methods of the soft-laser use in the preoperative medicinal program and in the postoperative period. During the preoperative preparation the basic group patients together with standard treatment received the combined soft-laser therapy, which included intravenous laser blood irradiation (ILBI) by He-Ve laser and external transcutaneous irradiation of the abscess projection by semi-conductorial arrenite-gallium laser. During postoperative treatment with ILBI remarkable changes were observed in the functional activity of the T- and B- cell. The soft-laser use allowed to achieve improvement of quality and shortening of terms of the preoperative preparation of 1,4 times, to level the immunosuppressive influence of surgery to reduce amount of the postoperative complications in 1,8 times and duration of the postoperative period in 1,5 times.

  18. Reduced BMP signaling results in hindlimb fusion with lethal pelvic/urogenital organ aplasia: a new mouse model of sirenomelia.

    PubMed

    Suzuki, Kentaro; Adachi, Yasuha; Numata, Tomokazu; Nakada, Shoko; Yanagita, Motoko; Nakagata, Naomi; Evans, Sylvia M; Graf, Daniel; Economides, Aris; Haraguchi, Ryuma; Moon, Anne M; Yamada, Gen

    2012-01-01

    Sirenomelia, also known as mermaid syndrome, is a developmental malformation of the caudal body characterized by leg fusion and associated anomalies of pelvic/urogenital organs including bladder, kidney, rectum and external genitalia. Most affected infants are stillborn, and the few born alive rarely survive beyond the neonatal period. Despite the many clinical studies of sirenomelia in humans, little is known about the pathogenic developmental mechanisms that cause the complex array of phenotypes observed. Here, we provide new evidences that reduced BMP (Bone Morphogenetic Protein) signaling disrupts caudal body formation in mice and phenocopies sirenomelia. Bmp4 is strongly expressed in the developing caudal body structures including the peri-cloacal region and hindlimb field. In order to address the function of Bmp4 in caudal body formation, we utilized a conditional Bmp4 mouse allele (Bmp4(flox/flox)) and the Isl1 (Islet1)-Cre mouse line. Isl1-Cre is expressed in the peri-cloacal region and the developing hindimb field. Isl1Cre;Bmp4(flox/flox) conditional mutant mice displayed sirenomelia phenotypes including hindlimb fusion and pelvic/urogenital organ dysgenesis. Genetic lineage analyses indicate that Isl1-expressing cells contribute to both the aPCM (anterior Peri-Cloacal Mesenchyme) and the hindlimb bud. We show Bmp4 is essential for the aPCM formation independently with Shh signaling. Furthermore, we show Bmp4 is a major BMP ligand for caudal body formation as shown by compound genetic analyses of Bmp4 and Bmp7. Taken together, this study reveals coordinated development of caudal body structures including pelvic/urogenital organs and hindlimb orchestrated by BMP signaling in Isl1-expressing cells. Our study offers new insights into the pathogenesis of sirenomelia.

  19. Nursing documentation of postoperative pain management.

    PubMed

    Idvall, Ewa; Ehrenberg, Anna

    2002-11-01

    Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware.

  20. Protocol for a phase III randomised trial of image-guided intensity modulated radiotherapy (IG-IMRT) and conventional radiotherapy for late small bowel toxicity reduction after postoperative adjuvant radiation in Ca cervix

    PubMed Central

    Chopra, Supriya; Engineer, Reena; Mahantshetty, Umesh; Misra, Shagun; Phurailatpam, Reena; Paul, Siji N; Kannan, Sadhna; Kerkar, Rajendra; Maheshwari, Amita; Shylasree, TS; Ghosh, Jaya; Gupta, Sudeep; Thomas, Biji; Singh, Shalini; Sharma, Sanjiv; Chilikuri, Srinivas; Shrivastava, Shyam Kishore

    2012-01-01

    Introduction External beam radiation followed by vaginal brachytherapy (±chemotherapy) leads to reduction in the risk of local recurrence and improves progression-free survival in patients with adverse risk factors following Wertheim's hysterectomy albeit at the risk of late bowel toxicity. Intensity Modulated Radiotherapy (IMRT) results in reduction in bowel doses and has potential to reduce late morbidity, however, needs to be confirmed prospectively in a randomised trial. The present randomised trial tests reduction if any in late small bowel toxicity with the use of IMRT in postoperative setting. Methods and analysis Patients more than 18 years of age who need adjuvant (chemo) radiation will be eligible. Patients with residual pelvic or para-aortic nodal disease, history of multiple abdominal surgeries or any other medical bowel condition will be excluded. The trial will randomise patients into standard radiation or IMRT. The primary aim is to compare differences in late grades II–IV bowel toxicity between the two arms. The secondary aims of the study focus on evaluating correlation of dose–volume parameters and late toxicity and quality of life. The trial is planned as a multicentre randomised study. The trial is designed to detect a 13% difference in late grades II–IV bowel toxicity with an α of 0.05 and β of 0.80. A total of 240 patients will be required to demonstrate the aforesaid difference. Ethics and dissemination The trial is approved by institutional ethics review board and will be routinely monitored as per standard guidelines. The study results will be disseminated via peer reviewed scientific journals, conference presentations and submission to regulatory authorities. Registration The trial is registered with clinicaltrials.gov (NCT 01279135). PMID:23242243

  1. Primate pelvic anatomy and implications for birth.

    PubMed

    Trevathan, Wenda

    2015-03-05

    The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the birth canal. The result for many species, and especially for encephalized primates, is an 'obstetric dilemma' whereby the neonate often has to negotiate a tight squeeze in order to be born. On top of what was probably a baseline of challenging birth, locomotor changes in the evolution of bipedalism in the human lineage resulted in an even more complex birth process. Negotiation of the bipedal pelvis requires a series of rotations, the end of which has the infant emerging from the birth canal facing the opposite direction from the mother. This pattern, strikingly different from what is typically seen in monkeys and apes, places a premium on having assistance at delivery. Recently reported observations of births in monkeys and apes are used to compare the process in human and non-human primates, highlighting similarities and differences. These include presentation (face, occiput anterior or posterior), internal and external rotation, use of the hands by mothers and infants, reliance on assistance, and the developmental state of the neonate.

  2. Primate pelvic anatomy and implications for birth

    PubMed Central

    Trevathan, Wenda

    2015-01-01

    The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the birth canal. The result for many species, and especially for encephalized primates, is an ‘obstetric dilemma’ whereby the neonate often has to negotiate a tight squeeze in order to be born. On top of what was probably a baseline of challenging birth, locomotor changes in the evolution of bipedalism in the human lineage resulted in an even more complex birth process. Negotiation of the bipedal pelvis requires a series of rotations, the end of which has the infant emerging from the birth canal facing the opposite direction from the mother. This pattern, strikingly different from what is typically seen in monkeys and apes, places a premium on having assistance at delivery. Recently reported observations of births in monkeys and apes are used to compare the process in human and non-human primates, highlighting similarities and differences. These include presentation (face, occiput anterior or posterior), internal and external rotation, use of the hands by mothers and infants, reliance on assistance, and the developmental state of the neonate. PMID:25602069

  3. Externally heated thermal battery

    NASA Astrophysics Data System (ADS)

    Pracchia, Louis; Vetter, Ronald F.; Rosenlof, Darwin

    1991-04-01

    A thermal battery activated by external heat comprising an anode (e.g., composed of a lithium-aluminum alloy), a cathode (e.g., composed of iron disulfide), and an electrolyte (e.g., a lithium chloride-potassium chloride eutectic) with the electrolyte inactive at ambient temperature but activated by melting at a predetermined temperature when exposed to external heating is presented. The battery can be used as a sensor or to ignite pyrotechnic and power electronic devices in a system for reducing the hazard of ordnance exposed to detrimental heating. A particular application is the use of the battery to activate a squib to function in conjunction with one or more other components to vent an ordnance case in order to prevent its explosion in a fire.

  4. Externally triggered microcapsules

    NASA Technical Reports Server (NTRS)

    Morrison, Dennis R. (Inventor); Mosier, Benjamin (Inventor)

    2011-01-01

    Disclosed are microcapsules comprising a polymer shell enclosing one or more immiscible liquid phases in which a drug or drug precursor are contained in a liquid phase. The microparticles also contain magnetic particles that can be heated by application of an external magnetic field and thus heated to a predetermined Curie temperature. Heating of the particles melts the polymer shell and releases the drug without causing heating of surrounding tissues.

  5. 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.

  6. Effect of Individual Strengthening Exercises for Anterior Pelvic Tilt Muscles on Back Pain, Pelvic Angle, and Lumbar ROMs of a LBP Patient with Flat Back.

    PubMed

    Yoo, Won-Gyu

    2013-10-01

    [Purpose] The purpose of this paper is to report the effect of individual strengthening exercises for the anterior pelvic tilt muscles on back pain, pelvic tilt angle, and lumbar ROM of a low back pain (LBP) patient with flat back. [Subject] A 37 year-old male, who complained of LBP pain at L3-5 levels with flat back, participated. [Methods] He performed the individual strengthening exercises for anterior pelvic tilt muscles (erector spinae,iliopsoas, rectus femoris). [Results] Pelvic tilt angles of the right and left sides were recovered to normal ranges. His lumbar ROMs increased, and low back pain decreased. [Conclusion] We suggest that individual resistance exercises are a necessary approach for effective and fast strengthening of pelvic anterior tilt muscles in LBP with flat back.

  7. Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy.

    PubMed

    Kinahan, John; Pai, Howard; Martens, Mildred; Gray, Jason; Biberdorf, Darren; Mihailovic, Alex; McAuley, Iain

    2014-01-01

    Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum.

  8. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities

    PubMed Central

    Qiu, Wen-Jun; Li, Yi-Fan; Ji, Yun-Han; Xu, Wei; Zhu, Xiao-Dong; Tang, Xian-Zhong; Zhao, Huan-Li; Wang, Gui-Bin; Jia, Yue-Qing; Zhu, Shi-Cai; Zhang, Feng-Fang; Liu, Hong-Mei

    2015-01-01

    In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined. PMID:26549312

  9. VLAP: results immediately post-op

    NASA Astrophysics Data System (ADS)

    Cowles, Robert S.

    1996-05-01

    Visual laser ablation of the prostate (VLAP) has been shown to be as effective with fewer complications than TURP in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia. Questions have been raised about VLAP regarding prolonged irritative and obstructive voiding symptoms postoperatively. It is postulated that these symptoms are due to the slow slough of necrotic debris following VLAP. In an effort to improve upon the technique of VLAP, patients underwent lasing of the prostate in the routine manner (2, 4, 8, and 10 o'clock positions with sixty watts for sixty seconds) using Nd:YAG free beam energy. A bladder neck incision was then performed using a contact laser fiber. International prostate symptom score assessments were done preoperatively; one week and six weeks postoperatively. Post void residual urine volumes and prostate size were also evaluated. The findings indicate that symptom scores and post void residual urine volumes have significantly improved within ten days postoperatively using this technique.

  10. Postoperative maladaptive behavioral changes in children.

    PubMed

    Yuki, Koichi; Daaboul, Dima G

    2011-06-01

    Induction of anesthesia can be a very stressful period for a child and his family and can be associated with increased risk of psychological disturbances. These disturbances are categorized as preoperative anxiety, emergence delirium and postoperative behavioral changes. Several tools have been developed to measure these psychological manifestations as well as the baseline personality traits of these patients. Postoperative negative behavioral changes, such as sleep and eating disorders, separation anxiety, temper tantrum, aggression toward authorities, may occur in up to 60% of all children undergoing general anesthesia. Several studies found a strong association between these postoperative behavioral changes, the distress of the child on induction and his individual personality characteristics, although a cause-effect relationship could not be determined. Understanding the risk factors for behavior changes helps us determine the best way for prevention and treatment of these changes in the perioperative period.

  11. 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

  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. Current concepts of female pelvic anatomy and physiology.

    PubMed

    Mostwin, J L

    1991-05-01

    The female urinary bladder and urethra are situated on the intrapelvic surface of the anterior vaginal wall, firmly anchored to the distal vagina by the urogenital diaphragm and to the superior vagina at the vesicocervicouterine junction. The anterior surface of the proximal urethra is firmly anchored to the posterior aspect of the symphysis pubis by the pubourethral ligaments and to the remaining distal vagina by the lower two thirds of the urogenital diaphragm. The lateral bladder wall derives its support from the anterior vaginal wall attachments to the pelvic sidewall. The anterior vaginal wall is strongly supported by pubococcygeus muscle fibers inserting on the vaginal wall and the genital hiatus and by the cardinal and uterosacral ligaments. Vaginal detachment from the lateral pelvic sidewall can result in herniation, with accompanying secondary posterior bladder descent. Levator ani weakness or injury may be a contributing etiologic factor in the genesis of vaginal wall detachment and the development of stress incontinence.

  14. Subperitoneal pelvic exposure of elemental mercury from a broken thermometer.

    PubMed

    Shen, Zhen; Zheng, Shan; Dong, Kuiran; Xiao, Xianmin; Shi, Wei

    2012-02-01

    Subperitoneal pelvic exposure of elemental mercury from a broken thermometer is quite rare. The outcome and intervention for such a situation is uncertain. A 10-month-old boy was exposed to elemental mercury when a mercury thermometer was broken while being used to measure a central temperature rectally. Deposits of mercury were localized in the subperitoneal pelvic cavity, as seen on consecutive abdominal films and CT scan. Serum and urine mercury concentrations were elevated but no systemic symptoms or signs were found. Laparoscopic surgery removed most of the mercury deposits but failed to remove them completely. At the 11-month follow-up, serum and urine mercury concentrations normalized and no systemic toxicity was present.

  15. Pregnancy-related pelvic girdle pain: an update

    PubMed Central

    2011-01-01

    A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women. PMID:21324134

  16. Computer-Assisted Resection and Reconstruction of Pelvic Tumor Sarcoma

    PubMed Central

    Docquier, Pierre-Louis; Paul, Laurent; Cartiaux, Olivier; Delloye, Christian; Banse, Xavier

    2010-01-01

    Pelvic sarcoma is associated with a relatively poor prognosis, due to the difficulty in obtaining an adequate surgical margin given the complex pelvic anatomy. Magnetic resonance imaging and computerized tomography allow valuable surgical resection planning, but intraoperative localization remains hazardous. Surgical navigation systems could be of great benefit in surgical oncology, especially in difficult tumor location; however, no commercial surgical oncology software is currently available. A customized navigation software was developed and used to perform a synovial sarcoma resection and allograft reconstruction. The software permitted preoperative planning with defined target planes and intraoperative navigation with a free-hand saw blade. The allograft was cut according to the same planes. Histological examination revealed tumor-free resection margins. Allograft fitting to the pelvis of the patient was excellent and allowed stable osteosynthesis. We believe this to be the first case of combined computer-assisted tumor resection and reconstruction with an allograft. PMID:21127723

  17. Computer-assisted resection and reconstruction of pelvic tumor sarcoma.

    PubMed

    Docquier, Pierre-Louis; Paul, Laurent; Cartiaux, Olivier; Delloye, Christian; Banse, Xavier

    2010-01-01

    Pelvic sarcoma is associated with a relatively poor prognosis, due to the difficulty in obtaining an adequate surgical margin given the complex pelvic anatomy. Magnetic resonance imaging and computerized tomography allow valuable surgical resection planning, but intraoperative localization remains hazardous. Surgical navigation systems could be of great benefit in surgical oncology, especially in difficult tumor location; however, no commercial surgical oncology software is currently available. A customized navigation software was developed and used to perform a synovial sarcoma resection and allograft reconstruction. The software permitted preoperative planning with defined target planes and intraoperative navigation with a free-hand saw blade. The allograft was cut according to the same planes. Histological examination revealed tumor-free resection margins. Allograft fitting to the pelvis of the patient was excellent and allowed stable osteosynthesis. We believe this to be the first case of combined computer-assisted tumor resection and reconstruction with an allograft.

  18. Hemorrhage Detection and Segmentation in Traumatic Pelvic Injuries

    PubMed Central

    Davuluri, Pavani; Wu, Jie; Tang, Yang; Cockrell, Charles H.; Ward, Kevin R.; Najarian, Kayvan; Hargraves, Rosalyn H.

    2012-01-01

    Automated hemorrhage detection and segmentation in traumatic pelvic injuries is vital for fast and accurate treatment decision making. Hemorrhage is the main cause of deaths in patients within first 24 hours after the injury. It is very time consuming for physicians to analyze all Computed Tomography (CT) images manually. As time is crucial in emergence medicine, analyzing medical images manually delays the decision-making process. Automated hemorrhage detection and segmentation can significantly help physicians to analyze these images and make fast and accurate decisions. Hemorrhage segmentation is a crucial step in the accurate diagnosis and treatment decision-making process. This paper presents a novel rule-based hemorrhage segmentation technique that utilizes pelvic anatomical information to segment hemorrhage accurately. An evaluation measure is used to quantify the accuracy of hemorrhage segmentation. The results show that the proposed method is able to segment hemorrhage very well, and the results are promising. PMID:22919433

  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. The Virtual Pelvic Floor, a tele-immersive educational environment.

    PubMed Central

    Pearl, R. K.; Evenhouse, R.; Rasmussen, M.; Dech, F.; Silverstein, J. C.; Prokasy, S.; Panko, W. B.

    1999-01-01

    This paper describes the development of the Virtual Pelvic Floor, a new method of teaching the complex anatomy of the pelvic region utilizing virtual reality and advanced networking technology. Virtual reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereo vision, viewer-centered perspective, large angles of view, and interactivity. Two or more ImmersaDesk systems, drafting table format virtual reality displays, are networked together providing an environment where teacher and students share a high quality three-dimensional anatomical model, and are able to converse, see each other, and to point in three dimensions to indicate areas of interest. This project was realized by the teamwork of surgeons, medical artists and sculptors, computer scientists, and computer visualization experts. It demonstrates the future of virtual reality for surgical education and applications for the Next Generation Internet. Images Figure 1 Figure 2 Figure 3 PMID:10566378

  1. A Unique Case of Systemic Lupus Erythematosus Pelvic Vasculitis

    PubMed Central

    Basnyat, Shristi; Eid, Hala; Kuzyshyn, Halyna; Feinstein, David

    2016-01-01

    The clinical presentation of Systemic Lupus Erythematosus (SLE) is diverse and vasculitis can be a potential manifestation. Cutaneous lesions involving small vessels are the most frequent presentation. However, medium and large vessel vasculitis may present with life-threatening visceral manifestations. We present a unique case of pelvic vasculitis mimicking a pelvic mass as an initial presentation of SLE. There are case reports of systemic vasculitis involving the female genital tract with giant cell arteritis (GCA), polyarteritis nodosa (PAN), and granulomatous with polyangiitis and microscopic polyangiitis (GPA/MPA), among others, but only a few cases attributed to SLE. Awareness of this condition and a prompt diagnosis are warranted as this is a severe and potentially life-threatening condition. PMID:28127489

  2. Pregnancy-related pelvic girdle pain: an update.

    PubMed

    Kanakaris, Nikolaos K; Roberts, Craig S; Giannoudis, Peter V

    2011-02-15

    A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women.

  3. [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.

  4. Pelvic hydatid disease: CT and MRI findings causing sciatica.

    PubMed

    Sanal, Hatice Tuba; Kocaoglu, Murat; Bulakbasi, Nail; Yildirim, Duzgun

    2007-01-01

    Pelvic masses, especially hydatid disease, rarely present with sciatica (1, 2). We present the computed tomography (CT) and the magnetic resonance imaging (MRI) findings of a 49-year-old female patient with presacral hydatid disease, who was evaluated for her sciatica. We also want to emphasize the importance of assessing the pelvis of patients with symptoms and clinical findings that are inconsistent and that cannot be satisfactorily explained by the spinal imaging findings.

  5. A three-dimensional definition of nodal spaces on the basis of CT images showing enlarged nodes for pelvic radiotherapy

    SciTech Connect

    Portaluri, Maurizio . E-mail: portaluri@hotmail.com; Bambace, Santa; Perez, Celeste; Angone, Grazia

    2005-11-15

    Purpose: To demonstrate that margins of each pelvic chain may be derived by verifying the bony and soft tissue structures around abnormal nodes on computed tomography (CT) slices. Methods and Materials: Twenty consecutive patients (16 males, 4 females; mean age, 66 years; range, 43-80 years) with radiologic diagnosis of nodal involvement by histologically proved cervix carcinoma (two), rectum carcinoma (three), prostate carcinoma (four), lymphoma (five), penis carcinoma (one), corpus uteri carcinoma (one), bladder carcinoma (two), cutis tumor (one), and soft-tissue sarcoma (one) were retrospectively reviewed. One hundred CT scans showing 85 enlarged pelvic nodes were reviewed by two radiation oncologists (M.P., S.B.), and two radiologists (C.P., G.A.). Results: The more proximal structures to each enlarged node or group of nodes were thus recorded in a clockwise direction. Conclusion: According to their frequency and visibility, craniocaudal, anterior, lateral, posterior and medial margins of common iliac, external and internal iliac nodal chains, obturator and pudendal nodes, and deep and superficial inguinal nodes were derived from CT observations.

  6. Management of postoperative complications: general approach.

    PubMed

    Sanguineti, V Ana; Wild, Jason R; Fain, Mindy J

    2014-05-01

    The goal of postoperative management is to promote early mobility and avoid postoperative complications, recognizing the potentially devastating impact of complications on elderly patients with hip fracture. The recommended approach involves early mobilization; freedom from tethers (indwelling urinary catheters and other devices); effective pain control; treating malnutrition; preventing pressure ulcers; reducing risk for pulmonary, urinary, and wound infections; and managing cognition. This carefully structured and patient-centered management provides older, vulnerable patients their best chance of returning to their previous level of functioning as quickly and safety as possible.

  7. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

    Ong, Cliff K. S.; Seymour, R. A.

    2003-01-01

    Pain is a major postoperative symptom in many oral surgical procedures. It is a complex and variable phenomenon that can be influenced by many factors. Good management of oral surgical pain requires a detailed understanding of the pathogenesis of surgical pain. This article aims at reviewing postoperative pain from a broad perspective by looking into the nociception, neuroanatomy, neurophysiology, and neuropharmacology of pain. Therapeutic recommendations are made after reviewing the evidence from the literature for maximizing the efficacy of pain management techniques for oral surgical pain. PMID:12722900

  8. Postoperative global amnesia reversed with flumazenil.

    PubMed

    Rinehart, Joseph B; Baker, Brandee; Raphael, Darren

    2012-07-01

    Global postoperative amnesia (profound anterograde and retrograde amnesia) is rare and usually attributed to transient global amnesia-a poorly understood condition with no broadly accepted mechanism. We report an incident of probable transient global amnesia in a patient after endoscopic retrograde cholangiopancreatogram under general anesthesia, which was successfully treated with flumazenil. On the basis of the results of flumazenil administration in this and a previous case report, we would recommend a trial dose of 0.2 mg for cases of global postoperative amnesia, repeated if the first dose seems effective.

  9. Surface-based determination of the pelvic coordinate system

    NASA Astrophysics Data System (ADS)

    Fieten, Lorenz; Eschweiler, Jörg; Heger, Stefan; Kabir, Koroush; Gravius, Sascha; de la Fuente, Matías; Radermacher, Klaus

    2009-02-01

    In total hip replacement (THR) one technical factor influencing the risk of dislocation is cup orientation. Computer-assisted surgery systems allow for cup navigation in anatomy-based reference frames. The pelvic coordinate system most used for cup navigation in THR is based on the mid-sagittal plane (MSP) and the anterior pelvic plane (APP). From a geometrical point of view, the MSP can be considered as a mirror plane, whereas the APP can be considered as a tangent plane comprising the anterior superior iliac spines (ASIS) and the pubic tubercles. In most systems relying on the pelvic coordinate system, the most anterior points of the ASIS and the pubic tubercles are selected manually. As manual selection of landmark points is a tedious, time-consuming and error-prone task, a surface-based approach for combined MSP and APP computation is presented in this paper: Homologous points defining the MSP and the landmark points defining the APP are selected automatically from surface patches. It is investigated how MSP computation can benefit from APP computation and vice versa, and clinical perspectives of combined MSP and APP computation are discussed. Experimental results on computed tomography data show that the surface-based approach can improve accuracy.

  10. [Follow-up and counselling after pelvic inflammatory disease].

    PubMed

    Derniaux, E; Lucereau-Barbier, M; Graesslin, O

    2012-12-01

    Pelvic inflammatory disease (PID) can be responsible for infertility and chronic pelvic pain. Treatment of acute PID is very important as it can reduce the risk of sequelae. However, follow-up, partner treatment and counselling are also useful to reduce the reinfection rate. Few weeks after PID, clinical evaluation as well as transvaginal and transabdominal sonography must be performed. The interest of systematic bacteriological tests is not proved. Hysterosalpingography and second-look laparoscopy should be considered only for women with infertility and severe infection. Use of condom is advisable in this population in order to prevent sexually transmitted diseases (STD) including HIV and to decrease rate of recurrence, associated to contraceptive pill, which is also a good option. In selected cases, intrauterine devices can be used in patients with history of PID if the infection is resolved and no significant risk factors for STD exist. Infertility and chronic pelvic pain are the most common sequelae in the population of young women with severe and recurrent infection. The risk of ectopic pregnancy is higher for these women and must be kept in mind. Counselling and risk-reduction interventions decreased significatively the rate of recurrence and sequelae in PID.

  11. Flight vibrations and bleeding in helicoptered patients with pelvic fracture.

    PubMed

    Carchietti, Elio; Cecchi, Adriana; Valent, Francesca; Rammer, Raphael

    2013-01-01

    Depending on their amplitude and frequency, vibrations may facilitate bleeding and worsen the prognosis of patients with pelvic fractures transported by helicopter emergency medical services (HEMS). We measured the range of frequencies and amplitudes of forced vibrations produced by the helicopter used by the HEMS of the Italian Friuli Venezia Giulia region on the pelvis of transported persons. We performed 3 flight tests with 3 different volunteers (mass 70, 80, and 90 kg, respectively) loaded on the helicopter's stretcher and recorded the amplitudes and frequencies of vibrations through a triaxis sensor placed on the HEMS stretcher in the pelvis area. The flight profile planned was identical for each of the 3 iterations. Over the whole flight, the frequencies of vibration were between 26.4 and 53.5 Hz, and the greastest amplitude was 0.035 mm. The vibrations recorded in the helicopter may facilitate bleeding in unstable fractures. In the management of patients with pelvic fractures, HEMS crews should provide prehospital care that includes the use of specific splinting devices in addition to the spinal board, which allows an early immobilization of fractures and the limitation of pelvic motion.

  12. Treatment of unstable fractures of the pelvic ring in pregnancy.

    PubMed

    Loegters, Tim; Briem, Daniel; Gatzka, Christian; Linhart, Wolfgang; Begemann, Phillip G; Rueger, Johannes M; Windolf, Joachim

    2005-04-01

    Unstable fractures of the posterior pelvic ring during pregnancy are rare. Pregnancy increases the high demands on the therapy of these types of fractures. The aim of the therapeutic strategy in such a situation is a good functional outcome of the mother without influencing the fetal health. Some osteosynthetic techniques result in good functional outcomes, but they are associated with high amounts of ionizing radiation. We report the case of a pregnant woman who sustained a vertical unstable fracture of the posterior pelvic ring as a result of a traffic accident. The fracture was treated surgically by open reduction and internal fixation with two transiliac reconstruction plates with minimal radiographic exposure to the fetus. One year later, a good functional result concerning the mother was shown. The child was healthy without any signs of prenatal impairment. Surgical treatment of an unstable fracture of the pelvic ring during pregnancy is possible with a justifiable risk to the mother and the child. Consideration of the expected fetal radiation exposure in the course of the therapy is particularly recommended. Using minimal doses of ionizing radiation, the described method results in a good clinical outcome of the mother while simultaneously reducing the radiation exposure of the fetus to an acceptable level.

  13. Conditioned place preference for mating is preserved in rats with pelvic nerve transection

    PubMed Central

    Meerts, Sarah H.; Clark, Ann S.

    2009-01-01

    Female rats exhibit a conditioned place preference (CPP) for a context paired with mating. The present experiment tested the hypothesis that the activation of the pelvic nerve mediates the reinforcing effects of mating for female rats. Rats underwent bilateral pelvic nerve or sham transection and then received paced mating, nonpaced mating or the control treatment during a CPP procedure. Pelvic nerve transection did not affect the CPP for paced or nonpaced mating. In tests of paced mating behavior, contact-return latencies following intromissions were significantly shorter in rats with pelvic nerve transection than rats with sham transections. These results show that the pathway conveying the reinforcing effects of mating stimulation does not depend on the integrity of the pelvic nerve, but that activation of the pelvic nerve contributes to the display of paced mating behavior. PMID:19485560

  14. Acetabular distraction: an alternative approach to pelvic discontinuity in failed total hip replacement.

    PubMed

    Brown, N M; Hellman, M; Haughom, B H; Shah, R P; Sporer, S M; Paprosky, W G

    2014-11-01

    A pelvic discontinuity occurs when the superior and inferior parts of the hemi-pelvis are no longer connected, which is difficult to manage when associated with a failed total hip replacement. Chronic pelvic discontinuity is found in 0.9% to 2.1% of hip revision cases with risk factors including severe pelvic bone loss, female gender, prior pelvic radiation and rheumatoid arthritis. Common treatment options include: pelvic plating with allograft, cage reconstruction, custom triflange implants, and porous tantalum implants with modular augments. The optimal technique is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable healing between the two segments. A method of treating pelvic discontinuity using porous tantalum components with a distraction technique that achieves both initial stability and subsequent long-term biological fixation is described.

  15. 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.

  16. Microlaparoscopic Conscious Pain Mapping in the Evaluation of Chronic Pelvic Pain: A Case Report

    PubMed Central

    2002-01-01

    Chronic pelvic pain is a debilitating, life-altering syndrome that negatively affects a woman's quality of life and personal relationships. Many women continue to suffer with pelvic pain despite having undergone multiple medical and surgical treatments. Unfortunately, some women are incorrectly labeled as having psychological illness when organic disease may be present. I report a case of a woman who underwent multiple pelvic and abdominal surgeries before the cause of her pain was identified through microlaparoscopic conscious pain mapping. PMID:12004805

  17. Are oral contraceptives masking symptoms of chlamydial cervicitis and pelvic inflammatory disease?

    PubMed

    Mårdh, P A; Hogg, B

    1998-03-01

    Tubal factor infertility is often diagnosed without any documented history of pelvic inflammatory disease. Chlamydial infection is one of the most common causes of pelvic inflammatory disease and likely also of infertility and ectopic pregnancy. Oral contraceptives may alter the course of chlamydial infections which may mask the clinical expression of the disease. This paper considers a number of unresolved matters related to oral contraceptive use and its possible influence on the epidemiology and course of chlamydial pelvic inflammatory disease.

  18. Pelvic Floor Disorders in Female Veterans: What a Difference an X Makes

    DTIC Science & Technology

    2011-07-22

    PELVIC FLOOR DISORDERS IN FEMALE VETERANS What a difference an X Makes July 22, 2011 Christine L. G. Sears MD CDR MC USN Report Documentation Page...DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Pelvic Floor Disorders in Female Veterans 5a. CONTRACT NUMBER 5b. GRANT NUMBER...Urinary Tract Infection and related symptoms  Pelvic Organ Prolapse  Urinary Incontinence  Bladder Pain Syndrome  Graphics non intrusive  Discuss

  19. Orthopedic emergencies: a practical emergency department classification (US-VAGON) in pelvic fractures.

    PubMed

    Wang, Hao; Coppola, Paolo T; Coppola, Marco

    2015-05-01

    Trauma is one of the leading causes of death before the age of 40 years and approximately 5% of patients with trauma who require hospital admission have pelvic fractures. This article updates the emergency department classification of pelvic fractures first described in 2000. This information is of practical value to emergency physicians in identifying the potential vascular, genitourinary, gastrointestinal, orthopedic, and neurologic complications and further assists them in the initial evaluation and treatment of patients with pelvic fractures.

  20. Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy

    PubMed Central

    Jeon, Hyun Woo; Kye, Yeo Kon; Kim, Kyung Soo

    2016-01-01

    Background Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. Methods From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. Results The median age was 19 years (range, 11−34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1−10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. Conclusions Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence. PMID:26904217

  1. External Ballistics. Part 1

    DTIC Science & Technology

    1978-07-11

    clcsely related with aezodyzasics, ky gzavtaetry and the thecry cf the figure of Earth , by metecrology. Ballistic calculatica Sives all the bamic data...external tallistics. %he conteaFcrary state of the sciemce of the action cf rcckets and artillery ste]l cf different t)pes is such, that many of the e...height. L- 14near distance ovX tOf surface of thq Earth . ol - crbital velocity. V-1 - escape velocity. 2v_ - range angle. S- eaight of projqctile. Q

  2. External split field generator

    DOEpatents

    Thundat, Thomas George [Knoxville, TN; Van Neste, Charles W [Kingston, TN; Vass, Arpad Alexander [Oak Ridge, TN

    2012-02-21

    A generator includes a coil disposed about a core. A first stationary magnetic field source may be disposed on a first end portion of the core and a second stationary magnetic field source may be disposed on a second end portion of core. The first and second stationary magnetic field sources apply a stationary magnetic field to the coil. An external magnetic field source may be disposed outside the coil to apply a moving magnetic field to the coil. Electrical energy is generated in response to an interaction between the coil, the moving magnetic field, and the stationary magnetic field.

  3. DIRBE External Calibrator (DEC)

    NASA Technical Reports Server (NTRS)

    Wyatt, Clair L.; Thurgood, V. Alan; Allred, Glenn D.

    1987-01-01

    Under NASA Contract No. NAS5-28185, the Center for Space Engineering at Utah State University has produced a calibration instrument for the Diffuse Infrared Background Experiment (DIRBE). DIRBE is one of the instruments aboard the Cosmic Background Experiment Observatory (COBE). The calibration instrument is referred to as the DEC (Dirbe External Calibrator). DEC produces a steerable, infrared beam of controlled spectral content and intensity and with selectable point source or diffuse source characteristics, that can be directed into the DIRBE to map fields and determine response characteristics. This report discusses the design of the DEC instrument, its operation and characteristics, and provides an analysis of the systems capabilities and performance.

  4. Embolization of Incompetent Pelvic Veins for the Treatment of Recurrent Varicose Veins in Lower Limbs and Pelvic Congestion Syndrome

    SciTech Connect

    Meneses, Luis Fava, Mario; Diaz, Pia; Andia, Marcelo; Tejos, Cristian; Irarrazabal, Pablo; Uribe, Sergio

    2013-02-15

    We present our experience with embolization of incompetent pelvic veins (IPV) in women with recurrence of varicose veins (VV) in lower limbs, as well as symptoms of pelvic congestion syndrome (PCS), after first surgery. In addition, we evaluated the effects of embolization in decreasing the symptoms of VV before surgery as well as its effects on PCS symptoms. We included 10 women who had consulted a vascular surgeon because of recurrent VV in lower limbs after surgery. All of these patients were included in the study because they also had symptoms of PCS, probably due to IPV. In patients who had confirmed IPV, we performed embolization before a second surgery. VV and PCS were assessed before and at 3 months after embolization (before the second surgery) using a venous clinical severity score (VCSS) and a visual analog pain scale (VAS), respectively. Patients were controlled between 3 and 6 months after embolization. Paired Student t test analysis was used for comparing data before and after embolization. Fifteen vein segments in 10 women were suitable for embolization. There was a significant (p < 0.001) decrease of VCSS after embolization, and recurrence of VV was not detected within a period of 6 months. There was also significant (p < 0.01) relief of chronic pelvic pain related to PCS evaluated using VAS at 3 months after embolization. Embolization decreases the risk of VV recurrence after surgery and also improves PCS symptoms in women with VV in lower limbs and IPV.

  5. Cortical activation associated with muscle synergies of the human male pelvic floor.

    PubMed

    Asavasopon, Skulpan; Rana, Manku; Kirages, Daniel J; Yani, Moheb S; Fisher, Beth E; Hwang, Darryl H; Lohman, Everett B; Berk, Lee S; Kutch, Jason J

    2014-10-08

    Human pelvic floor muscles have been shown to operate synergistically with a wide variety of muscles, which has been suggested to be an important contributor to continence and pelvic stability during functional tasks. However, the neural mechanism of pelvic floor muscle synergies remains unknown. Here, we test the hypothesis that activation in motor cortical regions associated with pelvic floor activation are part of the neural substrate for such synergies. We first use electromyographic recordings to extend previous findings and demonstrate that pelvic floor muscles activate synergistically during voluntary activation of gluteal muscles, but not during voluntary activation of finger muscles. We then show, using functional magnetic resonance imaging (fMRI), that a region of the medial wall of the precentral gyrus consistently activates during both voluntary pelvic floor muscle activation and voluntary gluteal activation, but not during voluntary finger activation. We finally confirm, using transcranial magnetic stimulation, that the fMRI-identified medial wall region is likely to generate pelvic floor muscle activation. Thus, muscle synergies of the human male pelvic floor appear to involve activation of motor cortical areas associated with pelvic floor control.

  6. A review of functional pelvic floor imaging modalities and their effectiveness.

    PubMed

    Ahmad, Aminah N; Hainsworth, Alison; Williams, Andrew B; Schizas, Alexis M P

    2015-01-01

    The anatomy of the pelvic floor is complex and clinical examination alone is often insufficient to diagnose and assess pathology. With a greater understanding of pelvic floor dysfunction and treatment options, imaging is becoming increasingly common. This review compares three imaging techniques. Ultrasound has the potential for dynamic assessment of the entire pelvic floor. Magnetic resonance imaging is able to rapidly image the entire pelvic floor but it is expensive and tends to underestimate pathology. Dynamic defaecating proctography or cystocolpoproctography is the current gold standard for posterior compartment imaging but requires opacification of the bladder to provide a global view.

  7. Coil Protruding into the Common Femoral Vein Following Pelvic Venous Embolization

    SciTech Connect

    Marsh, Petra Holdstock, Judith M.; Bacon, Jennifer L.; Lopez, Anthony J.; Whiteley, Mark S.; Price, Barrie A.

    2008-03-15

    Pelvic venous embolization is performed for pelvic congestion syndrome and prior to lower limb varicose vein surgery in females with associated pelvic venous insufficiency. The procedure is analogous to varicocele embolization in males, although refluxing internal iliac vein tributaries may also be embolized. We report a case of inadvertent coil placement in the common femoral vein while embolizing the obturator vein, during pelvic vein embolization for recurrent lower limb varicose veins. There were no clinical consequences and the coil was left in situ. We advise caution when embolizing internal iliac vein tributaries where there is clinically significant communication with veins of the lower limb.

  8. 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

  9. Cortical Activation Associated with Muscle Synergies of the Human Male Pelvic Floor

    PubMed Central

    Asavasopon, Skulpan; Rana, Manku; Kirages, Daniel J.; Yani, Moheb S.; Fisher, Beth E.; Hwang, Darryl H.; Lohman, Everett B.; Berk, Lee S.

    2014-01-01

    Human pelvic floor muscles have been shown to operate synergistically with a wide variety of muscles, which has been suggested to be an important contributor to continence and pelvic stability during functional tasks. However, the neural mechanism of pelvic floor muscle synergies remains unknown. Here, we test the hypothesis that activation in motor cortical regions associated with pelvic floor activation are part of the neural substrate for such synergies. We first use electromyographic recordings to extend previous findings and demonstrate that pelvic floor muscles activate synergistically during voluntary activation of gluteal muscles, but not during voluntary activation of finger muscles. We then show, using functional magnetic resonance imaging (fMRI), that a region of the medial wall of the precentral gyrus consistently activates during both voluntary pelvic floor muscle activation and voluntary gluteal activation, but not during voluntary finger activation. We finally confirm, using transcranial magnetic stimulation, that the fMRI-identified medial wall region is likely to generate pelvic floor muscle activation. Thus, muscle synergies of the human male pelvic floor appear to involve activation of motor cortical areas associated with pelvic floor control. PMID:25297107

  10. 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

  11. 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.

  12. Postoperative chylothorax: a case for recycling?

    PubMed

    Thomson, I A; Simms, M H

    1993-08-01

    Postoperative chylothorax in a patient who was rapidly deteriorating despite conservative treatment is described. A system of recycling chyle from the pleural space through a filter and pump into the subclavian vein is discussed. The history of reinfusion of chyle is reviewed.

  13. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  14. Postoperative nausea and vomiting following orthognathic surgery

    PubMed Central

    Phillips, C.; Brookes, C. D.; Rich, J.; Arbon, J.; Turvey, T. A.

    2015-01-01

    The purpose of this study was to assess the incidence and risk factors associated with postoperative nausea (PON) and vomiting (POV) after orthognathic surgery. A review of the clinical records of consecutively enrolled subjects (2008–2012) at a single academic institution was conducted between 9/2013 and 3/2014. Data on the occurrence of PON and POV and potential patient-related, intraoperative, and postoperative explanatory factors were extracted from the medical records. Logistic models were used for the presence/absence of postoperative nausea and vomiting separately. Data from 204 subjects were analyzed: 63% were female, 72% Caucasian, and the median age was 19 years. Thirty-three percent had a mandibular osteotomy alone, 27% a maxillary osteotomy alone, and 40% had bimaxillary osteotomies. Sixty-seven percent experienced PON and 27% experienced POV. The most important risk factors for PON in this series were female gender, increased intravenous fluids, and the use of nitrous oxide, and for POV were race, additional procedures, and morphine administration. The incidence of PON and POV following orthognathic surgery in the current cohort of patients, after the introduction of the updated 2007 consensus guidelines for the management of postoperative nausea and vomiting, has not decreased substantially from that reported in 2003–2004. PMID:25655765

  15. Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?

    SciTech Connect

    Al Yami, Ali; Griffin, Anthony M.; Ferguson, Peter C.; Catton, Charles N.; Chung, Peter W.M.

    2010-07-15

    Purpose: For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR). Methods and Materials: A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated. Results: Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13). Conclusions: We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did not provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.

  16. 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

  17. Swimming in external fields

    NASA Astrophysics Data System (ADS)

    Stark, Holger

    2016-11-01

    Microswimmers move autonomously but are subject to external fields, which influence their swimming path and their collective dynamics. With three concrete examples we illustrate swimming in external fields and explain the methodology to treat it. First, an active Brownian particle shows a conventional sedimentation profile in a gravitational field but with increased sedimentation length and some polar order along the vertical. Bottom-heavy swimmers are able to invert the sedimentation profile. Second, active Brownian particles interacting by hydrodynamic flow fields in a three-dimensional harmonic trap can spontaneously break the isotropic symmetry. They develop polar order, which one can describe by mean-field theory reminiscent to Weiss theory of ferromagnetism, and thereby pump fluid. Third, a single microswimmer shows interesting non-linear dynamics in Poiseuille flow including swinging and tumbling trajectories. For pushers, hydrodynamic interactions with bounding surfaces stabilize either straight swimming against the flow or tumbling close to the channel wall, while pushers always move on a swinging trajectory with a specific amplitude as limit cycle.

  18. Lower urogenital tract anatomical and functional phenotype in lysyl oxidase like-1 knockout mice resembles female pelvic floor dysfunction in humans.

    PubMed

    Lee, Una J; Gustilo-Ashby, A Marcus; Daneshgari, Firouz; Kuang, Mei; Vurbic, Drina; Lin, Dan Li; Flask, Chris A; Li, Tiansen; Damaser, Margot S

    2008-08-01

    Female pelvic floor dysfunction (FPFD) is a complex group of conditions that include urinary incontinence and pelvic organ prolapse (POP). In humans, elastin homeostasis has been implicated in the pathophysiology of FPFD. Lysyl oxidase-like 1 knockout (LOXL1-KO) mice demonstrate abnormal elastic fiber homeostasis and develop FPFD after parturition. We compared the lower urogenital tract (LUT) anatomy and function in LOXL1-KO mice with and without POP. LUT anatomy was assessed in LOXL1-KO mice over 28 wk. Pelvic visceral anatomy in LOXL1-KO was evaluated with a 7-Tesla magnetic resonance imaging (MRI) scanner. LUT function was assessed using conscious cystometry and leak point pressure (LPP) testing. Quantitative histological analysis of elastic fibers was performed on external urethral sphincter (EUS) cross sections. By 25 wk of age, 50% of parous LOXL1-KO mice developed POP. LOXL1-KO mice with POP had greater variability in the size and location of the bladder on MRI compared with mice without POP. Parity and POP were associated with lower LPP. Elastin clusters were significantly increased in the EUS of LOXL1-KO mice with POP. Because parity triggers POP in LOXL1-KO mice, LOXL1-KO mice with POP have variable internal pelvic anatomy, and both parity and POP are associated with a decrease in LPP, we conclude that LOXL1 LUT anatomical and functional phenotype resembles FPFD in humans. The increase in elastin clusters in the urethra of LOXL1-KO mice with POP suggests that elastin disorganization may lead to functional abnormalities. We conclude that LOXL1 warrants further investigation in the pathphysiology of FPFD.

  19. 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

  20. Management of Postoperative Lymphoceles After Lymphadenectomy: Percutaneous Catheter Drainage With and Without Povidone-Iodine Sclerotherapy

    SciTech Connect

    Alago, William Deodhar, Ajita; Michell, Hans; Sofocleous, Constantinos T.; Covey, Anne M.; Solomon, Stephen B.; Getrajdman, George I.; Dalbagni, Guido; Brown, Karen T.

    2013-04-15

    To report our single-center experience in managing symptomatic lymphoceles after lymphadenectomy for genitourinary and gynecologic malignancy and to compare clinical outcomes of percutaneous catheter drainage (PCD) alone versus PCD with transcatheter povidone-iodine sclerotherapy (TPIS). The medical records of patients who presented for percutaneous drainage of pelvic lymphoceles from February 1999 to September 2007 were retrospectively reviewed. Catheters with prolonged outputs >50 cc/day were treated with TPIS. Technical success was defined as the ability to achieve complete resolution of the lymphocele. Clinical success was defined as resolution of the patient's symptoms that prompted the intervention. Sixty-four patients with 70 pelvic lymphoceles were treated. Forty-six patients (71.9 %) had PCD, and 18 patients (28.1 %) had multisession TPIS. The mean initial cavity size was 294.9 cc for those treated with TPIS and 228.2 cc for those treated with PCD alone (range 15-1,600) (p = 0.59). Mean duration of catheter drainage was 19 days (29 days with TPIS, 16 days with PCD, p = 0.001). Mean clinical follow-up was 22.6 months. Technical success was 74.3 % with PCD and 100 % with TPIS. Clinical success was 97 % with PCD and 100 % with TPIS. Postprocedural complications included pericatheter fluid leakage (n = 4), catheter dislodgement (n = 3), catheter occlusion (n = 9), and secondary infection of the collection (n = 4). PCD of symptomatic lymphoceles is an effective postoperative management technique. Initial cavity size is not an accurate predictor of the need for TPIS. When indicated, TPIS is safe and effective with catheter outputs >50 cc/day.

  1. Postoperative radiotherapy improves local control and survival in patients with uterine leiomyosarcoma

    PubMed Central

    2013-01-01

    Background To examine the role of radiotherapy (RT) in uterine leiomyosarcomas (LMS) and to determine the patient population who may benefit from RT. Methods From 1998–2008, 69 patients with primary uterine LMS underwent hysterectomy with or without pelvic radiotherapy to a median dose of 45 Gy. Univariate analysis was performed using the Kaplan-Meier method and cumulative-incidence function, and multivariate analyses using Fine and Gray or Cox proportional hazard models. Results Following surgery, 32 out of 69 patients received RT. There was no evidence of any correlation between patient, disease and treatment characteristics and the use of RT. Median follow-up was 57 months. RT was associated with reduced local recurrence (3y LR 19% vs. 39%; Gray’s p = 0.019) and improved overall survival (3y OS 69% vs. 35%; log-rank p = 0.025) on univariate analysis. Multivariate analysis demonstrated that RT reduced LR (HR: 0.28, CI: 0.11-0.69, p = 0.006) and increased OS (HR: 0.44, CI: 0.23-0.85, p = 0.014) independent of other clinical and pathologic factors. Positive surgical margins increased the odds of LR (HR: 5.6, CI: 2.3-13.4, p = 0.00012). Large tumor size and advanced stage (II-IV) were associated with the development of distant metastases and inferior OS. Conclusions Postoperative pelvic RT reduces LR and improves OS of patients with uterine LMS. PMID:23705661

  2. [Carcinoma of the skin of the external auditory meatus].

    PubMed

    Jesić, S; Radulović, R; Djerić, D; Nesić, V; Dimitrijević, M; Petrović, Z; Arsović, N; Arsić-Mandarić, Z

    2004-01-01

    Carcinoma of the external meatus is a rare disease and a challenge to treat. Demographic and clinical characteristics of this disease are discussed for 14 patients treated in the Institute of Otorhinolaryngonlogy and Maxillofacial Surgery during the period 1993-2003. using four different clasification of the disease. All patients were treated surgically with postoperative radiotherapy. Five years survival is 100% for the II and II stage of the disease for all clasifications, and 75% for the III stage according to Pitsburg clasiffication. Reccurence of the disease in the first year after treatment is 66.6% and, 84% in the second year. The diagnostic protocol is clinical examination, computed tomography of the temporal bone, nuclear magnetic resonance of the temporal bone and endocranium, ultrasound examination of the neck and parotid region and tumor biopsy. The surgical approach could be less radical, through mastoid, with postoperative

  3. Postoperative adjuvant therapy of breast cancer. Oncology Overview

    SciTech Connect

    Not Available

    1984-12-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Postoperative chemotherapy; Postoperative radiotherapy; Postoperative hormone therapy; Postoperative immunotherapy and chemoimmunotherapy; Postoperative multimodal therapy; Prognostic factors in postoperative adjuvant therapy.

  4. 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.

  5. 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

  6. 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

  7. Disseminated pelvic actinomycosis presenting as metastatic carcinoma: association with the progestasert intrauterine device.

    PubMed

    Perlow, J H; Wigton, T; Yordan, E L; Graham, J; Wool, N; Wilbanks, G D

    1991-01-01

    Actinomycosis is caused by the anaerobic bacterium Actinomyces israelii. Asymptomatic colonization of the cervix with this organism has been noted in users of an intrauterine device (IUD), and its prevalence ranges between 1.6% and 36%. Rarely, symptomatic infection may occur, with the potential for extensive morbidity and even death. Herein we report a patient who survived severe disseminated actinomycosis yet presented with the clinical picture of a metastasized malignancy. This is the first report of disseminated pelvic actinomycosis presenting as an external lesion of the abdominal wall and in which a Progestasert IUD (Alza, Palo Alto, CA) was present. The common difficulty, and thus delay, in diagnosing this disease led to considerable morbidity due to an infection considered curable with penicillin. We recommend that all patients with an IUD or a history of IUD use have such information made known to those responsible for interpreting the Papanicolaou smear. Such knowledge may heighten suspicion and focus attention on the identification of these organisms before onset of clinical disease. It is important to consider this disease when caring for patients with an IUD or when counseling those contemplating its use as a contraceptive.

  8. Postoperative dressing and management strategies for transtibial amputations: a critical review.

    PubMed

    Smith, Douglas G; McFarland, Lynne V; Sangeorzan, Bruce J; Reiber, Gayle E; Czerniecki, Joseph M

    2003-01-01

    Postamputation management is an important determinant of recovery from amputation. However, consensus on the most effective postoperative management strategies for individuals undergoing transtibial amputation (TTA) is lacking. Dressings can include simple soft gauze dressings, thigh-high rigid cast dressings, shorter removable rigid dressings, and prefabricated pneumatic dressings. Postoperative prosthetic attachments can be added to all but simple soft dressings. These dressings address the need to cleanly cover a fresh surgical wound, but not all postoperative dressings are designed to facilitate the strategic goals of preventing knee contractures, reducing edema, protecting from external trauma, or facilitating early weight bearing. The type of dressing and management strategy often overlap and are certainly interrelated. Current protocols and decisions are based on local practice, skill, and intuition. The current available literature is challenging, and difficulties include variations in healing potential, in comorbidity, in surgical-level selection, in techniques and skill, in experience with postoperative strategies, and with poorly defined outcome criteria. This paper reviews the published literature and compares measures of safety, efficacy, and clinical outcomes of the various techniques. Analysis of 10 controlled studies supported only 4 of the 14 claims cited in uncontrolled, descriptive studies.

  9. Development and implementation of a dedicated postoperative evaluation service to improve compliance of postoperative visits

    PubMed Central

    Vacanti, Joshua Charles; Urman, Richard Dennis; Sarin, Pankaj; Liu, Xiaoxia; Kodali, Bhavani Shankar

    2015-01-01

    Background and Aims: Postoperative patient evaluation is an integral component of perioperative care. An audit of our anesthesia department's records demonstrated a compliance rate of <50%. We postulated that the development of clinical anesthesia service dedicated to performing such evaluations would improve compliance significantly. Materials and Methods: This retrospective study examined postoperative follow-up completion rate at a large academic center. Data were collected from 58,000 anesthetics during three periods, between each of which an intervention was introduced. The first period examined completion rate when postoperative evaluations were left to the team performing the anesthetic. During the second period, this task was delegated to groups of anesthesiologists based on surgical subspecialty; these smaller groups utilized rotating residents. The third period examined completion rate after implementation of a postoperative evaluation service. All periods utilized the department's electronics database to identify operative patients. The number of adverse anesthesia events reported was also recorded. Results: A significant difference in the proportions of compliance with postoperative evaluations among all three periods was detected. Compliance was 47% during period one and improved to 66% during period two. During period three, which employed a postoperative evaluation service, compliance was 83%. The number of adverse events reported per month increased significantly following the first study period from 95 reported monthly events to 215 and 201 in the second and third periods, respectively. Conclusion: By creating a dedicated postoperative evaluation service using available technology, we improved postoperative evaluation completion rate from 47% to 83%, and demonstrated a significant increase in the number of adverse events reported. Based on this, we support the deployment of a dedicated service as a quality improvement initiative. PMID:25788778

  10. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

    PubMed Central

    Kawada, Kenji; Sakai, Yoshiharu

    2016-01-01

    Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR. PMID:27433085

  11. 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.

  12. Bevalac external beamline optics

    SciTech Connect

    Kalnins, J.G.; Krebs, G.F.; Tekawa, M.M.; Alonso, J.R.

    1987-04-01

    This handbook is intended as an aid for tuning the external particle beam (EPB) lines at the Lawrence Berkeley Laboratory's Bevalac. The information contained within will be useful to the Bevalac's Main Control Room and experimenters alike. First, some general information is given concerning the EPB lines and beam optics. Next, each beam line is described in detail: schematics of the beam line components are shown, all the variables required to run a beam transport program are presented, beam envelopes are given with wire chamber pictures and magnet currents, focal points and magnifications. Some preliminary scaling factors are then presented which should aid in choosing a given EPB magnet's current for a given central Bevalac field. Finally, some tuning hints are suggested.

  13. External Measures of Cognition

    PubMed Central

    Cairό, Osvaldo

    2011-01-01

    The human brain is undoubtedly the most impressive, complex, and intricate organ that has evolved over time. It is also probably the least understood, and for that reason, the one that is currently attracting the most attention. In fact, the number of comparative analyses that focus on the evolution of brain size in Homo sapiens and other species has increased dramatically in recent years. In neuroscience, no other issue has generated so much interest and been the topic of so many heated debates as the difference in brain size between socially defined population groups, both its connotations and implications. For over a century, external measures of cognition have been related to intelligence. However, it is still unclear whether these measures actually correspond to cognitive abilities. In summary, this paper must be reviewed with this premise in mind. PMID:22065955

  14. Hanford External Dosimetry Program

    SciTech Connect

    Fix, J.J.

    1990-10-01

    This document describes the Hanford External Dosimetry Program as it is administered by Pacific Northwest Laboratory (PNL) in support of the US Department of Energy (DOE) and its Hanford contractors. Program services include administrating the Hanford personnel dosimeter processing program and ensuring that the related dosimeter data accurately reflect occupational dose received by Hanford personnel or visitors. Specific chapters of this report deal with the following subjects: personnel dosimetry organizations at Hanford and the associated DOE and contractor exposure guidelines; types, characteristics, and procurement of personnel dosimeters used at Hanford; personnel dosimeter identification, acceptance testing, accountability, and exchange; dosimeter processing and data recording practices; standard sources, calibration factors, and calibration processes (including algorithms) used for calibrating Hanford personnel dosimeters; system operating parameters required for assurance of dosimeter processing quality control; special dose evaluation methods applied for individuals under abnormal circumstances (i.e., lost results, etc.); and methods for evaluating personnel doses from nuclear accidents. 1 ref., 14 figs., 5 tabs.

  15. Design, manufacture, and evaluation of an anthropomorphic pelvic phantom purpose-built for radiotherapy dosimetric intercomparison

    SciTech Connect

    Harrison, K. M.; Ebert, M. A.; Kron, T.; Howlett, S. J.; Cornes, D.; Hamilton, C. S.; Denham, J. W.

    2011-10-15

    Purpose: An anthropomorphic pelvic phantom was designed and constructed to meet specific criteria for multicenter radiotherapy dosimetric intercomparison. Methods: Three dimensional external and organ outlines were generated from a computed tomography image set of a male pelvis, forming the basis of design for an anatomically realistic phantom. Clinically relevant points of interest were selected throughout the dataset where point-dose values could be measured with thermoluminescence dosimeters and a small-volume ionization chamber. Following testing, three materials were selected and the phantom was manufactured using modern prototyping techniques into five separate coronal slices. Time lines and resource requirements for the phantom design and manufacture were recorded. The ability of the phantom to mimic the entire treatment chain was tested. Results: The phantom CT images indicated that organ densities and geometries were comparable to those of the original patient. The phantom proved simple to load for dosimetry and rapid to assemble. Due to heat release during manufacture, small air gaps and density heterogeneities were present throughout the phantom. The overall cost for production of the prototype phantom was comparable to other commercial anthropomorphic phantoms. The phantom was shown to be suitable for use as a ''patient'' to mimic the entire treatment chain for typical external beam radiotherapy for prostate and rectal cancer. Conclusions: The phantom constructed for the present study incorporates all characteristics necessary for accurate Level III intercomparison studies. Following use in an extensive Level III dosimetric comparison over a large time scale and geographic area, the phantom retained mechanical stability and did not show signs of radiation-induced degradation.

  16. 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.

  17. External Community Review Committee:

    PubMed Central

    Smith, Maureen A.; Kaufman, Nancy J.; Dearlove, Andrea J.

    2013-01-01

    Background: Major gaps exist between what we know and what we do in clinical practice and community health programs and narrowing this gap will require substantive partnerships between academic researchers and the communities they serve. Objectives: We describe a research pilot award program that makes a unique commitment to community engagement through the addition of an External Community Review Committee to the typical research review process that gives external stakeholders decision-making power over research funding. Methods: Whereas engaging community reviewers in discussion and rating of research proposals is not novel, the ICTR ECRC review process is distinct in that it is subsequent to peer review and uses different criteria and methodology. This method of engagement allows for the community review panel to re-rank scientifically meritorious proposals—such that proposals funded do not necessarily follow the rank order from scientific peer review. The approach taken by UW ICTR differs from those discussed in the literature that present a model of community-academic co-review. Results: This article provides guidance for others interested in this model of community engagement and reviews insights gained during the evolution of this strategy; including how we addressed conflict, how the committee was able to change the pilot award program over time, and individual roles that were crucial to the success of this approach. Conclusions: The advantages of this approach include success through traditional academic metrics while achieving an innovative shared-power mechanism for community engagement which we believe is critical for narrowing the gap between knowledge and practice. PMID:24056512

  18. Distal tibial derotational osteotomy with external fixation to treat torsional deformities: a review of 71 cases.

    PubMed

    Erschbamer, Matthias; Gerhard, Pascal; Klima, Harry; Ellenrieder, Birte; Zdenek-Lehnen, Katja; Giesinger, Karlmeinrad

    2017-03-01

    We retrospectively reviewed the safety and efficacy of operative treatment of torsional malalignment of the tibia in 44 children, on whom we performed 71 derotational osteotomies of the distal tibia to treat tibial torsion. We placed four pins using an alignment jig, performed a percutaneous osteotomy, and applied an external fixator after derotation. Postoperative radiographs showed accurate tibial derotation and pin placement in all patients. Nine patients developed superficial pin-tract infections that resolved with antibiotic treatment. Two developed fractures after removal of the external fixator, which healed in a plaster cast. Operative treatment of these cases with an external fixator is safe, effective, and well tolerated.

  19. 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.

  20. 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